HIGH AND LOW RISK STRAINS. SITE SPECIFICITY

hpv-kling2ALAN KLING, M.D

Dr. Kling is a recognized expert in the field of HPV treatment, Dr. Kling has lectured on HPV at Columbia, Cornell, Mount Sinai, NYU, Yale and many other medical centers, as well as at numerous national meetings. He is up-to-date on the latest advances in the diagnosis and treatment of HPV. Dr. Kling is the recognized go-to-person for HPV-related diagnoses in the metropolitan NYC area.
Dr. Kling’s private practice offices are located on the Upper East Side in Manhattan and in Park Slope, Brooklyn. The offices are comfortable, stylish, elegantly decorated and impeccably clean. You can feel reassured that your consultation and treatment will be performed by an accomplished, experienced, and well-respected board-certified physician.

Q: I heard that there are lots of different kinds of HPV. What does this mean?
A:
There are over 200 different strains of HPV and they are site (or location) specific. There are certain strains that grow on the hands (hand warts), others that grow on the feet (plantar wart) or on the face (face warts). The strains that grow in the genital area are called genital warts.

Q: What does the term site-specific mean?
A:
The term site specific means that each of the different many strains of HPV grows better in certain areas of the body compared to others.

Q: Can you give an example of different HPV viruses being site specific?
A:
There are over 40 different types of HPV which occur in the genital area. These genital strains will generally not grow well in other parts of the body. The risk of the strains that cause genital warts growing on the hands, which touch the genital area every day, is low. The strains of HPV that cause hand warts, which are very common and are caused by completely different strains than those that cause genital warts, thrive in the environment on the hands but are unlikely to grow in the genital area despite the frequent contact that occurs between the hands and the genital area.

Q: What are the chances that the strains most frequently associated with hand warts may infect the genital area and cause cancer?
A:
Although there is a very small chance that a hand wart can grow in the genital area, the chances of that wart going into a cancer are zero. The strains that most frequently cause hand warts cannot evolve into a cancer.

Q: Can the strains that cause hand warts grow in the genital area?
A:
Yes they can, but this is not common and it is unlikely. The different strains of the virus are site (location) specific, so it would be unusual for an infection from hand or foot warts, for example, to spread to the genital area. The strains of HPV that cause hand warts do not grow well in the genital area.

Q: What are the more serious problems that HPV infections can cause?
A:
HPV infections have been associated with cancers of the cervix, vulva, vagina, penis, anus, rectum, and the oropharyngeal area (tonsils, tongue, roof of the mouth, back of the throat).

Q: How can I tell whether genital warts contain high risk strains?
A:
The only way that you can know for certain what strains are in the genital wart is if a sample is forwarded to the lab for a DNA test.

Q: How can I tell whether my infection contains high or low risk strains?
A:
A biopsy first needs to be obtained and forwarded to a laboratory in order to confirm whether an HPV infection is present. The physician can then request that the laboratory do typing to tell which strains of the infection are present.

Q: Are there any other ways to tell what strains of the virus that I have?
A:
A biopsy is the definitive test in both a man and a woman. Women can get a Pap smear as a screening test and can then get typing done on swabs from the cervix in order to tell whether high or low risk strains are present. Men at risk can get swabs from the rectal area. Blood and urine tests for HPV are not effective.

Q: Can you tell from how the genital warts look whether they are high or low risk?
A:
Genital warts associated with the low risk strains are more likely to be large, more numerous, rapidly spreading and are highly contagious. High risk strains are more likely to present in few numbers and as small, sometimes inconspicuous-appearing growths.. The only accurate way to tell whether they are high or low risk is to do an HPV DNA test.

Q: So the good news is that genital warts are more extensive in size and number, are more contagious, and look more funky but are not dangerous because they contain the low risk strains, and that the bad news is that the smaller warts may be less contagious
A:
Yes.

Q: What are the most common high risk strains?
A:
The most common high-risk strains are 16 and 18 (16/18), which together represent approximately 70% of the high-risk strains which occur in the general population.

Q: What is meant by the terms high risk and low risk strains of HPV ?
A:
Genital HPV infections are referred to as being either high risk or low risk strains. The presence of high risk strains places a person at a higher risk of developing a cancer or precancerous condition. The presence of low risk strains is associated with annoying and highly contagious conditions like genital warts but is not associated with an increased chance of getting cancer.

Q: What kind of conditions are associated with the high risk strains?
A:
The high risk strains of HPV have been associated with cancers or precancers of the cervix, vulva, vagina, anus, rectum, penis and the oropharygeal area.

Q: What kind of conditions are associated with the low risk strains?
A:
The low risk stains are associated with genital warts and do not have any potential to progress into a cancer.

Q: What are “mixed infections”?
A:
Mixed infections are areas or growths that contain both high and low risk strains. Approximately 10% -20% of genital warts are so-called “mixed infections.” The high risk strains in these mixed infections can progress into more aggressive cancerous and precancerous conditions. An HPV infection that is made up of predominantly low risk strains can still contain the potentially more aggressive high risk strains.

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