Human Papillomavirus (HPV): Teen Version

What is human papillomavirus?

Human papillomaviruses (HPVs) are a group of over 100 viruses. There are many types of HPV, including types that infect the genital area and some that cause genital warts. Some types of HPV infection can develop into cancer if the infection is not treated.

HPV infection is a common sexually transmitted disease. At least 50% of sexually active people will have genital HPV at some time in their lives.

HPV can cause changes in a woman's cervix. Most of the time these changes are harmless, but sometimes the changes may cause cervical cancer.

How does it occur?

Often HPV is passed from one person to another during sexual activity. However, some types of HPV infection can develop without sexual activity.

You are more likely to have sexually transmitted HPV if:

• You have had more than 1 sex partner.
• Your sex partner has been sexually active with other partners.
• You had sexual intercourse before the age of 18.
• You have had other sexually transmitted diseases (STDs).
• Your immune system is not working well because of cancer treatment (chemotherapy), immune-suppressing drugs (for transplants or autoimmune diseases), or an immune-suppressing infection, such as HIV. (The immune system helps the body fight infections.)
• You have used steroids for a long period of time.
• You have lupus.
• You smoke cigarettes. Smoking affects your ability to fight infection.

The types of virus that most often cause genital warts are called HPV-6 and HPV-11.

What are the symptoms?

Usually there are no symptoms, but some types of HPV cause genital warts. Genital warts are small growths in the genital or rectal area. They are similar to common warts. Genital warts are small, flesh-colored, grayish white or pinkish white growths. They usually appear as thin, flexible, solid bumps on the skin that look like small pieces of cauliflower. Some warts, however, are quite small and flat and may not be easily noticed.

Genital warts may appear within several weeks, months, or years after contact with an infected person. Genital warts are usually found around or in the vagina, cervix (the lower part of the uterus), penis, scrotum, rectum, or the area between the vagina and rectum. They may spread to other nearby parts of the body. You may get warts in your mouth if you have had oral sexual contact with an infected person.

Other symptoms of genital HPV infection are:

• a bad smell, mild irritation, burning, itching, or pain in the vulva or vagina
• pain with intercourse
• increased vaginal discharge
• bleeding (from injury to warts during sex)

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine your genital area, as well as the anus and surrounding skin. Your provider may put a liquid on the skin to make it easier to see warts. He or she may use a magnifying instrument, or scope, to look closely at your genitals. Your provider may do a biopsy, removing a sample of tissue for lab tests.

Often HPV is discovered when a woman has a pelvic exam and Pap test. If you have an abnormal Pap test, your provider will examine the genital area, vagina, and cervix with a magnifying instrument called a colposcope. A biopsy may be done during this exam. The exam and tests will help determine if HPV is the reason for the abnormal Pap test. An abnormal Pap test does not necessarily mean that you have HPV. Other things can also cause abnormal results.

Sometimes an HPV-DNA test may be done to see if the type of HPV you have is the type associated with cervical cancer.

How is it treated?

There are several ways to treat HPV. Your healthcare provider will discuss your treatment choices with you. Usually the treatment is done in the provider's office. Possible treatments are:

• medicines that are put on the site of the HPV infection
• cryotherapy, which is freezing of the warts with liquid nitrogen
• laser treatment, which is a high-intensity light beam used to destroy the infection
• electrocautery, which is an electric current used to burn or remove the infection with a wire loop
• surgery to cut away the growths or infection
• waiting to see if the warts go away on their own

You may need a local anesthetic to numb the area before some of these treatments.

If you have genital warts and plan to get pregnant, get treatment for the warts before you get pregnant. If you get genital warts while you are pregnant, it is rare for the HPV to affect the baby. However, warts tend to grow and you may get more of them during the pregnancy. Usually the warts are not treated until after you deliver your baby. A cesarean delivery (C-section) will not have to be done to prevent spread to the baby. You may need to have a C-section, however, if your healthcare provider thinks that the warts are so big that they could make it hard to deliver the baby, or might tear and cause too much bleeding. Rarely does the baby develop warts after the delivery.

How long will the effects last?

Removal of genital warts does not get rid of the virus. Because you will still have the virus after treatment, other warts can grow and you may need more treatment.

Genital HPV does not cause health problems for most people. However, some types of HPV infection can lead to cancer of the cervix, vagina, or vulva in women. The HPV-6 and HPV-11 types of virus, which are the usual cause of genital warts, rarely lead to cancer and are called low-risk HPVs.

Because some types of HPV can cause precancerous or cancerous changes in the cervix, it is important for women who have had HPV infection to have regular Pap tests to check for abnormal cells. Cervical cancer is highly preventable with regular Pap tests and follow-up.

Many HPV infections, even when they are caused by viruses called high risk, go away on their own and do not cause cancer.

How can I take care of myself?

• Get follow-up exams according to your healthcare provider's recommendations. Women should have pelvic exams and Pap tests as often as their provider recommends.
• If you have an abnormal Pap test, follow your provider's advice for tests and treatment.
• If you have an unusual vaginal discharge or irritation, or if you notice growths in the genital area, see your provider.
• If you have genital warts and plan to get pregnant, have your warts checked by your provider.

How can I help prevent HPV or its complications?

Because HPV is the most important risk factor for cervical cancer, you should do what you can to prevent HPV infection and get treatment if you think you have an infection.

The best way to prevent the spread of HPV is by not having sex.

A vaccine is available to prevent types of HPV infections that are high risk for genital warts and cancer of the cervix. If you already have HPV, the vaccine will not cure your infection, but it will prevent infections with several other types of HPV.

The HPV vaccine is approved for girls and women 9 to 26 years old. It is recommended for all girls 11 to 12 years old as part of their routine immunization schedule. It is given in 3 shots. The vaccine may protect against HPV for 5 years. Researchers are doing studies to see if a booster shot is needed after 5 years.

The HPV vaccine is usually not given to pregnant women.

Here are some other things you can do to help prevent HPV or its complications:

• Women: Get an exam and Pap test every year.
• Do not have sexual intercourse until you are married or over the age of 18.
• Use latex or polyurethane condoms during sex. Even after your warts are gone, you can infect your partner because the virus is still in your body. Condoms can reduce the risk of getting genital warts from another person, but HPV can spread from areas not covered by a condom.
• Have just one sexual partner who is not sexually active with anyone else.
• Avoid sexual contact until the genital warts or HPV is completely treated and healed.
• Do not smoke. Studies show that smoking increases the risks and problems related to HPV infection.