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Because human papillomavirus (HPV) infections often cause no symptoms in men or women and are hard to identify, you must rely on your health care professional for diagnosis.

Genital warts can be flesh-colored and hidden inside the cervix, vagina, penis, scrotum, or anus. They can be small or large, alone or in clusters, flat or round. They can spread along the groin or thigh or be found in the mouth.

Genital warts come in two forms--growths that can be seen with naked eye and are on the surface of the skin; and smaller, less visible growths called squamous intraepithelial lesions (SILs) that cover the cervix and require a special instrument, called a colposcope, to see.

Studies conducted in the past 10 years find that specific HPV types are responsible for the development of genital warts, also known as "condyloma acuminatum." Each HPV type has been numbered and divided into "high risk" or "low risk" categories depending on whether the virus is associated with the development of cancer.

For example, HPV types 6 and 11, which are usually associated with genital warts, are considered "low risk." HPV types 16, 18, 31, 33 and 35, found on the genitals and in the anus, but only occasionally as visible warts, have been linked to cancers in both men and women.

If you notice such warts, see your health care professional. You should also seek an examination if:

• You see any unusual growths, bumps or skin changes on or near the penis, vagina, vulva or anus.

• You experience unusual itching, pain or bleeding in the genital area.

• You have a sexual partner who tells you that he or she has genital HPV or genital warts.

During your examination, your health care professional may use a colposcope, a lighted magnifying lens, to find small warts. Your health care professional may also apply a vinegar solution to the genitals, which causes abnormal tissue to turn white. This doesn't hurt, but it does make it easier to see warts or precancerous lesions.

There are different classifications for abnormal results, but the most common is called atypical squamous cells of undetermined significance (ASCUS).

In conjunction with the Pap test, the Hybrid Capture II test can also be used in women over age 30 to help detect HPV infection. The test is the only method approved by the FDA for HPV DNA testing.

• All women should begin cervical cancer within three years of becoming sexually active or by age 21. Screenings should be done once a year if the conventional Pap test technique is used, and every two years if the liquid Pap test technique is used.

• At age 30, women who have had three Pap tests in a row with normal results may be screened every two to three years. If they also have the HPV DNA test, the Pap test can be conducted once every three years.

However, the ACS recommends that women with the following risk factors continue to have a Pap test once a year:

• Infection with a cancer-causing form of human papillomavirus (HPV)

• Infection with the AIDS virus (HIV)

• Chlamydia infection

• Exposure in utero to DES, a synthetic estrogen-like drug

• A personal or family history of cervical cancer

• An increased cancer risk because of certain conditions such as smoking

• Poor nutrition

• A weakened immune system or treatment with an immune-suppressing medication

Women age 70 and older who have had three or more normal Pap tests in a row and no abnormal test in the last 10 years may stop having cervical cancer screening, although women with the risk factors listed above should continue annual testing.

Women who have had a total hysterectomy (removal of the uterus and cervix) may to stop having cervical cancer screening unless the hysterectomy was performed because of cervical cancer- or pre-cancer-related reasons. If the hysterectomy was done to treat cervical cancer, you may need more frequent Pap screenings.

Women who have had a hysterectomy in which the cervix was not removed should continue to follow screening guidelines based on their age and prior history.

If your health care professional identifies any unusual cell changes, he or she will recommend some sort of follow-up, depending on the result and your health history. That may include a waiting period, a repeat Pap test, a DNA-based HPV test, a colposcopy, or a more thorough examination and biopsy of the abnormal area.

Regular Pap tests are equally important for lesbians and bisexual women who, studies find, may be less likely to seek routine health care because of the discomfort they feel discussing or revealing their sexual orientation to health care professionals. They may also may not want to be screened because they feel that they are not at risk. While their risk is lower than heterosexual women, lesbian and bisexual women are still at risk.