You may not have guessed it, but human papilloma viruses (HPV) are extremely common. Although many people associate this virus with sexually transmitted genital warts, HPV are also responsible for common warts. It is estimated that common warts can be found on the hands of about one-fourth of the U.S. population. Warts are small, painless, rounded growths that are beige, pink, or brown and may have either a smooth surface or a rough surface like a cauliflower. Between 60% to 70% of sexually active individuals have been exposed to HPV viruses. Furthermore, HPV affects approximately six percent of women with a normal pap smear and more than 60% of those with an abnormal pap smear. HPV viruses have also been associated with cervical and vulvar cancer in women. However, nobody knows the long-term problems this virus might cause in men.

Causes and Origins

More than 60 types of HPV have been identified, and different types have been associated with different medical conditions. Types 1, 3, and 5 have been linked to warts on the hands and feet, while types 6 and 11 have been associated with genital warts. Other types, such as 16, 18, 31, 33, and 35 have been associated with pre-cancerous and cancerous lesions of the cervix.

HPV is considered a sexually transmitted disease, but common warts--those not involving the sexual organs--can be spread through skin contacts such as shaking hands. In one study, the DNA of HPV was found in about 20% of virgins.

HPV comes in a few different forms:

• Flat warts - flat warts are flesh-colored and can occur in any area of the skin. They are most common in teen-agers and young adults.
• Plantar warts - thick, painful overgrowths of the sole of the feet, sometimes mistaken for calluses.
• Genital warts - usually appear as one or multiple painless growths with a rough surface like a cauliflower. In women they can appear anywhere on the outside of the vagina, labia, vulva, urethra, peri-anal skin, or rectum. In the male they commonly affect the tip of the penis, the opening of the urethra, and in the skin around the anus in men who practice anal sex. Symptoms can vary from none to itching, and occasionally bleeding when they are disrupted.

Diagnosing HPV

Asymptomatic HPV is usually detected through the pap smear, showing cellular changes consistent with HPV. These changes can range from mild or pre-cancerous lesions of the cervix to dysplasia (the abnormal development or growth of tissues, organs, or cells). In a recent study, 50% of male partners of women with genital warts had clinically visible lesions and 25% had lesions that were detected only when a solution of 5% of acetic acid was applied to the genital area.

Battling HPV: what you can do

Unfortunately, there is no definite way to prevent HPV, nor is there a cure. However, avoiding contact with someone with obvious lesions as well as practicing safe sex may reduce the chance of acquiring HPV, although the use of condoms has not been proven to reduce the risk of reinfection.

HPV infections are often marked by spontaneous regression and recurrence. Without treatment, about 50% of common warts spontaneously disappear within six to 12 months. Treatment depends on the presentation and usually consists of a variety of chemical, mechanical, and ablative techniques. These include topical solutions such as podophylin, trichloroacetic acid, and AldaraT cream. Some lesions may take anywhere from six to eight months of continuous treatment with one of these topical solutions. Other approaches, such as cryoablation, simple excision, electrosurgical excision, and laser vaporization are only used when simple topical treatments fail.

It is imperative that those people infected with HPV understand that there is no cure and that the lesions can spontaneously regress and recur. Treatment sometimes may be tedious and long, but with patience they usually go away. Fortunately, being infected with HPV does not mean a death sentence or sterility; women with HPV will simply have to be followed very closely with pap smears.