A little-known, infrequently discussed sexually transmitted disease is coming out of the shadows at Southern California universities, including three campuses in Orange County and at UCLA and USC.
Physicians at university health centers say the topic is not pleasant. Even the name of the disease--genital warts--brings nervous reactions from students, the doctors said.
Although precise figures are not available, the disease appears to hit college campuses in disproportionately high percentages, health officials said.
"It's a very common disease, especially among college students," said Dr. Adele Dellenbaugh Hofmann, a pediatrics professor and director of adolescent medicine at UC Irvine's department of pediatrics.
Hofmann noted that some strains of the virus that causes genital warts can lead to cancer of the genital areas.
Dr. James Felten of the California Department of Health Services in Sacramento, said reliable statistics on genital warts aren't available, because neither the state nor the federal government requires cases to be centrally reported. But Felten said that indications are that the incidence of genital warts is on the increase in California, especially among college-age students.
"In talking with clinicians and nurses throughout the state, I'm hearing of more and more (genital warts) cases," Felten said. He said he is gratified that discussion about the disease is bringing it into public focus.
Felten and numerous other health officials interviewed recently said that genital warts is generally rare.
"One of our best tools is to get information out about a disease," Felten said.
The visible signs of the disease are small, skin-colored or reddish warts on the male or female genitals. The warts usually are cauliflower-shaped. The disease, however, can have a long incubation period during which the patient shows no visible signs of warts and no indications of bad health.
"It's a significant problem" because, after chlamydia, genital warts "is the second-most prevalent sexually transmitted disease on our campus," Dr. Harry L. Siemonsma, associate director of UCI's student health center, said in a recent interview.
Dr. Ann Arcay, chief physician at the Cal State Fullerton Student Health Center, said genital warts has reached "epidemic" proportions on that campus. "It's an under-diagnosed epidemic," she said.
And even at the much smaller Chapman University campus in Orange, Jackie Brodsky, nurse-director of the student health center, said that genital warts is a recurring, worrisome disease. "I think it's serious," she said. Genital warts "can so easily be spread, and often you can't see it--you have to go looking for it."
Arcay, citing a 1985 New England Journal of Medicine report, said the virus that causes genital warts is potentially very dangerous, because it can lead to cervical cancer in women or penile cancer in men.
The virus that causes genital warts is the human papillomavirus, commonly referred to as HPV.
Epidemiologists at the federal Centers for Disease Control and Prevention in Atlanta said HPV infection is prevalent nationwide, with an estimated 24 million to 40 million people infected. Precise data on the disease is not available because federal law does not require centralized reporting of cases, said Dr. Samuel L. Groseclose, an epidemiologist at the Centers for Disease Control.
"The figures we have come from limited surveys, and we have to extrapolate from that," said Groseclose. "Based on the information we have, the estimate is that there are one-half million to a million new cases" of genital warts each year.
Groseclose said there is no indication of a big upswing in the disease nationally. "There's no real indication I can find of an epidemic out there, but perhaps it's being recognized a bit more," he said. "The tests to detect it aren't that great, and they only recently got better."
Dr. Mary Kamb, an epidemiologist at Centers for Disease Control, said there about 60 strains of HPV, and only about 20 are spread genitally. Some do not cause warts. She said the HPV that causes warts is not the strain believed to cause cancer. The cancer-causing HPV, Kamb said, is one that infects the genital areas but causes no warts or other physical signs.
Arcay said condyloma--the medical term for genital warts--differs markedly from herpes. "It's a different class of virus; it behaves differently," she said. "The symptoms of herpes usually present a painful irritation. Condyloma are completely painless. They are usually flesh colored and usually blend in with the surrounding skin, so they present a particularly difficult problem for diagnosing."
Arcay and other physicians familiar with genital warts said the disease is frequently first detected when women get a Pap smear test. Men often do not find they are infected until visible warts appear in their genital areas.