Human Papilloma Virus

Definition:
Human papilloma viruses or HPVs are a group of more than 80 different types of virus, including those causing genital warts. They can be transmitted through sexual intercourse and have been linked to cervical cancer. It is estimated that up to 15% of women aged 20 to 30 women and up to 6% of women over 40 carry the virus. The majority do not go on to develop cancer.

Human papillomavirus (HPV) is one of the most common causes of sexually transmitted infection (STI) in the world. Health experts estimate there are more cases of genital HPV infection than any other STI in the United States. According to the Centers for Disease Control and Prevention (CDC), approximately 6.2 million new cases of sexually transmitted HPV infections are reported every year. At least 20 million people in this country are already infected.


Genital warts
Genital warts (sometimes called condylomata acuminata or venereal warts) are the most easily recognized sign of genital HPV infection. Many people, however, have a genital HPV infection without genital warts.

Genital warts are soft, moist, or flesh colored and appear in the genital area within weeks or months after infection. They sometimes appear in clusters that resemble cauliflower-like bumps, and are either raised or flat, small or large. Genital warts can show up in women on the vulva and cervix, and inside and surrounding the vagina and anus. In men, genital warts can appear on the scrotum or penis. There are cases where genital warts have been found on the thigh and groin.



The name papillomavirus relates to warts or papillomas which many of the 80 types of the virus cause.These are non-cancerous tumours. Warts on different parts of the body relate to different types of papillomavirus.Thirty types are linked to infections in the genital tract. In women, warts or flat, abnormal growths may form on the skin around the external genitalia, the skin round the anus, the vagina and the cervix.

In men, warts may appear on and under the foreskin, on the penis and around the anus.People with visible warts are thought to be most at risk of spreading the virus through sexual intercourse.
They are likely to carry the virus for life.Doctors believe people are most infectious when they first contract the virus, but even people with no visible warts, but a past history of having them could be infectious.They say that there may be a time lag between contracting the virus and developing warts, sometimes lasting several years.People with a lowered immune system are more likely to develop warts than others. The body’s immune system can normally fight off the virus within three to six months.

Click to see pictures of different diseases caused by HPV

Cause
More than 100 different types of HPV exist, most of which are harmless. About 30 types are spread through sexual contact and are classified as either low risk or high risk.Some types of HPV cause genital warts–single or multiple bumps that appear in the genital areas of men and women including the vagina, cervix, vulva (area outside of the vagina), penis, and rectum. These are considered low-risk types.
High-risk types of HPV may cause abnormal Pap smear results. They could lead to cancers of the cervix, vulva, vagina, anus, or penis.

Transmission
Genital warts are very contagious. You can get them during oral, vaginal, or anal sex with an infected partner. You can also get them by skin-to-skin contact during vaginal, anal, or (rarely) oral sex with someone who is infected. About two-thirds of people who have sexual contact with a partner with genital warts will develop warts, usually within 3 months of contact.If you are infected but have no symptoms, you can still spread HPV to your sexual partner and/or develop complications from the virus.

Symptoms
In women, genital warts occur on the outside and inside of the vagina, on the opening to the uterus (cervix), or around the anus.In men, genital warts are less common. If present, they usually are seen on the tip of the penis. They also may be found on the shaft of the penis, on the scrotum, or around the anus.Rarely, genital warts also can develop in your mouth or throat if you have oral sex with an infected person.Like many STIs, genital HPV infections often do not have signs and symptoms that you can see or feel. One study sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) reported that almost half of women infected with HPV had no obvious symptoms.If you are infected but have no symptoms, you can still spread HPV to your sexual partner and/or develop complications from the virus.

Diagnosis
Genital warts are assumed to be caused by HPV, but other tests can be done to identify whether a person is carrying the virus, including biopsy.However, none has been totally reliable. Scientists say some people may have been told they have the virus when they do not because HPV-type changes may be similar to normal anatomical variations.

Your health care provider usually diagnoses genital warts by seeing them.If you are a woman with genital warts, you also should be examined for possible HPV infection of the cervix. Your health care provider can diagnose HPV infection based on results from an abnormal Pap smear, a primary cancer-screening tool for cervical cancer or pre-cancerous changes of the cervix. In some cases, a health care provider will take a small piece of tissue from the cervix and examine it under the microscope.Another test to diagnose HPV infection detects HPV DNA, which may indicate possible infection.Your provider may be able to identify some otherwise invisible warts in your genital tissue by applying vinegar (acetic acid) to areas of your body that might be infected. This solution causes infected areas to whiten, which makes them more visible.

Treatment
There are treatments for genital warts, though the warts often disappear even without treatment. There is no way to predict whether the warts will grow or disappear. Therefore, if you suspect you have genital warts, you should be examined and treated, if necessary.

Depending on factors such as the size and location of your genital warts, your health care provider will offer you one of several ways to treat them.

* Imiquimod cream
* 20 percent podophyllin antimitotic solution
* 0.5 percent podofilox solution
* 5 percent 5-fluorouracil cream
* Trichloroacetic acid (TCA)

If you are pregnant, you should not use podophyllin or podofilox because they are absorbed by your skin and may cause birth defects in your baby. In addition, you should not use 5-fluorouracil cream if you are pregnant.

If you have small warts, your health care provider can remove them by one of three methods.

* Freezing (cryosurgery)
* Burning (electrocautery)
* Laser treatment

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If you have large warts that have not responded to other treatment, you may have to have surgery to remove them.

Some health care providers inject the antiviral drug alpha interferon directly into warts that have returned after removal by traditional means. The drug is expensive, however, and does not reduce the rate that the genital warts return.

Although treatments can get rid of the warts, none get rid of the virus. Because the virus is still present in your body, warts often come back after treatment.

Complecations:
HPV and cancer

The presence of some forms of sexually-transmitted HPVs in both men and women have been linked with cancer.Cancer-associated forms of HPV usually have a thin, flat shape and are almost invisible, compared with other forms of genital warts.The major form of cancer linked to HPV is cervical cancer.Women who have been infected with sexually-transmitted HPV are thought to be at greater risk of developing cervical dysplasia, a pre-cancerous condition which can be detected on a Pap or smear test.This is treatable, but should be followed up by regular yearly smears.Doctors say the presence of HPVs should not affect a woman’s ability to give birth or her likelihood of needing a hysterectomy.HPVs can be detected in Pap tests. These divide the lesions caused by the virus into two main types: low-grade and high grade, both of which cause the growth of abnormal cells.High-grade lesions are thin, flat cells found in the vagina and the outer cervix.Low-risk lesions are fairly common and most return to normal after a few months or years. However, they can sometimes develop into cancer-associated lesions.Women who start having sex at an early age or have several sexual partners carry an increased chance of having HPV, but most infections disappear without treatment.Even those who develop cancer-associated HPVs rarely go on to develop cervical cancer.Researchers say this is because other factors may be involved in whether HPV may cause cancer, including smoking and a lowered immune system.

Cancer:
Some types of HPV can cause cervical cancer. Other types are associated with vulvar cancer, anal cancer, oral cancer, and cancer of the penis (a rare cancer).

Most HPV infections do not progress to cervical cancer. If you are a woman with abnormal cervical cells, a Pap smear will detect them. If you have abnormal cervical cells, it is particularly important for you to have regular pelvic exams and Pap smears so you can be treated early, if necessary.
Pregnancy and Childbirth

Genital warts may cause a number of problems during pregnancy. Because genital warts can multiply and become brittle, your health care provider will discuss options for their removal, if necessary.

Genital warts also may be removed to ensure a safe and healthy delivery of the newborn. Sometimes they get larger during pregnancy, making it difficult to urinate if the warts are in the urinary tract. If the warts are in the vagina, they can make the vagina less elastic and cause obstruction during delivery.

Rarely, infants born to women with genital warts develop warts in their throats (respiratory papillomatosis). Although uncommon, it is a potentially life-threatening condition for the child, requiring frequent laser surgery to prevent blocking of the breathing passages. Research on the use of interferon therapy with laser surgery indicates that this drug may show promise in slowing the course of the disease.

Prevention:
The best way to prevent getting an HPV infection is to avoid direct contact with the virus, which is transmitted by skin-to-skin contact. If you or your sexual partner has warts that can be seen in the genital area, you should avoid any skin-to-skin and sexual contact until the warts are treated.

Recently, the Food and and Drug Administration (FDA) approved a vaccine called Gardasil. Gardasil is highly effective in preventing persistent infection with HPV types 16 and 18, two “high-risk” HPVs that cause most (70 percent) of cervical cancers, and types 6 and 11, which cause virtually all (90 percent) of genital warts.

Gardasil has not been proven to provide complete protection against persistent infection with other HPV types, some of which also can cause cervical canter. Therefore, about 30 percent of cervical cancers and 10 percent of genital warts will not be prevented by the current vaccine. In addition, Gardasil does not prevent other STIs, nor does it treat HPV infection or cervical cancer.

The CDC Advisory Committee on Immunization Practices (ACIP) has federal HPV vaccine recommendations. In addition, the National Cancer Institute and CDC have more information on the HPV vaccine.

Historically, research studies have not confirmed that male latex condoms prevent transmission of HPV. Recent studies, however, demonstrate that consistent condom use by male partners suggests strong protection against low- and high-risk types of HPV infection in women.

Unfortunately, many people who don’t have symptoms don’t know that they can spread the virus to an uninfected partner.

Research
In June 2006, FDA approved Gardasil, the first vaccine developed to prevent cervical cancer, precancerous lesions, and genital warts due to HPV types 6,11,16, and 18. FDA licensed the vaccine for use in girls and women aged 9 to 26 years.

Researchers continue to work on another vaccine for HPV to help protect against HPV types 16 and 18.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://news.bbc.co.uk/2/hi/health/medical_notes/429762.stm
http://www3.niaid.nih.gov/healthscience/healthtopics/human_papillomavirus/

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