What is Human Papillomavirus?
The Human Papillomavirus (HPV) is a virus that can cause issues like skin lesions and different types of cancers, mainly on the skin and inner body surfaces.
HPV has over 100 different types. People who have long-term HPV infection or who have many sexual partners are at a high risk of getting more types of HPV. Based on the areas they affect, HPV infections are usually divided into three categories:
* Non-genital (Affecting the skin)
* Mucosal or anogenital (Affecting the mucus membranes or genital areas)
* Epidermodysplasia verruciformis (EV), a rare skin disorder.
The skin or bodily changes caused by HPV can sometimes be seen easily, but in other cases that don’t show clear signs (latent lesions), a viral DNA test may be necessary. Most HPV infections don’t show signs and often cause warts rather than cancer.
Today, HPV has been linked to cancers occurring in the larynx (voice box), oral cavity (mouth), lungs, and anogenital area (genitals and anal region). HPV types 6 and 11 are considered low risk and usually lead to the forming of warts and low-grade, non-cancerous lesions. However, types 16 and 18 are high risk and can cause severe skin lesions that may turn into cancer over time. It’s crucial to remember that HPV alone doesn’t cause cancer; other factors like smoking, lack of folate (a type of B vitamin), exposure to ultra-violet light, weakened immune system, and pregnancy also play a role.
What Causes Human Papillomavirus?
HPV, or the Human Papillomavirus, is a virus that doesn’t have an outer covering and carries its information in a circular DNA format. This virus is part of the Papillomaviridae family. HPV can enter your body’s skin cells when there are cuts or injuries in your skin or the mucous membranes, which are the soft, moist areas just inside the openings of your body, like the mouth or nose.
The virus contains a set of genes named as ‘early’ (E) and ‘late’ (L) genes. These genes are essential for the virus to replicate and spread. This viral DNA can exist independently inside the host’s cells for a while before it gets incorporated into the host’s own DNA. HPV usually inserts its DNA into parts of our DNA that are naturally weak and susceptible to breaking.
There are certain risk factors that can increase your chances of getting an HPV infection:
- Engaging in sexual activity, the age when you start having sex, and the amount of sexual partners you have
- Smoking
- Taking oral contraceptives for more than 5 years
- Chewing betel nut, a seed often used in certain cultural traditions
- Being exposed to radiation and UV light
Risk Factors and Frequency for Human Papillomavirus
HPV, or human papillomavirus, has over 180 different subtypes, each with its own preferred body site to infect, which can lead to different diseases. Warts on your hands or feet, for example, are usually caused by HPV subtypes 1, 2, 4, 27, or 57. Warts in the anogenital area, like condyloma acuminatum, are usually caused by HPV subtypes 6 or 11, which are considered low-risk. But these same types can also cause recurrent respiratory papillomatosis in both kids and adults.
More serious conditions like pre-cancerous and actual cancerous lesions in the cervix, anogenital areas in men and women, and the oropharyngeal area (back of the throat) are usually a result of infection by HPV subtypes 16 and 18. Though HPV subtypes 31, 33, 35, 45, 52, and 58 are less common, they’re still considered high-risk because they can cause cervical cancer.
You can get a cutaneous verruca (wart on your skin) after coming into contact with a carrier of the virus when you have a micro or macroscopic wound on your skin. The classic example is getting foot warts from a locker room.
Both low-risk and high-risk HPV types can be spread through sexual contact, but they can also be spread through other forms of close contact. Recent studies show that the presence of genital HPV in adults aged 18 to 59 is approximately 45.2% in men and 39.9% in women.
Signs and Symptoms of Human Papillomavirus
Checking and treating HPV infection diverges based on the infected body part and the symptoms shown. If you’d like more extensive information about each specific condition, please refer to the corresponding articles.
History
- For general skin warts (verruca vulgaris, verruca plantaris), doctors will inquire about possible contact with the infection and cleanliness routines, such as if shower footwear is worn at public showers, or if the warts are painful or bleed easily.
- For anogenital warts (condyloma acuminatum), healthcare providers usually ask patients about their sexual history and contacts, the duration and positioning of the warts, if HPV vaccination has been done (through vaccines like Gardasil or Cervarix), past wart treatments, and if any diseases or medications could be compromising their immune system.
- Doctors may also perform Pap smear tests (cervical for women, anal for men), HPV tests, and check for other sexually transmitted infections.
- For cervical dysplasia (squamous and glandular), healthcare providers typically inquire about menstrual history, previous Pap smears or HPV tests, sexually transmitted infections and sexual history, HPV vaccination (like Gardasil or Cervarix), and any correlated symptoms like bleeding or spotting outside periods, pelvic or genital pain, pain or bleeding during intercourse, or noticeable lumps on the cervix.
Physical Examination
- Doctor thoroughly scrutinize hands and feet, including between fingers and underneath the toes when dealing with ordinary skin warts (verruca vulgaris, verruca plantaris).
- For anogenital warts (condyloma acuminatum), the doctor examines the area around the genitals and anus. Women might also need a speculum examination of the vaginal walls and/or anus. Some men may need urethra check-up, depending on their symptoms. Depending on their sexual history, some individuals may also need a throat examination.
- For cervical dysplasia (squamous and glandular), a speculum examination of the cervix is done. An initial or follow-up Pap test may be needed, depending on the patient’s age and past Pap smear history.
Epidermodysplasia verruciformis (EV) is an inherited condition that heightens the risk of particular warts that are normally not seen in the public. EV can also occur in people with weakened immune systems and organ transplant recipients. This condition usually starts in childhood and can impact any body area. The warts are flat and often mistaken for another skin condition known as tinea versicolor. While these warts generally do not spread to other body parts, they can still cause local damage.
Testing for Human Papillomavirus
If you have skin, genital, or throat warts, your doctor might remove them and send them for lab testing. This is usually done if there’s uncertainty about what’s causing the warts or if there’s worry about abnormal cell growth, also known as dysplasia.
Screening for abnormal growths or cancer in the cervix is usually done through a procedure involving a device called a speculum and a test called a Pap smear. Along with this, a HPV test may be performed on cells from the cervix to check for the most common types of HPV virus that can cause abnormal cell growth. Your treatment plan will depend on your age, HPV status, and Pap smear results.
If your test results show certain types of skin or glandular lesions in the cervix, then you might need a colposcopy. In this procedure, the doctor applies a vinegar-like solution to the cervix which helps highlight any suspicious areas; these areas are then viewed with a special magnifying device, the colposcope. The doctor may also take samples from any area that looks concerning, this is then looked at under a microscope for signs of abnormal cell growth or cancer.
Treatment Options for Human Papillomavirus
If you have skin warts, you have plenty of treatment options to choose from. These can include surgical removal, freezing the wart, using certain medications that irritate or modify your immune system, or laser removal. The main goal of these treatments is to either physically or chemically irritate the affected skin. This helps your body’s immune system recognize and eliminate the infected tissue.
To prevent warts in the lower genital area caused by the most common strains of HPV, the CDC advises that children start their vaccinations for HPV at the age of 11 to 12. It’s also recommended that women continue vaccinations up to the age of 26 and men up to 21.
Like skin warts, warts that develop in the genital area and the mouth can be treated similarly, so long as the patient’s immune system is functioning well. However, if HPV-related cancer develops in these areas, it may need to be removed surgically, or treated with chemotherapy or radiation therapy.
For women, the patches of abnormal cells on the cervix that are caused by HPV can sometimes disappear without any treatment. Young and healthy women with such dysplasia are typically kept under close observation with regular Pap smears, HPV tests, and colposcopy exams. If the dysplasia persists or is severe, especially in older women, doctors might use methods like cryotherapy, Loop Electrosurgical Excision Procedure (LEEP), or Cold Knife Cone (CKC) excision. Both LEEP and CKC are surgical procedures that involve cutting out part of the cervix. If the abnormal cells turn into cancer, more intensive treatments like additional surgeries, chemotherapy, or radiation therapy might be needed.
For more detailed information on diseases associated with HPV infection, please look up those specific topics.
What else can Human Papillomavirus be?
These are some skin-related conditions that your doctor might consider when diagnosing your symptoms:
- Corns & calluses
- Acrochordon (skin tags)
- Condyloma latum (a specific type of syphilis)
- Keratoacanthoma (a type of skin tumor)
- Psoriasis
- Seborrhea (a skin condition that causes flaky scales)
- Chancroid (a bacterial infection)
- Herpes simplex
- Molluscum contagiosum (a viral infection)
What to expect with Human Papillomavirus
The outlook after being infected with HPV (Human Papillomavirus) is generally favorable, although it can come back again. Unfortunately, even though we have many ways to treat warts (skin growths caused by HPV), none are perfect. Most people need to go through multiple treatments to get rid of them.
HPV can also cause vulvar intraepithelial dysplasia (abnormal cells in the outer part of a woman’s genitals), cervical dysplasia (abnormal cells in a woman’s cervix), and even cervical cancer. Some women might also be at high risk of getting vaginal and anal cancer.
People with weaker immune systems are at the highest risk of developing cancer from HPV. And, if you’ve been diagnosed with HPV, there is a 5-20% chance that you might also have other sexually transmitted diseases (STDs), such as gonorrhea and chlamydia.
Possible Complications When Diagnosed with Human Papillomavirus
Negative effects:
- Poor cosmetic appearance
- Depression and loss of self-esteem
- Genital warts possibly blocking the urethra
- Formation of ulcers and risk of infection from condylomata
- Possibility of turning into cancer
- Spreading HPV to other people
Recovery from Human Papillomavirus
It’s really important for patients treated for warts to continue seeing their doctors regularly as the warts can often come back. Also, every treatment for warts may have side effects that doctors need to keep an eye on.
It’s also necessary for the sexual partner to be checked for condylomata, a medical term for genital warts.
Because of wart’s potential to turn into cancer in some high-risk patients, they should have DNA testing and screening. This helps doctors detect and treat any potentially dangerous changes as early as possible.
Preventing Human Papillomavirus
To mitigate the risk of sexually transmitted diseases, it’s essential to engage in safe sexual practices. These practices can include limiting the number of sexual partners, using a condom, and keeping up with regular health screenings like a Pap smear.
There is also a vaccine available, commonly known as the HPV vaccine, that can help protect both men and women from certain types of cancer. This vaccine works against specific versions of HPV – numbers 6,11,16,18,31,33,45,52, and 58. HPV, or Human Papillomavirus, can lead to several conditions, including anal cancer, genital warts, and several other types of diseases that affect the cervix and vulva.
Research has confirmed that this vaccine is effective. It’s most successful when given to individuals before they begin to engage in sexual activity, typically between the ages of 9 and 12. So, it’s a good idea to talk about this vaccine with a healthcare provider at an early age.
