What is HPV?
HPV is short for Human Papillomavirus. There are over 100 HPV types, including "common" warts transmitted via non-sexual contact and genital HPV transmitted via sexual contact. There are over 30 types of genital HPV - some are low risk and some are high risk types in terms of cancer and other cervical and anal abnormalities. "Common" warts and genital warts cannot be passed from one body part to another. For example, it is not possible to have common warts on your penis or genital warts on your hands.
The different types of HPV are given unique numbers. It has been found that 6 and 11 (low risk types) cause 90% of genital warts. Genital HPV most often presents as wart-like bumps on the penis, in and around the vagina, on the cervix (opening to the uterus), and/or around the rectum. Genital HPV is passed via skin-to-skin contact from one person to another during anal or vaginal sex.
Genital HPV is considered to be the most common STD in the U.S. Some call it the common cold of STDs. People who have had unprotected sex with more than two partners in their lifetime have probably been exposed to HPV. It's possible to have been exposed to the HPV months or years before warts appear, or for symptoms never to appear at all after exposure.
How many people have it?
As mentioned above, HPV is considered the most common STD in the U.S. among both men and women. It is estimated that 20 million people in the U.S. are current infected, with 6.2 million new infections annually. One study estimates that approximately 95 percent of gay men with HIV and 65 percent of gay men without HIV have HPV in their anal canals or the surrounding skin.
Why worry about HPV?
For most people infected with HPV, nothing will happen. The body's immune system eliminates the HPV infection. There are a few types classified as high risk, which can cause changes in the cells of the cervix (opening to the uterus) or the cells of the anus and could lead to cancer. Types 16 & 18 cause 70% of cervical and other cancers.
For this reason, it is recommended that all sexually active women under the age of 25 should have a pap smear every year. Recommendations for women over 25 vary, but are usually every two to three years unless she has had an abnormal test result in the past. Federal health officials are currently considering yearly anal pap smears for sexually active gay and bisexual men.
What are the symptoms?
Not everyone who has HPV will have visible warts. If you do, the warts may appear as wart-like growths or may be flat and only slightly raised from the skin. They may be single or multiple, small or large. They tend to be flesh-colored or whitish in appearance. Warts usually do not cause itching or burning.
Sometimes genital warts are so small that they cannot be seen with the naked eye. This is sometimes called "subclinical HPV." This means that a person may not even know he or she has them.
What is an HPV test like?
A complete examination for HPV includes taking a sexual history and examining any symptoms you might be having. Sometimes, warts can be very hard to see, even for a trained clinician. Also it can be hard to tell the difference between a wart and normal bumps on the genital area. Your medical provider may use a magnifying lens called a colposcope to see smaller warts. A biopsy is not necessary for diagnosing genital warts. This would only be done if the bump is unusual-looking or discolored.
Some medical providers put acetic acid (vinegar) on your genital area to check for warts. This would cause any warts present to turn white, making them easier to see, especially if they are viewed through a colposcope. However, the vinegar can sometimes cause normal bumps to be highlighted, so this method of diagnosis is not exact.
There are no blood tests available to diagnose HPV.
How is HPV treated?
Currently, there is no cure for HPV infections. There is treatment available for the symptoms, and depending on where you go, various treatments MAY be offered.
The goal of any treatment should be to get rid of annoying symptoms. No particular treatment is best for all cases. When choosing what treatment to use, your health care provider will consider the size, location and number of warts, changes in the warts, your preference, cost of treatment, convenience, adverse effects, clinic or office protocol, and their own experience with the treatments. Some treatments are done in a clinic or doctor's office; others are prescription creams that can be used at home.
Treatments done in the doctor's office include:
- Cryotherapy: This is freezing off the wart with liquid nitrogen.
- Podophyllin: A chemical compound to get rid of the warts. This is an older treatment and is not widely used today.
- TCA (trichloracetic acid): Another chemical compound applied to the surface of the wart.
- Cutting off warts: This has the advantage of getting rid of warts in a single office visit.
- Electrocautery: Burning off warts with an electrical current.
- Laser therapy: Using an intense light to destroy warts. This is used for larger or extensive warts, especially those that have not responded well to other treatments. Laser can be very expensive and is not available in all provider's offices.
At-home creams available by doctor's prescription:
- Imiquimod cream (Aldara): A self-applied treatment for external genital warts. Although expensive, it is safe, effective and easy to use. Aldara boosts the immune system to fight HPV.
- Podofilox cream or gel (Condylox): A self-applied treatment that destroys the tissue of external genital warts. It is inexpensive, easy to use and safe. The treatment period is about four weeks.
IMPORTANT: Over-the-counter wart treatments should not be used in the genital area. They will not be effective.
What can I do if I have HPV?
Some people have only one outbreak of warts, others have recurrences over time. For most people, the body's immune system will eliminate the HPV infection on its own.
Genital warts are most likely to be transmitted to your sex partners when the warts are actually present, but sometimes warts are too small to see with the naked eye. Very little is known about passing subclinical HPV to sex partners.
Yearly pap smears are advised for all women whose male sex partners have genital warts. While recommendations have yet to be set for gay and bisexual men, if you are a man who is a bottom with a top known to have HPV, it would be wise to request an anal pap smear once a year as well.
How do I avoid getting HPV?
The first vaccine developed expressly to prevent cervical cancer was licensed for use by the FDA in April of 2006 for females between the ages of 15-26. In addition to offering protection from infection and diseases associated with "high risk" HPV types that cause approximately 70% of cervical cancers, the vaccine also blocks the "low risk" types found with most cases of genital warts. The vaccine may eventually be considered for use with other populations, such as men and women over the age of 26, but more data are needed first.
Abstinence is the only way to completely avoid getting HPV and other STDs. If you're sexually active, using condoms consistently and correctly for anal and vaginal sex is your best bet for staying sexually healthy. However, using condoms will only reduce your risk of getting HPV from an infected partner because HPV can be shed from skin near the vagina, rectum or penis - areas not always protected by a latex condom.