Genital warts and HPV (Human Papilloma virus)

What is the human papilloma virus (HPV)?

The human papilloma virus is commonly referred to as HPV. It is a very common virus which has more than 100 different strains, with more than 30 of these spread via sexual contact. Forms of HPV that affect the genitals are identified as genital HPV. A large majority of people who are sexually active will be exposed to HPV within their lifetime, but most will never be aware as there are usually no symptoms. Genital HPV is either low or high risk. High risk HPV is associated with an elevated chance of cervical cancer (cancer of the cervix).

The difference between low risk and high risk HPV

Both high and low risk HPV can contribute to changes in the tissue of the cervix. The cervix is the part of the womb (uterus) that opens into the vagina. There are some forms of HPV that increase the chance of cervical cancer, which are known as high risk HPV. In most cases, HPV does not cause cervical cancer, but there are around 10 types that can cause cancer.

Developing high risk HPV is different from being diagnosed with cervical cancer, and in most cases, HPV infections subside without causing any symptoms or requiring any treatment. A persistent infection is the most common cause of cervical cancer. Regular HPV tests (also known as Pap tests) and smear tests can be very effective in preventing cervical cancer because they detect early changes in the cervical cells.

Low risk strains of HPV can result in genital warts. Genital warts can develop in weeks, months or even years following sexual contact with another person who has HPV. Genital warts are able to grow both inside and outside the vagina, on the vulva or around the groin and anus. In males genital warts can develop on the scrotum, penis and around the groin and anus. In rare cases, genital warts can develop inside the throat or mouth as a result of having oral sex. Warts vary in size and some are so small that you cannot see them with the naked eye. They can also vary in shape and may be flat or structured. Warts usually occur in small clusters and cause itching and a burning sensation. It is feasible to have a low risk HPV infection without developing warts, and many people have the infection without realising because they do not develop any symptoms.

How do women develop HPV?

Genital HPV can be passed through sexual contact, which involves skin-to-skin contact of the genital areas or through oral sex.

How do you diagnosis a HPV infection?

A pap or cervical smear test is used to check for changes to the cells in the cervix. The test involves a doctor or nurse taking a sample of the cells from the cervix using a small brush or instrument called a spectrum. The test is quick and simple and it should not be painful. A doctor may also recommend an HPV test, which is designed to detect the high risk HPV strains that increase the chances of cervical cancer. If you have a borderline smear test result, you may be advised to have an HPV test to determine whether the abnormal cells are caused by the HPV.

How often is it recommended that I get a smear test?

Your doctor will advise you when you should have a smear test. As a general guideline you should have regular tests every three years once you become sexually active, but in the UK cervical smear tests are provided for women aged 25 or over on the NHS. However, you may be advised to have the test at a younger age if you have symptoms of cervical cancer. Smear tests are not necessary for women who are beyond the age of 65 and have no signs of cervical cancer and normal smear test results in the past. If you have had a complete hysterectomy you will not need a smear test.

Doctors may have different views on when women should be tested and how often the test should be repeated. Ask your doctor or practice nurse for advice.

What happens if the test result is abnormal?

If the results of your smear test are abnormal, the doctor may inform you of your abnormal smear test results. This does not necessarily mean that you have cervical cancer but further investigations will be carried out. There could be numerous other causes of an abnormal result, including a yeast infection or hormonal changes in the body. If the test result is abnormal it may be repeated before further tests are ordered. Further tests include:

Colposcopy - this involves using a special instrument to closely inspect the cervix.
Schiller test - this test involves placing iodine on the cervical cells. Abnormal cells will turn yellow or white, while healthy cells will turn brown.
Biopsy - this involves removing a very small sample of the cervical tissue so that it can be examined under a microscope.

Is it possible to have cervical cancer even if the test is normal?

It is possible for an individual to have cervical cancer even if the smear test is normal, because it can take some time for changes in the cervix to appear. Women who have a negative smear and HPV test carry a very low chance of developing cervical cancer because the results show no changes to the cervix and no HPV infection.

Is HPV able to be treated?

There is no treatment for HPV but there are treatments that can be used for the changes to the cervix that are brought about by HPV infection. There are also treatments available for genital warts.

Which treatments can be used to treat irregular cells found on the cervix?

If you have irregular or abnormal cells in the cervix your doctor will advise you to have treatment. In some mild cases, they may adopt a policy of watchful waiting, which involves monitoring the condition very closely rather than treating it immediately.

Treatment options include:

Cryosurgery - this involves freezing the abnormal tissue.
Loop electrosurgical excision procedure (LEEP) - this involves implementing a hot wire loop used to remove abnormal cells.
Laser treatment - this involves using intensive laser beams to destroy abnormal cells.
Cone biopsy - this involves removing a cone-shaped tissue sample from the cervix.

After treatment you may experience symptoms including bleeding, cramping and abnormal discharge that may be dark brown in colour and more watery than usual.

How do you treat genital warts?

Genital warts may be treated but often they are left alone, as some people do not want to have treatment to remove them. It is imperative that you visit your doctor if you have developed genital warts, as over-the-counter medication designed for other types of wart will not be effective. Doctors can apply a special chemical to the wart to remove it and there are also creams available. Surgery is also possible and procedures include:

Electrocautery - this involves using an electric current to burn off the wart.
Laser treatment - this involves using an intensive laser beam to destroy the wart.
Cryosurgery - this involves freezing the wart.
Removal by means of cutting the wart off.

After warts have been treated it is possible for them to return as the HPV infection may remain. Genital warts may increase in size and number if they are left untreated, but they cannot become cancerous.

HPV in men

HPV is found in an equal number of men and women but it is very rare for HPV to cause serious conditions in men.

Protection from a HPV infection

You increase the risk of HPV infection by having a number of sexual partners. In reality the only method of protecting yourself from a HPV infection is to refrain from having sex or sexual contact. However, using a condom can help to reduce the risk and you will have a low threat of contracting the infection if you and the person you have sexual contact with have a small number of sexual partners. It is also possible for HPV to return as there are many different strains of the virus.

Protecting my partner from HPV once my genital warts have gone

It may be possible for you to have genital warts even after you think they have gone. The HPV may also remain, meaning that genital warts may return. You can lower the chance of giving other people genital warts by using a condom.

HPV and pregnancy

Women who have previously suffered with genital warts will usually not experience any difficulties during their pregnancy. However, women who still have warts may find that the warts grow in size and number and they may bleed. In rare cases, a mother can transfer HPV to her baby during delivery. Even more rarely, babies can develop warts within the throat as a result of exposure to the HPV.

If a wart is blocking the birth passage a Caesarean section may be required.

Preventing cervical cancer

Several risk factors have been identified for cervical cancer, including HPV infection, smoking and a weak immune system. You should take the following steps to lower your chances of developing cervical cancer:

Have regular smear tests - ask your doctor for advice about how often and when to have tests.
Visit your doctor if you experience symptoms such as pain during intercourse or bleeding between periods. The earlier cervical cancer is diagnosed the higher the chance of survival.
Eat a balanced and health diet with plenty of fruit and vegetables. Foods that contain vitamins E and C are particularly beneficial for reducing the risk of cancer, which includes strawberries, oranges, leafy green vegetables, carrots, tomatoes, broccoli, nuts and seeds.
Try to stick to one sexual partner; the more sexual partners you have, the higher the risk of HPV infection.
Avoid smoking as this has negative implications for almost every system and organ in the body and will lower your chance of developing several forms of cancer, as well as other life-threatening conditions, including heart disease and strokes.
Use a condom.