STD Information Center > HPV (and Genital Warts)

STD Information Center
HPV (and Genital Warts)

Like many sexually transmitted organisms, HPV usually causes a quiet infection — that is, one that does not have visible symptoms.

One study, sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), reported that almost half of the women infected with HPV had no obvious symptoms. Because the viral infection persists, individuals may not be aware of their infection or the potential risk of transmission to others and of developing complications.

HPV, which stands for Human papillomavirus is the most prominent STD in the United States with 6.2 million Americans becoming infected every year. In 2006 a major breakthrough was announced via a new HPV vaccine for young women that may prevent several types of HPV.

What is genital HPV infection?
Genital HPV infection is a sexually transmitted disease (STD) that is caused by human papillomavirus (HPV). Human papillomavirus is the name of a group of viruses that includes more than 100 different strains or types. More than 30 of these viruses are sexually transmitted, and they can infect the genital area of men and women including the skin of the penis, vulva (area outside the vagina), or anus, and the linings of the vagina, cervix, or rectum. Most people who become infected with HPV will not have any symptoms and will clear the infection on their own.

Some of these viruses are called “high-risk” types, and may cause abnormal Pap tests. They may also lead to cancer of the cervix, vulva, vagina, anus, or penis. Others are called “low-risk” types, and they may cause mild Pap test abnormalities or genital warts. Genital warts are single or multiple growths or bumps that appear in the genital area, and sometimes are cauliflower shaped.

How common is HPV?
More than 20 million Americans are currently infected with HPV. At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives. By age 50, at least 80 percent of women will have acquired genital HPV infection. More than six million Americans get a new genital HPV infection each year.

What are the signs and symptoms of genital HPV infection?
Most people who have a genital HPV infection do not know they are infected. The virus lives in the skin or mucous membranes and usually causes no symptoms. Some people get visible genital warts, or have pre-cancerous changes in the cervix, vulva, anus, or penis. Very rarely, HPV infection results in anal or genital cancers.

Genital warts usually appear as soft, moist, pink, or flesh-colored swellings, usually in the genital area. They can be raised or flat, single or multiple, small or large, and sometimes cauliflower shaped. They can appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh. After sexual contact with an infected person, warts can appear within weeks or months, or they never appear.

Genital warts are diagnosed by visual inspection. Visible genital warts can be removed by medications the patient applies, or by treatments performed by a health care provider. Some individuals choose to forego treatment to see if the warts will disappear on their own. No treatment for visible genital warts is better than another, and no single treatment is ideal for all cases.

How do people get genital HPV infections?
The types of HPV that infect the genital area are spread primarily through genital contact. Most HPV infections have no signs or symptoms; therefore, most infected persons are unaware they are infected, yet they can transmit the virus to a sex partner. Rarely, a pregnant woman can pass HPV to her baby during vaginal delivery. A baby that is exposed to HPV very rarely develops warts in the throat or voice box.

How is genital HPV infection diagnosed?
Most women are diagnosed with HPV on the basis of abnormal Pap tests. A Pap test is the primary cancer-screening tool for cervical cancer or pre-cancerous changes in the cervix, many of which are related to HPV. A test is available to detect HPV DNA. The test may be used in women with mild Pap test abnormalities, or in women >30 years of age at the time of Pap testing. The results of HPV DNA testing can help health care providers decide if further tests or treatment are necessary.

There are no HPV tests are available for men.

Is there a cure for HPV?
There is no “cure” for HPV infection, although in most women the infection eventually goes away on its own. The treatments provided are directed to the changes in the skin or mucous membrane caused by HPV infection, such as warts and pre-cancerous changes in the cervix. In 1996, the FDA approved an HPV vaccine for young women not yet exposed to the infection. The infection is believed to prevent several types of HPV, including the one responsible for cervical cancer in women.

What is the connection between HPV infection and cervical cancer?
All types of HPV can cause mild Pap test abnormalities that do not have serious consequences. Approximately 10 of the 30 identified genital HPV types can lead, in rare cases, to development of cervical cancer. Research has shown that for most women (90 percent), cervical HPV infection becomes undetectable within two years. Although only a small proportion of women have persistent infection, persistent infection with “high-risk” types of HPV is the main risk factor for cervical cancer.

A Pap test can detect pre-cancerous and cancerous cells on the cervix. Regular Pap testing and careful medical follow-up, with treatment if necessary, can help ensure that pre-cancerous changes in the cervix caused by HPV infection do not develop into life threatening cervical cancer. The Pap test used in U.S. cervical cancer screening programs is responsible for greatly reducing deaths from cervical cancer. The American Cancer Society estimates that each year in the United States, about 12,000 women develop invasive cervical cancer and about 4,000 women die from this disease. Most women who develop invasive cervical cancer have not had regular cervical cancer screening.

How can people reduce their risk for genital HPV infection?
The surest way to avoid transmission of sexually transmitted diseases, including HPV, is to refrain from genital contact.

HPV infection can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. While the effect of condoms in preventing HPV infection is unknown, condom use has been associated with a lower rate of cervical cancer, an HPV-associated disease.

The use of condoms should not be a substitute for routine screening with Pap tests to detect and prevent cervical cancer. Sexually active women should have a regular Pap test to screen for cervical cancer and other pre-cancerous changes.

Sources:

Cates W, Jr. Estimates of the incidence and prevalence of sexually transmitted diseases in the United States. American Social Health Association Panel. Sexually Transmitted Diseases 1999; 26(4:Suppl):Suppl-7.

Myers ER, McCrory DC, Nanda K, Bastian L, Matchar DB. Mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis. American Journal of Epidemiology 2000; 151(12):1158-1171.

Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002. MMWR 2002;51(no. RR-6).

Ho, G.Y.F., Bierman, R., Beardsley, L., Chang, C.J., Burk, R.D.: Natural history of cervicovaginal papilloma virus infection in young women. N Engl J Med 1998;338:423-8.

Koutsky, L.A., Kiviat, N.B. Genital human papillomavirus. In: K. Holmes, P. Mardh, P. Sparling et al (eds). Sexually Transmitted Diseases, 3rd edition. New York: McGraw-Hill, 1999, p. 347-359.

Kiviat, N.B., Koutsky, L.A., Paavonen, J. Cervical neoplasia and other STD-related genital tract neoplasias. In: K. Holmes, P. Mardh, P. Sparling et al (eds). Sexually Transmitted Diseases, 3rd edition. New York: McGraw-Hill, 1999, p. 811-831.

Watts, D.H., Brunham, R.C. Sexually transmitted diseases, including HIV infection in pregnancy. In: K. Holmes, P. Mardh, P. Sparling et al (eds). Sexually Transmitted Diseases, 3rd edition. New York: McGraw-Hill, 1999, 1089-1132.

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If you think you may have a sexually transmitted disease, you should see a physician immediately to be properly diagnosed and treated. You should not try to diagnose or treat symptoms on your own.

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