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Genital Warts and Human Papillomavirus

Infection of the vulvar skin with HPV is probably the most common vulvar infection in the United States currently. Although the virus apparently can be transmitted by sexual activity, it is also likely that it may be spread by noncoital sexual activity, by oral sexual activity, and perhaps at birth worts, warts, genital warts.

Some 80 subtypes of HPV have been described so far, and more subtypes will certainly follow. In most cases, visible warts are caused by subtypes 6 and 11. These subtypes do not seem to be associated with a significant increase in neoplasia. Small genital warts are easily recognized and usually are easily treated in the office with the application of an agent such as

More extensive treatment may be necessary when large masses of warts are present. If warts do not respond readily to therapy, immunosuppression should be considered, including that caused by HIV.

Infection with other subtypes of HPV are far more common. That is, most infected men and women do not develop genital warts. The single most common viral subtype identified in vulvar tissue is HPV 16. Although this virus is associated with neoplasia, very few of the

Human papillomavirus infection of the vulva frequently is overdiagnosed both clinically and histologically. Small vulvar papillae and whitening of the epithelium after the application of acetic acid are commonly interpreted as evidence of HPV infection. In addition, biopsy of the vulvar skin often may be interpreted as showing HPV infection when DNA analysis fails to identify the virus. The clinician should avoid making the diagnosis without proof of infection. Unless warts develop, treatment of HPV of the vulva is

Biopsies of vulvar skin that is infected with the HPV virus often are reported as showing vulva intraepithelial neoplasia (VIN) grade I. At the 1997 ACOG Annual Clinical Meeting, the panel of experts who presented the Richardson symposium agreed that VIN I is not a precursor of vulvar cancer and usually should