in the statistical count for this (HPV-related) infection if they seek medical treatment. This could underestimate the actual number of (HPV-related) infections for this malady or any other HPV-related infection (CDC, 2019a). Most people are familiar with common warts found on the hands and feet. These warts are caused when certain HPV types infect the skin. The HPV causes rapid growth in the skin’s outer layer, resulting in the appearance of warts. The types of HPV-related warts are flat, plantar, periungual, and genital warts (WebMD, n.d.c). Flat warts are more common in children and adolescents. As their name implies, these warts are flat or slightly raised, range from 2 to 5 mm in diameter, and generally appear on the face. Flat warts can also appear on the legs. Appearance of these warts on the legs is more commonly experienced by females (WebMD, n.d.c). Plantar warts occur on the soles of the feet and the underside of the toes. These warts appear as light brown or flesh-colored, with tiny black specks in their center. The black specks look like small seeds within the wart, which explains why plantar warts are also called “seed warts.” Plantar warts can be large and painful, but they resolve over time. Because these warts often cause pain when walking, people may seek treatment to have them removed (Mayo Clinic, 2022b). Periungual warts are cauliflower-like growths that typically appear in clusters around the toes and fingernails. These warts can be painful and often cause embarrassment for the infected individual and are caused by the Human Papillomavirus Types 1, 2,4, 27 or 57 and can invade the nail bed (Luria & Cardoza-Favarato, 2022). Anogenital or genital warts appear in the pubic area. These cauliflower-like growths can appear in or around the anus, vagina, or penis (CDC, n.d.). Typically, the warts form clusters, are not painful, but can cause itching. They are usually tiny and difficult to see. Anogenital warts are spread by direct skin-to-skin contact with an infected person. This contact usually occurs during oral, anal, or genital sex (Bacaj & Burch, 2018). Anogenital warts are highly contagious, and their presence signifies HPV infection (Cleveland Clinic, 2020). Genital HPV infections have a 1% occurrence of clinical manifestations and a 10%-20% estimated prevalence (Leslie, 2022). Healthcare practitioners treat warts in several ways. Treatment methods include topical application of liquid nitrogen to “freeze” the wart, application or injection of drugs onto or into the wart, and minor or laser surgery with multiple treatments required to fully remove some warts (Leslie, 2022). Recurrences rates of 20-30% of genital warts can occur at sites which are previously treated or at new sites regardless of the therapeutic modality used for treatment (Gilson, et al., 2019). Over-the-counter remedies are available; however, treatment time can be lengthy, patient compliance is variable, evidence of efficacy is lacking (Leslie, et al., 2022). sexually active is at risk for acquiring the virus, although in approximately 90% of cases a healthy immune system will naturally clear the virus within 12- 24 months (Huber, et al., 2021). In some cases, a body does not clear HPV naturally, allowing the virus to persist. Depending on the HPV type, health problems such as genital warts or cancer can arise (CDC, n.d.). It is impossible to know which individuals infected with a carcinogenic HPV type will subsequently develop cancer. However, an individual’s immune system status, viral type, number of sex partners and the length of time
Human papillomavirus (HPV) is a double-stranded DNA virus that can cause lesions anywhere on the surface of the skin, including the extremities, genitalia, and oral mucosa (Canuti, et al., 2019). The virus is made up of more than 200 genotypes, with 40 types capable of infecting the genital tract through genital or skin-to-skin contact (CDC, 2017a). Within the United States, at least 80% of sexually active adults are expected to acquire the virus in their lifetime with 14 million new (HPV) infections annually and an estimated 79 million sexually active adults infected with HPV at any given time (American Sexual Health Association, 2019). “Low risk” HPV types cause genital warts, and “high risk” types can lead to cancer, if given enough time (National Cancer Institute, 2019). HPV is strongly associated with invasive cancer of the vulva, and vaginal, penile, anal, and oropharyngeal (oral) cancers (Sanyaolu, et al., 2019). Recent vaccines for both males and females are expected to lower the number of HPV cases and, as a result, the number of HPV-related cancers (U.S. Food and Drug Administration, 201; CDC, 2021b; National Cancer Institute, 2019; Taberna, 2017). HPV was first identified in the 1950s by an international team of scientists, but the characteristics of HPV, as well as the common associations and strains of the virus, were not discovered until the 1970s and 1980s (Grace, 2017). In 1976, Dr. Harald zur Hausen, a German scientist and virologist, published his hypothesis proposing an association between HPV and cervical cancer. Nine years later, he and his team identified two strains of HPV (HPV 16 and 18) and demonstrated their association with cervical cancer (Syrjanen, 2017; Irabor, et al., 2018). For this work, Dr. Zur Hausen received the 2008 Nobel Prize in Physiology or Medicine (Grace, 2017). Almost all cervical cancers are attributable to the high-risk HPV types 16 and 18 (CDC, 2017a). Fourteen genotypes of HPV are the high-risk type and have been identified as carcinogenic to human beings (World Health Organization, 2019). Currently, of the more than 200 HPV genotypes identified by scientists, 40 can infect the genital area, causing symptoms such as anal and genital warts (CDC, 2017a). While some HPV types have been well characterized and are recognized as distinct, other types have been only partially sequenced. Therefore, as sequencing and typing continue to advance, more HPV viral types will likely be identified (Taberna, 2017). The CDC estimates that in the U.S. alone, 14,000,000 new HPV infections occur each year, with many cases involving teenagers. (CDC, 2019b). When considering both newly acquired and existing HPV infections, estimates place the total number of cases in the U.S. at 79,100,000 (American Sexual Health Association, 2019). However, the number of HPV infections is underestimated because approximately 20% of HPV-infected people are harboring more than one type of the virus. Because the CDC calculates HPV infections per person, individuals infected with more than one HPV type are counted only once. As an example, those who develop genital warts from (HPV) infection are only included Risk factors and at-risk populations HPV is spread through sexual contact and is transmitted to another person most often during vaginal and anal sex. However, the virus can also be transmitted during oral sex and genital-to-genital contact. Often, the infected partner has no signs or symptoms of the disease and unknowingly transmits the virus to others. A person can harbor HPV even if he or she has not had contact with an infected person for several years. This makes it difficult for a person to know when he or she was first infected. As a result, most sexually active men and women will become infected with HPV at some point in their lifetimes. This means that anyone who is
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