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WHAT IS HUMAN PAPILLOMAVIRUS?

Human papillomavirus (HPV) is one of the most common causes of sexually transmitted infection (STI) in the world. More than 100 different types of HPV exist, most of which are harmless. About 30 types are spread through sexual contact. Some types of HPV cause genital warts—single or multiple bumps that appear in the genital areas of men and women including the vagina, cervix, vulva (area outside of the vagina), penis, and rectum. Many people infected with HPV have no symptoms.

There are high-risk and low-risk types of HPV. High-risk HPV may cause abnormal Pap smear results, and could lead to cancers of the cervix, vulva, vagina, anus, or penis. Low-risk HPV also may cause abnormal Pap results or genital warts.

Health experts estimate there are more cases of genital HPV infection than any other STI in the United States. According to the American Social Health Association, approximately 5.5 million new cases of sexually transmitted HPV infections are reported every year. At least 20 million people in this country are already infected.

WHAT ARE GENITAL WARTS?

Genital warts (sometimes called condylomata acuminata or venereal warts) are the most easily recognized sign of genital HPV infection. Many people, however, have a genital HPV infection without genital warts.

Genital warts are soft, moist, or flesh colored and appear in the genital area within weeks or months after infection. They sometimes appear in clusters that resemble cauliflower-like bumps, and are either raised or flat, small or large. Genital warts can show up in women on the vulva and cervix, and inside and surrounding the vagina and anus. In men, genital warts can appear on the scrotum or penis. There are cases where genital warts have been found on the thigh and groin.

CAN HPV CAUSE OTHER KINDS OF WARTS?

Some types of HPV cause common skin warts, such as those found on the hands and soles of the feet. These types of HPV do not cause genital warts.

HOW ARE GENITAL WARTS SPREAD?

Genital warts are very contagious and are spread during oral, vaginal, or anal sex with an infected partner. They are transmitted by skin-to-skin contact during vaginal, anal, or (rarely) oral sex with someone who is infected. About two-thirds of people who have sexual contact with a partner with genital warts will develop warts, usually within 3 months of contact.

In women, the warts occur on the outside and inside of the vagina, on the opening to the uterus (cervix), or around the anus.

In men, genital warts are less common. If present, they usually are seen on the tip of the penis. They also may be found on the shaft of the penis, on the scrotum, or around the anus.

Rarely, genital warts also can develop in your mouth or throat if you have oral sex with an infected person.

Like many STIs, genital HPV infections often do not have signs and symptoms that can be seen or felt. One study sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) reported that almost half of women infected with HPV had no obvious symptoms. If you are infected but have no symptoms, you can still spread HPV to your sexual partner and/or develop complications from the virus.

HOW ARE HPV AND GENITAL WARTS DIAGNOSED?

Your health care provider usually diagnoses genital warts by seeing them. If you are a woman with genital warts, you also should be examined for possible HPV infection of the cervix.

Your provider may be able to identify some otherwise invisible warts in your genital tissue by applying vinegar (acetic acid) to areas of your body that might be infected. This solution causes infected areas to whiten, which makes them more visible. In some cases, a health care provider will take a small piece of tissue from the cervix and examine it under the microscope.

If you have an abnormal Pap smear result, it may indicate the possible presence of cervical HPV infection. A laboratory worker will examine cells scraped from your cervix under a microscope to see if they are cancerous.

How common is HPV?

In the United States, HPV is considered to be the most common sexually transmitted disease (STD). Some studies estimate that the majority of the sexually active population is exposed to at least one or more types of HPV - although most do not develop detectable symptoms. Because HPV is so common and prevalent, a person does not need have to have a lot of sexual partners to come into contact with this virus.

What about HPV and cervical cancer?

* There are many different types of genital HPV. * Only certain types of HPV are linked with cervical cancer. These are usually called "high-risk" types. * The types of HPV that cause raised external genital warts are not linked with cancer. These are called "low-risk" types. * These wart-types of HPV usually are not usually found on a female's cervix, and therefore, are not going to carry any risk of cancer. * It is common for a person to be exposed and have more than one type of HPV, including several "high-risk" types. Yet, most women do not develop cervical cancer. * Cervical cancer usually takes years to develop. * The majority of cases of cervical cancer are in women who have either never had a Pap smear, or have not had one in five years or more. * Cervical cancer can be prevented if a female gets a Pap smear at regular intervals. This way, if abnormal cell changes are found, it can be monitored and / or treated before progressing to cervical cancer. * Most of the time, men will not have any symptoms or health risks such as cancer with the "high-risk" types of HPV. It is the female's cervix that needs to be monitored.



What is genital HPV infection?

Genital HPV infection is a sexually transmitted disease (STD) that is caused by human papillomavirus (HPV). Human papillomavirus is the name of a group of viruses that includes more than 100 different strains or types. More than 30 of these viruses are sexually transmitted, and they can infect the genital area of men and women including the skin of the penis, vulva (area outside the vagina), or anus, and the linings of the vagina, cervix, or rectum. Most people who become infected with HPV will not have any symptoms and will clear the infection on their own.

Some of these viruses are called "high-risk" types, and may cause abnormal Pap tests. They may also lead to cancer of the cervix, vulva, vagina, anus, or penis. Others are called "low-risk" types, and they may cause mild Pap test abnormalities or genital warts. Genital warts are single or multiple growths or bumps that appear in the genital area, and sometimes are cauliflower shaped.

How common is HPV?

Approximately 20 million people are currently infected with HPV. At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives. By age 50, at least 80 percent of women will have acquired genital HPV infection. About 6.2 million Americans get a new genital HPV infection each year.

How do people get genital HPV infections?

The types of HPV that infect the genital area are spread primarily through genital contact. Most HPV infections have no signs or symptoms; therefore, most infected persons are unaware they are infected, yet they can transmit the virus to a sex partner. Rarely, a pregnant woman can pass HPV to her baby during vaginal delivery. A baby that is exposed to HPV very rarely develops warts in the throat or voice box.

What are the signs and symptoms of genital HPV

Most people who have a genital HPV infection do not know they are infected. The virus lives in the skin or mucous membranes and usually causes no symptoms. Some people get visible genital warts, or have pre-cancerous changes in the cervix, vulva, anus, or penis. Very rarely, HPV infection results in anal or genital cancers.

Genital warts usually appear as soft, moist, pink, or flesh-colored swellings, usually in the genital area. They can be raised or flat, single or multiple, small or large, and sometimes cauliflower shaped. They can appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh. After sexual contact with an infected person, warts may appear within weeks or months, or not at all.

Genital warts are diagnosed by visual inspection. Visible genital warts can be removed by medications the patient applies, or by treatments performed by a health care provider. Some individuals choose to forego treatment to see if the warts will disappear on their own. No treatment regimen for genital warts is better than another, and no one treatment regimen is ideal for all cases.

How is genital HPV infection diagnosed?

Most women are diagnosed with HPV on the basis of abnormal Pap tests. A Pap test is the primary cancer-screening tool for cervical cancer or pre-cancerous changes in the cervix, many of which are related to HPV. Also, a specific test is available to detect HPV DNA in women. The test may be used in women with mild Pap test abnormalities, or in women >30 years of age at the time of Pap testing. The results of HPV DNA testing can help health care providers decide if further tests or treatment are necessary.

No HPV tests are available for men.

What is the connection between HPV infection and cervical cancer?

All types of HPV can cause mild Pap test abnormalities which do not have serious consequences. Approximately 10 of the 30 identified genital HPV types can lead, in rare cases, to development of cervical cancer. Research has shown that for most women (90 percent), cervical HPV infection becomes undetectable within two years. Although only a small proportion of women have persistent infection, persistent infection with "high-risk" types of HPV is the main risk factor for cervical cancer.

A Pap test can detect pre-cancerous and cancerous cells on the cervix. Regular Pap testing and careful medical follow-up, with treatment if necessary, can help ensure that pre-cancerous changes in the cervix caused by HPV infection do not develop into life threatening cervical cancer. The Pap test used in U.S. cervical cancer screening programs is responsible for greatly reducing deaths from cervical cancer. For 2004, the American Cancer Society estimates that about 10,520 women will develop invasive cervical cancer and about 3,900 women will die from this disease. Most women who develop invasive cervical cancer have not had regular cervical cancer screening.

How can people reduce their risk for genital HPV

The surest way to eliminate risk for genital HPV infection is to refrain from any genital contact with another individual.

For those who choose to be sexually active, a long-term, mutually monogamous relationship with an uninfected partner is the strategy most likely to prevent future genital HPV infections. However, it is difficult to determine whether a partner who has been sexually active in the past is currently infected.

For those choosing to be sexually active and who are not in long-term mutually monogamous relationships, reducing the number of sexual partners and choosing a partner less likely to be infected may reduce the risk of genital HPV infection. Partners less likely to be infected include those who have had no or few prior sex partners.

HPV infection can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. While the effect of condoms in preventing HPV infection is unknown, condom use has been associated with a lower rate of cervical cancer, an HPV-associated disease.


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