Diagnosing Human Papillomavirus

Most human papillomavirus (HPV) infections of the genitals cause no symptoms and disappear on their own within two years. There are many different strains of the virus, though just a few can cause genital warts or lead to more serious complications, such as cancer.

Though there’s no cure for HPV infection, NYU Langone doctors can create treatment plans for the conditions it can cause, such as genital warts; changes in the cells of the cervix, called cervical dysplasia, that are sometimes precancerous; and cervical cancer. A person can be infected with multiple strains of HPV at once, and our doctors can quickly and accurately diagnose HPV infection and determine appropriate treatment.

About 1 percent of Americans have the strain of HPV that is found in oropharyngeal cancers, cancers of the throat, tongue, and tonsils. Having oral sex with an infected partner may transmit the virus that can cause these cancers, which affect more men than women.

Genital Warts

Each year, about 360,000 Americans with low-risk HPV develop genital warts. These warts can be small or large and flat or raised; they may appear alone or in a cluster. They’re most often noticed on the vulva—the outer part of a woman’s genitals—and the penis but can also be found in the cervix, vagina, scrotum, urethra, mouth, throat, or anus.

Although most warts don’t cause symptoms, some people experience itching, bleeding of the vagina or urinary tract, and discomfort, and women may have excess vaginal discharge. If you notice any of these symptoms, or bumps or lesions on your genitals, see your NYU Langone gynecologist (for women) or urologist (for men).

A gynecologist performs a pelvic exam and checks a woman’s cervix, vagina, vulva, anus, rectum, and, if symptoms warrant, the mouth for warts. A urologist examines a man’s penis, scrotum, anus, rectum, and, if symptoms warrant, the mouth, for warts.

Some genital warts are too small to be seen during a physical exam. If you’re experiencing itching, bleeding, or mild discomfort and your doctor suspects that you have genital warts, he or she may take a sample of tissue from the affected area and send it to a laboratory for analysis.

Cervical Abnormalities and Cancer

In women, infection with a high-risk strain of HPV can lead to cancer of the cervix—the lower part of the uterus, or womb. The cervical canal is the passageway that connects the uterus to the vagina. The early stages of cervical cancer often don’t cause symptoms, and so it’s important that women get screened regularly.

Keep in mind, if you test positive for infection with a high-risk HPV but don’t have any symptoms, your doctor may decide to monitor your health without treatment; most of the time, HPV disappears on its own. Even precancerous cell changes can vanish if the immune system builds up resistance to the virus.

Colposcopy

If your Pap test results show abnormal cells on the cervix or screening test results indicate infection with a high-risk strain of HPV, your NYU Langone doctor may perform a colposcopy in his or her office. This procedure helps the doctor diagnose cervical dysplasia or cervical cancer. During the test, your doctor uses a magnifying instrument called a colposcope to view the surface of the cervix and vagina and may take a sample of tissue for biopsy in a laboratory.

Cone Biopsy

Your doctor may perform a cone biopsy if a Pap test or biopsy from a colposcopy shows precancerous changes in the cells of the cervix. In this procedure, a cone-shaped wedge of tissue is removed from the cervix, including the cervical canal, and examined for abnormalities under a microscope. Performed under general or spinal anesthesia, this procedure is done in the hospital.

Loop Electrosurgical Excision Procedure

The loop electrosurgical excision procedure, also known as LEEP, is used to diagnose and treat abnormal cervical tissue. In this procedure, which is performed in the doctor’s office with sedation and local anesthesia or in the hospital with general anesthesia, a wire loop heated by an electrical current removes tissue, which is sent to a laboratory for analysis. You may feel some discomfort during this procedure, but it is not painful.

If any of these tests shows that you have cervical cancer, your NYU Langone gynecologist refers you to a gynecologic cancer specialist, who oversees your treatment.