I was diagnosed with genital warts, being treated on third round of acid. more new warts keep coming back every 3 months. Will this ever stop? How do I prevent another outbreak? Once cleared when and how often will they come back? Once clear when I choose to have sex again do I have to tell my next partner or will this be end of it?
HPV (Human Papillomavirus) July 2009
What is HPV?
HPV (human papillomavirus) is a sexually transmitted virus. It is passed on through genital contact (such as vaginal and anal sex). It is also passed on by skin-to-skin contact. At least 50% of people who have had sex will have HPV at some time in their lives.
Why haven't I heard of HPV?
HPV is not a new virus. But many people don't know about it. Most people don't have any signs. HPV may go away on its own-- without causing any health problems.
Who can get HPV?
Anyone who has ever had genital contact with another person may have HPV. Both men and women may get it -- and pass it on -- without knowing it. Since there might not be any signs, a person may have HPV even if years have passed since he or she had sex.
What makes a person more likely to get HPV?
Most people who have sex may get HPV. You are more likely to get HPV if you have:
sex at an early age,
many sex partners, or
a sex partner who has had many partners.
If there are no signs, why do I need to worry about HPV?
There are over 100 different kinds of HPV and not all of them cause health problems. Some kinds of HPV may cause problems like genital warts, cervical cancer or cancer of the vagina or vulva. HPV types 16 and 18 cause about 70% of cervical cancers. HPV types 6 and 11 cause about 90% of genital warts. HPV types 6 and 11 cause 20-50% of vulvar cancers and 60-65% of vaginal cancers.
Is there a cure for HPV?
There is no cure for the virus (HPV) itself. There are treatments for the health problems that HPV can cause, such as genital warts, cervical changes, and cervical cancer.
What should I know about genital warts?
There are many treatment choices for genital warts. But even after the warts are treated, the virus might still be there and may be passed on to others. If genital warts are not treated they may go away, stay the same, or increase in size or number, but they will not turn into cancer.
What should I know about cervical cancer?
All women should get regular Pap tests. The Pap test looks for cell changes caused by HPV. The test finds cell changes early -- so the cervix can be treated before the cells turn into cancer. This test also can also find cancer in its early stages so it can be treated before it becomes too serious. It is rare to die from cervical cancer if the disease is caught early.
What should I know about vaginal or vulvar cancer?
Vaginal cancer is cancer of the vagina (birth canal). Vulvar cancer is cancer of the clitoris, vaginal lips, and opening to the vagina. Both of these kinds of cancer are very rare. Not all vaginal or vulvar cancer is caused by HPV.
Is there a test for HPV?
Yes. It tests for the kinds of HPV that may lead to cervical cancer. The FDA approved the HPV test to be used for women over 30 years old. It may find HPV even before there are changes to the cervix. Women who have the HPV test still need to get the Pap test.
Can I lower my chances of getting HPV?
You can choose not to have sex (abstinence).
If you have sex, you can limit the number of partners you have.
Choose a partner who has had no or few sex partners. The fewer partners your partner has had -- the less likely he or she is to have HPV.
It is not known how much condoms protect against HPV. Areas not covered by a condom can be exposed to the virus.
What is the HPV vaccine and how does it work?
The vaccine, called Gardasil, mimics the disease and creates resistance. It is NOT a live or a dead virus. It prevents infection with HPV types 6, 11, 16 and 18.
Is it safe?
Tests of the vaccine showed some minor problems. Some people had a headache, slight fever, nausea, or fainting. Others had redness, bruising, pain or swelling on their skin where they got the shot.
Some people have fainted and had jerking or seizure-like movements after getting the shot. Some people who have fainted have fallen and hurt themselves.
You should be seated or lying down when you get the shot. Make sure to stay at the doctor's office or clinic and continue to stay seated or lying down for at least 15 minutes so they can watch for any problems.
Is it effective?
Gardasil is between 95-100% effective against HPV types 6, 11, 16, 18.
Who should get the HPV vaccine?
The FDA has approved Gardasil for girls and women ages 9 to 26. It is best to get the shot before the start of sexual activity. It is NOT recommended for women over age 26.
How many shots do you need?
There are three shots. Once you get the first shot, you need a second shot two months later. You need to get a third shot six months after you get the first shot.
How long are you protected?
Since the vaccine is new, more studies need to be done. For example, the FDA does not know if you will need to have a booster after a couple of years.
Should I get the vaccine if I already have HPV?
The vaccine will not treat or cure HPV. It may help people who have one type of HPV from being infected with the other types. For example, if you have type 6, it may protect you from getting type 16.
Can I catch HPV from getting the vaccine?
No. The vaccine does not contain the HPV virus.
To learn more:
FDA Center for Biologics Evaluation and Research
Human Papilloma Virus (HPV) and HIV/AIDS April 2010
What Is HPV?
Human Papillomavirus (HPV) is the name of a large group of viruses. Certain types of HPV cause warts on the hands or feet. About 30-40 types can cause infections in the genital area (the vulva, vagina, penis, buttocks, scrotum, and anus).
Genital HPV types are often referred to as "low risk" and "high risk." Low-risk types can cause genital warts. High-risk types can cause cervical cancer or cancer of the vulva, vagina, anus, and penis.
The types of HPV that can cause genital warts are not the same as the types that cause cancer. However, if you have warts, you may have also been exposed to the types of HPV that could cause cancer.
Genital HPV is spread easily through skin-to-skin contact during vaginal or anal sex with someone who has the infection. Condoms do not totally prevent transmission. Even though many people who have HPV don't know it, they can still pass it on to someone else.
Genital HPV is the most common sexually transmitted disease (STD) in the US. Over 50 percent of all sexually-active men and women become infected with HPV at some time in their lives.
Most people with HPV do not know they have it because they do not develop symptoms. In 90 percent of cases, the body's immune system clears HPV infection naturally (without treatment) within two years.
People living with HIV (HIV+ people) are more likely to be infected with HPV than HIV-negative people. HIV+ people with HPV are also more likely to develop genital warts, as well as cervical or anal cancer.
If you have sex, it is important to be checked for signs of HPV such as genital warts or cervical and anal cancer. This is because the body does not always clear HPV on its own and you may need treatment to prevent health problems.
Certain types of HPV can cause warts on the vulva; in or around the vagina or anus; or on the penis, scrotum, groin, or thigh. Warts can appear anywhere from a few weeks to a few months after you are exposed to HPV. They can even appear years after exposure.
Flesh-colored, pinkish, or white warts that appear as small bumps or groups of bumps. They can be raised or flat, different sizes, and are sometimes shaped like cauliflower.
Health care providers can usually identify genital warts by looking at them
Sometimes a biopsy is done (a sample of the suspected wart is cut off and examined under a microscope)
Some health care providers may use a vinegar solution to help identify flat warts, however, this test may sometimes wrongly identify normal skin as a wart
There is no cure for HPV, but genital warts can be treated by removing the wart.
The following treatments must be done in a health care provider's office:
TCA (trichloracetic acid): A chemical is applied to the surface of the wart
Cryotherapy: Freezing off the wart with liquid nitrogen
Electrocautery: Burning off the wart with an electrical current
Laser therapy: Using an intense light to destroy the wart
Excision: Cutting the wart out
Some treatments can be done at home with prescription creams
Do not use over-the-counter wart removal products to treat genital warts
Some wart treatments should not be used by pregnant women
Warts can reappear after successful treatment
If left untreated, genital warts may go away, remain unchanged, or increase in size or number. Some people decide not to have treatment right away to see if the warts will go away on their own. When considering treatment options, you and your health care provider may take into account the size, location and number of warts, changes in the warts, your preference, and the side effects of treatment.
Many HIV+ women, especially those with low CD4 cell counts, may not be able to get rid of genital warts using standard treatments. Several different treatments may be needed.
Dysplasia and Cervical Cancer
Certain types of HPV can cause abnormal cells to form. This is called dysplasia. The main place dysplasia occurs is on the cervix. Other less common areas are the vagina, vulva, and anus. Dysplasia is not cancer, but if left untreated, it can develop into cancer.
Cervical cancer can be life threatening. It is one of the few AIDS-defining conditions specific to women. Fortunately, it can be prevented through early diagnosis and treatment.
Cervical cancer screening is done by using a Pap test (sometimes called a Pap smear). This test checks for changes in the cervix. Cervical cancer usually takes years to develop, but it does not have symptoms until it is quite advanced. This is why getting screened on a regular basis is important; screening can catch potential problems before they get worse.
It is especially important for HIV+ women to have regular Pap tests. This is because HIV+ women are more likely to have abnormal Pap tests than HIV-negative women.
Many women do not experience symptoms
In very advanced stages, a woman may experience pain, vaginal discharge, and bleeding between periods
HIV+ women should have a complete gynecological examination, including a Pap test and a pelvic exam, when they are first diagnosed or when they first seek prenatal care
HIV+ women should have another Pap test six months later
If both tests are normal, yearly screening is recommended
An abnormal Pap test can indicate inflammation, infection, dysplasia, or cancer
If you have an abnormal Pap, you may need a colposcopy (an exam of your cervix using a magnifier to look at the tissue more closely) and a biopsy (cells or tissues are removed so they can be checked under a microscope for signs of cancer)
An HPV test can be used along with the Pap test to detect cancerous and pre-cancerous conditions. However, there are no firm recommendations for using the HPV test in HIV+ people. Speak with your health care provider to see if the HPV test is appropriate for you.
Treatment for Dysplasia
If it is determined that you have dysplasia, discuss your treatment options with your health care provider. While there is no cure for HPV, dysplasia can be treated. Most treatments focus on destroying the abnormal tissue so that it doesn't progress to cancer.
Electrocautery Burning off the cells with an electrical current
Laser therapy: Using an intense light to destroy the cells
Cold-knife cone biopsy: Cutting the cells out
LEEP: Loop electrosurgical excision procedure
Cryotherapy: Freezing the cells with liquid nitrogen
In cases of mild dysplasia, your health care provider may just monitor the cervix by colposcopy, repeat Pap, or HPV test
Dysplasia is more common in HIV+ women than HIV-negative women, especially women with advanced HIV disease and low CD4 cell counts. Dysplasia is often more serious and difficult to treat in HIV+ women than HIV-negative women.
Treatment of Cervical Cancer
Cervical cancer is most treatable when it is diagnosed and treated early, so regular Pap tests are vital. Treatment depends on the type of cervical cancer and how far it has spread. Often, more than one kind of treatment is used.
Surgery: Cancer tissue is cut out in an operation
Chemotherapy: Drugs (pills and/or intravenous medications) are used to shrink or kill the cancer
Radiation: High-energy rays (similar to X-rays) are used to kill the cancer cells
Dysplasia and Anal Cancer
Nearly all HIV+ men with a history of receptive anal intercourse have anal HPV infection. Certain strains of HPV may cause dysplasia and cancer in the anus. Although the risk of developing dysplasia is higher among men who have sex with men, women are also at risk, especially those with HIV or who have had anal intercourse.
May be no symptoms
Anal bleeding, irritation, itching, or a burning sensation
In very advanced stages, there may be abscesses, lumps, ulcers, and anal discharge
Careful physical examination by a health care provider may be the best way to detect anal cancers
An abnormal anal Pap test may indicate dysplasia or cancer
If you have symptoms, you may need an anoscopy (an exam of the anus using a magnifier to look at the tissue more closely) and a biopsy (cells or tissues are removed so they can be checked under a microscope for signs of cancer)
It is important to ask your health care provider to check for anal cancer on a regular basis
Same as treatment for dysplasia and cervical cancer (see section above)
HPV is More Common and Can Be More Serious for HIV+ People
HIV+ people are more likely to be infected with HPV than HIV-negative people. One study found HPV in more than 3 out of 4 HIV+ women. Because of immune suppression, HIV+ women are more likely to have:
HPV infection that does not clear up on its own
Infection with the HPV strains that are more likely to cause cancer
Higher risk of developing cervical cancer
HPV in both the cervix and anus
Several strains of HPV at once
HPV infections that were previously under control that come back again
HPV that responds poorly to standard therapies -- multiple treatments using different methods may be needed
Prevention of HPV
There are two Food and Drug Administration (FDA)-approved HPV vaccines: Merck's Gardasil and GlaxoSmithKline's Cervarix. Gardasil is approved for females and males ages 9 to 26. Cervarix is approved for females ages 10-25. Pregnant women should not use the vaccines.
Both vaccines protect against types of HPV that cause the majority of cervical cancer cases and genital warts.
It is important for young people to get vaccinated before their first sexual contact (before they have been exposed to HPV). People who are already infected with HPV are not protected by the vaccines. Also, the vaccines do not protect against less common HPV types. Therefore, health care providers still recommend regular Pap tests to look for dysplasia before it becomes cancer.
There are payment assistance programs for people who cannot afford the HPV vaccines, see the resource section of this sheet for contact info.
The safety and effectiveness of the vaccines in HIV+ people has not been determined. Speak to your health care provider about the HPV vaccine to see if it is appropriate for you.
Regular pelvic and anal exams and Pap tests are very important. While they cannot prevent HPV-related problems, they can help catch warts and dysplasia before they progress and cause greater problems.
It has been found that many HIV+ women skip PAP tests. It is crucial that HIV+ women get routine Pap testing and follow up as needed to identify problems before cancer develops. Prevention is always better than treatment.
Even though condoms do not fully protect HPV, when used correctly, they can help reduce the risk of HPV transmission.
Smoking has been shown to increase the chance of developing numerous types of cancer including cervical and anal. If you smoke, it is a good idea to try and quit.
Taking Care of Yourself
HPV can be very serious for HIV+ people. Since there are frequently no symptoms, regular monitoring by your health care provider is the best way to be sure that any problems are found and treated before they progress.
A recent study also found that HIV+ women who were adherent (stuck closely) to their HIV drugs and had an undetectable viral load, had lower levels of HPV and were less likely to have pre-cancerous cervical cell changes. Although more research is needed, these findings suggest that sticking to an effective HIV drug regimen may help reduce HPV-related problems.