HPV, Genital Warts, and Cancer

With the recent federal approval of Gardasil, the first HPV vaccine, HPV has been making headline news. Still, there is confusion about the sometimes complex relationship between HPV, genital warts, and cervical cancer. For a clearer understanding, read on.

HPV

HPV infects skin and mucous membranes throughout the body. Scientists have identified more than 100 strains of HPV. Of these 100 strains, about 40 affect only the genital area. The other strains affect other areas of the body, like the hands and feet. Certain strains of HPV cause warts, while other strains cause microscopic changes in skin cells that can't be seen by the naked eye.

Genital HPV

Genital HPV is considered a sexually transmitted infection. The virus is spread through direct skin-to-skin contact with an infected person. Transmission usually occurs during vaginal, anal, and oral sex. Rarely, it can be spread through other kinds of sex play, like body-rubbing.

One reason genital HPV is so common is that it's highly contagious. Two-thirds of people who come into contact with the virus will develop an infection within three months. As with non-genital HPV, some of these infections are visible, in the form of warts, while others are not. It is also possible for someone to have more than one type of HPV infection at the same time.

HPV and Genital Warts

When it comes to genital HPV, only two of the more than 40 types actually cause genital warts. Genital warts look like small bumps or cauliflower-like growths. They can appear anywhere on the genitals — the vulva, vagina, cervix, and anus in women; and the shaft and head of the penis, scrotum, and anus in men. Less commonly, these warts are transmitted to the mouth or throat.

Genital warts are harmless and often go away on their own within a few months. If not, clinicians can easily treat or remove them.

Some people mistakenly believe that genital warts lead to cancer. They do not. However, a few other kinds of genital HPV infections may.

HPV and Cervical Cancer

Scientists have identified several types of genital HPV that are associated with certain types of genital cancer — in particular, cervical cancer and, more rarely, penile and anal cancers. These are not the same types of genital HPV that cause warts. The signs of these HPV infections are microscopic. This means that the women and men who are infected with these strains of HPV often have no idea they have them.

Like genital warts, these microscopic HPV infections often go away on their own in eight to 13 months. But sometimes, HPV infections of the cervix do not go away. These long-term HPV infections can lead to cervical cancer.

But today, only one in 1,000 women who contract cancer-related HPV will develop full-blown cervical cancer. This is because many women know how to prevent cervical cancer with proper health care — including regular Pap tests, regular use of condoms, and, when appropriate, HPV tests.

• Pap tests: Leading women's health groups suggest that routine Pap testing begin at age 21 or three years after first vaginal intercourse. Pap tests can detect pre-cancerous conditions of the cervix. Diagnosed early on, the initial stages of cervical cancer are nearly 100 percent curable.
  
  
• Condoms: Condoms help reduce the spread of HPV by preventing some (but not all) skin-to-skin contact during sex play. In addition, recent studies show that consistent condom use can help keep existing HPV infections from becoming long-term infections, including the long-term HPV infections that are associated with genital cancer.
  
  
• HPV tests: Women over 30, and women of any age who receive abnormal or unclear Pap test results, may also use the HPV test. The HPV test detects the DNA of high-risk HPV associated with cervical cancer. Women who have normal results for Pap and HPV tests are at very low risk of developing cervical cancer and do not need to be tested again for three years.

The HPV Vaccine

On June 8, 2006, the U.S. Food and Drug Administration approved the first vaccine against two types of HPV that cause about 70 percent of cervical cancer cases — HPV-16 and HPV-18. Gardasil also protects against HPV-6 and HPV-11, which account for about 90 percent of genital warts. The CDC Advisory Committee on Immunization Practices on June 29, 2006, recommended that 11- and 12-year-old girls receive routine vaccinations. The group also said vaccines can be administered to girls as young as 9, at the discretion of their health care providers.

The HPV vaccine represents a new front in the struggle to end cervical cancer. However, although the vaccine protects against the leading causes of cervical cancer, it will not protect against all causes. That means the vaccine will not take the place of regular screening for cervical cancer. Also, the vaccine is not designed to protect people who have already been exposed to HPV-6, -11, -16, or -18.

Just the Facts

Remember, HPV infections are very common, and they're almost always harmless. Only a few strains of HPV are associated with cancer, and regular Pap tests can help detect precancerous conditions at the earliest, most treatable stages. Condom use is key in reducing the risk of HPV, because condoms cut down on skin-to-skin contact. Consistent use of condoms can also help reduce the effects of an HPV infection and shorten the time it lasts. As always, prevention is the key to good health.