Information on HPV
 
 

WHAT IS HPV?

HPV is the human papillomavirus. HPV is the most common sexually transmitted virus. HPV is very common. It is spread through skin-to-skin contact. Around 70-80% of sexually active people have been infected with HPV and the infection rate is much higher in people with HIV.

Some types of HPV (low risk types) cause common warts of the hands or feet. Infections of the hands and feet are usually not transmitted through sexual activity. Several types of HPV (low risk types) cause genital warts on the penis, vagina, and rectum. People with HIV can get worse lesion outbreaks in or around the anus and cervical area. HPV can also cause problems in the mouth or throat or on the tongue or lips. Other types of HPV (high risk types) can cause abnormal cell growth known as dysplasia. Dysplasia can develop into anal or throat cancer in men and women, cervical cancer, or cancer of the penis.

Most infections with HPV will go away on their own, without treatment, within 2 years of infection. In some cases, the infection does not go away. The infection becomes chronic or persistent. Chronic infection with high-risk types of HPV may cause dysplasia and could eventually lead to cancer.

Dysplasia around or in the anus is called anal intraepithelial neoplasia (AIN). Anal intraepithelial neoplasia is the development of new abnormal cells in the lining of the anus. Dysplasia in the cervical region is called cervical intraepithelial neoplasia (CIN). AIN or CIN appear to be more common in people with HIV infection than those who are HIV negative.

HOW IS HPV DETECTED?

Many people have HPV infections but don't know it. HPV can go away without causing any problems. To detect HPV, health care providers look for dysplasia or genital warts.

A Pap test (or smear) is used to check a woman's cervix. It can also be used to check the anus of men and women. They are mixed into liquid and examined under a microscope. The cells are examined for abnormalities that may indicate abnormal cell changes, such as dysplasia or cancer.

GENITAL WARTS

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 or may go away on their own.

Your health care provider can usually tell if you have genital warts by looking at them. You can also develop warts inside your anal canal or around your anus. Sometimes an anoscope is used to look inside your anus to see if you have any internal warts. Genital warts are not caused by the same type HPV that causes cancer. However, if you have warts, you may have also been exposed to other types of HPV that could cause cancer.

CAN HPV INFECTION BE PREVENTED?

There is no easy way to tell if someone is infected with an HPV. People who don’t have any signs or symptoms of HPV infection can still transmit the infection.

Condoms do not totally prevent transmission of HPV. HPV can be transmitted by direct contact with infected areas that aren’t covered by a condom.

Men and women with HIV who are sexually active may want to have a regular Pap smear, anal and/or vaginal, to check for abnormal cells or early signs of warts or dysplasia. A positive result can be followed up to see if treatment is needed.

A vaccine called Gardasil was approved in 2006 to prevent infection with 2 low risk types of HPV (6,11) which cause warts and 2 high-risk types of HPV (16,18) which cause anal, cervical, throat, and penile cancer. However, it has not been tested in or approved for people already infected with HPV. For more information on vaccination against HPV, see http://www.immunize.org/vis/hpv.pdf

HOW ARE HPV INFECTIONS TREATED?

There is no direct treatment for HPV infection. Some people “clear” an HPV infection (are “cured”). They can later be infected with HPV again. Dysplasia 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.

Other, less common treatments for warts include the drugs 5-FU (5-fluorouracil) and Interferon-alpha. 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.

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.