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human papillomavirus infection in females

Alternative Names
genital HPV, venereal wart infection

Human papillomavirus, or HPV, infection is a sexually transmitted disease, or STD, caused by a group of viruses.

What is going on in the body?
More than 70 types of HPV have been classified but not all cause genital warts. It is estimated that 70% of sexually active women have been exposed to HPV. Those women who become infected do not always have visible genital warts.

The virus may be quiet, or not active, for a long time. Symptoms may then occur as a result of illness or stress on the immune system, such as other vaginal infections. Sexual contact with a new partner who is infected with a different type of HPV may trigger an outbreak of visible lesions.

What are the signs and symptoms of the infection?
Most women have no symptoms during the early stage of infection. In several studies that involved college women, nearly half were positive for HPV. However, only 1% to 2% had visible warts and fewer than 10% remembered ever having warts. If symptoms are present, they may include the following:
  • dry, painless, cauliflower-like warts on the genitals
  • genital sores
  • increased dampness or moisture in the area of the warts
  • chronic itching of the outer lips of the vagina
  • increased vaginal discharge
  • abnormal vaginal bleeding
  • abnormal Pap smear results. A Pap smear is an examination, under a microscope, of cells scraped from the cervix.
  • warts in other sexually exposed areas, such as the anus or mouth
What are the causes and risks of the infection?
The human papilloma virus is usually passed from one partner to another during sexual intercourse. Any other intimate contact of the genitals, mouth, rectal area, or the sharing of sexual toys can transmit the organism from one individual to another. A woman's risk of HPV infection is increased if she has more than one sexual partner.

What can be done to prevent the infection?
Safer sex practices can help lower a woman's risk of HPV infection. The use of male condoms or female condoms can reduce, but does not always prevent, catching or spreading the human papilloma virus. The virus may be outside the "field of protection," such as on the scrotum or the outer area of the vagina. Avoiding sexual intercourse is the only definite way of avoiding genital warts. Having sex with only one partner, who is disease-free, is the most practical way of avoiding STDs.

To prevent spreading the virus to other areas of the body, hands should be washed after touching the area where the warts are located. A hair dryer can be used to keep the area dry. Sexual contact should be avoided until all warts are healed after treatment. Scratching of warts should be avoided because they may bleed and spread.

How is the infection diagnosed?
Genital warts on the skin are often noticed by the woman or her partner and confirmed by a doctor. A Pap smear may show changes from the virus even if genital warts are not seen. These changes may be the abnormal cells of cervical dysplasia or even cancer of the cervix. Special tests to determine the type of HPV may also be done to determine if there may be an increased risk of cancer.

What are the long-term effects of the infection?
Certain types of human papilloma virus are associated with genital warts and have a small chance of causing cancer. Several other types of HPV are associated with cervical dysplasia and even cancer of the cervix, vagina, and vulva. A woman who has an HPV infection combined with genital herpes may further increase the risk of cervical cancer. If a woman with HPV smokes, her chance of developing cervical dysplasia is also much higher.

During pregnancy, genital warts of HPV may grow to an extremely large size. This may result in heavy bleeding during a vaginal delivery of the child. There is also a risk of transmitting the virus to the infant's vocal cords. Extensive growth of warts during pregnancy may require a caesarean section for these reasons.

What are the risks to others?
Human papilloma virus is highly contagious and can be spread through sexual intercourse and other intimate contact. It can also be transmitted to the vocal cords of a newborn during delivery.

What are the treatments for the infection?
Treatment of human papilloma virus does not necessarily cure the infection. The virus may still be present in the cells around the genital region. It often is not detected until a wart occurs or the woman has an abnormal Pap smear. The main methods of treatment are as follows:
  • surgical removal of the warts with a scalpel
  • loop electrosurgical excision procedure, or LEEP, which is a procedure that uses an electrical current to remove the warts
  • cryotherapy, which uses liquid nitrogen to freeze the warts
  • laser surgery, which uses laser beams to vaporise the warts
  • electrocautery, or burning of the warts
  • chemical treatments of external warts. A chemical such as podophyllin may be used once or twice a week for 6 weeks or until the warts disappear. The warts commonly come back after this kind of treatment.
  • antiviral therapy, which often involves injection of a biological response modifier such as interferon. This chemical is injected directly into a wart to prevent the virus.
  • 5-fluorouracil intravaginal cream, which can be applied to external vaginal warts. This treatment causes significant burning and pain and is rarely used today.
  • Most recently Immunotherapy has proven to be effective with a drug called Aldara. This is a topical cream that is put on the warts and rubbed in. It is usually not painful and needs to be used for some 4 to 6 weeks to have effect
What are the side effects of the treatments?
During cryotherapy, women often feel cramping and pelvic discomfort. For about a month afterward, they may have a great deal of watery vaginal discharge.

Laser surgery, LEEP, and other procedures may cause the following: What happens after treatment for the infection?
Additional treatment may be necessary over weeks or months because of high rates of recurrence. In addition, a woman should tell her sexual partners about the problem to prevent possible spread to others. Regular Pap smears are also important to detect any abnormal cells or cancer of the cervix.

How is the infection monitored?
Being screened for HPV infection every year, or any time there is a new sexual partner, is a good practice. Any new or worsening symptoms should be reported to the doctor.

Author: Eva Martin, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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