Genital HPV (human papillomavirus) is one of the most common sexually transmitted diseases in the United States. As many as one million cases of genital warts are diagnosed each year.

What Is HPV?

HPV is the name of a group of viruses that includes more than 60 different types. Certain types of HPV cause warts on the hands or feet, while others can cause visible genital warts. However, sometimes HPV infection causes no warts, and many people with genital HPV do not know they have it.

What Do Genital Warts Look Like?

Genital warts are growths or bumps that appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh. They may be raised or flat, single or multiple, small or large. Some cluster together forming a cauliflower-like shape.

What About HPV That Causes No Visible Warts?

Sometimes HPV causes very subtle changes on the skin that can't be seen with the naked eye. Health care providers can find these "microscopic warts" only with the help of special instruments. In other cases, HPV can live in the skin without causing any warts at all. This is called "clinically inapparent" or "subclinical" HPV infection.

Who Gets HPV Or Genital Warts?

HPV infection, including genital warts, can occur in sexually active men and women of all ages, races, and social classes, and can affect homosexuals and heterosexuals alike. Infants can be infected by their mothers during birth, but this is very rare.

How Do YOU Get HPV Or Genital Warts?

HPV and genital warts are usually spread by direct, skin-to-skin contact during vaginal, anal, or oral sex with, someone who has this infection. Warts on other parts of the body, such as the hands, are caused by different types, of HPV.

Warts may appear within several weeks after sexual relations with an infected person; or they may take months to appear; or they may never appear.

Very little is known about the transmission of subclinical HPV infection, although some researchers believe it's less contagious than genital warts.

How Would I Know If I Had HPV Or Genital Warts?

In some cases, it's difficult to know. Sometimes people do not notice warts because they are inside the vagina, or on the cervix, or in the anus. In addition, they are often flesh-colored and painless. Only in rare instances do they cause symptoms such as itching, pain, or bleeding. Sometimes warts will be found during a physical exam in men or a pelvic exam in women. For women, an abnormal Pap smear may be the first warning sign that HPV is present, though a Pap smear is not an accurate test for HPV.

You should go to a health care provider if:

• you notice any unusual growths, bumps, or skin changes on or near your penis, vagina, vulva, or anus; or

• you notice any unusual itching, pain, or

• bleeding; or

• your sex partner(s) tells you that he or she has genital HPV or genital warts.

How Are Genital Warts Diagnosed?

You can check yourself and your partner(s) for warts, but remember: warts sometimes can be very difficult to see. Also, sometimes it's hard to tell the difference between a wart and other bumps or pimples, If you think you have warts or have been exposed to HPV, go to a health care provider. The health care provider will check more closely and may use a magnifying lens to find small warts.

To detect warts or other abnormal tissue, health care providers sometimes put a solution of acetic acid (like vinegar) on the genitals. This causes abnormal tissue to turn white and makes it easier to see, especially if it is viewed through a magnifying lens such as a colposcope. This procedure is particularly common in detecting HPV infection on the cervix.

How Is Subclinical HPV Infection Detected?

A Pap smear is a test designed to detect precancerous cervical changes - not HPV. However, an abnormal Pap smear often shows changes that could be caused by HPV infection. Women with abnormal Pap smears should be examined further for cervical problems (usually through a colposcope) or followed closely by a doctor.

There are several new tests that can detect the genetic material of HPV. These are available through doctors' offices.

How Are Genital Warts Treated?

There are many different opinions about how to treat genital warts. The guidelines of the US Centers for Disease Control (CDC) include the following treatment information:

• The goal of treatment should be to remove visible genital warts and get rid of annoying symptoms.

• Cryotherapy (freezing off the wart with liquid nitrogen) is the preferred treatment in many cases.

• Treatments such as podophyllin or trichloracetic acid (TCA) are other acceptable options. These chemicals are applied to the surface of the wart by a health care provider.

• Electrocautery (destroying the infected tissue with electric current) is another option used by some health care providers.

• Laser therapy (using an intense light to destroy the warts) or surgery (cutting off the warts) is expensive and generally is used only in complicated cases.

• The antiviral drug interferon is also used, but less expensive therapies work just as well with fewer side effects.

A new treatment called podofilox was not available when the CDC guidelines were written in 1989 but is now on the market. This prescription drug works the same way as podophyllin but can be applied at home by the patient.

Whatever the treatment, here are some important points to remember:

• Ask your health care provider for an explanation of the treatment, including its costs and likely benefits.

• Avoid treatments which cause bad side effects or scarring.

• Be sure you understand the follow-up instructions such as what to do about discomfort and when to come back to the office or clinic.

• Be patient - treatment often takes several visits and a variety of approaches.

• If you are pregnant or think you might be, tell your health care provider so he or she can choose treatment that won't be harmful to you or to your baby.

• Don't use drug store treatments for warts, as they are not meant for sensitive genital skin.

• Some experts suggest avoiding sexual contact with the infected area during treatment. This is partly to protect the treated area of skin from friction and help it heal.

Should Subclinical HPV Infection Be Treated?

While experts disagree on this question, many say there's no proven benefit to treating subclinical HPV and some discourage it. It is important, however, that health care providers watch carefully for precancerous changes on the cervix that may be found along with HPV infection.

Can HPV And Genital Warts Be Cured?

Treatment of genital warts can be frustrating for both health care provider and patient alike. The average patient may take a few treatments to clear their genital warts. Warts often recur after treatment. Patients should occasionally inspect their genital skin after treatment to see if the warts have returned.

HPV can persist after treatment: The virus lives inside skin. Treatment gets rid of HPV by destroying infected cells. But treatment doesn't always destroy all the infected cells.

What About HPV Genital Warts And Cancer?

The types of HPV linked to cervical cancer usually are not the types that cause genital warts. But a woman with genital warts, like any other sexually active woman, should get yearly Pap smears.

The types of HPV that cause "clinically inapparent" or "subclinical" infection, however, are being studied as risk factors, for cervical cancer. This means that certain HPV types, along with other factors, may make someone more likely to develop cancer. These other factors may include multiple sex partners, first intercourse at an early age, smoking, and the presence of other STDs.

Yearly Pap smears are the best safeguard against cervical cancer. Pap smears detect abnormal cells present on the surface of the cervix. Cancer usually can be prevented through the early detection and treatment of abnormal cervical tissue.

What About HPV, Genital Warts And Pregnancy?

Genital warts sometimes cause problems during pregnancy and delivery. Because of hormone changes in the body during pregnancy, warts can grow in size and number, bleed, or make delivery more difficult. Very rarely, babies exposed to HPV during birth may develop warts in the throat. Despite these risks, a woman with genital warts does not need to have a cesarean-section delivery unless warts are blocking the birth canal.

It is important that a pregnant woman notify her health care provider if she or her partner(s) has had HPV or genital warts.

How Can I Avoid Getting HPV Or Genital Warts?

Certain ways to lower your risk of getting any sexually transmitted disease also may be effective with HPV or genital warts:

• You can reduce your risk of getting HPV or genital warts by not having sex with anyone or by having sex only with one uninfected partner who has sex only with you. People who have many sexual partners are at higher risk of getting sexually transmitted infections.

• Latex condoms ("rubbers"), used properly from start to finish for each time you have sex, may provide protection if they over the area of the HPV infection. Condoms are recommended with all new or casual sexual partners.

• Spermicidal foams, creams, and jellies are not proven to act against HPV and genital warts, but they are effective against some other STDs. They are best used along with condoms, not in place of condoms. (Birth control pills do not protect you from any sexually transmitted disease.)

Is It Normal To Feel Emotional Or Upset About Having HPV Or Genital Warts?

Yes. Some people feel very upset. They feel ashamed or less attractive or less interested in sex. They feel angry at their sexual partner(s), even though it is usually not possible to know exactly when or from whom the a virus was spread. They're afraid that the infection could lead to cancer. It is normal to have all, some, or none of these feelings. If you are worried about HPV or genital warts, remember:

• Genital HPV can be managed.

• Cervical cancer, the most serious problem associated with genital HPV, is easily prevented through regular Pap smears and treatment of precancerous cell changes.

• Informing yourself and others about HPV will help you to understand and manage the infection.

• You are not alone. Tens of millions of Americans have HPV infection. For most, it is a minor problem.