Genital HPV

The human papillomavirus is a common virus that infects the body’s skin and mucous membranes. There are over 100 types of the human papillomavirus and some of these are sexually transmitted and infect the genital area. These types are referred to as genital HPV. Genital HPV can be divided into low-risk or high-risk types. The low-risk types include types 6 and 11 which are associated with genital warts. High-risk types are those associated with cancer, with the most common being types 16, 18, 31 and 45. A person can be infected with more than one type of genital HPV at the same time. Genital HPV is not related to the herpes simplex virus which causes genital herpes.

Genital HPV is transmitted through direct skin to skin contact of the genitals. It is not transmitted through the exchange of bodily fluids or blood (1). Transmission usually occurs during vaginal, anal or oral sex. Genital HPV is transmitted very easily. It has been estimated that four out of five sexually active people will have genital HPV at some point in their lifetime (2).

Who is at risk?

Anyone who is sexually active can get genital HPV. While having more sexual partners (or having a partner who has had multiple sexual partners) will increase the risk, those with one life-time sexual partner can still get genital HPV (if their partner is infected with the virus). The use of condoms does not provide complete protection from genital HPV as transmission can still occur if infected areas of skin are not covered. HPV infection most commonly occurs during the first few years of sexual activity and so it is very common in young women.

What happens if you become infected with genital HPV?

HPV infection affects the body in different ways:

No symptoms
Many people infected with genital HPV will experience no symptoms. Most people’s immune system will get rid of the virus on its own.

Genital warts
A small number of people infected with types 6 and 11 will develop genital warts. Warts occur, on average, three months following exposure to genital HPV, but can take longer. They may, for example, first appear when a person’s immune system is lowered (during times of stress, ill-health or pregnancy). Warts can be found on the vulva, clitoris, cervix, penis, scrotum, inside the vagina or urethra, and in or around the anus.

Warts can be flesh coloured or pink and come in a variety of sizes and shapes, occurring singularly and in clusters. If they are small and/or inside the vagina, urethra or anus a woman may not be aware of them. While warts are generally painless they can cause itching and burning sensations, bleeding and vaginal discharge and can sometimes become infected.

Visible warts can be detected during a visual examination of the genital area by a health professional. An acetic acid solution (vinegar) may be applied to the skin to highlight areas for closer examination.

There a number of treatments for genital warts. The most suitable treatment will depend on the size and location of the warts, cost and convenience (3). They can be removed through the use of: chemical applications (podophyllin or trichloroacetic acid); cryosurgery (freezing), electrocautery (burning with an electric current) or laser therapy. The drug Imiquimod, administered in a cream, is also used and works by enhancing the body’s immune response to the virus. Genital warts can recur following treatment. Maintaining a healthy immune system and not smoking can minimise the risk of the recurrence.

Cell changes and cancer
Genital HPV can cause changes in the cells of the skin and mucous membranes. If these cell changes persist they can develop into cancer. High-risk types of genital HPV are associated with a range of cancers, in particular cervical cancer. Abnormal cell changes of the cervix due to HPV can be detected by a Pap smear. For many women this is the first time they are aware they have the virus (see section on HPV and cervical cancer).

Emotional impact

Being diagnosed with genital HPV can be emotionally distressing for some women. In particular, questions concerning the source of infection and/or the possibility of having passed on the infection are common. It is important to remember that a diagnosis of genital HPV does not necessarily mean a person has been recently infected with the virus. It may have been from a previous sexual relationship, even years ago. As the infection is easily transmitted it is quite possible that current sexual partner/s also have the virus.

Recognising that genital HPV is a very common infection and becoming informed may help women with the diagnosis. If women do experience concern or have negative feelings about having genital HPV they can talk to their health professional, a close friend or relative, or seek counselling.

Vaccine

The vaccine, Gardasil, prevents infection from four types of genital HPV ( 6, 11, 16 and 18) (4). Types 6 and 11 are responsible for 90% of genital warts while types 16 and 18 account for approximately 70% of cases of cervical cancer. In 2007, a free school-based vaccination program for girls will be introduced. The vaccine will also be made available for free to other young women through general practitioners. Women who have the Gardasil vaccine will still need to have Pap smears as it does not offer protection from all the types of genital HPV that cause cervical cancer.

A second HPV vaccine, Cervarix, is seeking approval from the Therapeutic Goods Administration. It prevents infection from genital HPV types 16 and 18.

References

1 Ooi, C and Dayan L. Genital warts Medical Observer 19 September 2003; 36-37
2 Koutsky L. Epidemiology of genital human papillomavrius Am J Med 1997; 102:3-8
3 White J & Donovan B. Managing genital warts Current Therapeutics 1999; 40:9: 43-49
4 Villa LL et al. High sustained efficacy of a prophylactic quadrivalent human papillomavirus types 6/11/16/18 L! virus-like particle vaccine through 5 years of follow up Br J Cancer 2006; 95:11:1459-66

Further help and information from Women's Health

Health Information Line:
Our free statewide line is staffed by women's health nurses and midwives. They provide women with up to date information, support and referral to health practitioners and services. Women can contact the Health Information Line by phone or email via the 'Ask a Health Question' page on the website. All phone calls and emails are confidential.
(07) 3839 9988 or 1800 017 676 (toll free outside Brisbane)

Library:
Our free lending library offers a select range of books on major women's health topics. Topic-based booklists are availableon our website, or can be posted out; books can be requested by phone or email and are posted to borrowers.
Contact on administration : (07) 3839 9962

Website:
All our factsheets and booklets are available on our website. The website also features articles on women's health from our newsletter, student factsheets, upcoming events, library services and 'Ask a Health Question' page. A list of reputable links is also available where women can search for further information on health topics.
www.womhealth.org.au

Further reading/viewing

Chlamydia factsheet

Cervical cancer vaccine newsletter article

Cervical cancer update videostream

This factsheet was originally published by Women’s Health Queensland Wide (Women’s Health) in April 1999. It was revised by Kirsten Braun at Women’s Health, February 2002 and January 2007.

Last Modified: January 31, 2007