HPVs cause a multitude of changes (benign and malignant) in the skin and mucous membranes of the human body. The type of lesion that will be caused depends on the type of virus. Virus infection of the epithelium results in clinical, subclinical and latent disease. A clinical disease is defined as the existence of any change that is visible to the naked eye. Here belong the papillomas of the genital area. Acute warts are the most typical case of clinical infection, which this article deals with.
The role of the clinician dealing with this particular infection is important, because there are differences in the morphology of the external genitalia, but also pathological manifestations of diseases that resemble acute warts. Once the diagnosis of acute warts is made, the appropriate treatment should be given and the patient and the corresponding sexual partner should be informed about the significance of the infection. Unfortunately, in our time there is an exaggeration in the whole presentation of the subject and there is an unjustified panic in public opinion. A properly informed physician can put the matter on the right footing and convince the patient to make the appropriate diagnostic approach and then follow the appropriate treatment.
We will try to answer some of your most frequent questions with the following article in order to inform you more fully and dispel some "urban myths".
HPV is a sexually transmitted virus. Any sexually active person can contract the virus.
The types of HPV that cause warts are usually transmitted by simple skin-to-skin contact (genitals and perineal area) even if there is no complete sexual intercourse.
We do not know much about transmission of the virus in subclinical cases (that is, in cases where the person is an "asymptomatic carrier" has been in contact with the virus but does not have clinically evident lesions). What is certain is that the virus can be transmitted very easily if there is an active wart, but it cannot be ruled out that it can be transmitted even when there are no obvious symptoms.
There is also the transmission of the virus that is not related to sexual intercourse, eg vertical transmission from mother to child during childbirth. [/faq]
What are the symptoms caused by warts? What do they look like?
Warts are asymptomatic lesions. They do not cause itching, pain or burning sensation. Warts appear as protrusions of the skin with a change in its architecture. They can be single or multiple and look like small pimples or, more often, a tiny cauliflower. Most often they are the color of the skin, but they can also be a little whiter or darker. This is why there is often a delayed diagnosis as patients think they are moles (olives) of the skin. [/faq]
Does condom use prevent HPV transmission?
The use of a condom is considered necessary, not only for HPV infections, but because it also protects against other sexually transmitted diseases. Nevertheless, the transmission of HPV occurs mainly through the skin and not through biological fluids, which is why the condom does not provide sufficient protection. Condoms may help and provide protection, but only for the skin covered by them, so they do not protect 100%. The condom "protects" from skin-to-skin contact a very small percentage of the surface where the virus can be (eg it does not protect the groin, inguinal folds, scrotum, peranal area). [/faq]
What kind of sexual intercourse carries a risk of HPV infection? Is full intercourse required?
The HPV virus is transmitted through sexual contact – but not always requiring complete sexual intercourse. As far as oral sex is concerned, it is not considered safe since there has been an increase in the relationship between HPV and cancer in the oral cavity (in the mucous membrane of the mouth and especially in the corners of the lips) and in the pharynx. The same applies to anal intercourse where there is also a correlation between HPV infection and anal cancer.
Is it permissible to shave the genital area of my patient with acute warts
No, it should be avoided. Patients seek it because with the area shaved they have a better visual control for the appearance of new lesions, but we must not overlook that the razor can spread (inoculate) the warts in the surrounding area.
Anal warts are very often located inside the anus as well as on the perianal skin. Infection with HPV usually occurs through intercourse, however anal warts can also occur without anal intercourse.
Anal warts can be transmitted by fingers, e.g. during washing. Factors that alter or weaken the patient's immune system (HIV infection, immunosuppression from chemotherapy or other drugs, diabetes mellitus, systemic administration of cortisone or application of creams containing cortisone to the anus for a prolonged period of time) predispose to the manifestation anal warts.
Are there any population groups that can "stick" more easily?
The risk of HPV infection increases when:
Sexual activity begins at an early age
The number of sexual partners is increased. This risk has been estimated to increase by approximately 15% per new sexual partner. [/faq]
Genital warts in general, are they precancerous conditions?
"Typical" warts are most commonly caused by "low-risk" strains of the virus (6,11,42,43,44) that are not associated with cervical cancer.
How are warts treated?
While there is no medical cure for HPV eradication, there are several symptomatic treatment options. The goal of any treatment is to remove the warts to relieve the bothersome symptoms. Some treatments are done in the doctor's office and others are creams that can be used at home for several weeks:
- Application of podophyllin solution (this is a chemical compound that must be applied by a doctor. It works "caustic" on the lesions.
-Destruction by diathermocoagulation
This is a classic and very effective destruction of lesions using electric current in a unipolar diathermocoagulation device. Disadvantages of the method are the longer recovery time of 2-3 weeks (especially in the treatment of multiple lesions), the necessary preparation of local anesthesia (with injectable lidocaine), as well as the increased risk of hypopigmentation and scar formation. In addition, there is a risk of infection of the lesions. The advantages of the method are that the destruction of the lesion is immediately noticeable, that it achieves very effective hemostasis, while most of the time a single session is sufficient
- Destruction by Cryotherapy
Application of liquid nitrous oxide or nitrous oxide, by light spraying or by contact with a cotton swab, is most often effective and perhaps the most widely used treatment. Cell freezing/thawing works cytotoxically (destructively) for the damaged cells. Advantages of the method are that it does not require the use of local anesthesia and that multiple lesions can be treated simultaneously very quickly. Also, the recovery process is quick and painless (usually causing only mild irritation lasting a few days). A disadvantage of the method is that it is a "blind" method as we do not observe immediate disappearance of the lesions, as a result of which we often under-treat if we choose short times and repeated sessions are required. On the contrary, if prolonged periods of cooling are preferred, these lead to an increased depth of cooling and impair the vascularization of the dermis, causing the formation of pustules (blisters), permanent discoloration and the risk of scarring. Finally, the possibility of recurrence is mentioned
-Application of 5% imiquimod cream
Imiquimod is an immunomodulatory drug that is highly effective in the treatment of multiple acute warts. It is in the form of a cream which is applied 3 times a week for a period of 4 weeks (a therapeutic cycle). The treatment not only causes the destruction of the visible lesions, but is also effective in the adjacent subclinical lesions (we understand this by the irritation it causes in the area adjacent to the lesions in field therapy), while it is reported to cause in the applied area immunostimulation which leads in a reduced likelihood of future AKs.
– Surgical laser destruction
The carbon dioxide (CO2) laser is effective in treating mostly isolated lesions. The advantage of the method is that the destruction of the damage (which is due to sublimation) is immediately noticeable, while most of the time a single session is sufficient. Disadvantages of the method are the longer recovery time (especially in the treatment of multiple lesions) compared to cryosurgery, and that local anesthesia is required (with injectable lidocaine combined or not with adrenaline).
Whichever method is chosen, even after the warts are treated, the person still has the virus (since the virus is not cured but its manifestations are simply treated). In some cases the symptoms will return, but in the vast majority of people the body itself will bring the virus under control.
In addition to the treatment, it is good for the patient to follow a proper diet, to have a good sleep schedule every day and to avoid physical and mental stress if possible. The above contribute significantly to the strengthening of the patient's immune system, which contributes to the treatment and self-limitation of the disease
What are the possible complications of warts?” dropcap_question=”Q” dropcap_answer=”A”]
The possible complications of warts are divided into minor and major and are as follows:
-Minor complications of warts: ulceration (sore formation), bleeding after injury, infection after injury, mechanical problems during urination and minor psychological problems
-Major complications of warts: giant warts, dysplasias and cancers of the anus, cervical cancer, major psychological problems.
Should the partner of an affected woman be examined or treated as well?
The partner of a woman with detected lesions due to HPV infection is considered to be most likely infected with the same virus and to either be a simple carrier without showing symptoms, or he also has subclinical or clinical HPV lesions. So the clinical examination by an experienced physician is deemed necessary. It is important to distinguish here whether the woman's lesions are of the warty (benign-low risk) or dysplastic (malignant-high risk) form, regardless of the fact that these two forms may coexist. The probability of HPV - a warty lesion in the man is quite high, almost as much as in the female partner, while on the contrary, when the woman has precancerous lesions of the cervix, corresponding lesions in the man are rare, a fact that is probably due to anatomical differences of the epithelium (of the tissue of the genital organs) between the penis and the cervix. This explains the large difference in the incidence of cancer in the cervix and the penis.
After treatment of clinical warts is there a chance of re-infection from the partner?
First of all, it should be made clear that the "cure" of HPV lesions is not always guaranteed, regardless of whether clinical lesions are not detected immediately afterwards. This is because often the tissues surrounding the damage (damaged) continue to contain the virus and thus newly appearing warts are not due to re-infection but to a delayed manifestation.
Besides, after frequent contact of the host organism with one and the same strain of the virus, the immune mechanism of the first against the antigens of the second has been activated and the immune response is not affected by the continuous contact with the same viral antigens.
So new warts may appear, which are not due to infection from the partner, but to delayed development of the appearance of the wart. [/faq]
Abnormal PAP test, does it necessarily mean that it is a high-risk HPV infection for uterine cancer?
- No. It can also mean local irritation, non-HPV infection, low-risk HPV, error in sample preparation.
Should vaccine takers not worry about cervical cancer?
– Unfortunately, the vaccine only protects against 4 potentially more dangerous strains of the virus most commonly associated with cancer, and does not provide universal protection against all strains of the HPV family. Regarding vaccination, recent studies have shown that the combination of vaccination and regular screening with the Pap test can reduce the incidence of cervical cancer by 94%.
The National Immunization Committee recommends vaccination of all girls aged 12-15 years and young women aged 15-26 years who have not been vaccinated. Girls or young women who are vaccinated before the start of sexual contacts will benefit most, while women who have started their sexual life will also benefit greatly from vaccination. Most insurance funds cover since September 2008 the free vaccination for girls aged 12-15. From January 2009, young women aged 16-26 are also covered free of charge (provided they have not been vaccinated at the recommended age).
Is the HPV vaccine only suitable for girls?
– The Centers for Disease Control and Prevention and the Academy of Pediatrics in America recommend vaccinating boys as well, for 2 main reasons
A. Boys will not be carriers of the disease, causing dangerous infections to their partners
B. The frequency of association between HPV and cancer of the penis, anus, oropharynx in men has increased.
Despite this, the vaccination of boys does not yet have an official indication in Greece. [/faq]
[faq question=”Can the vaccine protect a woman who is already infected with HPV?” dropcap_question=”Q” dropcap_answer=”A”]
Yes, even in a woman who has already been in contact with the virus, vaccination can be effective. It protects her from another high-risk type of HPV in the future. For example, if you were infected with type 16 in the past, you may be infected with type 18 in the future.
[gravityform id=”4″ name=”More Info” title=”false” ajax=”true”]