HPV

Human papilloma virus (HPV) is a virus that infects the skin and mucous membranes (tissues that line the mouth, cervix, vagina, urethra and anus) of humans.  Of the more than 100 strains of HPV, approximately 30 cause genital infections.1 HPV is primarily spread by skin-to-skin contact with an infected person or by contact with body fluids contaminated with the virus. This means that most cases of genital HPV are acquired through sexual intercourse. Transmission of HPV via oral sex 4, genital touching 5  and via inanimate objects 6 may also be possible, but the risk of infection from these activities has not been well documented. Most patients with HPV infection have no symptoms. Approximately 1 percent of all individuals who have been infected with HPV and 7 percent of those with current HPV infection have genital warts.7

Most people who are infected with HPV have no visible signs of infection. Since testing for HPV infection is not performed routinely, most infected women discover their infection when abnormalities are detected on a Pap smear. Most asymptomatic men do not know they are infected. HPV infection is not curable at the present time, although most HPV infections resolve spontaneously.8 (There is an experimental, genetically engineered vaccine, Gardasil, which claims to block two of the HPV strains, HPV16 and HPV18, but this vaccine has not been approved yet.)  Individuals with genital warts typically undergo treatment with topical medications applied to the wart in the physician’s office or at home. Such medications may cause the warts to decrease in size or disappear. Laser (burning) or LEEP (removal of the abnormal cells) or cryo (freezing) treatments are also possible.  Even if warts do resolve, infection may remain, and can still be passed on to a future sexual partner. In addition, warts frequently recur in the months following treatment.

Annually, 2.5 million women experience an abnormal Pap smear in the United States, with a majority of these due to HPV infection.9 Untreated cervical intraepithelial neoplasia (the “pre-cancer” that typically causes abnormal Pap smears) can develop into cervical cancer. In fact, cervical cancer occurs in approximately 13,000 women every year in the United States, and kills almost 5,000 American women yearly.10 HPV is the primary cause of over 99 percent of cervical cancers.11,12 HPV is also associated with a number of other cancers, including oral, vaginal, vulvar, penile and anal cancer.13-19

Since HPV is spread by skin-to-skin contact, and condoms do not cover the entire genital area, condoms are likely to be less effective in reducing the risk of HPV transmission than with other sexually transmitted infections.20 A few studies have shown that condoms may partially reduce the transmission in men, but their effectiveness has not been demonstrated for women.21 Since HPV is so common among sexually active individuals, those who become sexually active outside of marriage are likely to be infected by the virus even if they use condoms. Women should receive regular Pap smears for early detection of cervical abnormalities like cervical cancer. If you have already been sexually active outside a lifelong mutually faithful relationship (as in marriage), talk to your healthcare provider about getting you and your partner tested for STDs. Abstinence from sexual activity--including oral sex--or lifetime faithfulness to one uninfected partner is the only certain way to avoid being infected sexually. Read more at http://www.cdc.gov/std/HPV/STDFact-HPV.htm

1. Division of STD Prevention. Prevention of genital HPV infection and sequelae: Report of an external consultants’ meeting. Department of Health and Human Services, Atlanta: Centers for Disease Control and Prevention (CDC), December 1999. 2. American Social Health Association. Sexually Transmitted Diseases in America: How Many Cases and at What Cost? Menlo Park, CA: Kaiser Family Foundation; 1998. 3. Koutsky LA, Kiviat NB. Genital human papillomavirus. In: Holmes KK, Mardh PA, Sparling PF, et al., eds. Sexually Transmitted Diseases. 3rd ed. New York, NY: McGraw Hill, Co; 1999:347-359. 4. Edwards S, Carne C. Oral sex and the transmission of viral STIs.Sex Transm Inf. 1998;74:6-10. 5. Sonnex C, Strauss S, Gray JJ. Detection of human papillomavirus DNA on the fingers of patients with genital warts. Sex Transm Infect. 1999;75:317-319. 6. Koutsky LA, Kiviat NB. Genital human papillomavirus. In: Holmes KK, Mardh PA, Sparling PF, et al., eds. Sexually Transmitted Diseases. 3rd ed. New York, NY: McGraw Hill, Co; 1999:347-359. 7. Ibid. 8. Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med. 1998;338:423-428. 9. Kurman RJ, Henson DE, Herbst AL, Noller KL, Schiffman MH, for the 1992 National Cancer Institute Workshop. Interim guidelines for management of abnormal cervical cytology. JAMA. 1994;271:1866-1869. 10. American Cancer Society. Cancer facts and figures 2000: Selected cancers. Available at: http://www.cancer.org/statistics/cff2000/selected cancers.html. Accessed February 21, 2000. 11. Bosch FX, Manos MM, Munoz N, et al., for the International Biological Study on Cervical Cancer (IBSCC) Study Group. Prevalence of human papillomavirus in cervical cancer: A worldwide perspective. J Natl Cancer Inst. 1995;87:796-802. 12. Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189:12-19. 13. Sugase M, Matsukura T. Distinct manifestations of human papillomaviruses in the vagina. Int J Cancer. 1997;72:412-415. 14. Kiviat N, Koutsky LA, Paavonen J. Cervical neoplasia and other STD-related genital tract neolasias. In: Holmes KK, Mardh PA, Sparling PF, et al., eds. Sexually Transmitted Diseases. 3rd ed. New York, NY: McGraw Hill, Co; 1999:811-831. 15. Ke LD, Adler-Storthz K, Mitchell MF, Clayman GL, Chen Z. Expression of human papillomavirus E7 mRNA in human oral and cervical neoplasia and cell lines. Oral Oncol. 1999;35:415-420. 16. Wang J, Li J, Huang H, Fu Y. Detection of the E7 transform gene of human papilloma virus type 16 in human oral squamous cell carcinoma. Clin J Dent Res. 1998;1(3):35-37. 17. Aggelopoulou EP, Skarlos D, Papadimitriou C, Kittas C, Troungos C. Human papilloma virus DNA detection in oral lesions in the Greek population. Anticancer Res. 1999;19:1391-1395. 18. Goldie SJ, Kuntz KM, Weinstein MC, Freedberg KA, Welton ML, Palefsky JM. The clinical effectiveness and cost-effectiveness of screening for anal squamous intraepithelial lesions in homosexual and bisexual HIV-positive men. JAMA. 1999;281:1822-1829. 19. Poletti PA, Halfon A, Marti MC. Papillomavirus and anal carcinoma. Int J Colorectal Dis. 1998;13:108-111. 20. Division of STD Prevention. Prevention of genital HPV infection and sequelae: Report of an external consultants’ meeting. Department of Health and Human Services, Atlanta: Centers for Disease Control and Prevention, CDC, December 1999. 21. Ibid.

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