Human Papillomavirus Infection (HPV)

Human Papillomavirus (HPV) infections are caused by Human papillomavirus and spread through sexual activity and direct contact. It is one of the most common sexually transmitted infections (STIs) and causes skin or mucous membrane overgrowths called warts. More than 100 varieties of human papillomavirus (HPV) have been identified. Some types cause common warts that can grow in any body part, particularly hands, fingers, plantar region of feet, etc. Some HPV can cause different cancers, especially HPV 16 and HPV 18. All HPV infections don't result in cancer, but genital HPV can cause cancer of the cervix. Other HPV types can cause different types of cancers, including cancers of the anus, penis, vagina, vulva, and oropharynx. Vaccines are helpful against some HPV, especially those that cause genital warts or cervical cancer.

There are many strains of HPV, but HPV division according to virulency is as follows.

1)High-risk HPV

·         HPV 16

·         HPV 18

·         HPV 31,33,35,39

·         HPV 45

·         HPV 51,52,56,59

·         HPV 66,68

2) Low-risk HPV

·         HPV 6

·         HPV 11

HPV enters the body mainly through a cut, abrasion, or tiny tear in the skin. The virus is transmitted primarily by skin-to-skin exposure. Genital HPV infections are transmitted through sexual intercourse, anal sex, and skin-to-skin contact in the genital region. Some HPV infections that result in oral or upper respiratory infections are passed through oral sex. In pregnant females, if there is an HPV infection with genital warts, the baby may get the viral infection too. Sometimes the infection may result in noncancerous growth in the baby's voice box called the larynx. Children are more vulnerable to getting common warts due to inadequate hygiene, whereas genital warts commonly occur in adolescents and young adults.

Some of the common risk factors for HPV infection include:

·         Multiple sexual partners:  The more the sexual partners, the more probability of contracting a genital HPV infection. Having sex with the one who has had multiple sex partners also increases the risk.

·         Smoking: Smoking tobacco can increase the risk of HPV warts converting to cervical cancer.

·         Immunocompromised individuals: People who have weakened immune systems are at risk of getting HPV infections. Immune systems are weak in HIV-positive individuals.

·         Damaged skin areas get viral infection easily.

·         Personal contact by touch without someone who has warts can transfer infection.

Overall 14 million new HPV infections occur every year, with nearly half occurring in people aged 15 to 24 years. The prevalence of genital warts was 45.2%, and high-risk HPV types was 25.1% in men aged 18 to 59 years in the United States.

In many cases of HPV, there are no symptoms, and most of them resolve without any treatment. Signs of infection can appear very late, about weeks, months, or even years after the person has been in contact with the viral infection. Among these commonest are genital warts. Warts can appear as flat-topped or as raised skin projections shaped like cauliflower or plant stems. Rarely can they be painful, itchy, or can bleed. Plantar warts are hard and grow on the foot. In men, flat warts grow on the beard, whereas they grow on the legs in women.

Examination of warts is an important tool for diagnosis. Following tests are often performed if the warts are not visible to the naked eye.

·         Vinegar (acetic acid) solution test.: In this, vinegar is applied on genital warts to increase visibility.

·         Pap test: In this test, a sample is taken from the cervix for laboratory analysis.

·         DNA testing: It is recommended after the age of 30, along with a pap test.

Several skin lesions and cancers can resemble HPV infection like;

• Basal Cell Carcinoma
• Benign Cervical Lesions
• Benign Vulvar Lesions
• Bowen Disease
• Cervical Cancer
• Chancroid
• Giant Condylomata Acuminata
• Cutaneous Squamous Cell Carcinoma of Head and Neck
• Hemorrhoids
• Herpes Simplex
• Lichen Planus
• Malignant Vulvar Lesions
• Molluscum Contagiosum
• Rectal Cancer

If you believe you have a wart, don’t forget to consult your healthcare provider for management. In children, warts usually go away themselves and do not require any treatment. Although reoccurrence in the same place or other places is common.

Medications

Some medications are very successful in eradicating warts. These medications are generally applied directly to the lesion, and multiple applications are required to eliminate them entirely. Some examples include:

·         Salicylic acid. It is an over-the-counter (OTC) treatment that works by removing layers of a wart, gradually removing it all. For common warts, salicylic acid can result in skin irritation, and it is not used on the face.

·         Imiquimod. This cream might increase the immune system's ability to combat HPV infection. Some common side effects of this cream include redness and swelling at the site of application.

·         Podofilox. It is a topical prescription as well. It works by destroying genital wart tissue from its base. Podofilox may likewise cause burning and itching at the site of application.

·         Trichloroacetic acid. It is a chemical treatment that burns off warts on the palms, soles, and genitals. It may also cause local irritation on the site of application.

Surgical and other procedures:

If medications didn’t work well, then warts may be removed by one of these procedures:

·         Freezing with liquid nitrogen (cryotherapy/freezing)

·         Burning with an electrical current (electrocautery)

·         Surgical removal

·         Laser surgery

·         Cold knife conization.

·         Loop electrosurgical excision procedure

As these viruses invade the basal layer of epithelial, recurrences and regressions are very common, but the prognosis is not bad as effective treatments are available. HPV can lead to serious consequences if not treated earlier.

·         Common warts: Prevention of HPV infections that cause common warts is difficult.  Pricking at a wart and biting the nails can spread the infection.

·         Plantar warts: To decrease the risk of  HPV infections that cause plantar warts, avoid walking barefoot in pools and public areas.

·         Genital warts: The risk of Genital warts can be reduced by reducing multiple sexual partners and using latex condoms

·         HPV vaccines: Gardasil 9 is an approved HPV vaccine that can be used for adults to protect against cervical and genital warts.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 07, 2023.

References

https://www.cdc.gov/std/hpv/stdfact-hpv.htm

https://www.mayoclinic.org/diseases-conditions/hpv-infection/symptoms-causes/syc-20351596