Sexually Transmitted Diseases (STDs In Men) (cont.)
Human Papillomavirus (HPV)
More than 40 types of human papillomavirus (HPV), which
are the cause of genital warts (known as
condylomata acuminate or venereal warts), can infect the genital tract of men
and women. These warts are primarily transmitted by sexual intimacy. Note that
these are generally different from the HPV types that cause common warts
elsewhere on the body. Genital warts are smoother and softer lesions than the
typically rougher and firmer common warts. Genital warts usually appear as
small, fleshy, raised bumps, but they can sometimes be extensive and have a
cauliflower-like appearance. In men, the lesions are often present on the penis
or in the anal region. In most cases genital warts do not cause any symptoms,
but they are sometimes associated with itching, burning, or tenderness.
While HPV infection has long been known to be associated
with cervical cancer and other cancer of the genitals and anus (anogenital) in women, it has also
been linked with both anal and penile cancer in men. In patients who are
simultaneously infected with HIV, the HPV infection is more severe and the
associated cancers are even more frequent.
HPV infection is common and does not usually lead to the
development of warts, cancers, or specific symptoms. In fact, the majority of
people infected with HPV have no symptoms or lesions. Determination of whether
or not a person is infected with HPV involves tests that identify the genetic
material (DNA) of the virus. Furthermore, it has not been definitively
established whether the immune system is able to permanently clear the body of an HPV infection. For
this reason, it is impossible to predict exactly how common HPV infection is in
the general population, but it is believed at least 75% of the reproductive-age
population has been infected with sexually-transmitted HPV at some point in
their life. Asymptomatic (those without HPV-induced warts or lesions) people who
have HPV infections are still able to spread the infections to others through
sexual contact.
How is HPV treated?
Treatment of external anogenital warts:
There is no cure or treatment that can eradicate HPV
infection, so the only currently possible treatment is to remove the lesions
caused by the virus.. Unfortunately, even removal of the warts does not
necessarily prevent the spread of the virus, and genital warts frequently recur.
None of the available treatment options is ideal or clearly superior to others.
A treatment that can be administered by the patient is a
0.5% solution or gel of podofilox. The medication is applied to the warts twice
per day for 3 days followed by 4 days without treatment. Treatment should be
continued up to 4 weeks or until the lesions are gone. Alternatively, a 5% cream
of imiquimod (a substance that stimulates the body's production of cytokines, chemicals that
direct and strengthen the immune response) is likewise applied by the patient
three times a week at bedtime, and then washed off with mild soap and water 6-10
hours later. The applications are repeated for up to 16 weeks or until the
lesions are gone.
Only an experienced clinician can perform some of the
treatments for genital warts. These include, for example, placing a small amount
of a 10-25% solution of podophyllin resin on the lesions, and then, after 1 to 4
hours, washing off the podophyllin. The treatments are repeated weekly until the
genital warts are gone. An 80-90% solution of trichloroacetic acid (TCA) or
bichloracetic acid (BCA) can also be applied weekly by a physician to the
lesions. Injection of 5-flurouracil epinephrine gel into the lesions has also been shown to be
effective in treating genital warts.
Interferon alpha, a substance that stimulates the body's
immune response, has also been used in the treatment of genital warts. Treatment
regimens are injections of interferon into the lesion every other day over a period of 8 to
12 weeks.
Alternative methods include cryotherapy (freezing the genital warts with
liquid nitrogen) every
1 to 2 weeks, surgical removal of the lesions, or laser surgery. Laser surgery and
surgical excision both require a local or general anesthetic, depending upon the extent of the lesions.
What should a person do if exposed to someone with genital warts?
Both people with HPV infection and their partners need
to be counseled about the risk of spreading HPV and the appearance of the
lesions. They should understand that the absence of lesions does not exclude the
possibility of transmission, and that condoms are not completely effective in
preventing the spread of the infection. It is important to note that it is not
known whether treatment decreases infectivity. Finally, female partners of men
with genital warts should be reminded of the importance of regular PAP smears to
screen for cervical cancer and precancerous changes in the cervix (since precancerous
changes can be treated, reducing a woman's risk of developing cervical cancer).
Similarly, men should be informed of the potential risk of anal cancers,
although it is not yet been determined how to optimally screen for or manage
early anal cancer.
The HPV vaccine
Recent research studies have led to the development of a vaccine against four
common HPV types associated with the development of genital warts and cervical
and anogenital carcinomas. This vaccine (Gardasil)has received FDA approval for use in
females between 9 and 26 years of age and confers immunity against HPV types 6,
11, 16 and 18. Studies are ongoing to determine the effectiveness of the vaccine
in males. Another vaccine directed at HPV types 16 and 18 is currently being
tested, and initial trials with the vaccine have shown that the HPV-16/18
vaccine is safe and induces a high degree of protection against HPV-16/18
infection. These encouraging results suggest that widespread vaccination for HPV
types could begin in the near future.
Next: Urethritis »
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