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HPV and Genital Warts

Human papilloma virus (HPV) is the most common sexually transmitted infection seen at sexual health clinics in the UK and it is likely that most of us have had HPV at some time in our lives — although we may not have known it. So what is HPV, how can it be prevented and treated, and what does papilloma mean anyway?

Papilloma means a growth or wart, which is why HPV is also known as the 'wart virus'. In practical terms, however, only about 10% of people with HPV develop warts. The vast majority of people with HPV don't, and are therefore unlikely to know that they are infected or that they may be passing the virus to their sexual partner(s).

Young sexually active people are at greatest risk of getting genital HPV, with the highest rate of infection in those between the ages of 20 and 24. Recent research suggests that many young women may become infected with the virus during their first sexual experience, and the risk of infection increases with the number of sexual partners. HPV prevalence seems to decrease with age.

What is HPV?

There are thought to be more than 100 types of human papilloma virus that can infect the body. Some strains lead to common warts on people's hands and feet, but these are different from genital warts and cross-infection is extremely rare. About 30 types of HPV affect the genital area. Some types cause genital warts, others cause changes in cervical cells that may lead to cervical cancer, but most HPV infections cause no symptoms at all and go away on their own.

How is the virus spread?

Genital HPV is highly infectious, particularly when warts are present, and is spread mainly through direct skin-to-skin contact with the infected area. Genital HPV is passed on during sexual contact, including vaginal and anal sex, oral sex and, while less risky, non-penetrative sex play. It is also possible for sex toys to carry an infection from one person to another. In rare cases, HPV may be spread without direct sexual contact. It may be possible, for example, to pick up the virus if you use a towel to wipe your genitals after it has been used by someone who has HPV or genital warts.

Can HPV be spread from woman to woman?

Lesbian sex is generally considered low risk for sexually transmitted infections (STIs), but research shows that HPV can be spread between women. Recent studies suggest that HPV is more common among lesbians than previously thought, and is as likely to affect lesbians who have never had sex with a man as those who have.

How do I know if I have HPV?

Genital warts are the only visible sign of HPV infection, but they may not appear for weeks, months or even years after infection occurs, if they appear at all. Women are more likely than men to develop warts, and they can grow on the lips of the vulva, around the clitoris, inside the vagina, around the urethra, on the cervix, on the area between the vagina and the anus (perianal region), and in and around the anus itself. In men, warts tend to develop on the tip and shaft of the penis, on the scrotum, as well as in and around the anus. Although rare, genital warts may develop in a person's mouth or throat if infected through oral sex.

Warts may appear as small red or white bumps, they may grow alone or in cauliflower-like clusters, or they may be flat and barely visible.

Genital warts are generally not painful, but may be itchy or uncomfortable. You may not realise you have warts, particularly if they are small, inside the vagina or on your cervix.

How is HPV diagnosed?

HPV is usually diagnosed based on the presence of genital warts. If there are no obvious warts, but infection is suspected (because a partner has warts, for example), the doctor or nurse may apply a solution that turns warts white, making very small or flat warts more visible.

An abnormal smear result may be a sign that you have been exposed to HPV, but not all cervical smears can detect current HPV infection. If your smear result suggests HPV might be present, you may be scheduled for another smear, or for a colposcopy. During a colposcopy, a specially-trained doctor or nurse looks at your cervix through a microscope (the colposcope) for signs of HPV and s/he may take a sample (biopsy) of cervical tissue for further investigations.

A new type of smear test, which uses liquid-based cytology (LBC) to sample and store cells from the cervix, offers a more accurate and quicker way of diagnosing HPV, but is not widely available in the UK. LBC is currently being piloted (tested) in clinics and GP practices in Bristol, Newcastle, Norfolk and Cardiff. Depending on the results, LBC may be available for national use over the next couple of years. (For more information about the trials, contact the NHS Cancer Screening Programmes press office on 020 7838 4890)

If you don't have visible genital warts and your smear result doesn't show signs of HPV, there is currently no other way of knowing whether or not you have the virus.

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Written by Tamara Beus and published in printed form by Women's Health (2002)

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