What is Anogenital Human Papilloma Virus (HPV)?
•Human Papilloma Virus (HPV) is a group of viruses consisting of more than 100 different types.
•Most people who have genital HPV do not know they have it.
•There are often no symptoms.
•You can pass HPV to others without knowing it.
•There are many different types of HPV. Some types can cause health problems including genital warts and cancers.
•There are vaccines that can stop these health problems from health problems from happening.
How does someone get Anogenital Human Papilloma Virus?
HPV is transmitted by skin to skin contact. Skin to skin contact in the genital region happens during sex. So when HPV affects the genital region it is considered as a sexually transmitted infection.
Genital warts are transmitted mainly through unprotected sex, but also through skin to skin contact even if the index case is asymptomatic or has subclinical signs and symptoms. After treatment, the infectivity risk is not yet known. Condoms may reduce risk.
It can be transmitted to lesser extent through oral sex and sharing of sex toys, with an infected person with HPV. Although persons infected would have no signs or symptoms, they can still transmit the virus to others.
You can’t get anogenital warts from kissing, hugging, sharing baths or towels, from swimming pools, toilet seats or sharing cups, plates or cutlery.
Risk Factors for HPV infection:
- Sexually active at a young age
- Sexual activity with multiple partners
- Risk of being infected is increased if partner has multiple sex partners
- In people with low immunity, HPV is more likely to be detected and persist.
- In males, risk is increased in uncircumcised males.
What are the health effects of HPV?
Certain types of HPV can cause health problems like genital warts and cancer.
Genital HPV infection is generally transient with no clinical features or complications and generally caused by HPV type 6 and 11. Not everyone who has the virus develops anogenital warts. People can get rid of virus on its own. However, you may not know that you have the virus, and the warts can develop weeks to many months, or even years after coming into contact with the virus. The warts are usually painless and not a serious problem. They can show in the genital or anal area and can be flat or raised, single or in groups, small or large, shaped like a cauliflower. Warts may go without treatment, however they can stay or grow in size or number. They may cause bleeding from the anus or from the urethra and may affect the flow of urine.
Women with HPV might have warts on the vagina, vulva and cervix. Men, warts may be found on the penis, scrotum and urethra. Genital warts can be found on the upper thighs and around or inside the anus.
HPV infections can sometimes develop into cancer. HPV can cause cervical and other cancers including cancer of the vulva, vagina, penis, or anus. Cervical cancer is the fourth most common cancer in women. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils.
Can HPV be treated?
If you have genital warts, you should also be tested for other STIs such as HIV, gonorrhoea or syphilis, as you may have more than one infection at the same time. Treatment can be discussed with your doctor as there a number of ways of how HPV can be treated. Genital warts may return after treatment. However, a healthy immune system may clear the virus or suppress it.
Cervical precancer can be treated. It is usually identified during a Pap smear. For other HPV-related cancers, these may also be treated when diagnosed especially if picked up at an early stage.
Should I have sex if I have genital warts?
It is important to have a check for other sexually transmitted infections before having sex. It is always recommended to use condoms during sex especially if you have warts.
What about the HPV vaccine?
In Malta, the government is offering the HPV vaccine for free to all girls aged 12 years of age, born after the year 2000. If you don’t meet these criteria, then the vaccine can be purchased. The HPV vaccination schedule involves 3 doses over a 6 month period.
Genital warts and Pregnancy
Genital warts do not affect fertility. You should speak to your doctor if you have genital warts and you are pregnant. HPV infection rarely affect the baby. Pregnant women with genital warts do not need to have a cesarean section delivery unless warts are blocking the birth canal.
Key Messages for Persons with Anogenital Warts
- The types of HPV that cause genital warts are different from the types that can cause cancer. Women with genital warts do not need Pap tests more often than other women.
- Time of Anogenital Human Papilloma Virus acquisition cannot be definitively determined. Genital warts can develop months or years after getting HPV. The infection can be passed on to another person even in the absence of visible signs of warts. Sex partners tend to share HPV, even though signs of HPV (e.g., warts) might occur in only one partner or in neither partner.
- Treatment does not cure the virus itself and warts can recur after treatment.
- Because genital warts can be sexually transmitted, patients with genital warts benefit from testing for other STIs.
- A vaccine (Gardasil 9) is available for males and females to prevent genital warts and to protect against the high risk types of HPV which are linked with cancer, but it will not treat existing HPV or genital warts.
- Persons should inform current partner(s) about having genital warts. Partners might already have HPV despite no visible signs of warts, so HPV testing of sex partners of persons with genital warts is not recommended.
- No recommendations can be made regarding informing future sex partners about a diagnosis of genital warts because the duration of viral persistence after warts have resolved is unknown.
References:
-https://www.cdc.gov/hpv/
-https://www.cdc.gov/std/hpv/the-facts/genital_hpv_bro508-2017.pdf
-https://www.who.int/immunization/diseases/hpv/en/
-https://www.ecdc.europa.eu/en/human-papillomavirus
-https://iusti.org/wp-content/uploads/2019/11/GenitalWarts2019.pdf
Dr Donia Gamoudi graduated from the Malta Medical School as a doctor of medicine and surgery in 2011, and later on furthered her specialist training in Genitourinary Medicine at the Nottingham University Hospital NHS Trust for 3 years.
She is keen on teaching and taught the HIV and STI modular courses to various medical students and other healthcare professionals.
