My Doctor Online The Permanente Medical Group

Symptoms and Diagnosis

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Most people with HPV have no symptoms and will not develop any health problems from the infection. Often, a person will be infected with more than 1 type of HPV. Typically, within 12 months after the infection occurs, the virus is no longer detectable.

Some types of HPV can cause genital warts. Genital warts usually appear as cauliflower-like bumps or flat pink, red, or flesh-colored patches inside the vagina, on the lips around the vagina, on the penis or scrotum, around the anus, or occasionally on the belly or thighs. The affected area can itch or feel irritated, but sometimes the warts do not cause any discomfort at all. Often, an outbreak of genital warts may occur when the immune system is weakened.

Other types of HPV can be associated with cervical and anal cancer, but this is rare. These types usually do not cause warts. If a woman has an abnormal Pap test, follow-up testing may be needed to determine if HPV is the cause. The two main ways to know if you have HPV are:

• If genital warts appear
• If you are a woman and you have abnormal Pap test results

Causes

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HPV is spread by skin-to-skin contact, usually during sex. Catching HPV through vaginal and anal sex is the most common, but it is possible to be infected during oral sex as well.

HPV is spread easily during sex, even if condoms are used, and even if no genital warts are present. Because of this, the only sure way to protect yourself from HPV is not to have sex.

Talk with your partner

Talk openly and honestly with your partner about the risk for STDs and the importance of practicing safer sex. Remember that a person can be infected with an STD without knowing it. Be clear about what you will and will not do sexually and respect what your partner will and will not do. Decide together what is right for both of you.

Find Help if Your Partner Has Ever Hurt or Threatened You

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Unfortunately, abusive relationships are common. Abuse can include pressuring or forcing you to have sex, or refusing to use a condom to protect against pregnancy or STDs. If you think you are being abused, you can get help by talking to us or you can:

• Contact the National Domestic Violence Hotline, 1-800-799-7233 or 1-800-787-3224 for hearing/speech impaired.
• Visit the National Sexual Assault Hotline or call 1-800-656-4673.

Prevention

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• Get regular Pap tests. In most women who develop cervical cancer, the changes in their cervical cells were present for years before they became cancerous. These changes can be treated with early detection, so screening is very effective.
• If you smoke, quit now! If you are ready to quit, we can help. More information is available at your local Health Education Center or department, or you can visit kp.org/quitsmoking.

Lower your chances of getting HPV by:

• Limiting the number of sexual partners you have.
• Receiving the HPV vaccine before you become sexually active.

The HPV vaccine

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In 2006, the Food and Drug Administration approved an HPV vaccine (the brand name is Gardasil®) for girls and women from ages 9 to 26.  The vaccine protects against the strains of HPV that may cause precancerous changes in the cervix and some genital warts. 

• The vaccine is given in 3 doses.
• It works best when it is given to girls before they are sexually active (usually ages 9 to 12).
• Girls and young women between ages 13 and 26 may also consider the vaccine.
• The vaccine probably will not benefit women who have had more than 4 sexual partners in their lifetime.
• The vaccine is also approved for use in boys and young men.

We strongly recommend the vaccine for all girls 11 to 18 years old. We can talk about whether the vaccine is right for you at your next check-up.

If you have already had the HPV vaccine, you will still need to have a Pap test at least every 3 years. While the vaccine is effective against certain types of HPV, it does not prevent all the types that could possibly cause cervical cancer. It is also important to know that the HPV vaccine does not protect you against other sexually transmitted diseases like chlamydia, herpes, or HIV.

Risk Factors

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Sexual history. You have a greater chance of getting HPV if you have had multiple sexual partners (or if your partner has had lots of sexual partners).

Cigarette smoking. If you use tobacco, one of the best things you can do for your health is to quit now. Smoking doubles the risk of cervical cancer in women who have HPV. Exposure to second-hand smoke may also be a contributing factor.

A weakened immune system. If your immune system is weakened (you have HIV, for example, or you are undergoing chemotherapy) you should take extra precautions. You are at higher risk for catching HPV, and it is also more likely to develop into cervical cancer.

HPV, Genital Warts, and Pregnancy

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A pregnant woman who has HPV is more likely to develop genital warts than a woman with HPV who is not pregnant. Treatment of the warts may be recommended to prevent complications during the pregnancy.

• Genital warts may increase in size, bleed, or become infected with bacteria.
• In very rare cases, genital warts may partially obstruct the birth canal. In these cases, having a C-section may be necessary to prevent complications.

During a vaginal delivery, a woman can transmit the HPV infection to her baby, although this is very rare. Because HPV can be present but not active, it is possible for warts that were transmitted during delivery to appear up to 3 years after the baby's birth.

Treatments

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Sometimes genital warts clear up without treatment after a few months. However, they can sometimes grow and spread through the genital area. Although there is no cure for HPV, the symptoms can be treated.

We may recommend:

• Medication
• Surgical removal
• Freezing the warts
• Laser treatment

It may take several visits to completely remove the warts. The virus may still be present, even after the warts are gone, so passing it to your partner is still possible.

Living with HPV and Genital Warts

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HPV can be a difficult topic to discuss with a partner because, aside from not having sex, there is no reliable way to prevent HPV transmission. If you choose to tell your partner you have HPV, you may want to let him or her know that this is a very common virus that many sexually active people carry, and that it rarely causes serious problems for most people. 

Your Care with Me

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If you are worried about being exposed to HPV and you have one or more genital warts, make an appointment to see me. I will look at the size, number, and location of your warts and recommend one of several treatment options. If you do not have any warts, it will not be possible for us to tell for sure whether you have HPV. HPV by itself is almost never dangerous, and many types will go away over time without treatment.

If you have been diagnosed with genital warts, I will discuss your treatment options with you:

• If you have only a few genital warts, I may prescribe a medication that you can use at home or I may treat them in the office. We want to make sure that at-home treatment is effective, so please come back to my office if your warts do not respond to this kind of treatment.
• If you have many genital warts, or if you have warts that are not responding to at-home treatment, I may recommend surgical or laser treatment. I may perform these procedures myself, or I may refer you to a colleague who specializes in the procedure you need.

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Contacting Me

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

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How We Coordinate Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

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Convenient Resources for You

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As your personal physician, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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