What are the symptoms and how is it diagnosed?

While a blood test can check for HPV infection, a positive result doesn't really say much. Being infected with HPV does not mean that genital warts will develop, nor does it mean that dysplasia or cancer will occur. Also, the blood test may falsely diagnose a person as not being infected with HPV when they actually have it.

Genital warts should be reported to a health-care provider. The warts should be biopsied—a sample collected in a minor surgical procedure—to determine if they might go on to cause cancer.

Cervical Dysplasia and Cancer

To check for cervical dysplasia or cancer, a health-care provider can perform a Pap smear, in which cells are scraped from the cervix and examined under a microscope.

Women should have their first cervical Pap smear by age 18 or when they become sexually active, whichever comes first. It is recommended that HIV-positive women have a cervical Pap smear every six months. Men and women who practice anal sex should also have regular anal Pap smears.

An abnormal Pap-smear result calls for closer examination. At this point, colposcopy—a procedure that uses a microscope to visualize the vagina and cervix during a pelvic exam—is used to look for cancerous or pre-cancerous patches, or lesions, on or around the cervix. These lesions are often referred to as cervical intraepithelial neoplasia (CIN). If lesions are found, a biopsy can be performed to learn more about the abnormal cells.

Depending on the results of the biopsy, CIN is given a stage number, either I, II, or III. The stage of dysplasia depends on the thickness of abnormal cells within the cervical wall. CIN I is considered to be a mild or "low-grade" form of dysplasia and generally does not require therapy (but must be monitored closely), whereas CIN II or III are considered to be more advanced or "high grade" forms of dysplasia and are more likely to develop into cancer. Advanced forms of CIN often require therapy to prevent them from developing into cancer.

Anal Dysplasia and Cancer

The best method of detecting anal dysplasia or cancer has not been determined. Some health care providers recommend routine anal Pap smears—the collection of cells lining the anal wall for analysis by a laboratory—followed by direct visualization, or anoscopy, if the results are abnormal. Other heatlh care providers have doubts about the effectiveness of anal Pap smears and prefer to refer patients for much more sensitive direct visualization testing performed by a specialist. Either way, HPV experts recommend routine anal dysplasia testing for all HIV-positive men who have sex with men and women with a history of cervical dysplasia. Studies are also underway or planned to clarify which methods are best for monitoring anal dysplasia and to confirm that treating it may reduce the risk of developing anal cancer.

The University of California in San Francisco maintains a list of providers trained to conduct anoscopy and can be found here.

The staging system for AIN is similar to the one used for CIN, discussed above.

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