The majority of college students know very little about the human papillomavirus (HPV; Lambert, 2001). The fact is that there are over 30 types of the human papillomavirus (HPV) that can infect the genital tract (Centers for Disease Control and Prevention, 2004a). Some of these viruses are called “high risk” because they may cause abnormal Pap tests and increase the potential for certain kinds of cancers (on the cervix, anus, vagina, vulva, or penis). There is ample evidence that almost all cervical cancers can be attributed to HPV infection (Peyton et al., 2001). Other types of the virus are called “low risk” and can cause genital warts (condyloma acuminata, venereal warts), which are similar to warts that appear on other parts of the body. The human papillomavirus can be transmitted through sexual intercourse, oral sex, vulva-to-vulva sex, or anal sex.
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It has been estimated that by the age of 50, 80% of women will be infected with the human papillomavirus (Centers for Disease Control and Prevention, 2005d).
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Incidence As of 2004, there were 20 million people infected with genital HPV in the United States (Centers for Disease Control and Prevention, 2004a). It is estimated that at least 50% of sexually active men and women will acquire HPV at some point in their life (Centers for Disease Control and Prevention, 2004a).
Several factors have been found to be related to HPV infection, including early age of first intercourse (before the age of 16; J. A. Kahn et al., 2002) and having more than two sexual partners within the past year (Peyton et al., 2001). Research has found that Hispanic women are at higher risk for HPV than are non-Hispanic white women (Peyton et al., 2001). In 2002, experts proposed comprehensive screening guidelines that recommended testing all women every 2 years for HPV to decrease rates of cervical cancer (Mandelblatt et al., 2002).
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Symptoms Many people who are infected with HPV are asymptomatic, but those who develop symptoms do so as late as 6 weeks to 9 months after infection (Centers for Disease Control and Prevention, 2004a). It is estimated that 10% of HPV infections lead to genital warts (Koutsky, 1997). Genital warts are usually flesh colored and may have a bumpy surface. Warts develop in women on the vagina, vulva, or cervix, and in men on the penile shaft, head, scrotum, and rarely, the urethra (Krilov, 1991). Warts can also appear on the anus in both men and women. In some areas, warts may grow together and have a cauliflowerlike appearance. These lesions are generally asymptomatic; and, unless the warts are large, many people do not notice them and unknowingly infect other sexual partners. Because of the contagious nature of genital warts, approximately 65% of sexual partners of people with cervical warts develop warts within 3 to 4 months of contact (Krilov, 1991).
HPV can also cause a foul-smelling discharge, which may cause some itching and pain. Children who are infected with HPV at birth are at risk of developing viral growths in the respiratory tract, which can cause respiratory distress and hoarseness (Fletcher, 1991).
Diagnosis A healthcare provider may be able to detect warts upon visual inspection. If not, a high-risk detection kit can also be performed to aid in diagnosis. A healthcare provider may also soak the infected area with acetic acid (white vinegar), which turns the skin of the warts white and makes them easier to see under magnification. An examination of the cervix under magnification (called colposcopy) can also be used. Biopsies are also done to check for HPV. Although HPV may show up on Pap testing, 80% to 90% of the time, it does not (Kassler & Cates, 1992).
Finally, the FDA approved an HPV DNA test in 2003 that can identify 13 of the high-risk types of HPV associated with cervical cancer. Cells are collected during a woman’s Pap testing and sent to a lab for analysis. Healthcare providers recommend that women who have more than one sexual partner should ask their medical provider for an HPV DNA test. At this time, there are no specific HPV tests for men.
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genital wart
Wartlike growth on the genitals; also called venereal wart, condylomata, or papilloma.
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condoms during sexual intercourse for at least 6 months following treatment (Lilley & Schaffer, 1990). Some couples decide to use condoms long term because of the possibility of transmitting the virus when no warts are present. Newer research indicates, however, that over time most HPV infections are cleared up by the immune system. The Centers for Disease Control and Prevention have reported that the majority of HPV infections in women resolve within 1 year (Centers for Disease Control and Prevention, 2005d). Persistent infections are usually caused by specific types of HPV, which may also be related to the development of cervical cancer.
Women who have been diagnosed with cervical dysplasia are encouraged to have pelvic exams and Pap tests at least once a year. Some studies indicate that folic acid (vitamin B) may help to keep HPV in check in women who have been diagnosed with genital warts. It is not known exactly how folic acid may help reduce the effects of HPV, but it is thought that it helps to strengthen the cervical cells. Folic acid can be found in green leafy vegetables, yeast breads, and liver. Researchers are exploring ways to prevent HPV—clinical trials that test the safety and efficacy of developed HPV vaccines are already underway (Kahn & Bernstein, 2005; see Sex in Real Life, “Vaccines for Sexually Transmitted Infections?” on page 507).
