Doctors claim that more than 60 per cent of sexually active adults are infected with human papillomavirus (HPV), and it is implicated in cervical cancer.

HPV, or human papillomavirus virus, causes unsightly warts in various parts of the body, especially around the genitals when it is more commonly known as genital warts. However, the types of HPV that cause warts to grow on hands and feet are not the same as those that form warts in the mouth or in the genital area.

Not all HPV viruses cause warts. Some are sub-clinical, which means the virus lives in the skin without any sign or symptom. This is why many people with HPV do not know they have it. Some forms of HPV can also cause cancers of the vulva in women, the penis in men and head, neck and anal cancers in men and women.

Evidence suggests that HPV is strongly implicated in cervical changes and the development of cervical cancer - the virus was present in 99.7 per cent of tumours taken from 1,000 women with the disease. A test for HPV that could be used to detect cervical cancer is not yet available on the NHS. Meanwhile, it is important for women to maintain regular cervical smear tests. The NHS cervical screening programme in the UK is offered to all women every three to five years, from the age of 25 to age 64.

Many women discover they are infected only after they've had a cervical smear test done, as the smear report includes any evidence of HPV infection. The presence of HPV on the smear may or may not be associated with abnormal cervical cells.

Types of HPV
Studies conducted in the past 10 years have pinpointed the specific HPV types that are responsible for the development of genital warts. Each HPV type has been numbered and divided into 'high risk' or 'low risk' categories, depending on whether the particular virus is associated with the development of cancer. For example, HPV types 6 and 11, which are associated with genital warts, are considered 'low risk.' HPV types 16 and 18, which have been found on the genitals and in the anus, but aren't usually contained in visible warts, have been linked to cancers in both men and women and are therefore considered a higher risk.

Can it be prevented?
HPV is so widespread that it is very difficult to prevent people from catching it. The majority of people infected with HPV have no symptoms and are completely unaware that they carry the virus. There is doubt whether condoms provide adequate protection against HPV transmission during sex. However, despite the worry about cervical cancer, in the great majority of cases HPV's only threat is that it can cause unsightly warts, which usually disappear without treatment.

The immune system can usually keep the virus in check without the help of drugs or other medical treatment. Only about one per cent of all sexually active men and women have genital HPV infection with symptoms. Eating a balanced diet, exercising regularly and avoiding tobacco and alcohol are simple ways to help maintain a strong immune system.

The most recent development in the drive to reduce the incidence of cervical cancer, is the creation of a vaccine against HPV types 16 and 18. The Department of Health has agreed in principle to introduce a vaccination programme in 2008. The vaccine has been shown to be effective and safe. The current debate is about who to vaccinate and at what age. The vaccine is likely to be most effective if given to girls before they are at risk of HPV infection, i.e. before they become sexually active. There is a proposal to vaccinate girls at age 12, but this has generated a moral and ethical debate, with opponents voicing concern that HPV vaccination will condone or promote promiscuity. Also, vaccinations at this age usually require parental consent, and some parents may be opposed. The vaccine is expensive, and some people feel it should only be given to those at high risk, i.e to slightly older girls who are or intend to become sexually active, rather than implementing a mass vaccination programme at age 12. All these issues should be clarified before vaccination starts in 2008.

Is there a cure?
Currently, HPV cannot be cured. At present the best defence against HPV is to choose sexual partners wisely, as people who have had many sexual partners are at a higher risk of contracting HPV.

How is it transmitted?
HPV is spread by skin-to-skin contact with an HPV-infected area, whether or not warts are visible. It can take weeks, months or years for genital warts to surface after sex with an infected person. So it is almost impossible to pinpoint when or who transmitted the virus.

When to see your doctor
If you notice any unusual growths, bumps or skin changes on or near the penis, vagina, vulva or anus, or any unusual itching, pain or bleeding, you should make an appointment to see your GP. You should also seek medical advice if a sexual partner tells you that he or she has genital HPV or genital warts.

What is the treatment?
Most genital warts are treated because people don't like the look of them. Even with treatment, about one in four people will have a recurrence within three months. Studies have shown that small warts of short duration (less than one year) respond better to therapy than large warts of long duration. All treatments can cause mild irritation.

No single treatment is ideal for all women. The goal of treatment should be to remove visible genital warts and get rid of annoying symptoms. None of the available treatments is better than another, and no single treatment is ideal for all cases.

DIY treatments

• Podophyllotoxin solution or gel is a relatively cheap, safe and easy-to-use treatment that can be applied by you. It must be applied twice a day for three days, followed by four days of no therapy. It can cause considerable irritation of the treated area.


• Imiquimod cream is a treatment for external genital warts and perianal warts. It is safe, effective, easy-to-use and, unlike podophyllotoxin, is not a tissue-destructive therapy, although it can cause local reactions including itching, redness and pain. This cream stimulates the immune system to target the warts. You apply the cream three times a week for up to 16 weeks.


• Although comparative studies of the two drugs have not been conducted, it appears that podophyllotoxin works faster and is less expensive, although imiquimod may be more effective and less irritating. Both treatments require that you be able to identify and reach the warts. Responses to these drugs can include tenderness, irritation and localised burning.

Prescription treatments

• Cryotherapy - freezing off the wart with liquid nitrogen is inexpensive but can be painful and take several weeks.
• Podophyllin - a chemical that must be applied by your doctor and washed off after use.
• Trichloracetic acid (TCA) should also only be applied by a doctor.
• Laser therapy using an intense light to destroy the warts. Treatment can be expensive and can cause burning and scarring if not performed correctly.

Points to remember about HPV infection

• Getting rid of the warts may take one to six months and there may be recurrences, but they will eventually go.
• Smokers with HPV infections should give up, as smoking adds to the harm caused by the virus.
• Women with HPV infections should have regular cervical smear tests to catch any abnormal cells.
• Use barrier methods of contraception with sexual partners while the infection is present.
• HPV infection can lie dormant so it does not necessarily imply infidelity.
• Your current partner, and any others you have had sexual contact with in the past six months, should be checked by their doctor for signs of HPV infection.