STD Symptoms Even Older People Should Never Ignore
What Does HPV Look Like In Your Mouth?
Human papillomavirus (HPV) can affect the inside of the mouth, the tongue, and the lips. Symptoms of HPV in the mouth can include small, hard, bumps or growths. They may be slightly raised or flat, and they may be painless.
In most cases, the immune system clears human papillomavirus (HPV) from the body before it can cause a full infection and symptoms.
Some strains of HPV result in harmless oral lesions that usually resemble common warts, but doctors have linked some others with oral cancers.
Oral HPV spreads mostly through oral sex and mouth-to-mouth contact between people.
During mouth-to-genital or mouth-to-mouth contact, HPV particles in the saliva or mucus of someone with the virus enter someone without the infection through an open cut or sore in the mouth or throat.
During pregnancy, HPV can also pass to babies. In some cases, it may spread via oral contact with contaminated utensils or medical instruments.
The immune system usually destroys invading HPV particles before they cause disease. Healthy immune systems usually resolve HPV infections within 1–2 years. However, some HPV infections can persist.
The most significant risk factor for developing oral HPV is having oral sex or mouth-to-mouth contact with someone who has acquired an HPV infection.
Researchers are still trying to determine the full range of risk factors for oral HPV, but some known factors include:
The symptoms that the many different strains of HPV cause can vary slightly. Many people with minor cases of HPV do not have any apparent symptoms.
When it does cause a productive infection, HPV can cause growths that are:
HPV is the leading cause of oropharyngeal, or oral cavity, cancers, although this complication is rare. Cancer is most likely to result from infections that involve the tongue and base of the tongue into the throat.
The type of HPV called HPV 16 causes most oral cancers related to HPV.
Oral cancers tend to cause obvious symptoms, especially as they progress. Signs and symptoms of oral cancer include:
There is currently no easy way for a doctor to diagnose HPV. The most useful test for HPV is a polymerase chain reaction (PCR) test.
A PCR test takes a tiny fragment of the DNA that scientists have extracted from cells in a sample of mucus and amplifies it, making countless identical copies. Having so many copies of the DNA fragment allows scientists to look inside cells and detect minute quantities of abnormal or viral DNA.
In rare cases, when lesions are present in the mouth, a doctor may be able to diagnose HPV through an examination alone.
There is currently no treatment that can cure HPV or even reduce its growth.
Researchers have tried and tested a range of topical medications on HPV growths to no effect. Currently, surgical removal is the only way to treat HPV growths. Some doctors will also use cryotherapy with liquid nitrogen to freeze and remove the growths.
After a person receives a diagnosis, they will need to undergo testing for HPV every 8–12 months until the infection has cleared, or it is no longer possible to detect it in DNA samples.
One of the best ways for people to lower their risk of developing HPV is by getting vaccinated.
In the U.S., a vaccine called Gardasil 9 offers almost 100% protection against the strains of HPV associated with types of cancer — specifically, HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58.
Currently, doctors recommend that people up to 45 years of age have the HPV vaccination.
Children usually receive two doses, at least 6 months apart, between the ages of 11 and 12 years. Adolescents who receive their first dose of the vaccine at the age of 15 years or older will require three doses.
Aside from getting vaccinated, people can also reduce their risk of contracting HPV by:
They can also increase the likelihood of early detection by:
Most people who get HPV do not develop symptoms and clear the virus naturally.
However, those who experience symptoms will require medical monitoring to ensure that their body eventually rids itself of the virus and that growths do not become cancerous.
People with HPV can take steps to reduce the chance of the virus spreading to another person. For example, they can use barrier methods during sexual activity and communicate openly with any sexual partners about STIs.
HPV, Cervical Cancer Vaccine: 15 Facts
Gardasil, the new vaccine against human papilloma virus (HPV) -- which causes cervical cancer and genital warts -- is now available nationwide.
Here is what you need to know now about this new vaccine.
1. What is Gardasil?
Gardasil is a vaccine, licensed for use in June 2006, by the FDA. It targets four strains of human papillomavirus (HPV) -- HPV-6, 11, 16, and 18. HPV-16 and HPV-18 account for about 70% of all cervical cancers. HPV-6 and -11 cause about 90% of genital warts. HPV is also linked to anal cancer.
2. How does HPV spread?
Sexual activity spreads the virus, a very common one. It's one of the most common sexually transmitted diseases (STDs) in the country, according to the CDC, with more than 20 million people currently infected and another 6.2 million contracting the virus each year.
About half of those with HPV are aged 15 to 24. Surveys suggest 3.7% of U.S. Girls have sex by age 13, and 62.4% have had sex by the 12th grade.
3. Who should get the vaccine?
Gardasil is approved by the FDA for girls and women ages 9 to 26. The CDC and the American Academy of Pediatrics recommend that the vaccine be given routinely to girls at age 11 to 12 years old, although doctors may choose to vaccinate girls as young as 9. The CDC also recommends the vaccine for women age 13 to 26 who did not receive the vaccine at an earlier age.
However, if a girl or woman is already infected with HPV, the vaccine will not prevent that strain of HPV from causing disease. It will protect against new infections with other strains of HPV included in the vaccine.
The vaccine is also being studied in women up to age 45, although that group may be targeted for the vaccine later.
The vaccine is being studied in males, too. Men can get HPV infections and can pass the virus to their sex partners. HPV causes genital warts and is associated with rare cases of cancer of the penis. Particularly in gay men, HPV is linked to anal cancers. Merck is currently testing Gardasil in men, including gay men.
4. What is the best way to talk to my daughter about this?
Emphasize that the primary goal is to help prevent cervical cancer. If you, as a parent, are worried this will give your child a false sense of security that they can't catch a sexually transmitted infection from sexual activity, you can also emphasize that the vaccine only protects against certain strains of HPV -- not against any of the many other types of sexually transmitted infections.
5. Does Gardasil protect against all cervical cancers?
No. The vaccine does protect against the strains of HPV most likely to cause cancer. But it does not protect against all HPV strains.
However, recent reports suggest that the vaccine may give wider protection than originally thought. There is preliminary evidence it may offer some protection against other HPV strains, which cause 8% or 9% of cervical cancers.
6. How effective is the new vaccine?
Studies have shown it is 100% effective in the prevention of cervical precancers and noninvasive cervical cancers caused by HPV-16 and 18 in those not already exposed to those strains, according to Merck & Co. Inc., which makes Gardasil. Merck is a WebMD sponsor.
7. If someone is already sexually active, will this vaccine still work?
If a person has been infected with any of the four strains the vaccine protects against, the vaccine won't provide protection against that type. But it will prevent infection from the other three.
8. How long is Gardasil effective?
Research suggests the vaccine lasts at least four years. Long-term results are not yet certain. The protection might last longer.
9. Does the vaccine actually contain HPV or any live virus?
No. It has a virus-like particle, but not the actual virus.
10. Is Gardasil safe?
Clinical trial data have found it is safe.
11. What does the vaccine cost? Will insurance cover it?
The "list" price is about $120 per dose, and three doses are needed. But that is the price your doctor pays to the manufacturer. It does not include the cost of an office visit or other charges, so the cost to individuals could be higher. The federal Vaccines for Children Program will provide free vaccines to those under age 19 who qualify. More information on that program is on the CDC web site, www.Cdc.Gov. A number of insurers say they plan to cover the costs.
12. Is it available everywhere in the U.S.?
Supplies have been shipped nationwide, according to Merck, although your individual doctor's office or clinic may not have ordered it.
13. Will the new vaccine make cervical cancer screens such as the Pap test passé?
No. Screening with a Pap test is still needed, since the vaccine does not protect against all cervical cancer.
14. Is this the only vaccine for cervical cancer?
There's a second vaccine in the works: Cervarix, from GlaxoSmithKline. Cervarix targets two HPV strains, HPV-16 and HPV-18. GSK says it plans to seek FDA approval for Cervarix by the end of the year. Early studies find that this vaccine, like Gardasil, is extremely safe and effective. GlaxoSmithKline is a WebMD sponsor.
15. How common is cervical cancer and how deadly?
The American Cancer Society predicts that in 2007, there will be about 11,150 new U.S. Cases of invasive cervical cancer, and 3,670 cervical-cancer deaths.
Cervical cancer is the second most common cancer in women worldwide. There are about 500,000 new cases, and 250,000 cervical-cancer deaths each year. According to the World Health Organization, nearly 80% of cases occur in low-income countries, where cervical cancer is the most common cancer in women
HPV Warts: The Misunderstood STD
Fast Facts About the Human PapillomavirusMore than 42 million Americans are thought to have an active HPV infection at any given time, according to the Centers for Disease Control and Prevention (CDC). An additional 13 million people become newly infected with HPV each year.
But not all strains of HPV cause genital warts. Some cause common skin warts, and some can cause cellular changes that can lead to cancer of the cervix, vagina, vulva, anus, penis, and oropharynx — the area at the back of the throat that includes the base of the tongue and tonsils.
For many people, an HPV infection never causes any symptoms or harm because the body is able to clear the virus naturally.
But in some cases, according to one study, the virus may still be present in the body and may become active if a person's immune system is weakened because of illness or age.
"I've had older women show up with the warts for the first time in their lives, and they're widows who haven't had sex for 20 years," says Anita L. Nelson, MD, a professor of obstetrics and gynecology and a staff physician at Harbor-UCLA Medical Center in Torrance, California.
"Suddenly, their bodies can't cope with a virus that they've been walking around with for decades, and it shows itself," Dr. Nelson says.
Your Common HPV Questions AnsweredDiscovering you have a sexually transmitted infection is never a pleasant surprise, but knowing more about it and the treatments available can help to set your mind at ease.
Here, Nelson answers some common questions about HPV.
Q. What causes genital warts?
A. Genital warts are caused by certain types of sexually transmitted HPV. There are more than 40 HPV types that can affect the genital area of women and men. But more than 90 percent of genital warts are caused by just two types: HPV 6 and 11.
Q. How common are HPV 6 and 11?
A. One percent of all sexually active women and men get genital warts every year. We see them in everyone — women who are pregnant, young adults exploring their sexuality, older women and men.
Q. How soon after contact do the warts typically occur?
A. That's one of the most frequently asked questions because a person's really asking, "Who gave it to me?"
Typically, you get warts within one to four months of being infected with HPV. But the virus can be kept in check by the immune system for longer than that.
Q. Does everyone exposed to HPV 6 and 11 get warts?
No. Warts can appear after a person is infected, or you can have none at all, as the body's immune system fights the virus.
Q. Can HPV warts surface at any time in your life — even years after exposure?
A. Yes. Sometimes, we'll see them later in life, when people get sick or their immune system gets compromised by chemotherapy or other drugs.
So they don't just occur when you have a new sex partner.
Q. How can sexually active individuals avoid getting HPV warts?
A. Using condoms — or "finger condoms" for manual stimulation — consistently reduces the risk of acquiring or transmitting the virus that causes the warts.
Also, interestingly, HPV infects rapidly dividing cells. So anywhere there's a little trauma, tear, or abrasion, the body can pick up the virus and bring it inside the cells.
Sometimes, we'll see the warts in younger women because it's the first time they've had sex and the vaginal tissue isn't quite elastic. It's the same with some older women who have vaginal dryness.
Q. Does the number of sex partners a person has over a lifetime increase the risk of HPV warts?
A. Yes, people who have had more than 10 sexual partners over their lifetime are more likely to report a diagnosis of genital warts than those who've had one or two.
The more sex partners you have, the more likely you are to have different types of HPV infection as well.
And there's no limit to how many different HPV types you can have. Limiting the number of partners and using condoms are very important to reducing your risk.
Q. Are HPV warts spread only through genital contact?
A. No, you can spread the virus from any moist source to another. The same type of warts that develop on the genitals can also grow in the mouth and throat and even in the insides of the eyelids.
But there has to be a source, and generally, you're going to be carrying the virus in the genitals.
We have to be quite frank about sexual practices today. There's a lot of oral-genital contact. If one partner has a wart in their mouth, the other partner can wind up with warts on the genitalia if there's oral-genital contact.
Q. Can HPV warts lead to cervical cancer?
A. The two types of HPV that cause most genital warts — types 6 and 11 — do not cause cancer.
However, some types of HPV that are associated with cancer have been found in genital warts.
It's also possible to have or get more than one type of HPV at once, including those that can cause cancers in the genital area, such as cervical, vulvar, or anal cancer, or cancers of the mouth and throat.
Having genital warts caused by noncancer-causing HPV strains doesn't mean you don't also have potentially cancer-causing HPV.
Q. Are genital warts more a psychological issue than a health danger?
A. Genital warts may cause some physical discomfort, such as burning and itching, or even bleeding in an intimate situation.
The various treatments to remove genital warts can also cause pain and irritation and can be expensive, depending on what type of treatment you use and what kind of health insurance coverage you have.
For many people, though, there is significant psychological discomfort in realizing they've been exposed to a virus they're going to live with for the rest of their lives and could transmit to others.
Q. Are women more likely than men to get the warts?
A. No, but we have more statistics on women because doctors tend to see women much more routinely. Gynecologists, for example, do Pap smears and visually inspect a woman's genitals.
Q. Can Pap tests detect HPV warts?
A. No. Pap tests detect abnormalities in cervical cells that may be cancerous or precancerous. A newer HPV test detects the presence of the virus in cervical cells.
RELATED: New Analysis Suggests Cervical Cancer Screenings Should Continue After Age 65
Q. How are genital warts diagnosed?
A. You want to have them professionally diagnosed. Usually, physicians just eyeball them and don't have to do a biopsy. A doctor can often tell it's a wart because warts have a little attachment to the skin and multiple protuberances from the single stalk.
Q. What do the warts look like?
A. They can look soft and fleshy, almost like a skin tag, or they can be rock-hard and large with branches like a cauliflower.
They can be a small little dot or bigger than your fist.
Q. Are they easier to treat if discovered early?
A. Yes. Don't wait if you think you might have genital warts. When you feel a bump, especially around the opening of the vagina, or behind the vagina, see your doctor.
Also, it's important to know that once you get infected, it's a regional infection. For example, you can get a wart inside your anus even if you haven't had anal sex.
Q. How soon should a wart be treated?
A. It's not a medical emergency. But the HPV warts that are really hard to treat have been there for months and have hardened.
If you can't get an appointment for two to three weeks after feeling the bump, don't freak out. But don't wait months.
Most women will get the HPV virus, and their body can handle it. But women with persistent HPV infections are the ones we want to identify.
I want to see a young woman three or four years after her first sexual encounter to see if her body can handle the virus.
Is she having persistent infections, which could be a predictor of cervical cancer? Those are the women we want to find, so we can treat any precancers.
For women over age 30 who got the virus earlier in life, we're testing to see if they show cells that go awry and also to determine if they're still shedding the virus.
Q. When a woman has visible HPV warts, should she stop having sex?
A. When we're treating women for warts, we ask them to be particularly careful and maybe even abstain from sex.
That's because as we're treating it, there are inflammatory changes and maybe even a little ulcer, and those tissues are more vulnerable to acquiring another infection.
So take it easy for a while, or use condoms. Abstain from oral sex, too.
Q. Once you have HPV warts, are you always contagious?
A. You spread more viral particles when you have a concentration of warts. But with treatment, you rev up the body's immune system, and it will help reduce the amount of viruses you have and spread.
You also can avoid spreading it through practicing safer sex.
Q. What's the recommended treatment for HPV warts?
A. Get rid of the warts. We can treat fresh warts with easy topical therapies. There are three creams your doctor can prescribe for external genital warts that can be applied at home.
Q. How do these work?
A. Podofilox works by destroying the skin of the wart. The two imiquimods are really groundbreaking because they don't play with the wart at all but instead turn on the body's immune system, which attacks the virus in the wart so it melts away.
These therapies have really simplified things. When a new wart comes, just put cream on it.
Q. Are there natural remedies?
A. Sinecatechins (Veregen) is a green tea extract, which is applied three times a day for up to 16 weeks. We're not quite sure how it works, but some people really like the idea because it's natural. Green tea is an antioxidant. You use it in ointment form.
Q. How are hardened warts treated?
A. If you've had them for a while and they've hardened, then you're talking doctor-administered destructive therapies.
We can snip them off if they have a tiny base. Or we can freeze them with acids to dehydrate them and kill the cells.
For the ones that are really hard to deal with, we'll surgically excise them or do laser treatments.
Q. Are women more likely to get HPV warts if they're on oral contraceptives?
A. It isn't that the pill causes more problems but that condoms protect against HPV infection, and a woman who's on the pill may be less likely to use condoms.
That said, if someone's warts don't disappear after treatment, it may be that her immune system is teetering on the edge, and the pill pushed it over.
But I would never stop prescribing a woman's birth control pill just because she had a wart.
Q. Are HPV warts a danger during pregnancy?
A. The virus can be passed on before or during birth, but the warts don't pose a major risk to the baby's health.
Symptoms of genital warts can get worse during pregnancy, however, because a woman's immune system gets suppressed.
Warts can grow so large they'll obstruct delivery of the baby. And you have to treat the warts in a way that's not harmful to the baby.
Q. Does the HPV vaccine protect against genital warts?
A. Yes, Gardasil 9, which is the HPV vaccine used in the United States today, as well as the original Gardasil vaccine, protect against the HPV 6 and 11, which cause 90 percent of genital warts.
Cervarix, a vaccine that is no longer available in the United States but is available elsewhere in the world, protects only against HPV type 16 and 18, which significantly raise the risk of cervical, genital, and oropharyngeal cancers. Cervarix does not protect against the strains of HPV that cause warts.
RELATED: What Are HPV 16 and 18?
Q. What are the top things a woman should keep in mind about HPV warts?
A. Use condoms, and be choosy in your partners. People ought to take a good look at what they're being exposed to when they're getting into a relationship where there's going to be sex. But keep in mind that a person can have the virus that causes genital warts without having visible warts.
Also, make sure you're paying as much attention to health in your genital area as you are to other parts of your body. Some women are more in tune with the bottoms of their feet than they are with their genitalia.
Examine your genitalia, and feel if there are any bumps or areas of soreness where there shouldn't be.
And don't hesitate to see your doctor if you do find anything.
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