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  HPV (Human Papilloma Virus)  
 
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There are more than 60 viral strains lumped together under the term Human Papilloma Virus (HPV). These viruses can cause warts anywhere on the human body. The HPV types that attack the genital tract are sexually transmitted; HPV is currently the most common sexually transmitted virus in the United States with a 1000% increase in HPV patients since 1987. Because it is a non-reportable disease, the actual number of patients infected with HPV is unknown. It is believed more than 50 million Americans are currently infected with the virus, with the number growing by a million every year.

Venereal warts (also known as genital warts or condylomata) are the "clinical" form of this infection because they can be easily seen and diagnosed. Venereal warts look like a fleshy bump of tissue on the labia, clitoris, or around the anus. The "sub-clinical" version is more common, and resides under the skin and cannot be seen. The sub-clinical varieties have been linked to cancers of the genital tract so it is important for sexually active women to have yearly Pap tests to detect pre-cancerous changes. You are at risk for HPV if you have had sex with more than one partner, or have had sex with a person who has had more than one partner.

Whether there are symptoms depends on the strain of HPV present. If there are warts, you will notice a raised, fleshy area. If left untreated, the wart may disappear or it may grow and merge with other warts to take on a cauliflower-like appearance. Some people complain of burning or itching and occasionally a wart may bleed if irritated. You may see warts appear from one to eight months after exposure, or they may appear many months or years later. It may be difficult or impossible for you to determine when you were exposed.

Evidence of a sub-clinical infection may first show up on a Pap test. Your test may show HPV changes or dysplasia (pre-cancerous cells). HPV infection on the cervix usually has no symptoms at all.

Diagnosis
HPV cannot be grown in a lab and there is no blood test for it. Diagnosis of warts is usually made visually. If a suspected wart is flat and difficult to see, your doctor may look at the area with a Colposcope (a binocular-like instrument). Warts or HPV infection on the cervix is suggested on a Pap test. Definitive diagnosis is usually made with a colposcopic exam and biopsies.

There is a test available that can identify HPV DNA called the Virapap. This test will only indicate whether you are shedding the HPV virus when the test is performed; a negative result does not necessarily mean you have not come into contact with the virus. If your doctor is going to request the HPV test, the cells collected for a Pap smear will be used for the test.

By testing for the presence of the virus, the early detection of cervical disease is improved with the consequent saving of lives. Early detection of HPV is an important part of cervical cancer prevention. Apart from HPV testing, borderline Pap smears can be more accurately evaluated with PAPNET, an FDA approved computer assisted test which helps the pathologist more accurately interpret the Pap smear slide.

Once you have the virus it will always be present in your body, but it can be controlled. Visible warts can be treated as they appear so you may have to return to your doctor for repeat treatments. It is important to note, however, that the majority of HPV infections go away on their own and do not cause any abnormal growths.

Studies suggest that HPVs may play a role in cancers of the anus, vulva, vagina, and penis, and some cancers of the oropharynx.

Some types of HPVs are referred to as "low-risk" viruses because they rarely develop into cancer; these include HPV-6 and HPV-11. HPV viruses that can lead to the development of cancer are referred to as "high-risk." Both high-risk and low-risk types of HPVs can cause the growth of abnormal cells, but generally only the high-risk types of HPVs may lead to cancer. Sexually transmitted, high-risk HPVs have been linked with cancer in both men and women; they include HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, and 69. These high-risk types of HPVs cause growths that are usually flat and nearly invisible, as compared with the warts caused by HPV-6 and HPV-11.

There are several compounds on the market for the topical treatment of venereal warts.
 

 
 

Conditions that suggest HPV (Human Papilloma Virus):
 
 
Symptoms - Reproductive - STDs  Human papilloma virus

Counter-indicators:
  No history of human papilloma virus

Uro-Genital

  Cervical Dysplasia
  Vulvodynia / Vestibulitis
 Whether there is an association between vestibulitis and HPV infection is still being debated.
 
 

HPV (Human Papilloma Virus) can lead to:
 
 
Risks  Increased Risk of Cervical Cancer
 All cases of cervical cancer are positive for HPV. Cervical cancer is the first major solid tumor cancer to be identified as being caused by a virus.
 
 

Recommendations for HPV (Human Papilloma Virus):
 
 
Botanical  Green / Oolong / BlackTea (Camellia sinensis)
 Genital and anal warts are caused by human papillomavirus (HPV), and there has been a lack of effective, well tolerated treatments.

Researchers assigned over 500 adults with 30 warts to either sinecatechins (a green tea extract) ointment or a placebo. In the sinecatechins groups, warts cleared completely in roughly 57% of patients, compared to just 34% of subjects in the control group. [Obstetrics and Gynecology, 111(6):pp.1371-1379, June 2008]

Drug

  Conventional Drugs / Information
 A conventional MD may offer you one of several ways to treat genital warts.
  • Imiquimod, an immune response cream which you can apply to the affected area
  • 20 % podophyllin anti-mitotic solution, which you can apply to the affected area and later wash off
  • 0.5 % podofilox solution, applied to the affected area but shouldn’t be washed off
  • 5 % 5-fluorouracil cream
  • Trichloroacetic acid (TCA)
If you have small warts, the doctor can remove them by freezing (cryosurgery), burning (electrocautery), or laser treatment. Occasionally, the doctor will have to use surgery to remove large warts that have not responded to other treatment.

The antiviral drug alpha interferon is sometimes injected directly into the warts, to treat those which have returned after removal by traditional means.

If you are pregnant, you should not use podophyllin or podofilox because they are absorbed through the skin and may cause birth defects. 5-fluorouracil cream should be avoided also during this time.

While treatment can remove warts, the virus remains present and warts can appear again in the future.
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Very strongly or absolutely counter-indicative
Likely to help
Highly recommended







GLOSSARY

Cancer:  Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.

Cervix:  The lower part of the uterus that opens into the vagina.

DNA:  Deoxyribonucleic acid, the large molecule that is the main carrier of genetic information in cells. DNA is found mainly in the chromosomes of cells.

Dysplasia:  Abnormal development of tissue.

FDA:  The (American) Food and Drug Administration. It is the official government agency that is responsible for ensuring that what we put into our bodies - particularly food and drugs - is safe and effective.

Genital Warts:  Single or clusters of soft, cauliflower-like growths in and around the vagina, anus, penis, groin, and scrotal area.

Oropharynx:  The middle part of the throat that includes the soft palate, the base of the tongue and the tonsils.

Pap Test:  Papanicolaou test. Microscopic examination of cells collected from the vagina and cervix to test for uterine cancer or dysplasia.

Topical:  Most commonly 'topical application': Administration to the skin.

Virus:  Any of a vast group of minute structures composed of a protein coat and a core of DNA and/or RNA that reproduces in the cells of the infected host. Capable of infecting all animals and plants, causing devastating disease in immunocompromised individuals. Viruses are not affected by antibiotics, and are completely dependent upon the cells of the infected host for the ability to reproduce.