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Dec 10 2008

A Urologist’s Wart Schpeel to Patients

Posted at 4:32 pm under General Info

A Urologist's Wart Schpeel to Patients

My wart schpeel
I see a fair number patient consults for “rule-out HPV” or “rule-out warts.”  The typical scenario is the following:

A woman goes to her gynecologist for a routine Pap smear and is told that the results came back positive for HPV.  She is then told by her doctor to have her male partner “checked-out.”
What does all that mean and what really happened at that patient’s doctor visit?


In a nutshell, the American College of Ob-Gyn recommends that women get periodic Par smears since Pap smears can detect cervical cancer early, and this saves lives.  Pap smears can also detect other disorders such as yeast infections and HPV infections.  HPV is the virus that causes genital warts.  On a Pap smear, the HPV virus produces cells with a characteristic look that most medical students would easily recognize.  That finding is called a Koilocyte.  When a Pap test shows Koilocytes, it indicates that the woman has been exposed to the HPV virus.

So what?

HPV is what is known as a ubiquitous virus.  This means that everyone—and their mothers—has been exposed to it at some point in their lives.  Most people just don’t know it.  The HPV virus family has many strains—more than 400.  Some strains cause genital warts.  Some strains cause Pap smear changes on women.  Some strains cause penile cancer while other strains cause cervical cancer.  Some strains cause warts on the ankles of young children.  And still, some strains don’t do anything that we can detect or that cause problems.

Here is the real interesting part about the HPV virus.  It exhibits a characteristic called tropism.
TROPISM

Tropism is a feature of many viruses.  It means that a specific virus can only attack and cause damage to a specific target, such as a cell in the cervix or on the ankle or a blood cell.  HIV has tropism for CD-4 blood cells.  HPV has tropism also.  Some strains will only cause problems on the ankle while other strains will only cause penile warts.  Other strains will only cause Koilocyte changes on a Pap smear while a different strain will cause cervical cancer.

Clinically this means that when a woman has a positive Pap test, it does not mean that the man necessarily infected her with the virus or that the man has a penile wart.  It does not mean that he did not do so either.  It just means that the virus strain that caused the Pap findings may not be the same strain that would cause a penile wart on the man.  It also means that the man should be evaluated for the presence of any lesions or warts on his penis.

Does that mean that you will always need to use a condom.  I tell my patients that there are many good and important reasons to use condoms, especially with new or not well known partners, but that HPV prevention is among the least important of those reasons.  Condoms can help prevent the transmission of HPV virus but not necessarily.  HPV can be transmitted in semen, but also is other body fluids.  The best way to prevent transmission of HPV is abstinence or to keep the number of sexual partners to a minimum.  Barring those 2 strategies, HPV infection will definitely occur.  Whether you develop problems from HPV depends on your own immune system and the viral strain with which you have been infected.

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