Condyloma (HPV-Human Papilloma Virus)

The most common STD (sexually transmitted disease) is the human papilloma virus or HPV which is three times more common than herpes. It is most common in men and women between the ages of 20 and 40. It is estimated that one in every ten Americans-men and women-will have the HPV virus at some time.

Symptoms of HPV

The HPV appears as soft, flat irregularly shaped growths called 'warts' that appear on, in and around the genitals, rectum, mouth and throat. They can even be located in the anus and in the urethra, the tube in the penis that transports urine from the bladder to the outside of the body. They may appear as single isolated lesions but frequently are multiple in number. Very small warts can not be seen with the naked eye and may not produce any symptoms. The diagnosis can be made by applying a dilute solution of acetic acid or full-strength white vinegar to the genital skin and then looking for the lesions with a special magnifying instrument or glasses.Most researchers believe that the increase in the number of HPV cases is a result of the recent changes in sexual behavior, that is, sexual activity starting at an earlier age and/or with multiple sexual partners.Genital warts are highly contagious and spread by sexual or intimate bodily contact. HPV is most common in young people but it is present in all age groups and rich and poor alike. Many people have the virus and are contagious even if there are no visible lesions on the genitals.

Treatments of HPV

It has been confirmed that some forms of HPV can cause cancer of the cervix in women. The diagnosis is made in women by identifying abnormal cells on the PAP smear. It is for this reason, that all women with the characteristic findings on their PAP smear have their sexual partners examined for HPV. Although not as common and not as conclusive, HPV is weakly associated with penile and bladder cancer in men.

All sexual partners must be evaluated and treated, as sexual partners may carry the virus and if untreated they may reinfect the treated partner. Condoms are effective to prevent reinfection and transmission of the virus. Small lesions can be treated by topical application of podophyllum, an extract of the May apple, which interferes with the virus. The medication must be removed with soap and water 4 hours after the application. Podophyllum usually requires weekly application. Interferon is a reasonably new antiviral drug that can be injected directly into the lesion. The disadvantage is the expense and the necessity for nine office visits (3 times a week for 3 weeks) for a normal course of treatment. Cryotherapy consists of the application of liquid nitrogen to the lesions. This treatment destroys the virus by freezing. Scarring is a rare complication of cryotherapy. Surgical excision is often the quickest and most effective treatment for large lesions and those that do not respond to other methods. Electrosurgical removal using a high-energy electrical current can be employed to treat HPV lesions. The use of electrosurgery has the advantage of less bleeding. Small lesions can be removed with surgery using local anesthesia. Larger lesions require a general anesthetic. Lasers have been used with a high success rate in removing HPV lesions. Lasers' advantages include high cure rates and less bleeding after the procedure. The disadvantages are the expense and lack of availability in most physicians' offices.

Treatments for Men Who Have No Visible Lesions

We believe that all of the female partners who either have lesions or abnormal PAP smears are at an increased risk of cervical cancer and therefore their male partners need to be evaluated and, if lesions are identified, appropriate treatment provided. For those men who are uncircumcised and continue to have recurrent lesions underneath their foreskin, a circumcision is recommended.HPV is probably one of the most common sexually transmitted diseases in the United States. Both visible lesions and lesions visibly enhanced with the use of acetic acid can be removed, it is unlikely that all the HPV virus can be destroyed. Therefore, the use of condoms is strongly advised for those with active lesions or when one or both partners are being treated.