Human papillomavirus (HPV)

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WHAT IS HPV?

Human papillomavirus (HPV) is the name of a group of viruses that includes more than 100 different types that cause infection on the skin surface. Certain types of HPV cause warts on the hands or feet, while others can cause visible genital warts. However, sometimes HPV infection causes no warts and many people with genital HPV do not know they have it. The wart virus is mostly cleared naturally by the body’s immune system.

WHAT DO GENITAL WARTS LOOK LIKE?

Genital warts are growths or bumps that appear on the vulva, in or around the vagina or anus, on the cervix and on the penis, scrotum, groin or thigh. They may be raised or flat, single or multiple, small or large. Some cluster together forming a cauliflower-like shape.

WHO GETS HPV OR GENITAL WARTS?

Evidence suggests that the majority of individuals who have ever been sexually active experience one or more genital HPV infections during their lifetime. Most HPV infections clear spontaneously.
The most common effects of HPV infection are genital warts or abnormalities in the Pap test.

HOW DO YOU GET HPV OR GENITAL WARTS?

HPV and genital warts are usually spread by direct, skin-to-skin contact during vaginal or anal sex. It is also possible, but rare, to transmit it to the mouth by oral sex.

Warts on other parts of the body, such as the hands, are caused by different types of HPV. Contact with these warts does not seem to cause genital warts. Warts may appear within several weeks after sexual relations with a person who has the virus; or they may take months to appear; or they may never appear. This makes it hard to know exactly when or from whom you got the virus.

HOW WOULD I KNOW IF I HAD HPV OR GENITAL WARTS?

In some cases it is difficult to know. Sometimes people do not notice warts because they are inside the vagina or on the cervix or in the anus. In addition, they are often flesh coloured and painless. Only rarely do they cause symptoms such as itching, pain or bleeding.

Sometimes warts will be found during a physical examination.. For women, an abnormal Pap test may be the first sign that HPV is present, though a Pap test is not a test for HPV. 

You should go to a doctor or clinic if:

  • you notice any unusual growths, bumps, or skin changes on or near your penis, vagina, vulva or anus
  • you notice any unusual itching, pain or bleeding
  • your sexual partner(s) tells you that he or she has genital HPV or genital warts.
  • if a women has an abnormal Pap test she should be followed up as advised by her doctor or health care provider 

HOW ARE GENITAL WARTS DIAGNOSED?

You can check yourself and your partner(s) for warts. Also, sometimes it’s hard to tell the difference between a wart and other bumps and pimples. If you think you have warts go to a doctor or sexual health clinic. 

WHAT SHOULD MY PARTNER DO IF I HAVE GENITAL  WARTS?

Give them this pamphlet to read. Visit a doctor or sexual health clinic for an examination for warts and a general sexual health check up.

HOW ARE GENITAL WARTS TREATED?

There are many different options for treating genital warts. The Australian and New Zealand Guidelines on the Management of Genital HPV and/or Genital Warts include the following treatment information:

  • The goal of treatment should be to remove visible genital warts and relieve annoying symptoms.
  • It is important to remember that treatment does not get rid of the virus, it only treats the visible warts. For most people the body’s natural immunity will get rid of the virus over time. 
  • There are several available treatments and no one treatment is ideal for all people or all warts.
  • Podophyllotoxin (Condyline™) solution is a patient applied treatment for external genital warts. It is easy to use and safe if instructions are followed. Not recommended for use in pregnancy.
  • Imiquimod (Aldara™) cream is a patient applied treatment for external genital and perianal warts. It is safe, effective, easy to use and offers an alternative to tissue destructive therapies.
  • Cryotherapy (freezing off the wart with liquid nitrogen) must be performed by a trained health practitioner.
  • Trichloroacetic acid (TCA) is another chemical applied to the surface of the wart by a health practitioner.
  • Laser therapy (using an intense light to destroy the warts) or surgery (cutting off the warts) has the advantage of getting rid of the warts in a single office visit. However, treatment can be expensive and the healthcare provider must be well trained in these methods. Recurrences still do occur. This method is not widely available. 

Factors that might influence selection of treatment include size, location and number of warts, changes in the warts, patient preference, cost of treatment, convenience, adverse effects and provider experience.

Whatever the treatment, here are some important points to remember:

  • It is advisable to seek medical advice before starting treatment for genital warts.
  • Ask your doctor or nurse for an explanation of the treatment, including the costs and likely benefits.
  • Be sure to understand the follow-up instructions, such as what to do about discomfort and when to return for more treatment.
  • Be patient – treatment often takes several visits and a variety of approaches.
  • If you are pregnant or think you might be, tell your doctor so he or she can choose a treatment that won’t be harmful to you or your baby.
  • Don’t use over the counter treatments which are not specifically for genital warts. These are not meant for sensitive genital skin.
  • Some clinicians suggest avoiding sexual contact with the infected area during treatment. This is mainly to protect the treated area of skin from friction and help it heal. 
COMMON SIDE-EFFECTS OF CRYOTHERAPY, IMIQUIMOD,
PODOPHYLLOTOXIN AT TREATMENT SITE
  • Localised skin irritation, ulceration, pain and discomfort.
  • Imiquimod can cause redness and irritation to the skin.  If using Imiquimod and ulceration occurs, cease treatment for 2 days and if the symptoms don’t settle return to your doctor for review.
MANAGEMENT OF TREATMENT SIDE-EFFECTS

  • Salt baths
  • Analgesia—paracetamol (panadol)

 

    CAN HPV BE PREVENTED?

    GARDASIL is an HPV vaccine available in Australia that can prevent infection with four HPV types – two types cause 70% of cervical cancers, and the other two types cause 90% of genital warts.

    The vaccine is provided free to eligible females and males. It is available through school vaccination programs or for school leavers. It is available at a cost, through GPs and Community Health Centres. The HPV vaccine does not prevent all cervical cell changes, so it is important to continue to have regular Pap tests. 

    Further information is available at: www.cancerscreening.gov.au

    DISCLAIMER:
    This fact sheet is designed to provide you with information on Human papillomavirus (HPV). It is not intended to replace the need for a consultation with your doctor. All clients are strongly advised to check with their doctor about any specific questions or concerns they may have. Every effort has been taken to ensure that the information in this pamphlet is correct at the time of printing.
    Last Updated August 2012