[ HPV - Human Papillomavirus and Genital Warts ]

What is HPV or Human Papillomavirus?

The human papilloma viruses (HPVs) are a family of over 100 different viruses responsible for causing warts, most of which are harmless. About 40 types are spread through sexual contact, and the lesions produced by these genital viruses are called genital warts. Not only are there more cases of genital HPV infection than of any other STD in the United States, but it is one of the most common STDs, globally. At least 20 million Americans are already infected, and according to the American Social Health Association, approximately 5.5 million new cases of sexually transmitted HPV infections are reported every year. A study by the U.S. Centers for Disease Control (CDC) on prevalence of HPV 16 in the U.S. showed also that twice as many women are infected than men. Two types of HPV, HPV 16 and HPV 18, have been found to be the chief causes of cervical cancer, which is the second leading cause of death in women with cancer worldwide. Merck's Vaccine, Gardasil, received the Food and Drug Administration's (FDA) approval and the Centers for Disease Control's (CDC) Advisory Committee on Immunization Practices' (ACIP) recommendation for prevention of cancer and diseases caused by HPV 16, HPV 18, HPV 6, and HPV 11.

Condylomata acuminata, venereal warts, or genital warts 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 warts will develop warts, usually within three months. A concern is also that people who are infected, but who have no symptoms, may not know they can transmit HPV to others. To prevent transmission, if you or your sexual partner have warts that are visible in the genital area, avoid any sexual contact until the warts are treated. Studies have not confirmed that male latex condoms prevent transmission of HPV itself, but results do suggest that using condoms may reduce the risk of developing diseases linked to HPV, such as genital warts and cervical cancer, although, most HPV infections do not progress to cervical cancer.

Fifteen types of HPV (HPV 16 and HPV 18 top the list) that cause genital infections can also cause cervical cancer and are also associated with vulvar cancer, anal cancer, and cancer of the penis (a rare cancer); they are called “high risk” types. Merck's Vaccine , Gardasil, is approved for young girls from 9-years-old, to prevent infection. Other types of HPV that cause raised external genital warts, called "low-risk" types, are not usually found on a female’s cervix, and are not linked with cancer.

Sometimes genital warts get larger during pregnancy, making it difficult to urinate, and if the warts are in the vagina, they can make the vagina less elastic and cause obstruction during delivery. Although rare, it is a potentially life-threatening condition when infants, born to mothers with genital warts, develop warts in their throats (laryngeal papillomatosis). This condition requires frequent laser surgery to prevent obstruction of the breathing passages.

Symptoms

Genital warts are the obvious signs of genital HPV infection, but many people have a genital HPV infection without genital warts. Half of the women infected with HPV, in one study sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), had no obvious symptoms. Genital warts can be very tiny, occur in clusters, or can spread into large masses in the genital or anal area In women, the warts occur on the outside and inside of the vagina, on cervix, or around the anus. Genital warts are less common in men, but may be found on the tip or shaft of the penis, on the scrotum, or around the anus. Genital warts can develop in the mouth or throat of a person who has had oral sex with an infected person, though it rarely happens.

Testing

A doctor usually can visually diagnose genital warts.

By applying vinegar (acetic acid) to whiten areas of suspected infection, a doctor may be able to identify invisible warts, especially if a procedure called colposcopy is performed. A doctor may use a magnifying instrument to examine the vagina and cervix, in colposcopy, or use a microscope to examine a small piece of tissue.

A Pap smear test also may be used to identify the possible presence of cervical HPV infection. The Pap smear is sent to a lab, where cells scraped from the cervix are examined under a microscope to see if they are cancerous or detect any other abnormality.

Treatment

In some cases, genital warts often disappear even without treatment; sometimes they may develop a fleshy, small raised growth that looks like cauliflower. There is no way to predict whether the warts will grow or disappear. Although treatments can get rid of the warts, none can destroy the virus. Since the virus is still remains in the body, warts often come back after treatment.

Depending on factors such as the size and location of the genital warts, there several ways to treat them. Prescribed treatments include:imiquimod, podophyllin anti-mitotic solution, podofilox solution, fluorouracil cream, and Trichloroacetic acid. Podophyllin or podofilox are absorbed by the skin may cause birth defects, so if you are pregnant, do NOT use them. If you are pregnant, it is also recommended that you do NOT use fluorouracil cream.

Small warts can be removed by cryosurgery (freezing), electrocautery (burning), or laser treatment. The doctor might have to use surgery to remove large warts that have not responded to other treatment.

Nontoxic and noninvasive homeopathic remedies are also proven to help eliminate warts. “Warts No More” is all natural and safely treats warts with 100% pure organic essential oils and plant extracts.

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Vaccines

Merck

Merck’s study produced an effective vaccine! Merck's investigational vaccine GARDASIL™ prevented 100% of cervical pre-cancers and non-invasive cervical cancers associated with HPV Types 16 and 18 in their clinical study. The subjects were nonpregnant women ages 16 to 23 with no prior abnormal Pap smears and no more than 5 lifetime male sex partners. After initial evaluation, including cervical cytology and HPV assessment, the women received three injections of vaccine or placebo at day 0, month 2, and month 6 of the study. Participants were followed for 4 years after the third injection.

GARDASIL was designed to target HPV types 16 and 18, which account for 70% of cervical cancers, and HPV types 6 and 11, which account for 90% of cases of genital warts. A trial continues, as part of the ongoing phase III program for GARDASIL, which involves over 25,000 people in 33 countries worldwide.

On June 8, 2006, the Food and Drug Administration (FDA) approved GARDASIL, the only vaccine available in the U.S. for the prevention of HPV 16 and HPV 18 related cervical cancer, for use in girls and women ages 9 to 26 years.

On June 29, 2006, Merck announced that the U.S. Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices (ACIP) voted unanimously to recommend that girls and women 11 to 26 years old be vaccinated with GARDASIL to prevent cervical cancer, precancerous and low-grade lesions, and genital warts caused by HPV 6, 11, 16 and 18. The Committee recommended that GARDASIL be administered to 11 and 12- year-old females and to females aged 13 to 26 who have not previously been vaccinated, and that 9 and 10-year-old females can be vaccinated with GARDASIL at the discretion of their physicians. The ACIP stated that Pap and HPV screening prior to vaccination are not necessary. The ACIP also recommended that females can receive GARDASIL regardless of whether they have or previously had an abnormal Pap test, a positive HPV test or genital warts.

GlaxoSmithKline

GlaxoSmithKline also is developing a vaccine targeting the strains HPV 16 and HPV 18. The GlaxoSmithKline studies are “almost identical” to the findings of Merck (Reuters, 4/6/2005). GlaxoSmithKline plans to file for regulatory approval for its vaccine (Cervanix™) in Europe in 2006.

New data shows Cervarix™, GlaxoSmithKline's HPV 16 and 18 cervical cancer candidate vaccine, is highly immunogenic and well-tolerated in women over 25 years of age. In this Phase III study, 100 per cent of women across all study age groups (15-55 years of age) vaccinated with GlaxoSmithKline’s cervical cancer candidate vaccine demonstrated antibody response against HPV 16 and HPV 18 ( the two most common cancer-causing HPV types) one month after completion of the vaccination course. All women remained seropositive when evaluated at 12 months after the first dose, with antibody levels substantially higher than those reported following natural infection. GlaxoSmithKline’s cervical cancer candidate vaccine is formulated with the proprietary innovative adjuvant system AS04, selected to ensure this vaccine confers strong and sustained antibody levels.

It is estimated 4,100 women will die of cervical cancer this year. Each year about 15,000 women in the United States learn that they have cervical cancer. Worldwide, about 500,000 new cases of cervical cancer are diagnosed each year, resulting in 290,000 deaths, making cervical cancer the second or third most common cancer among women. Cervical cancer and colorectal cancer are virtually tied for second place after breast cancer; cervical cancer is the number one killer in undeveloped countries.

HPV and Colorectal and Anal Cancer

"Colorectal Papillomavirus Infection in Patients with Colorectal Cancer"
Sohrab Bodaghi, Koji Yamanegi, Shu-Yuan Xiao, Maria Da Costa, Joel M. Palefsky and Zhi-Ming Zheng

Though HPVs role in colorectal cancer remains controversial, the results of this study suggest that colorectal HPV infection is common in patients with colorectal cancer, with HPV 16 being the most prevalent type. HPV infection may play a role in colorectal carcinogenesis.

"Age-Related Prevalence of Anal Cancer Precursors in Homosexual Men:
The EXPLORE Study

Peter V. Chin-Hong, Eric Vittinghoff, Ross D. Cranston, Lynette Browne, Susan Buchbinder, Grant Colfax, Maria Da Costa, Teresa Darragh, Dana Jones Benet, Franklyn Judson, Beryl Koblin, Kenneth H. Mayer, Joel M. Palefsky

HPV is causally linked to the development of anal cancer. The United States has a higher incidence of anal cancer among men who have sex with men than the incidence of cervical cancer among women. This study concludes that sexually active HIV-negative men having sex with other men, in all age groups, have a high prevalence of anal squamous intraepithelial lesions, possibly reflecting their ongoing sexual exposure to HPV.

HPV and Oral and Head Cancer

"Human Papillomavirus in Oral Exfoliated Cells and Risk of
Head and Neck Cancer"
Elaine M. Smith, Justine M. Ritchie, Kurt F. Summersgill, Henry T. Hoffman, Dong Hong Wang, Thomas H. Haugen, Lubomir P. Turek

HPV has been associated with the development of head and neck cancers. This study investigates whether the risk factors for head and neck cancer in relation to HPV infection are different from those in the absence of HPV infection and whether HPV detected in oral exfoliated cells is an independent predictor of head and neck cancer risk. This study concluded that infection of oral exfoliated cells with HPV high risk types, HPV 16 being the most frequently detected type, is a risk factor for head and neck cancer, independent of alcohol and tobacco use, and exacerbates when combined with alcohol consumption. HPV testing of an oral rinse may give insight to an HPV related head and neck cancer.

"Human Papillomavirus and Oral Cancer:
The International Agency for Research on Cancer Multicenter Study"

Rolando Herrero, Xavier Castellsagué, Michael Pawlita, Jolanta Lissowska, Frank Kee, Prabda Balaram, Thangarajan Rajkumar, Hema Sridhar, Barbara Rose, Javier Pintos, Leticia Fernández, Ali Idris, María José Sánchez, Adoración Nieto, Renato Talamini, Alessandra Tavani, F. Xavier Bosch, Ulrich Reidel, Peter J. F. Snijders, Chris J. L. M. Meijer, Raphael Viscidi, Nubia Muñoz, Silvia Franceschi For the IARC Multicenter Oral Cancer Study Group

HPV appears to be involved in the etiology of cancer of the oral cavity and oropharynx. This study conducted a multicenter case-control study of cancer of the oral cavity and oropharynx in nine countries, and concluded HPV appears to play an etiologic role in many cancers of the oropharynx and possibly a small subgroup of cancers of the oral cavity. The most common HPV type in genital cancers (HPV 16) was also the most common in these tumors. The transmission of HPV to the oral cavity still needs further investigation.

"Oral Cancer Risk in Relation to Sexual History and Evidence of
Human Papillomavirus Infection"

Stephen M. Schwartz, Janet R. Daling, David R. Doody, Gregory C. Wipf, Joseph J. Carter, Margaret M. Madeleine, Er-Jia Mao, E. Dawn Fitzgibbons, Shixuan Huang, Anna Marie Beckmann, James K. McDougall, Denise A. Galloway

Experimental analyses of human tumors suggest HPVs are etiologic factors in the development of oral squamous cell carcinoma. This study concluded that HPV 16 infection may contribute to the development of a small proportion of oral squamous cell carcinomas in 284 residents of three counties in western Washington State, most likely in combination with cigarette smoking. Among males, the age-, smoking-, and alcohol consumption- adjusted risk of oral cancer increased with decreasing age at first regular intercourse and increased with increasing number of opposite sex partners, and history of genital warts. These patterns were not seen among women. For both sexes combined, the associations with sexual history were strongest for tumors containing HPV 16.

HPV and Lung Cancer

"The Association of Human Papillomavirus 16/18 Infection with Lung Cancer among Nonsmoking Taiwanese Women"
Ya-Wen Cheng, Hui-Ling Chiou, Gwo-Tarng Sheu, Ling-Ling Hsieh, Jung-Ta Chen, Chih-Yi Chen, Jan-Ming Su and Huei Lee

This study suggests there may be a link between HPV 16 and HPV 18 infection and with lung cancer among non-smoking Taiwanese women. The study’s non-smoking female lung cancer patients, who were older than 60 years old, had significantly high prevalence of HPV 16 and HPV 18 infection.