Spread of Genital Warts Hitting Colleges Hardest : Health: Three county campuses report high infection rates. Experts say transmission is easy, detection often difficult and some strains can lead to cancer.

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.

In the past, Arcay said, doctors commonly tried to eradicate the disease by removing the warts. But she said a study found that condyloma frequently reappeared even when all visible warts were removed.

“In the last three years there has been development of a human product called interferon, and we’re using that now (at Cal State Fullerton), injecting it under the warts,” Arcay said. She said that with interferon, the recurrence rate for genital warts “is extremely low, compared to having the warts burned off.”

Arcay said she gave a talk on campus last month about genital warts to help raise student awareness. The Cal State Fullerton Daily Titan covered the session, and the student newspaper displayed the front-page story with a banner headline that said: “Genital Warts Hit Epidemic Levels.”

Arcay later praised the newspaper for helping to bring more campus attention to the disease. She said an increasing number of students have come in for examinations since the campus newspaper story appeared.

Arcay said she had no precise statistics, but she estimated that at Cal State Fullerton’s Student Health Center, she sees about 40 to 50 cases of genital warts each week. Not all are new cases, she added. There are about 22,600 students enrolled.

Officials at the student health centers at UCI and Chapman University said that no exact totals were available on the number of genital warts cases. Brodsky, of the 2,600-student Chapman University, estimated that the health center there sees four to five genital wart cases a month. Siemonsma of UCI, where there are 16,750 students, declined to estimate how many cases that student health center sees a month.

Dr. Steven Gardner, executive director of student health and counseling services at 28,000-student USC, said genital warts “is probably among the top three” sexually transmitted diseases on that campus. Gardner said the incidence of the disease has been stable in the last two to three years at USC, largely because of increased campus warnings about sexually transmitted infections.

Dr. Edward Wiesmeier, director of student health services at 36,000-student UCLA, similarly said that genital warts is “certainly a significant problem” on that campus, although it is not currently on the increase there. “As a result of a number of years of outreach effort, we’re encouraging more and more people to engage in safer sex, by using condoms, if they choose to engage in sex,” Wiesmeier said.

All of the medical officials said that universities try to make students aware of genital warts because the disease proportionately is greater among college-age young people. They say this is because college students are more sexually active and less cautious than other age groups.

In warning talks given to students, condoms get only limited endorsement. Condoms help protect, but do not guarantee protection against genital-warts infections, officials warn.

HPV “is one of the few viruses that can be transmitted just by skin-to-skin contact,” Arcay said. She said a condom does not provide total protection, because much skin is uncovered during sex.

Siemonsma agreed. He said that even with condoms, the pubic areas remain unprotected and are vulnerable to the virus that causes the disease.

Arcay, in her warnings to students at Cal State Fullerton, said that HPV is a virus that can even be transmitted by objects, such as toilet seats or bath towels.

But Kamb of the federal Centers for Disease Control said she knows of no evidence that HPV has been spread genitally other than by direct sexual contact. Kamb, however, said Arcay is correct in warning that HPV infection can be spread by sexual skin contact, even if there is no sexual penetration.

Arcay said she has treated such cases at Cal State Fullerton. “I’ve had virgins who have come in for treatment of HPV,” she said.

Worry over the dangers of sexually transmitted diseases such as genital warts is making chastity look increasingly attractive to many students, according to the campus health officials in Orange County.

Siemonsma said: “A lot of students (at UCI) are electing to be abstinent.”

Wart Epidemic

A genital-warts epidemic at three Orange County universities mirrors a nationwide trend in which cases increase at twice the rate of genital herpes. An estimated 24 million to 40 million people have been infected nationwide. A profile of this most common sexually transmitted disease:

* Cause: The human papilloma virus (HPV).

* Occurrence: Found mainly on warm, moist surfaces; on the penis shaft, vulva, vaginal wall and cervix.

* Transmitted: Most commonly through sexual activity.

* Identification: Warts are soft, moist, small pink or red swellings that grow rapidly. Several are usually found in the same area and look like cauliflower.

* Incubation: one to six months.

* Diagnosis: Usually identified by appearance. Biopsies should be done. Annual Pap smears are essential to early detection.

* Treatment: No completely satisfactory treatment. Can be removed by cauterization, freezing, surgical excision, or repeated topical applications. Women should wait for Pap smear results.

* Connections: Some warts have been strongly associated with cervical, vaginal, penile and anal cancers. Pregnant women can pass the infection to unborn children.

Sources: Centers for Disease Control, The Merck Manual;

Researched by BILL BILLITER and CAROLINE LEMKE / Los Angeles Times

Los Angeles Times