Like many sexually transmitted organisms, HPV usually causes a silent infection -- one that does not have visible symptoms. One study sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) reported that almost half of the women infected with HPV had no obvious symptoms. Because the viral infection persists, individuals may not be aware of their infection or the potential risk of transmission to others and of developing complications.
In women, the warts occur on the outside and inside of the vagina, on the cervix (the opening to the uterus), or around the anus. In men, genital warts are less common. If present, they are seen on the tip of the penis; however, they also may be found on the shaft of the penis, on the scrotum, or around the anus. Rarely, genital warts also can develop in the mouth or throat of a person who has had oral sexual contact with an infected person. Genital warts often occur in clusters and can be very tiny or can spread into large masses on genital tissues. Left untreated, genital warts often disappear. In other cases, they eventually may develop a fleshy, small raised growth with a cauliflower-like appearance. Because there is no way to predict whether the warts will grow or disappear, however, people who suspect that they have genital warts should be examined and treated, if necessary.
A Pap smear test also may indicate the possible presence of cervical HPV infection. A Pap smear is a microscopic examination of cells scraped from the uterine cervix in order to detect cervical cancer. Abnormal Pap smear results are associated with HPV infection. Women with abnormal Pap smears should be examined further to detect and treat cervical problems.
The U.S. Food and Drug Administration (FDA) has approved imiquimod cream, which the patient can apply to the affected area, to treat genital warts. Other treatments include a 20 percent podophyllin solution, which the patient can apply to the affected area and later wash off, and a 0.5 percent podofilox solution, which also is applied to the affected area, but is not washed off. Pregnant women should not use podophyllin or podofilox because they are absorbed by the skin and may cause birth defects in babies. The doctor may also prescribe 5 percent 5-fluorouracil cream, which also should not be used during pregnancy, or trichloroacetic acid (TCA).
Small warts can be removed by cryosurgery (freezing), electrocautery (burning), or laser treatment. Occasionally, surgery is needed to remove large warts that have not responded to other treatment.
Some doctors use the antiviral drug alpha interferon, which they inject directly into the warts, to treat warts that have recurred after removal by traditional means. The drug is expensive, however, and does not reduce the rate of recurrence.
Genital warts may cause a number of problems during pregnancy. Sometimes they enlarge during pregnancy, making urination difficult. If the warts are on the vaginal wall, they can make the vagina less elastic and cause obstruction during delivery.
Rarely, infants born to women with genital warts develop laryngeal papillomatosis (warts in the throat). Although uncommon, it is a potentially life-threatening condition for the child, requiring frequent laser surgery to prevent obstruction of the airways. Research on the use of interferon therapy in combination with laser surgery indicates that this drug may show promise in slowing the course of the disease.
Researchers are working to develop two types of HPV vaccines. One type would be used to prevent infection or disease (warts or pre-cancerous tissue changes); another type would be used to treat cervical cancers. Clinical trials are in progress for both types of vaccines.
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