HPV (Human Papilloma Virus, Genital Warts, and Cervical Dysplasia)

There are over 100 viruses known as human papilloma

viruses (HPVs.) They are common. One study found HPVs in 77%

of HIV-positive women. HPVs are transmitted easily during sexual

activity. Condoms do not totally prevent transmission of HPVs.

They can be transmitted from person to person by direct contact

To detect HPV, doctors look first for the problems HPVs cause:

dysplasia or genital warts.

Dysplasia can be detected by Pap smears. They are usually

used to check a woman’s cervix. They can also be used to check

the anus in men and women. A swab is rubbed on the area being

checked to pick up some cells. They are smeared on a glass slide

and examined under a microscope. A new HPV blood test is starting

to be used to follow up on Pap smear results that are not clear.

It can indicate who needs more careful examination or treatment.

Some researchers believe that anal and cervical smears should

be checked each year for people with elevated risk:

• People who have had receptive anal intercourse
• Women who have had cervical intraepithelial neoplasia (CIN)
• Anyone with under 500 T-cells.

However, other researchers think that careful physical examination

can detect as many cases of anal cancer as anal Pap testing.

Genital warts can appear anywhere from a few weeks to

a few months after you are exposed to HPV. The warts might look

like small bumps. Sometimes they are fleshy and look like small

cauliflowers. They can get bigger over time.

Your doctor can usually tell if you have genital warts by looking

at them. Sometimes a tool called an anoscope is used to look at

the anal area. If necessary, a sample of the suspected wart will

be cut off and examined under a microscope. This is called a biopsy.

Genital warts are not caused by the same HPV that causes cancer.

However, if you have warts, you may have also been exposed to

other HPVs that could cause cancer.

HOW ARE HPV INFECTIONS

TREATED?

There is no direct treatment for HPV infection. However, dysplasias

and warts can be removed. There are several ways to do this:

• Burning them with an electric needle (electrocautery) or

  a laser

• Freezing them with liquid nitrogen
• Cutting them out
• Treating them with chemicals like Trichloroacetic Acid (TCA),

  Podophyllin or Podofilox. NOTE: Podophyllin and Podofilox

  should not be used by pregnant women.

Other, less common treatments for warts include the drugs 5-FU

(5-fluorouracil) and Interferon-alpha. 5-FU exists in a cream

form. Interferon must be injected into the warts. A new drug,

imiquimod (Aldara®), has been approved for treatment of genital

warts. Cidofovir (Vistide®), originally developed to fight

cytomegalovirus (CMV), might also help fight HPV. A new drug called

HspE7 has shown benefits in early research.

HPV infection can last for a long time, especially in people

who are HIV-positive. Dysplasia and warts can return. They should

be treated as soon as they are found to reduce the chances of

the problem spreading or returning.

THE BOTTOM LINE

through sexual activity.

HPV infection can last a long time, especially in people with

HIV.

A Pap smear can detect abnormal cell growth in the cervix.

It can also be used to check the anus of men and women. Although

Pap smears may be the best way to detect early cervical cancer,

careful physical examination may be the best way to detect anal

cancers.

The signs of HPV infection – warts or dysplasia – should be

treated as soon as they show up. Otherwise, the problem could

spread and be more likely to return after treatment.

Revised September 18, 2002

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