HPV

The Human Papilloma Virus (HPV) belongs to the family of viruses responsible for producing warts and has been implicated as a cause of genital cancers and other abnormal growths. More than 100 types of HPV have been identified. Type 2 is known to produce warts on the hands while type 6 gives rise to genital warts. Type 13 causes flat oral lesions in the mouth. The ones usually linked with cancers are types 16 and 18 although several others are associated with a rare skin disease that can get cancerous. These viruses are transmitted congenitally, sexually, as well as by other means of contact. According to the Centers for Disease Control and Prevention (CDC), approximately 6.2 million new cases of sexually transmitted HPV infections are reported every year. Manifestations of HPV

The commonest manifestation of HPV is in the form of genital warts which are also called condylomata acuminata or venereal warts; Although one can remain asymptomatic in spite of being infected by the virus. These warts may be pedunculated (with stalks) and are cauliflower-like in appearance or sessile (without stalks). In females, genital warts may appear on the labia majora, minora, cervix, vagina, and anus. In males, genital warts mostly appear on the scrotum or penis, especially around the corona glandis like a garland of warts encircling the head of the penis. The warts are usually soft, fleshy, and moist. They may ooze, bleed, get pustular and itch at times. These types of HPV which only produce warts on the genitals or elsewhere on the body are considered to be low risk. On the other hand, the types which lead to abnormal Pap smear tests or can predispose cancers in the genital region are called high risk.

Mode of transmission or spread of HPV Most warts are contagious and  genital warts are highly contagious. Any sexual activity can cause them to spread. The lesions are usually initially restricted to the exposed area of infection, i.e. genital warts are seen in vaginal intercourse, anal warts when anal sex is practiced, and warts in the mouth or throat accompany oral sex. They can also be transmitted vertically or trans-placentally from mother to child. Even direct contact of the skin or mucosa with the warts can cause the infection to spread.

Clinical diagnosis by a physician includes a physical examination. Pap smear tests in women are mandatory to look for dysplasia in the cervix which could undergo precancerous changes. An HPV DNA test can also be carried out to suggest an infection. In suspicious looking lesions, a biopsy followed by histopathological examination can be done to ascertain the diagnosis. Application of acetic acid to almost invisible warts causes them to fade and appear prominent for better diagnosis and to spot the exact location and extent of the lesions.

The papilloma virus remains within your body and manifests itself whenever there is a drop in the immunity. In fact, many a time, genital warts disappear even without treatment. Especially with people that have good immunity. The prognosis of the fate or progress of the disease is difficult and depends upon the strain of the virus, its virulence, and the patient’s immunity.

Creams containing podophyllin extracts are usually prescribed. Warts can be removed by electric or chemical cauterization. Cryosurgery or freezing, and Laser ablation are also availble. Interferon injections into the warts have been tried and trials are yet on to develop a vaccine for HPV. Alternative medicines such as homeopathy and naturopathy have a lot of offer as these therapies attempt to treat the disease from within and stimulate the body’s defenses to combat and eliminate the virus so that the body can heal itself naturally.

One of the most dreaded complications of HPV is cancer. In women, the possibility of cervical cancer is more as compared to the vulvar or anal cancers due to the virus. Penile cancer of the males, is a rare feature. It is therefore very important that once HPV is detected, women get their Pap smear tests done at regular intervals to tackle dysplastic and precancerous changes at the earliest. HPV and its effects on pregnancy Since there is a natural drop in one’s immune status during pregnancy, the genital warts multiply rapidly during pregnancy and at times get large enough to obstruct the urethral opening, making urination difficult or obstructing the cervical or vaginal opening besides reducing the contractility and elasticity of the vaginal walls, thus producing impediments to a normal delivery. Most Gynecologists advocate the removal of the genital warts prior to the delivery for these reasons and to ensure the safety of the newborn. HPV and its effect on childbirth Large warts obstructing the birth canal can lead to fetal distress as one of the complications. Respiratory papillomatosis is an extremely rare condition found in infants of mothers with genital warts in which warts in the throat of the infant makes swallowing and breathing difficult and the infant fails to thrive and can succumb to it if not treated in time. Usually laser ablative surgery is the option so as to improve the patency of the respiratory passage.

HPV can only be prevented by avoiding direct skin or mucosal contact with the warts and by avoiding any unprotected sexual activity with an infected partner. The use of condoms definitely helps to control the transmission provided that the warts are only over the penis and are fully covered by the condoms during sexual activity. If the warts are elsewhere like the scrotum, thighs, or pubic region, the infection can get transmitted and hence any sexual activity should be avoided till the warts are fully treated. Since the virus is in the body fluids too, French kissing with a lot of salivary exchange between partners is also risky as the virus can get transmitted. If a woman has warts on her breast near the areola or nipples, she should avoid breast-feeding her child as she could infect her child.