HPV or Human Papillomavirus is a virus that infects the skin and the mucous membranes of the body. To date, more than 150 types of HPV have been isolated, some of which are responsible for skin papillomas, others for warts, while more than 40 types are implicated in the infection of the genital and perianal area.
Most HPV infections remain asymptomatic or are transient and self-limiting. HPV types, however, are recognized in both “low risk” and “high risk”. High risk HPV types (for example, types 6 and 11) are responsible for genital warts and recurrent respiratory papillomatosis. “High risk” types (for example, types 16 and 18) are responsible for the development of cervical cancer as well as cancer of the anus, penis, vulva, vagina and the oropharyngeal cavity.
Skin papillomas, are innocent, benign HPV lesions, which mainly occur in areas where our skin presents folds (e.g., neck, armpits, under the breasts in women, thigh-groin folds, etc.). These are small skin nodules, usually in the color of the skin or darker with thin stalk.
They often get injured and bleed, resulting in possible transmission of HPV particles in the surrounding areas. For this reason they exhibit a high proliferation rate. In general, papillomas do not cause any symptoms, when they inflame, however, they can become itchy and painful and require topical or systemic treatment with antibiotics.
Warts are also an HPV infection and usually occur in children and young adults, while the most frequent sites of occurrence are the fingers of the hands and the soles. They are benign HPV skin vegetations with characteristic “warty” (cauliflower) texture. They may occur up to 12 months following HPV infection. Warts can be quite troublesome and painful depending on the site of their occurrence (e.g., at the sole where they can cause walking difficulty for the patient) and their transmission to other sites is quite easy; this is the reason why their removal is imperative.
Genital warts (condylomata acuminata) are the most common HPV lesions. Ninety percent (90%) of genital warts are caused by the HPV types 6 and 11. Many times an infection with other HPV types, such as 16, 18, 31, 33 and 35 coexists, and in these cases they are associated with lesions of high grade cervical intraepithelial neoplasia.
Genital warts are usually asymptomatic, but depending on their size and the anatomical region, in which they occur, they can be painful or itchy or they can even bleed or cause dyspareunia (pain during sexual intercourse). They can take the form of flat, papular lesions or cauliflower-like skin lesions (condylomata acuminata) found in the genital and perianal region.
These HPV lesions can be solitary or appear in clusters, forming larger “cauliflower” shaped lesions.
Their diagnosis is made on the basis of clinical examination by a specialist Dermatologist-Venereologist. In some cases, clinical diagnosis can also be confirmed by biopsy. Patients with chronic problems or with frequently recurrent lesions are commended to undergo HPV DNA test. This test provides identification of the HPV types and a more detailed diagnosis of the problem.