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Human Papillomavirus and Genital Warts

Diagnosis

Your health care provider, an or OB/GYN 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

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.

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.

Complications and 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.

Research

In June 2006, the Food and Drug Administration 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. The vaccine is three injections given over the course of three months.

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


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