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• human papillomavirus
• Sexually Transmitted Diseases
  

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 site or IM) and intralesionally (i.e., injected into the This subjects) .

Systemic interferon is not effective.

The efficacy and recurrence rates of intralesional interferon are comparable to other treatment modalities.

Interferon is likely effective because of its anti-viral and/or immunostimulating effects.

However, interferon therapy is not recommended for routine use because of inconvenient routes of administration, frequent office visits, and the association between its use and a high frequency of systemic adverse effects.

Because of the shortcomings of all available treatments, some clinics employ combination therapy (i.e., the simultaneous use of two or more modalities on the same This subject at the same time) .

However, some specialists believe that combining modalities may increase complications without improving efficacy.

Cervical Warts

For women who have exophytic cervical This subjects, high-grade squamous intraepithelial lesions (SIL) must be excluded before treatment is initiated.

Management of exophytic cervical This subjects should include consultation with a specialist.

Recommended Regimens for Vaginal Warts

One class of these topical agents is Immune Response 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 production 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 help the body control or eliminate virus-infected and tumor cells.

Because IRMs assist the immune system as a whole – 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 This subjects caused by human papillomavirus (HPV) infections.

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

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

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

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 This subjects.

“Before the approval of imiquimod, the only patients whose genital This subject 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 need for surgery and destructive ablations.”

Another potential use for IRMs is to treat keloids, the excessive scars that result 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 form 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 production of interfreron to prevent the keloid from returning following surgery.

“These disfiguring scars are tender, can cause pain 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 original keloid removed.

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

IRMs also show promise for the treatment of skin cancer and actinic keratoses, the precursor to a form of skin cancer.

Basal cell carcinoma (BCC) is the most common form 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 rate in patients with BCC.

Patients were treated five 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

More than 30 types of HPV can infect the genital tract.

Most HPV infections are asymptomatic, unrecognized, or subclinical.

Visible genital This subjects usually are caused by HPV types 6 or 11.

Other HPV types in the anogenital region (e.g., types 16, 18, 31, 33, and 35) have been strongly associated with cervical neoplasia.

Diagnosis of genital This subjects can be confirmed by biopsy, although biopsy is needed only under certain circumstances (e.g., if the diagnosis is uncertain; the lesions do not respond to standard therapy; the disease worsens during therapy; the patient is immunocompromised; or This subjects are pigmented, indurated, fixed, and ulcerated) .

No data support the use of type-specific HPV nucleic acid tests in the routine diagnosis or management of visible genital This subjects.

In addition to the external genitalia (i.e., the penis, vulva, scrotum, perineum, and perianal skin) , genital This subjects can occur on the uterine cervix and in the vagina, urethra, anus, and mouth; these This subjects are sometimes symptomatic.

Intra-anal This subjects are seen predominantly in patients who have had receptive anal intercourse; these This subjects are distinct from perianal This subjects, which can occur in men and women who do not have a history of anal sex.

In addition to the genital area, HPV types 6 and 11 have been associated with conjunctival, nasal, oral, and laryngeal This subjects.

HPV types 6 and 11 rarely are associated with invasive squamous cell carcinoma of the external genitalia.

Depending on the size and anatomic location, genital This subjects can be painful, friable, and pruritic, although they are commonly asymptomatic.

HPV types 16, 18, 31, 33, and 35 are found occasionally in visible genital This subjects and have been associated with external genital (i.e., vulvar, penile, and anal) squamous intraepithelial neoplasia (i.e., squamous cell carcinoma in situ, bowenoid papulosis, Erythroplasia of Queyrat, or Bowen's disease of the genitalia) .

These HPV types also have been associated with vaginal, anal, and cervical intraepithelial dysplasia and squamous cell carcinoma.

Patients who have visible genital This subjects can be infected simultaneously with multiple HPV types.

Treatment

The primary goal of treating visible genital This subjects is the removal of symptomatic This subjects.

In most patients, treatment can induce This subject-free periods.

If left untreated, visible genital This subjects may resolve on their own, remain unchanged, or increase in size or number.

Determining whether treatment of genital This subjects will reduce transmission is difficult, because no laboratory marker of infectivity has been established and because clinical studies evaluating the persistence of HPV DNA in genital tissue after treatment have shown variable results.

Existing data indicate that currently available therapies for genital This subjects may reduce, but probably do not eradicate, infectivity.

Whether the reduction in viral DNA that results from current treatment regimens impacts future transmission remains unclear.

No evidence indicates that either the presence of genital This subjects or their treatment is associated with the development of cervical cancer.

Regimens

Treatment of genital This subjects should be guided by the preference of the patient, the available resources, and the experience of the health-care provider.

No definitive evidence suggests that any of the available treatments is superior to the others, and no single treatment is ideal for all patients or all This subjects.

The use of locally developed and monitored treatment algorithms has been associated with improved clinical outcomes and should be encouraged.

Because of uncertainty regarding the effect of treatment on future transmission and the possibility for spontaneous resolution, an acceptable alternative for some patients is to forego treatment and await spontaneous resolution.

Most patients have <10 genital This subjects, with a total This subject area of 0.5--1.0 cm2.

These This subjects respond to most treatment modalities.

Factors that may influence selection of treatment include This subject size, This subject number, anatomic site of This subject, This subject morphology, patient preference, cost of treatment, convenience, adverse effects, and provider experience.

Many patients require a course of therapy rather than a single treatment.

In general, This subjects located on moist surfaces and/or in intertriginous areas respond better to topical treatment than do This subjects on drier surfaces.

The treatment modality should be changed if a patient has not improved substantially after three provider-administered treatments or if This subjects have not completely cleared after six treatments.

The risk-benefit ratio of treatment should be evaluated throughout the course of therapy to avoid overtreatment.

Both patient-applied therapies and provider-administered therapies are available.

Providers should be knowledgeable about, and have available to them, at least one patient-applied and one provider-administered treatment.

HPV testing may also aid in eliminating second and third Pap smears when unnecessary.

Under the current system, a patient with an abnormal Pap smear must come back and give a second sample for the HPV testing to be done.

Then, a third test is required if the HPV is determined a high risk strain, according to an informational brochure on STD's published by ASHA, the American Social Health Association.

The HPV test can identify high risk strains on the first visit, with no extra lab work.

This tells clinicians immediately is further testing is needed.

The Vaccine

Researchers at the National Cancer Institute and Johns Hopkins School of Public Health are developing a vaccine for the disease.

The vaccine is focused on two strains of HPV, those most linked with cervical cancer.

The vaccine is currently entering Phase III testing.

Thus far, it causes few side effects and seems to be highly effective, said the STD Advisor.

Researchers are also planning on adding two strains to the vaccine, both of which cause visible genital This subjects.

This, they hope, will increase public desire for the vaccine.

People do not often feel concerned about the virus unless they notice a physical change.

When [people] develop This subjects, it becomes more concerning because of the cosmetic damage.

Guys don't like having This subjects on their penis, said Conrad.

Researchers hope that preventing genital This subjects will entice people toward vaccination, thus helping to eliminate the greater concern, cervical cancer.

Also, scientists are testing possibilities of adding the oral cancer strain to the list.

Now scientist are expanding a planned clinical trial of the anti-cancer vaccine to include oral cancer patients, too.

The trial should begin within a year [Dr.

Maura Gillison, a Johns Hopkins University oncologist] said, stated the Lateline news article.

The best time to administer the vaccine would be between ages ten and thirteen.

This is because of HPV's sexual transmission.

If vaccinated earlier, people would lose resistance by the time they came in contact with the disease.

If vaccinated later, doctors fear adolescents may already have contacted it.

Questions and Controversy

The potential of HPV testing is very good, but a few questions still remain.

Changing medical procedure leads to controversy.

The idea of replacing, or reducing the use of the trusted Pap smear test makes some women’s health care professionals uncomfortable.

Women should be having regular Paps smears.

If they test negative for HPV, they could still have cervical cancer.

The Pap smear is a very reliable, well-utilized test.Said Conrad.

Also, the test must be cost-effective, which remains questionable.

If the HPV-DNA test is very expensive, it won't be practical or desirable for patients.

Researchers, however, feel optimistic about this issue.

But even if [HPV testing] runs between 50 dollars and 75 dollars, there would likely be savings from avoiding a follow-up visit for a second Pap, which is now required, Thomas Wright, Jr, MD, director of gynecology pathology at Columbia University School of Medicine,said in the STD Advisor.

Problems may also arise in the release of the vaccine.

First, researchers believe that, in order to wipe out cervical cancer, both men and women should receive the vaccine.

However, since men can’t get cervical cancer, they may not be anxious to pay for vaccination.

If the vaccine could protect against visible This subject strains and oral cancer, men would become more interested, but that would require more time for development and testing.

Also, problems may arise since ideal vaccination time is ten to thirteen.

Parents and pediatricians often hesitate to discuss sexual health with their children at this age, and may be adverse to protecting against an STD before it seems necessary.

Introducing an STD vaccination at this age would lead to many questions and issues that some parents don't want to discuss.

Some parents will talk about [STD's] and some won't.

What is human papillomavirus?

Human papillomavirus (HPV) is one of the most common causes of sexually transmitted infection (STI) in the world.

Health experts estimate that there are more cases of genital HPV infection than of any other STI in the United States.

According to the American Social Health Association, approximately 5.5 million new cases of sexually transmitted HPV infections are reported every year.

At least 20 million Americans are already infected.

Scientists have identified more than 100 types of HPV, most of which are harmless.

About 30 types are spread through sexual contact.

Some types of HPV that cause genital infections can also cause cervical cancer and other genital cancers.

Like many STIs, genital HPV infections often do not have visible signs and symptoms.

One study sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) reported that almost half of the women infected with HPV had no obvious symptoms.

People who are infected but who have no symptoms may not know they can transmit HPV to others or that they can develop complications from the virus.

What are genital This subjects?

Genital This subjects (condylomata acuminata or venereal This subjects) are the most easily recognized sign of genital HPV infection.

Many people, however, have a genital HPV infection without genital This subjects.

Can HPV cause other kinds of This subjects?

Some types of HPV cause common skin This subjects, such as those found on the hands and soles of the feet.

These types of HPV do not cause genital This subjects.

How are genital This subjects spread?

Genital This subjects are very contagious and are spread during oral, genital, or anal sex with an infected partner.

About two-thirds of people who have sexual contact with a partner with genital This subjects will develop This subjects, usually within three months of contact.

In women, the This subjects occur on the outside and inside of the vagina, on the opening (cervix) to the womb (uterus) , or around the anus.

In men, genital This subjects are less common.

If present, they usually are seen on the tip of the penis.

They also may be found on the shaft of the penis, on the scrotum, or around the anus.

Rarely, genital This subjects also can develop in the mouth or throat of a person who has had oral sex with an infected person.

Genital This subjects often occur in clusters and can be very tiny or can spread into large masses in the genital or anal area.

How are genital This subjects diagnosed?

A doctor or other health care worker usually can diagnose genital This subjects by seeing them on a patient.

Women with genital This subjects also should be examined for possible HPV infection of the cervix.

The doctor may be able to identify some otherwise invisible This subjects in the genital tissue by applying vinegar (acetic acid) to areas of suspected infection.

This solution causes infected areas to whiten, which makes them more visible, particularly if a procedure called colposcopy is performed.

During colposcopy, the doctor uses a magnifying instrument to look at the vagina and cervix.

In some cases, the doctor takes a small piece of tissue from the cervix and examines it under the microscope.

A Pap smear test also may indicate the possible presence of cervical HPV infection.

In a Pap smear, a laboratory worker examines cells scraped from the cervix under a microscope to see if they are cancerous.

If a woman’s Pap smear is abnormal, she might have an HPV infection.

If a woman has an abnormal Pap smear, she should have her doctor examine her further to look for and treat any cervical problems.

What is the treatment for genital This subjects?

Genital This subjects often disappear even without treatment.

In other cases, they eventually may develop a fleshy, small raised growth that looks like cauliflower.

There is no way to predict whether the This subjects will grow or disappear.

Therefore, if you suspect you have genital This subjects, you should be examined and treated, if necessary.

Depending on factors such as the size and location of the genital This subjects, a doctor will offer you one of several ways to treat them.

Imiquimod, an immune response cream which you can apply to the affected area

A 20 percent podophyllin anti-mitotic solution, which you can apply to the affected area and later wash off

A 0.5 percent podofilox solution, applied to the affected area but shouldn’t be washed off

A 5 percent 5-fluorouracil cream

Trichloroacetic acid (TCA)

If you are pregnant, you should not use podophyllin or podofilox because they are absorbed by the skin and may cause birth defects in your baby.

In addition, you should not use 5-fluorouracil cream if you are expecting.

If you have small This subjects, the doctor can remove them by freezing (cryosurgery) , burning (electrocautery) , or laser treatment.

Occasionally, the doctor will have to use surgery to remove large This subjects that have not responded to other treatment.

Some doctors use the antiviral drug alpha interferon, which they inject directly into the This subjects, to treat This subjects that have returned after removal by traditional means.

The drug is expensive, however, and does not reduce the rate that the genital This subjects return.

Although treatments can get rid of the This subjects, none gets rid of the virus.

Because the virus is still present in your body, This subjects often come back after treatment.

How can HPV infection be prevented?

The only way you can prevent getting an HPV infection is to avoid direct contact with the virus, which is transmitted by skin-to-skin contact.

If you or your sexual partner have This subjects that are visible in the genital area, you should avoid any sexual contact until the This subjects are treated.

Studies have not confirmed that male latex condoms prevent transmission of HPV itself, but results do suggest that condom use may reduce the risk of developing diseases linked to HPV, such as genital This subjects and cervical cancer.

Can HPV and genital This subjects cause complications?

Cancer

Some types of HPV can cause cervical cancer.

Others, however, cause cervical cancer and also are associated with vulvar cancer, anal cancer, and cancer of the penis (a rare cancer) .

Most HPV infections do not progress to cervical cancer.

If a woman does have abnormal cervical cells, a Pap test will detect them.

It is particularly important for women who have abnormal cervical cells to have regular pelvic exams and Pap tests so that they can be treated early, if necessary.

Pregnancy and Childbirth

Genital This subjects may cause a number of problems during pregnancy.

Sometimes they get larger during pregnancy, making it difficult to urinate.

If the This subjects are in the vagina, they can make the vagina less elastic and cause obstruction during delivery.

Rarely, infants born to women with genital This subjects develop This subjects in their throats (laryngeal papillomatosis) .

Although uncommon, it is a potentially life-threatening condition for the child, requiring frequent laser surgery to prevent obstruction of the breathing passages.

Research on the use of interferon therapy in combination with laser surgery indicates that this drug may show promise in slowing the course of the disease.

What research is going on?

Scientists are doing research on two types of HPV vaccines.

One type would be used to prevent infection or disease (This subjects or pre-cancerous tissue changes) .

The other type would be used to treat cervical cancers.

Researchers are testing both types of vaccines in people.

Where can I get more information?

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.

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