HPV Information - Take-Home Message 1:
Even though a genital wart has been removed, the patient may still be contagious in this area and may still harbor a virus that may be associated, in the setting of females, with cervical cancer.
HPV comes in different "strains", or types. Certain types, most notably types 16 and 33, are associated with more serious changes in the skin that may lead to cancer. Studies now abound that have shown a close link between these types of HPV and cancer of the cervix. The presumption in these cases is that the patient acquired the HPV through sexual contact, allowing the cervix to become infected with that strain of HPV. Passing years, then, allow the HPV to begin to cause "mutation" in the DNA of the cells of the cervix, eventually resulting in cancer of the cervix.
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Genital Warts - Photos Courtesy of : Condyloma Acuminatum Images
Dermatology Online Atlas (DermIS), Univ Erlangen/Univ Heidelberg, Germany |
This association between cancer of the cervix and HPV is well-established and very hard to discount. By now, as many as 90% of cases of cancer of the cervix can have detectable HPV in the cancerous cells. The correct conclusion to draw seems to be that HPV can "cause" cervical cancer. It is even proper to conclude that "unprotected intercourse can lead to cancer of the cervix".
Fortunately the changes in the cells of the cervix are gradual. Cells may become "atypical", sometimes being mistaken for the irritation seen in cells of the cervix associated with common vaginal and cervical infections, such as "vaginitis" or "cervicitis". However, later changes become evident on the PAP smear through such features as "Cervical Intraepithelial Neoplasia" (CIN), which means that a tiny cancerous change has been found actually within the cells of the cervix. Such changes call for prompt action.
The first action, of course, is that any female who is of child-bearing years, especially if this female is sexually active, should have regular physical examinations by a knowledgeable gynecologist skilled in the area of evaluation and management of "cervical dysplasia". This examination includes the regular visual examination of the cervix as well as the use of the PAP smear to examine for any evidence of abnormal cervical tissue. Only through these regular examinations can a patient at risk for contracting HPV be protected of these most serious consequences of the disease.
HPV Information - Take-Home Message 2:
Every sexually active person, especially females, should establish contact with a skilled physician who can examine the patient at regular intervals to rule out the possibility of HPV infection.
HPV Information - Take-Home Message 3:
Every female having sexual activity should have regular PAP smears, even if a hysterectomy has been performed.
HPV Information - Treatment of HPV Infections
Please make sure that you have read the discussion on the cause of HPV infections and the risks involved with these infections posted on this site.
Since it is nearly impossible to tell whether most people have HPV infections with a high degree of accuracy, then it is obvious that most people who carry HPV will not end up undergoing any treatment because the infection is not detected. For this reason, virtually all HPV transmission to sexual partners goes undetected and, thusly, untreated.
Simple warts are treated by killing both the skin of the wart itself and usually the skin directly beneath the wart. The theory is that the wart is extremely contagious with a high load of HPV virus, and the destruction of the wart is called for. The skin beneath the wart must be destroyed because this is actually the area from which the wart grew. If the skin beneath the wart is not destroyed, then the wart may return.
Often this treatment is curative with no further warts resulting. Also, the destruction of the wart and its underlying skin creates an inflammatory response in the body which seems to assist the body in preventing further wart formation, especially in the area of the wart itself.
Herbal treatments are available, if unproved in the scientific literature. Certain topical essential oils have been shown to have antiviral properties for HPV in the scientific literature.
Some encouraging results have been shown using the electrophoresis technique with a silver electrode.
Other medical treatments are very useful. Salicylic acid preparations are very effective in directly dissolving the wart and have been time-tested for years. Often this acid creates a local inflammation in the area of the wart, creating the immune response mentioned above. Many such wart remedies are available in the marketplace. Other acid preparations are available for use by physicians which are much quicker and stronger, sometimes requiring analgesia for pain relief.
A recent preparation, contains a chemical called "imiquimod". This chemical is said to stimulate the immune system of the body apparently through the production of "cytokines" that can cause the body to destroy cells infected with the virus. On the average, after about four months of treatment, about sixty per cent of patients overall clear their wart-type lesions. This chemical is not made for internal lesions.
Electrocautery and laser are very effective in directly destroying both the wart as well as the skin beneath it. Such treatment usually leaves a small hole in the skin, perhaps 2 millimeters or more, in the area where the wart was destroyed. This hole is actually a third-degree burn, and the skin heals "circumferentially", closing in slowly from the area around the burned hole. This therapy is very specific, very quick, and much more expensive than the acid therapy. These treatments often require local, or sometimes even general, anesthesia so that the patient can tolerate the treatment.
Treatment of abnormal cervical tissue, including CIN (mentioned above), is usually carried out by either direct acid treatment of the affected areas, by laser, or by similar instruments which can actually destroy the infected part of the cervix. Such treatment is highly successful and time tested. However, even after such treatments, the patients with CIN must be carefully monitored to make sure that the patient remains free of disease. Else, a cervical cancer may develop even in a patient previously treated for CIN.
Vaccines to treat warts are, at this time, still far into the research future. Hopefully some sort of inoculation will be available which will stimulate the body to eradicate HPV from infected cells. Research is ongoing throughout the world to determine if it is even possible for the immune system of the body to in fact be able to remove HPV DNA from infected cells. Only time will tell. We will continue to actively monitor research to determine when such therapies can be recommended.
