HPV is the virus that causes genital and anal warts, also sometimes called condyloma. It also causes cervical and anal cancer. There are over 100 types of HPV. The virus may cause wart-like bumps to form on the penis, in and around the vagina, on the cervix (opening to the uterus), and/or around the rectum. The virus is passed via skin-to-skin contact from one person to another during anal or vaginal sex. Warts caused by HPV are not the same warts commonly found on hands and feet, and one type of wart can not be passed from one body part (hands and feet) to another (genital area).

HPV is considered to be the most common STI in the U.S. People who have had unprotected sex with more than two partners in their lifetime have probably been exposed to the virus. It’s possible to have been exposed to the wart virus months or years before warts appear, or for symptoms never to appear at all after exposure.

Why worry about HPV?

There are many different types of HPV. Most are harmless – especially the ones which cause the external warts you can see. There are a few types, classified as high risk, which can cause changes in the cells of the cervix (opening to the uterus) or the cells of the anus and could lead to cancer. For this reason, the American College of Obstetricians and Gynecologists recommends that women have their first Pap smear at age 21 and continue over other year until age 30. Women age 30 and over who have had three consecutive negative Pap smears may be screened once every three years. Federal health officials are currently considering recommending yearly anal pap smears for sexually active gay and bisexual men.

What are the symptoms of HPV?

Not everyone who has the wart virus will have visible warts. Warts may appear as wart-like growths or may be flat and only slightly raised from the skin. They may be single or multiple, small or large. They tend to be flesh-colored or whitish in appearance. Warts usually do not cause itching or burning

Sometimes genital warts are so small that they cannot be seen with the naked eye. This is sometimes called “subclinical HPV.” This means that a person may not even know he or she has the type or types of HPV that cause genital warts.

What is an HPV test like?

A complete examination for HPV includes taking a sexual history and examining any symptoms you might be having. Sometimes, warts can be very hard to see, even for a trained clinician. Also it can be hard to tell the difference between a wart and normal bumps on the genital area. Your medical provider may use a magnifying lens called a colposcope to see smaller warts. A biopsy is not necessary for diagnosing genital warts. This would only be done if the bump looks unusual or discolored.

Some medical providers put acetic acid (vinegar) on your genital area to check for warts. This would cause any warts present to turn white, making them easier to see, especially if they are viewed through a colposcope. However, the vinegar can sometimes cause normal bumps to be highlighted, so this method of diagnosis is not exact.

There are no blood tests available to diagnose HPV.

How is HPV treated?

Currently, there is no treatment to cure HPV. If you have it, it may live in your body forever. Treating the warts may help reduce the risk of transmission to a partner who has never been exposed to the types of HPV you are carrying.

There are several treatment options available for removing warts. The goal of any treatment should be to get rid of annoying symptoms. No one treatment is best for all cases. When choosing what treatment to use, your health care provider will consider the size, location and number of warts, changes in the warts, your preference, cost of treatment, convenience, adverse effects, and their own experience with the treatments. Some treatments are done in a clinic or doctor’s office; others are prescription creams that can be used at home.

Treatments done in the doctor’s office include:

• Cryotherapy: Freezing off the wart with liquid nitrogen.
• Podophyllin: A chemical compound to get rid of the warts. This is an older treatment and is not widely used today.
• TCA (trichloracetic acid): Another chemical compound applied to the surface of the wart.
• Cutting off warts: This has the advantage of getting rid of warts in a single office visit.
• Electrocautery: Burning off warts with an electrical current.
• Laser therapy: Using an intense light to destroy warts. This is used for larger or extensive warts, especially those that have not responded well to other treatments. Laser can be very expensive and is not available in all providers’ offices.

At-home creams available by doctor’s prescription:

• Imiquimod cream (Aldara): A self-applied treatment for external genital warts. Although expensive, it is safe, effective and easy to use. Aldara boosts the immune system to fight HPV.
• Podofilox cream or gel (Condylox): A self-applied treatment that destroys the tissue of external genital warts. It is inexpensive, easy to use and safe. The treatment period is about four weeks.

Over-the-counter wart treatments should not be used in the genital area. They will not be effective.

What should I do if I have HPV?

Some people have only one outbreak of warts, while others have recurrences over time. Genital warts are most likely to be transmitted to your sex partners when the warts are actually present, but sometimes warts are too small to see with the naked eye. Very little is known about passing subclinical HPV to sex partners.

How do I avoid getting HPV?

Abstinence is the only way to completely avoid getting HPV and other STIs. If you’re sexually active, using condoms consistently and correctly for anal and vaginal sex is your best bet for staying sexually healthy. However, using condoms will only reduce your risk of getting warts from an infected partner because the wart virus can be on the skin near the vagina, rectum or penis – areas not always protected by a latex condom. Some data suggest condoms reduce the risk of cervical cancer in women who have certain types of HPV. Also, condoms can reduce the risk of recurrent HPV in those who already have the virus.

Genital herpes is a sexually transmitted disease caused by two herpes simplex viruses (HSV type I and type II). Herpes is transmitted from person to person via direct skin-to-skin contact during unprotected oral, anal and vaginal sex. HSV I usually causes fever blisters and cold sores on the mouth, but can also cause sores on the genitals. HSV II usually causes sores on the genitals (vagina, penis, anus) and the skin around those areas but is not usually transmitted to the mouth area. IN college students, most genital herpes is actually caused by HSV-I, transmitted during unprotected oral sex. HSV is different from other common viral infections because once it is introduced into your system, it lives there forever, often with periodic symptoms or without symptoms at all.

Why worry about Herpes?

Genital herpes is seldom a severe or dangerous infection by itself, although it can cause psychological distress because of the nature of the sores and the length of time the virus stays in your system.

The open sores of herpes do play a role in the spread of HIV. A person with a herpes sore is three to five times more likely to acquire HIV if exposed to an HIV-positive sex partner. Also, people with HIV and herpes have an increased amount of HIV fluid in their open herpes sores, which increases the risk of transmitting both diseases to a partner during unprotected sex.

Pregnant women who have a first episode of genital herpes near delivery may transmit herpes to their infant, which could be a serious, even deadly, problem. Fortunately, infection of infants is rare among women with recurrent genital herpes.

What are the symptoms of Herpes?

Many people have genital herpes but don’t know it because they have no symptoms. Others have very mild symptoms. For people who do have symptoms, who are symptomatic, the first outbreak is usually the worst. It lasts the longest, is most severe and often very uncomfortable. The initial sores can last five to ten days, first “weeping”, then scabbing over, then healing. In addition to blisters or open sores, a person may have swollen glands, fever, and body aches. Women tend to have more severe symptoms than men.

Genital recurrences after the first outbreak seem to be linked to stress, fatigue, lack of sleep, menstruation, and genital friction (new sexual partner after a time of no sex), although more research is definitely needed about this subject. Usually recurrences are more frequent in the first year after the initial outbreak. Some people have tingling or itching at the site of the sores before they appear, which can help them prepare for an upcoming outbreak. For some people, the recurrences are so mild that they have been mistaken for jock itch, razor burns, insect bites, ingrown hairs, and the like. Outbreaks can appear in different locations over time.

What is a Herpes test like?

Even experienced clinicians cannot reliably diagnose an initial herpes outbreak by its appearance alone. There are good viral culture tests available that can tell if herpes is present and which type (HSV I or HSV II). These tests use fluid from an open sore and are most accurate during initial outbreaks and when blisters are present.

There are several new blood tests that are very accurate for diagnosis. These tests also distinguish type (HSV I or HSV II). Speak to your medical provider about these tests if you’re interested.

How is Herpes treated?

There is no cure for herpes. However there are currently three FDA-approved antiviral medications available to treat herpes: Zovirax (acyclovir), Famvir (famciclovir) and Valtrex (valacyclovir). Using medication to treat genital herpes can help speed the healing process of an outbreak or be used as a preventative (when taken daily) to help reduce the frequency of future outbreaks.

Valtrex has also been proven effective when taken daily to reduce the risk of herpes transmission to sex partners. The most common short-term side effects of these drugs are nausea and headaches. Thus far, no long-term side effects have been found.

What should I do if I have Herpes?

In order to reduce outbreaks, keep your stress levels low, eat well, exercise regularly and get lots of rest. Learn to recognize the symptoms that occur during the period before the lesions appear. People often describe a tingling or burning feeling during this time. Taking medications in this time period before an outbreak can abort or reduce its duration. In order to avoid transmission of the virus to your sex partners, we advise discussing your herpes diagnosis with a prospective partner before you have sex. A potential partner would need to understand that it’s possible for him or her to become infected even if you’re using condoms since not all affected areas can be covered by a condom. Most good relationships can weather the news. Your partner may want to gather information and take some time to adjust to the fact that you have herpes. If you’re in a serious, long-term relationship, your partner might want to test for herpes as he or she might already be infected, but without symptoms.

How do I avoid getting Herpes?

Condoms provides some, but not complete, protection against transmission of the herpes virus. If you or your partner has herpes, abstain from sexual activities when sores are present. Communication is a wonderful tool to help you and your partner(s) make decisions about what’s right for each of you at any given time. However, be aware that herpes can be transmitted to a partner even when there isn’t a current outbreak.