Genital HPV: Diagnosis and Treatment

HPV (human papillomavirus) is a virus. Genital HPV is often found during a routine exam. Your doctor may ask if you are sexually active, and if you have had abnormal development of cells (dysplasia) or genital, anal, or oral warts before. Your doctor will also ask you about your sexual partners and whether they are known to have genital warts or other sexually transmitted infections. You may also be checked for signs of other sexually transmitted infections. Genital HPV can't be removed completely from the body, but it can be treated.

The HPV vaccine can prevent HPV. Talk with your doctor about the vaccine.

• An HPV test can be used to help diagnose an HPV infection and find out which strain of HPV you have. Certain strains of HPV put you at higher risk of developing cancer in the future. A positive or negative HPV test will be used to decide on your treatment plan. In some cases, you can collect your own HPV test sample.
• A Pap test can show signs of dysplasia or warts on the cervix or in the anus. A sample of cells is taken and viewed under a microscope.
• HPV and Pap tests may be done at the same time. This is called co-testing.
• A colposcopy may be done to assess dysplasia more closely. A magnifying scope (colposcope) is used to look at the cervix through the vagina. In the anus, this test is called high-resolution anoscopy.
• An acetowhite test makes HPV disease (dysplasia or warts) easier to see. Vinegar is put on the cervix or anal skin that may be affected. If dysplasia or warts are present, they turn white. This test may be done during a colposcopy.

The strains of HPV that cause warts are often not the same strains that lead to cancer. If you have genital warts, report them to your doctor. Be aware that genital warts:

• Can appear alone or in groups, and may be hard to see.
• May feel like dry, firm bumps and look like a rash.
• May look different on skin than on mucous membrane.
• May look different depending on your sex.
• Can also involve the anus and skin around the anus, or the lips and inside the mouth. Warts or cancer can develop at these sites if HPV is not diagnosed and treated.

No treatment can completely rid your body of HPV, but it can be treated well in most cases.

Treating dysplasia removes the cells that can lead to cancer. Treating warts may help to keep them under control, and they may not come back. Treatment will also help you to prevent spreading the virus to others.

• Dysplasia or warts can be removed with heat (cautery), freezing or laser. The procedure is done by your doctor, usually in the doctor's office. The number of treatments you need depends on how much tissue must be removed.
• Medicines can be applied to treat external warts. Some medicines prompt your immune system to fight HPV. Others are substances that destroy warts. Medicines may be applied at the doctor's office or at home.
• Other treatments are being developed as more is learned about HPV.

Some strains of HPV are linked to cervical cancer, but most people with HPV don't develop cancer. Following up with your doctor helps reduce the cancer risk even more. And being vaccinated against HPV may prevent you from getting warts or dysplasia from HPV strains that you haven't been exposed to yet. Consider getting the HPV vaccine if you haven't already been vaccinated and even if you've had HPV.

• Schedule follow-up visits as instructed. See your doctor if you notice any new warts.
• Have Pap tests as often as your doctor tells you to. This way any dysplasia is found early, when treatment works best and cancer can be prevented.

• Don't smoke. Smoking weakens the immune system, which makes you more likely to get HPV. Smoking also increases the risk for cervical and other types of cancer.
• If you are living with HIV infection, make sure you keep it under excellent control. Poorly controlled HIV weakens the immune system and leads to worse HPV lesions.

If you have sex, the best way to prevent the spread of HPV is to use a latex condom every time. But remember that condoms and other barriers only protect the skin they cover. If you're with someone new, talk about HPV and other sexually transmitted infections before you have sex. If you're in a committed relationship and aren't currently using condoms, you may not need to change your habits. Talk to your partner and make a choice that feels right to both of you.

One of the best ways to prevent HPV is to make sure you have had the HPV vaccine. It may be given up to age 26 if it was not given earlier. If you are older than 27 and have not been vaccinated, talk with your doctor to see if you may need the vaccine. In some cases, it may be offered from ages 27 to 45.