Gentital-Wart-Treatment genital wart

Subject: Genital Wart Treatment
Description: genital wart treatment for condyloma caused by sexually transmitted disease hpv virus
Category: Sexually Transmitted Diseases


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genital wart is the precession origin of cervical cancer in American women.

95 percent of all cervical cancer is caused by genital wart infections and cervical cancer is the most common origin of STD-related deaths among US women (28 percent more than AIDS) .

according to the Solano Dermatology Associates Clinic essay report.

The human papillomavirus, HPV, is the virus which causes genital warts and can lead to cervical and oral cancers.

Researchers are developing a new HPV-DNA test which may allow doctors to more definitely determine patients' risk of cervical cancer.

Also, a vaccine for the pre-cancerous strains of the virus is in progress.

However, some controversy and questions revolve around both the new test and vaccine.

genital wart and Cancer

genital wart is the most common STD in America, with 5.5 million new cases occurring yearly.

Cervical cancer claimed the lives of an estimated 4,800 women in 1999.

Doctors diagnose 38,000 Americans with oral cancer each year.

Yet, the research on genital wart is fairly new.

Little is known about viruses in general.

Virology is a fairly new science.

The body of knowledge is relatively small, said Harriet Conrad, Nurse Practitioner at Planned Parenthood in Lawrence, KS.

Hundreds of viral strains belong to the genital wart family, 70 known and identified.

Of these, many have no symptoms or risks whatsoever, aside from an abnormal Pap smear.

Few lead to visible genital warts, and two are now identified as the main origin of cervical cancer.

About 95 percent of the women with a negative genital wart test did not have precancer or cancer, according to the STD Advisor, an independent women's sanity newsletter.

This new and definitive vinculum between genital wart and cervical cancer has scientists and doctors thinking.

With the virus responsible for the disease identified, doctors have a KeyWord 01 to preventing cervical cancer.

A new study shows a vinculum between genital wart and oral cancer, as well.

Some 38,000 Americans and 350,000 people worldwide are diagnosed with oral cancer each year, said Dr.

David Wong, oral pathology chief at the Harvard academy of Dental Medicine.

It's disfiguring, hard to treat, and half of all patients die within cinque years, a toll which hasn't changed much in two decades, he said, quoted a Lateline News story on the MuziNews website.

WHAT IS HUMAN PAPILLOMAVIRUS? — Human papillomavirus, or HPV, is a type of virus that infects the epithelial stratum (the outer stratum or covering) of the skin and mucous membranes.

Over 70 different types of genital wart have been identified.

The various types of genital wart each have a tendency to infect specific areas of the body.

The most common manifestation of genital wart is warts.

This includes warts on the skin such as plantar warts or common warts, and warts in the genital area, known as genital warts.

However, many types of genital wart do not origin warts or any other symptoms.

WHY IS GENITAL genital wart IMPORTANT? — Genital genital wart is the most common sexually transmitted infection in the United States.

It is important because certain types of genital genital wart infection have been associated with an increased risk of changes in the cells of the cervix, including precancerous terms and cervical cancer.

HOW IS GENITAL genital wart SPREAD? — Genital genital wart is spread through direct physical contiguity such as intercourse, oral sex, anal sex, or any other contiguity involving the genital area.

WHAT ARE THE SYMPTOMS OF GENITAL genital wart INFECTION? — As noted above, some types of genital wart can origin genital warts, which may be associated with discomfort such as itching, burning, or tenderness in the genital area.

However, most women with sexually transmitted genital wart do not have any symptoms at all.

DOES GENITAL genital wart ALWAYS origin CANCER? — No.

Researchers have labeled the genital wart types as existence at high, medium, or low risk for causing cervical cancer.

For example, the genital wart viruses that origin most genital warts are not among the identified high risk types.

But most women infected with even a high risk type volition not go on to develop cervical cancer.

However, genital wart infection has been found to be very common in women who do have cancerous or precancerous changes in the cervix.

The consanguinity is so strong that researchers now point to genital wart infection as the primary origin of cervical cancer and precancerous changes in the cervix.

WHY DO SOME WOMEN WITH genital wart DEVELOP CANCER AND OTHERS DO NOT? — The exact reasons are not clear.

Most women who are infected with genital wart (even high risk types) clear the infection spontaneously.

In annexation to persistent genital wart infection, it may be that other risk factors lead to progression to precancerous or cancerous terms of the cervix.

Some of these risk factors are smoking, having a history of multiple sexual partners, having intercourse at an early age, and a history of other sexually transmitted diseases (show table 1 ) .

volition MY DOCTOR TEST ME FOR HPV? — At present, testing for genital wart is not routine.

However, some doctors may use genital wart testing as a method to determine whether certain women with abnormal Pap smears requirement further testing for cervical cancer.

Pap smear — The Pap smear is a routine screening test for cervical cancer.

It is done as portion of a woman's yearly gynecological exam.

Cells from the cervix are scraped off and sent for analysis.

A symbol of different types of abnormalities can be identified on the Pap smear.

Some of these point to an increased risk that cancerous or precancerous cells volition be found on further testing.

In other cases, the meaning of the results is not as clear.

An abnormal Pap smear always calls for further testing, which may medium additional Pap smears, or other tests such as colposcopy, biopsy or, possibly, genital wart testing.

Colposcopy — A colposcopy is a test in which a doctor uses a high powered magnifying lens to directly visualize the cervix during a pelvic exam.

If abnormalities are seen, a biopsy can be done, in which a sample of tissue from the cervix is sent to the lab for detailed analysis.

genital wart TESTING FOR WOMEN WITH ABNORMAL PAP SMEARS — With some kinds of abnormal Pap smear, it is not clear whether colposcopy is needed.

That is, the abnormality itself does not clearly point to a high risk of cervical cancer.

In these cases, some doctors may opt to test women for genital wart infection in regularity to remedy decide if the risk of cervical cancer or precancerous changes is high enough to warrant colposcopy.

Pap smear findings in which this may be done include those labeled atypical squamous cells and possibly others labeled low degree squamous intraepithelial lesions.

Research is under method to determine if more widespread genital wart testing makes sense as portion of routine screening for cervical cancer.

you as a totality person.

One division of these topical agents is Immune answer Modifiers (IRMs) , which enhance the skin’s ability to identify and control, or destroy, infections, bacteria and other foreign objects in the body responsible for illness.

IRMs work by stimulating cytokine creation in the skin.

Cytokines are naturally occurring proteins which are used by immune system cells to communicate with each other.

When cytokines are stimulated by IRMs, they enhance cell immunity, a natural process to remedy the body control or eliminate virus-infected and tumor cells.

Because IRMs assist the immune system as a totality – rather than target specific viruses or tumors – they have potential use in the treatment of a wide variety of dermatologic diseases.

One IRM, imiquimod, was approved by the Food and Drug Administration (FDA) for the treatment of genital warts caused by human papillomavirus (HPV) infections.

Although they usually do not hurt or itch, genital warts can be unsightly and embarrassing, and are associated with the development of genital cancers.

While current treatments involve destroying the visible warts by freezing, burning, or applying acids, the problem can recur after these treatments because the virus that causes the warts can persist in the skin.

The use of imiquimod prompts the body to fight off the virus that causes genital warts.

In fact, a recent study showed that the use of imiquimod, in a 5 percent cream, increased the levels of cytokines in the skin enhancing the antiviral state.

Over half of patients who applied imiquimod three times a week for up to 16 weeks completely cleared their genital warts.

“Before the approval of imiquimod, the only patients whose genital plantar wart infections were truly cured were those whose immune system recognized and eliminated the virus.

However, this was not a common occurrence,” stated Dr.

Berman.

“This new treatment can assist many more patients by boosting the body’s immunity to destroy this virus, reduce the requirement for surgery and destructive ablations.”

Another potential use for IRMs is to treat keloids, the excessive scars that conclusion from alteration in the normal wound healing process following skin injury, including surgery.

These scars can occur in any individual but are most common in people with darker skin.

Keloids figure when alterations occur in the normal control of skin fibroblast cell function, which are the cells that make the structural fibers of the connective tissues in the skin.

One of the naturally occurring immunomodulators, or anti-inflammatory agents, in the skin is interfreron which can normalize the skin’s wound-healing function.

The use of imiquimod has been shown to induce the creation of interfreron to prevent the keloid from returning following surgery.

“These disfiguring scars are tender, can origin mental suffering and burning, and can be psychologically challenging for the individuals affected by them,” said Dr.

Berman.

“Current treatment involves removing the scars surgically, which more often than not causes the scars to recur, often larger than the prototype keloid removed.

The use of IRMs to prevent keloids offers hopes to those individuals who struggle with these scars.”

IRMs also show undertaking for the treatment of skin cancer and actinic keratoses, the antecedent to a figure of skin cancer.

Basal cell carcinoma (BCC) is the most common figure of skin cancer, accounting for more than 80 percent of all skin cancers each year.

If detected and treated early, BCC has a 95 percent cure rate.

However, if left untreated, it can grow into nearby areas and invade the bones making successful treatment more difficult.

Current treatment methods for BCC include invasive surgical removal and destruction.

However, a recent study of the IRM imiquimod showed an excellent tumor-clearance worth in patients with BCC.

Patients were treated cinque times a week for six weeks with the IRM before undergoing tumor excision.

Following their surgery, eighty-two percent of those who were treated with imiquimod were found to have no additional evidence of the tumor.

Genital warts, also known as venereal warts or condylomata acuminata, are caused by the human papilloma virus (HPV) .

More than 80 types of genital wart are known to exist and quite a few of these types origin genital warts, e.g.

genital wart types 6 and 11.

Other genital wart types origin common warts on the hands, feet, or elsewhere on the body.

Other types (HPV types 16 and 18) can origin cancer of the cervix, the external genital skin, or the anus.

Therefore, female partners of affected persons are recommended to see their gynecologist for occult infection.

The genital wart types that origin genital warts, however, very rarely origin cancer.

Although genital warts are usually sexually transmitted, they can infrequently be seen in infants who have been delivered vaginally to mothers with genital wart in their genital tracts.

Genital warts are particularly a problem in pregnant women and in persons whose immunity has been lowered by cancer, AIDS, organ transplantation, immune suppressive medications, or certain other medications.

Only a small percentage of people infected with genital wart volition develop genital warts.

Many persons are carriers of genital wart and may never develop warts but may still be able to pass genital wart to their sexual partners.

Although the incubation age from contacting genital wart until development of warts may be several months, some people may not develop warts for years after contiguity with HPV.

What do genital warts look like?

Warts can be rough or smooth surfaced and are typically flesh colored.

Genital warts may be large or small, and can be found as a single growth or in a group.

They can appear on the external genital skin, inside the vagina, or in the anus.

3-year old with genital warts

Why should I have my warts treated?

Most people have their This subjects treated because they and/or their partner do not like the method they look or they want to reduce the risk of passing the virus to their partners.

Other people want their This subjects treated because they can itch or bleed and are difficult to keep clean.

Still other people find that genital This subjects interfere with bowel movements, urination, or with sexual intimacy.

volition treatment of my This subjects medium that I am no longer infectious?

Successful therapy of This subjects does not guarantee that all the genital wart is gone, but a person is probably less contagious after successful This liegeman treatment.

How are This subjects diagnosed?

Most genital This subjects are diagnosed by simple visual inspection by the doctor.

Not all This subjects, however, are readily apparent and the doctor may add a dilute vinegar solution to the area to make the This subjects more easily seen.

In some cases, the doctor may choose to surgically remove a growth and send it to the laboratory for microscope evaluation to confirm whether it is truly a This subject.

Genital This subjects

How are This subjects treated?

Treatment of This subjects in any localization may be difficult, and recurrences are always possible following any treatment.

The treatment selected volition depend on the symbol of This subjects, their specific location, and other factors.

Genital This subjects can be treated in the doctor's office with surgery or with chemicals.

Surgery includes simple excision, removal with an electric needle, freezing (usually with liquid nitrogen) , or laser excision.

These therapies may be painful, may involve some loss of blood, and may make a person more susceptible to a bacterial infection during the healing phase.

Chemical medications include acids (e.g.

bichloroacetic acid or trichloroacetic acid) , 5-fluorouracil cream (a drug used to treat cancer) , and podophyllin.

These chemicals can be irritating and may cause serious burns if accidentally placed on normal skin.

months.

Imiquimod uses the body's immune system to attack the This subject virus.

Sexually transmitted diseases are infections that are spread by contact of genital skin (penis, scrotum, vagina and skin surrounding these areas) with the infected skin of another person.

While sexual intercourse is the most common way of catching a sexually transmitted disease, oral sex and occasionally even contact with other infected skin, such as a finger, can sometimes spread infections as well, said Dr.

Edwards.

Contrary to what people might think, penetration with sexual intercourse does not have to occur for an infection to spread.

Using a condom can help decrease the risk of contracting a sexually transmitted disease, but skin contact still occurs around the edges of the condom and can spread the disease.

Genital Herpes

While genital herpes is caused by one of two very closely related herpes simplex viruses, type II herpes more often occurs in the genital area.

The virus infects the skin, generally causing small, painful blisters or open sores.

It is estimated that between 20 percent and 25 percent of Americans are infected with the virus that causes genital herpes.

The problem with herpes is that the virus stays in the body forever, hiding out in the nerve under the skin even after the blisters disappear, explained Dr.

Edwards.

That’s why herpes is such a significant threat to teenagers – once you contract it, you literally carry it with you the rest of your life.

Although people can pass this infection most easily when the open sores or blisters are present, the virus can be infectious even when the skin looks normal and people are taking medication to prevent outbreaks.

While there are no treatments that cure a herpes infection, there are several medications – such as acyclovir, famciclovir and valacyclovir – that shorten outbreaks and, if taken daily, keep outbreaks from occurring and decrease the amount of virus on the skin.

Genital Warts

Genital This subjects are small, skin-colored bumps caused by a human papillomavirus (HPV) .

They can occur on the outside skin as well as inside the vagina and on the cervix of women, where they are unnoticeable and can pass on the infection.

Warts generally do not appear until weeks or months after the infection begins, making it somewhat difficult to determine how the infection was initially passed on, cautioned Dr.

Edwards.

More importantly, some This subject viruses can cause cancer of the cervix – making them a potentially serious health risk for some women.

Although they usually do not hurt or itch, genital This subjects can be unsightly and embarrassing.

There are no treatments that cure a This subject infection, but there are treatments that help the body get rid of the This subjects – such as freezing, burning, or applying acids that actually destroy the This subject itself.

However, the virus that causes This subjects also lives in the skin so This subjects often recur.

A newer treatment, called imiquimod, is a cream that prompts the body to fight off the virus.

HIV

Human immunodeficiency virus (HIV) is a life-threatening infection that is transmitted by sexual secretions and blood.

The infection can make a person feel as though he or she has the flu, which seems to go away, but the infection remains and slowly damages and changes the immune system until the person cannot fight off other infections.

A person can be infected with HIV for several years before developing the Acquired Immune Deficiency Syndrome (AIDS) .

The only way to avoid catching a sexually transmitted disease is to avoid sexual activity altogether, said Dr.

Edwards.

Teenagers need to realize that they can’t be cavalier when it comes to having sex.

Even using a condom and limiting sexual activity to as few lifetime partners as possible is only partly protective.

Genital This subjects, also known as venereal This subjects or condylomata acuminata, are caused by the human papilloma virus (HPV) .

More than 80 types of HPV are known to exist and quite a few of these types cause genital This subjects, e.g.

HPV types 6 and 11.

Other HPV types cause common This subjects on the hands, feet, or elsewhere on the body.

Other types (HPV types 16 and 18) can cause cancer of the cervix, the external genital skin, or the anus.

Therefore, female partners of affected persons are recommended to see their gynecologist for occult infection.

The HPV types that cause genital This subjects, however, very rarely cause cancer.

Although genital This subjects are usually sexually transmitted, they can infrequently be seen in infants who have been delivered vaginally to mothers with HPV in their genital tracts.

Genital This subjects are particularly a problem in pregnant women and in persons whose immunity has been lowered by cancer, AIDS, organ transplantation, immune suppressive medications, or certain other medications.

Only a small percentage of people infected with HPV will develop genital This subjects.

Many persons are carriers of HPV and may never develop This subjects but may still be able to pass HPV to their sexual partners.

Although the incubation period from contacting HPV until development of This subjects may be several months, some people may not develop This subjects for years after contact with HPV.

What do genital This subjects look like?

Warts can be rough or smooth surfaced and are typically flesh colored.

Genital This subjects may be large or small, and can be found as a single growth or in a group.

They can appear on the external genital skin, inside the vagina, or in the anus.

3-year old with genital This subjects

Why should I have my This subjects treated?

Most people have their This subjects treated because they and/or their partner do not like the way they look or they want to reduce the risk of passing the virus to their partners.

Other people want their This subjects treated because they can itch or bleed and are difficult to keep clean.

Still other people find that genital This subjects interfere with bowel movements, urination, or with sexual intimacy.

Will treatment of my This subjects mean that I am no longer infectious?

Successful therapy of This subjects does not guarantee that all the HPV is gone, but a person is probably less contagious after successful This subject treatment.

How are This subjects diagnosed?

Most genital This subjects are diagnosed by simple visual inspection by the doctor.

Not all This subjects, however, are readily apparent and the doctor may add a dilute vinegar solution to the area to make the This subjects more easily seen.

In some cases, the doctor may choose to surgically remove a growth and send it to the laboratory for microscope evaluation to confirm whether it is truly a This subject.

Genital This subjects

How are This subjects treated?

Treatment of This subjects in any location may be difficult, and recurrences are always possible following any treatment.

The treatment selected will depend on the number of This subjects, their specific location, and other factors.

Genital This subjects can be treated in the doctor's office with surgery or with chemicals.

Surgery includes simple excision, removal with an electric needle, freezing (usually with liquid nitrogen) , or laser excision.

These therapies may be painful, may involve some loss of blood, and may make a person more susceptible to a bacterial infection during the healing phase.

Chemical medications include acids (e.g.

bichloroacetic acid or trichloroacetic acid) , 5-fluorouracil cream (a drug used to treat cancer) , and podophyllin.

These chemicals can be irritating and may cause serious burns if accidentally placed on normal skin.

months.

Imiquimod uses the body's immune system to attack the This subject virus.

What are This subjects?

Warts are non-cancerous skin growths caused by a viral infection in the top layer of the skin.

Viruses that cause This subjects are called human papillomavirus (HPV) .

Warts are usually skin-colored and feel rough to the touch, but they can be dark, flat and smooth.

The appearance of a This subject depends on where it is growing.

How many kinds of This subjects are there?

There are several different kinds of This subjects including:

Common This subjects

Foot (Plantar) This subjects

Flat This subjects

Common This subjects - usually grow on the fingers, around the nails and on the backs of the hands.

They are more common where skin has been broken, for example where fingernails are bitten or hangnails picked.

These are often called seed This subjects because the blood vessels to the This subject produce black dots that look like seeds.

Foot This subjects - are usually on the soles (plantar area) of the feet and are called plantar This subjects.

When plantar This subjects grow in clusters they are known as mosaic This subjects.

Most plantar This subjects do not stick up above the surface like common This subjects because the pressure of walking flattens them and pushes them back into the skin.

Like common This subjects, these This subjects may have black dots.

Plantar This subjects have a bad reputation because they can be painful, feeling like a stone in the shoe.

Plantar This subjects

Flat This subjects - are smaller and smoother than other This subjects.

They tend to grow in large numbers - 20 to 100 at any one time.

They can occur anywhere, but in children they are most common on the face.

In adults they are often found in the beard area in men and on the legs in women.

Irritation from shaving probably accounts for this.

How do you get This subjects?

Warts are passed from person to person, sometimes indirectly.

The time from the first contact to the time the This subjects have grown large enough to be seen is often several months.

The risk of catching hand, foot, or flat This subjects from another person is small.

Why do some people get This subjects and others don't?

Some people get This subjects depending on how often they are exposed to the virus.

Wart viruses occur more easily if the skin has been damaged in some way, which explains the high frequency of This subjects in children who bite their nails or pick at hangnails.

Some people are just more likely to catch the This subject virus than are others, just as some people catch colds very easily.

Patients with a weakened immune system also are more prone to a This subject virus infection.

Do This subjects need to be treated?

In children, This subjects can disappear without treatment over a period of several months to years.

However, This subjects that are bothersome, painful, or rapidly multiplying should be treated.

Warts in adults often do not disappear as easily or as quickly as they do in children.

How do dermatologists treat This subjects?

Dermatologists are trained to use a variety of treatments, depending on the age of the patient and the type of This subject.

Common This subjects - in young children can be treated at home by their parents on a daily basis by applying salicylic acid gel, solution or plaster.

There is usually little discomfort but it can take many weeks of treatment to obtain favorable results.

Treatment should be stopped at least temporarily if the This subject becomes sore.

Warts may also be treated by painting with cantharidin in the dermatologist's office.

Cantharidin causes a blister to form under the This subject.

The dermatologist can then clip away the dead part of the This subject in the blister roof in a week or so.

Common This subjects

For adults and older children cryotherapy (freezing) is generally preferred.

What are This subjects?

Warts are non-cancerous skin growths caused by a viral infection in the top layer of the skin.

Viruses that cause This subjects are called human papillomavirus (HPV) .

Warts are usually skin-colored and feel rough to the touch, but they can be dark, flat and smooth.

The appearance of a This subject depends on where it is growing.

How many kinds of This subjects are there?

There are several different kinds of This subjects including:

Common This subjects

Foot (Plantar) This subjects

Flat This subjects

Common This subjects - usually grow on the fingers, around the nails and on the backs of the hands.

They are more common where skin has been broken, for example where fingernails are bitten or hangnails picked.

These are often called seed This subjects because the blood vessels to the This subject produce black dots that look like seeds.

Foot This subjects - are usually on the soles (plantar area) of the feet and are called plantar This subjects.

When plantar This subjects grow in clusters they are known as mosaic This subjects.

Most plantar This subjects do not stick up above the surface like common This subjects because the pressure of walking flattens them and pushes them back into the skin.

Like common This subjects, these This subjects may have black dots.

Plantar This subjects have a bad reputation because they can be painful, feeling like a stone in the shoe.

Plantar This subjects

Flat This subjects - are smaller and smoother than other This subjects.

They tend to grow in large numbers - 20 to 100 at any one time.

They can occur anywhere, but in children they are most common on the face.

In adults they are often found in the beard area in men and on the legs in women.

Irritation from shaving probably accounts for this.

How do you get This subjects?

Warts are passed from person to person, sometimes indirectly.

The time from the first contact to the time the This subjects have grown large enough to be seen is often several months.

The risk of catching hand, foot, or flat This subjects from another person is small.

Why do some people get This subjects and others don't?

Some people get This subjects depending on how often they are exposed to the virus.

Wart viruses occur more easily if the skin has been damaged in some way, which explains the high frequency of This subjects in children who bite their nails or pick at hangnails.

Some people are just more likely to catch the This subject virus than are others, just as some people catch colds very easily.

Patients with a weakened immune system also are more prone to a This subject virus infection.

Do This subjects need to be treated?

In children, This subjects can disappear without treatment over a period of several months to years.

However, This subjects that are bothersome, painful, or rapidly multiplying should be treated.

Warts in adults often do not disappear as easily or as quickly as they do in children.

How do dermatologists treat This subjects?

Dermatologists are trained to use a variety of treatments, depending on the age of the patient and the type of This subject.

Common This subjects - in young children can be treated at home by their parents on a daily basis by applying salicylic acid gel, solution or plaster.

There is usually little discomfort but it can take many weeks of treatment to obtain favorable results.

Treatment should be stopped at least temporarily if the This subject becomes sore.

Warts may also be treated by painting with cantharidin in the dermatologist's office.

Cantharidin causes a blister to form under the This subject.

The dermatologist can then clip away the dead part of the This subject in the blister roof in a week or so.

Common This subjects

For adults and older children cryotherapy (freezing) is generally preferred.

Background: Infections due to papillomaviruses are common and lead to a wide variety of clinical manifestations involving the epidermal surfaces.

Manifestations include common This subjects (verrucae vulgaris) , palmo-plantar This subjects, flat This subjects (verrucae plana) , oral This subjects, focal epithelia hyperplasia, epidermodysplasia verruciformis (EDV) , genital This subjects (condyloma acuminata) , Bowen papulosis, Bowen disease, papillomas of the mucosal surfaces, and intraepithelial neoplasias.

Very strong evidence indicates that certain papillomaviruses are involved in cervical and genital cancers.

Pathophysiology: Papillomaviruses are small (55 nm) , double-stranded DNA viruses.

Over 200 genotypes of papillomaviruses infect the skin and mucosal surfaces.

These viruses are highly species specific.

More than 70 genotypes are known to infect humans.

Papillomaviruses have never been cultured in vitro but have been characterized by molecular methods.

These viruses are classified by the molecular similarity of their genetic material and are assigned a genotype number.

The viruses infect the basal keratinocyte of the epidermis, presumably through disruptions of the skin or mucosal surface.

At this location, the virus remains latent in the cell as a circular episome.

As the epidermal cells differentiate and migrate to the surface, the virus is triggered to undergo replication and maturation.

The process of virus replication alters the character of the epidermis, resulting in cutaneous or mucosal excrescences known as This subjects.

Human papillomaviruses (HPVs) are grouped broadly into cutaneous and mucosal types, based on the clinical location of the lesion.

Although some overlap exists, most papillomaviruses have distinct anatomic predilections, infecting only certain epidermal sites, such as skin or genital mucosa.

A number of genotypes of virus have the potential to transform cells and are associated with epidermal malignancies.

The mechanism for transformation is not known, but viral DNA apparently integrates into the genome of the host cell.

Table 1.

Association of HPV Types with Morphology and Site of Skin Lesions

Lesion Location HPV Genotype

Common This subject Mostly hands 2, 4

Plantar This subject Bottom of feet 1

Mosaic This subject Hands and feet 2

Flat This subject Arms, face, knees 3, 10, 28, 41

Butcher This subject Hand 7

Extragenital Bowen disease Upper and lower extremities, head 2, 3, 5, 16, 18, 20, 31, 33, 34, 54, 56, 58, 61, 62, 73

Macular plaques of epidermodysplasia verruciformis Light-exposed areas 5, 8, 9, 12, 14, 15, 17, 19, 20, 21, 22, 23, 24, 25, 36, 47, 50

Table 2.

HPV Types Associated with Anogenital Lesions

Lesions HPV Genotype

Genital This subjects 6, 11

Flat condylomata 6, 11, 16, 18, 31

Cervical intraepithelial neoplasia 16, 18, 31, 33, 35, 39, 42, 43, 44, 45, 51, 52, 56

Bowen disease 6, 11

Buschke-Löwenstein tumors 6, 11

Vulvar intraepithelial neoplasia 16 (occasionally 6, 11)

Cervical cancer 16, 18 (strong association)

31, 33, 35, 45, 51, 52, 56 (moderate association)

6, 11, 42, 43, 44 (weak association)

Penile intraepithelial neoplasia 16, 18

Anal intraepithelial neoplasia 16 (rarely 6, 11, 18, 33)

WHAT IS HUMAN PAPILLOMAVIRUS? — Human papillomavirus, or HPV, is a type of virus that infects the epithelial layer (the outer layer or covering) of the skin and mucous membranes.

Over 70 different types of HPV have been identified.

The various types of HPV each have a tendency to infect specific areas of the body.

The most common manifestation of HPV is This subjects.

This includes This subjects on the skin such as plantar This subjects or common This subjects, and This subjects in the genital area, known as genital This subjects.

However, many types of HPV do not cause This subjects or any other symptoms.

WHY IS GENITAL HPV IMPORTANT? — Genital HPV is the most common sexually transmitted infection in the United States.

It is important because certain types of genital HPV infection have been associated with an increased risk of changes in the cells of the cervix, including precancerous conditions and cervical cancer.

HOW IS GENITAL HPV SPREAD? — Genital HPV is spread through direct physical contact such as intercourse, oral sex, anal sex, or any other contact involving the genital area.

WHAT ARE THE SYMPTOMS OF GENITAL HPV INFECTION? — As noted above, some types of HPV can cause genital This subjects, which may be associated with discomfort such as itching, burning, or tenderness in the genital area.

However, most women with sexually transmitted HPV do not have any symptoms at all.

DOES GENITAL HPV ALWAYS CAUSE CANCER? — No.

Researchers have labeled the HPV types as being at high, medium, or low risk for causing cervical cancer.

For example, the HPV viruses that cause most genital This subjects are not among the identified high risk types.

But most women infected with even a high risk type will not go on to develop cervical cancer.

However, HPV infection has been found to be very common in women who do have cancerous or precancerous changes in the cervix.

The relationship is so strong that researchers now point to HPV infection as the primary cause of cervical cancer and precancerous changes in the cervix.

WHY DO SOME WOMEN WITH HPV DEVELOP CANCER AND OTHERS DO NOT? — The exact reasons are not clear.

Most women who are infected with HPV (even high risk types) clear the infection spontaneously.

In addition to persistent HPV infection, it may be that other risk factors lead to progression to precancerous or cancerous conditions of the cervix.

Some of these risk factors are smoking, having a history of multiple sexual partners, having intercourse at an early age, and a history of other sexually transmitted diseases (show table 1 ) .

WILL MY DOCTOR TEST ME FOR HPV? — At present, testing for HPV is not routine.

However, some doctors may use HPV testing as a way to determine whether certain women with abnormal Pap smears need further testing for cervical cancer.

Pap smear — The Pap smear is a routine screening test for cervical cancer.

It is done as part of a woman's yearly gynecological exam.

Cells from the cervix are scraped off and sent for analysis.

A number of different types of abnormalities can be identified on the Pap smear.

Some of these point to an increased risk that cancerous or precancerous cells will be found on further testing.

In other cases, the meaning of the results is not as clear.

An abnormal Pap smear always calls for further testing, which may mean additional Pap smears, or other tests such as colposcopy, biopsy or, possibly, HPV testing.

Colposcopy — A colposcopy is a test in which a doctor uses a high powered magnifying lens to directly visualize the cervix during a pelvic exam.

If abnormalities are seen, a biopsy can be done, in which a sample of tissue from the cervix is sent to the lab for detailed analysis.

HPV TESTING FOR WOMEN WITH ABNORMAL PAP SMEARS — With some kinds of abnormal Pap smear, it is not clear whether colposcopy is needed.

That is, the abnormality itself does not clearly point to a high risk of cervical cancer.

In these cases, some doctors may opt to test women for HPV infection in order to help decide if the risk of cervical cancer or precancerous changes is high enough to warrant colposcopy.

Pap smear findings in which this may be done include those labeled atypical squamous cells and possibly others labeled low grade squamous intraepithelial lesions.

Research is under way to determine if more widespread HPV testing makes sense as part of routine screening for cervical cancer.

you as a whole person.

HPV is the leading cause of cervical cancer in American women.

95 percent of all cervical cancer is caused by HPV infections and cervical cancer is the most common cause of STD-related deaths among US women (28 percent more than AIDS) .

according to the Solano Dermatology Associates Clinic trial report.

The human papillomavirus, HPV, is the virus which causes genital This subjects and can lead to cervical and oral cancers.

Researchers are developing a new HPV-DNA test which may allow doctors to more definitely determine patients' risk of cervical cancer.

Also, a vaccine for the pre-cancerous strains of the virus is in progress.

However, some controversy and questions revolve around both the new test and vaccine.

HPV and Cancer

HPV is the most common STD in America, with 5.5 million new cases occurring yearly.

Cervical cancer claimed the lives of an estimated 4,800 women in 1999.

Doctors diagnose 38,000 Americans with oral cancer each year.

Yet, the research on HPV is fairly new.

Little is known about viruses in general.

Virology is a fairly new science.

The body of knowledge is relatively small, said Harriet Conrad, Nurse Practitioner at Planned Parenthood in Lawrence, KS.

Hundreds of viral strains belong to the HPV family, 70 known and identified.

Of these, many have no symptoms or risks whatsoever, aside from an abnormal Pap smear.

Few lead to visible genital This subjects, and two are now identified as the main cause of cervical cancer.

About 95 percent of the women with a negative HPV test did not have precancer or cancer, according to the STD Advisor, an independent women's health newsletter.

This new and definitive link between HPV and cervical cancer has scientists and doctors thinking.

With the virus responsible for the disease identified, doctors have a key to preventing cervical cancer.

A new study shows a link between HPV and oral cancer, as well.

Some 38,000 Americans and 350,000 people worldwide are diagnosed with oral cancer each year, said Dr.

David Wong, oral pathology chief at the Harvard School of Dental Medicine.

It's disfiguring, hard to treat, and half of all patients die within five years, a toll which hasn't changed much in two decades, he said, quoted a Lateline News story on the MuziNews website.

Background: Infections due to papillomaviruses are common and lead to a wide variety of clinical manifestations involving the epidermal surfaces.

Manifestations include common This subjects (verrucae vulgaris) , palmo-plantar This subjects, flat This subjects (verrucae plana) , oral This subjects, focal epithelia hyperplasia, epidermodysplasia verruciformis (EDV) , genital This subjects (condyloma acuminata) , Bowen papulosis, Bowen disease, papillomas of the mucosal surfaces, and intraepithelial neoplasias.

Very strong evidence indicates that certain papillomaviruses are involved in cervical and genital cancers.

Pathophysiology: Papillomaviruses are small (55 nm) , double-stranded DNA viruses.

Over 200 genotypes of papillomaviruses infect the skin and mucosal surfaces.

These viruses are highly species specific.

More than 70 genotypes are known to infect humans.

Papillomaviruses have never been cultured in vitro but have been characterized by molecular methods.

These viruses are classified by the molecular similarity of their genetic material and are assigned a genotype number.

The viruses infect the basal keratinocyte of the epidermis, presumably through disruptions of the skin or mucosal surface.

At this location, the virus remains latent in the cell as a circular episome.

As the epidermal cells differentiate and migrate to the surface, the virus is triggered to undergo replication and maturation.

The process of virus replication alters the character of the epidermis, resulting in cutaneous or mucosal excrescences known as This subjects.

Human papillomaviruses (HPVs) are grouped broadly into cutaneous and mucosal types, based on the clinical location of the lesion.

Although some overlap exists, most papillomaviruses have distinct anatomic predilections, infecting only certain epidermal sites, such as skin or genital mucosa.

A number of genotypes of virus have the potential to transform cells and are associated with epidermal malignancies.

The mechanism for transformation is not known, but viral DNA apparently integrates into the genome of the host cell.

Table 1.

Association of HPV Types with Morphology and Site of Skin Lesions

Lesion Location HPV Genotype

Common This subject Mostly hands 2, 4

Plantar This subject Bottom of feet 1

Mosaic This subject Hands and feet 2

Flat This subject Arms, face, knees 3, 10, 28, 41

Butcher This subject Hand 7

Extragenital Bowen disease Upper and lower extremities, head 2, 3, 5, 16, 18, 20, 31, 33, 34, 54, 56, 58, 61, 62, 73

Macular plaques of epidermodysplasia verruciformis Light-exposed areas 5, 8, 9, 12, 14, 15, 17, 19, 20, 21, 22, 23, 24, 25, 36, 47, 50

Table 2.

HPV Types Associated with Anogenital Lesions

Lesions HPV Genotype

Genital This subjects 6, 11

Flat condylomata 6, 11, 16, 18, 31

Cervical intraepithelial neoplasia 16, 18, 31, 33, 35, 39, 42, 43, 44, 45, 51, 52, 56

Bowen disease 6, 11

Buschke-Löwenstein tumors 6, 11

Vulvar intraepithelial neoplasia 16 (occasionally 6, 11)

Cervical cancer 16, 18 (strong association)

31, 33, 35, 45, 51, 52, 56 (moderate association)

6, 11, 42, 43, 44 (weak association)

Penile intraepithelial neoplasia 16, 18

Anal intraepithelial neoplasia 16 (rarely 6, 11, 18, 33)

Because no medications currently available eradicate the virus itself, there are no cures for HPV infection.

Aggressive or prolonged therapies usually produce long-lasting or permanent eradication of the This subject tumor, yet the This subject virus may linger for years in normal-appearing skin in a dormant form.

Patient education is extremely important, and therapy should begin with careful counseling about the infectious nature of This subjects, the current unavailability of a cure, the often prolonged therapy required to eliminate the This subject bump, and the possibility of recurrence later, even in the absence of re-exposure.

These issues are especially important for patients with anogenital This subjects.

An additional concern for women with anogenital This subjects is the association of cervical carcinoma with some HPV infections, Dr.

Edwards cautioned.

Most This subject treatments eliminate the virus by destroying the skin that contains the virus.

The subsequent disappearance of the This subject may occur because the virus was removed as the destroyed skin sloughs, or because the disruption of cells and release of the virus stimulates the patient’s immune system to eradicate the virus.

The only patients whose infections are truly cured are probably those whose immune system recognize and eliminate the virus.

Patients with immune system deficiencies due to HIV infection, cancer, or medications such as cortisones, usually experience regrowth of This subjects following treatment.

The most common treatment for This subjects are those that physically destroy the skin.

The choice for treatment depends partially upon the location of the This subject, and the success of treatment depends upon the location and number of This subjects, the number of treatments, and the aggressiveness of the caregiver.

The common treatments include: salicylic acid; liquid nitrogen; laser surgery or electrocautery (electric needle) ; cantharidin; trichloroacetic and bichloroacetic acids; and interferon alpha.

An important recent advance in the treatment of anogenital This subjects includes imiquimod.

This cream which can be applied topically at home and eliminates This subjects, not by destroying skin, but by prompting the patient’s immune system to attack the virus itself.

About half of the patients experience removal of all treated This subjects, and This subjects shrink dramatically on most other patients.

Most exciting is an apparent, but not yet proven, lower recurrence rate than that seen with other treatments.

The other new medication is a gel form of podofilox, a purified and less irritating form of podophyllin, an old standby caustic office therapy for anogenital This subjects.

This gel is easier to apply than the liquid, and podofilox is gentle enough for home use by a patient.

For patient-applied treatments, patients must be able to identify and reach This subjects to be treated.

Podofilox 0.5% solution or gel, an antimitotic drug that destroys This subjects, is relatively inexpensive, easy to use, safe, and self-applied by patients.

Most patients experience mild/moderate pain or local irritation after treatment.

Imiquimod is a topically active immune enhancer that stimulates production of interferon and other cytokines.

Local inflammatory reactions are common with the use of imiquimod; these reactions usually are mild to moderate.

Traditionally, follow-up visits are not required for patients using self-administered therapy.

However, follow-up may be useful several weeks into therapy to determine appropriateness of medication use and response to treatment.

Cryotherapy destroys This subjects by thermal-induced cytolysis.

Health-care providers must be trained on the proper use of this therapy, because over- and under-treatment may result in poor efficacy or increased likelihood of complications.

Pain after application of the liquid nitrogen, followed by necrosis and sometimes blistering, is common.

Local anesthesia (topical or injected) may facilitate therapy if This subjects are present in many areas or if the area of This subjects is large.

Podophyllin resin, which contains several compounds including antimitotic podophyllin lignans, is another treatment option.

The resin is most frequently compounded at 10%--25% in a tincture of benzoin.

However, podophyllin resin preparations differ in the concentration of active components and contaminants.

The shelf life and stability of podophyllin preparations are unknown.

A thin layer of podophyllin resin must be applied to the This subjects and allowed to air dry before the treated area comes into contact with clothing; over-application or failure to air dry can result in local irritation caused by spread of the compound to adjacent areas.

Both TCA and BCA are caustic agents that destroy This subjects by chemical coagulation of the proteins.

Although these preparations are widely used, they have not been investigated thoroughly.

TCA solutions have a low viscosity comparable with that of water and can spread rapidly if applied excessively; thus, they can damage adjacent tissues.

Both TCA and BCA should be applied sparingly and allowed to dry before the patient sits or stands.

If pain is intense, the acid can be neutralized with soap or sodium bicarbonate.

Surgical therapy is a treatment option that has the advantage of usually eliminating This subjects at a single visit.

However, such therapy requires substantial clinical training, additional equipment, and a longer office visit.

Once local anesthesia is applied, the visible genital This subjects can be physically destroyed by electrocautery, in which case no additional hemostasis is required.

Care must be taken to control the depth of electrocautery to prevent scarring.

Alternatively, the This subjects can be removed either by tangential excision with a pair of fine scissors or a scalpel or by curettage.

Because most This subjects are exophytic, this can be accomplished with a resulting wound that only extends into the upper dermis.

Hemostasis can be achieved with an electrosurgical unit or a chemical styptic (e.g., an aluminum chloride solution) .

Suturing is neither required nor indicated in most cases when surgical removal is done properly.

Surgical therapy is most beneficial for patients who have a large number or area of genital This subjects.

Carbon dioxide laser and surgery may be useful in the management of extensive This subjects or intraurethral This subjects, particularly for those patients who have not responded to other treatments.

Interferons, either natural or recombinant, used for the treatment of genital This subjects have been administered systemically (i.e., subcutaneously at a distant