Human papillomavirus (HPV) infection is the most common sexually transmitted viral infection of the lower genital tract. There are many subtypes of this virus, and infections by different varieties lead to disparate clinical conditions. These include genital warts (condylomata acuminata), sub-clinical infection, abnormal growth of epithelial cells (intraepithelial neoplasia), and/or carcinoma of the vulva, vagina, and cervix. In fact, more than 60 subtypes of HPV have been identified, but only a few cause infections of the genital tract. Subtypes 6 and 11 are more often associated with genital warts (overt condylomata acuminata), hut subtypes 16 and 18 are more likely to promote progression to premalignancies or malignancies. HPV infection is widespread. As many as 60% of women tested for HPV DNA with sensitive molecular biology techniques (polymerase chain reaction, or PCR) are positive. Although the majority who test positive are asymptomatic, there is always the risk of reactivation, with subsequent serious consequences, because this virus remains in a woman’s system for life once she is infected.

Health care providers diagnose warts by their typical appearance on physical examination. They can be flat or raised; pink, white, or other pigments; large or small; and they can appear singly or in clusters. Pap smears provide an important screening test to determine the presence of warts. One diagnostic method involves applying 5% acetic acid to the affected area and then examining it microscopically. A colposcopic examination offers a more definitive diagnosis. The surgical excision or biopsy of suspicious tissue and examination of it by a pathologist are often required. Symptoms include occasional itching or bleeding but usually not much pain, in pregnancy, if the wart becomes large it can interfere with a vaginal delivery. Although rare, the vocal cords of vaginally delivered infants have become infected. The most appropriate treatment depends on the location of the lesion, its extent, the severity of the disease, and whether the patient is pregnant. There are several chemical treatments (podophyllin, bichloroacetic acid, trichloroacetic acid, and 5-fluorouracil [5-FLJ]). Physical treatments include freezing the lesion (cryotherapy), laser therapy, electrotherapy, and surgical excision. Immunotherapy also is used in severe cases. Although each of these methods has a success rate that approaches 95% in properly selected patients, recurrences are common. We need research to develop agents that would confer immunity, eradicate latent infection, improve the treatment of overt infection, and further clarify the association between this virus and malignancy.

Human Papillomavirus (HPV)

 The warts are often painless (though they may occasionally itch, burn, or bleed), and in most cases they won’t pose any problems for mother or baby. They do tend to grow during pregnancy, though, possibly from the extra vaginal discharge that provides the virus with a moist growing environment. In certain cases, your practitioner may offer to remove them with a mild acid solution. But unless your warts are so large or numerous that they block your birth canal or there’s a concern that they’ll bleed excessively, you can still have a normal vaginal birth whether they’re treated or not. (What’s more, they often improve on their own or even disappear altogether after delivery.) Though HPV can be transmitted to your baby during birth and lead to a serious condition characterized by warts on his vocal cords and other areas, this is extremely rare. Having a c-section doesn’t seem to offer a baby complete protection from the virus, anyway, so your birth won’t be managed any differently than it would have been if you ware HPV-free.

Human Papillomavirus (HPV)

Another virus that is sexually transmitted is the human papillomavirus (HPV), which causes genital warts, also called condylomata acuminala. These genital warts may occur in the urogenital, perineal, or anal areas, and may be either external or internal. The population at risk seems to be teenage girls or young women in their twenties. In the United States, it is estimated that there are approximately 1 million new cases of genital warts identified every year, and as many as 24 million already infected with HPV (NIAID and NIH, July 1998b). The incubation period for genital warts appears to be approximawly 1 to 2 months, but may be up to 6 months. Unlike genital herpes, genital warts are usually painless, soft fleshy growths appearing most commonly in the genital area. Sometimes many warts may grow together to form a large cauliflower-shaped growth. The greatest health threat that HPV poses to a female client is the predisposition to the development of cervical cancer. Although there are over 60 different types of HPV, only 6 of those have been associated with the development of cervical cancer. Cigarette smoking has been linked to the development of cancerous cervical changes in women with HPV. Women who have HPV should be advised not to smoke. HPV appears to play a role in the development of cervical cancer, along with many other factors. An abnormal Pap test may be the first indication of HPV. Genital warts are less common in men. If seen, they are usually on the lip of the penis.

Medical—Surgical Management
Since genital warts are caused by a virus, there is no cure for the disease. The focus is on preventing the spread of the disease to sexual partners, and reducing the possibility of cancer. Use of a condom during sexual intercourse may provide some protection. Once the genital warts disappear, the disease may lie dormant for many years until there is a recurrence of the outbreak.

Surgical
The warts may be removed under local anesthesia. This is especially recommended if the warts have formed a large fleshy cauliflower-like growth. Freezing the warts off with cryosurgery, or surgical use of extreme cold, is the treatment of choice for small warts. The warts may also be removed with laser surgery, or cauterized. Whatever treatment is recommended, it mu.st be remembered that the treatment will not cure HPV, but only provide a palliative effect. The warts may recur after any treatment.

Pharmacological
A topical solution of podophyllum resin (Poddoen) may be applied to the genital warts. It is only recommended for treatment of I or 2 lesions at a time, since it can be toxic if applied to too large an area at one time. Most people report experiencing a good deal of pain from the treatment. After the solution has been in contact with the genital warts for a period of 4 to 6 hours, it is then washed off with soap and water. If not thoroughly washed off, podophyllum may cause
chemical burns that 1w-al very slowly and are very painful. This therapy must not be used on a diabetic client, a client with poor circulation, or a pregnant client.

Human Papillomavirus (HPV)

Genital warts are caused by the Human Papilloma Virus (HPV). The warts vary in appearance from tiny bumps to large, spreading masses which can appear on the penis, the labia, around the anus, in the vagina and on the cervix. The disease spreads through sexual contact with warts on the genitalia of an infected person. HPVs are now associated with cancer of the cervix, as well as tumours of vulva, vagina, anus and penis.

Human Papillomavirus (HPV)