Human Papillomavirus (HPV)

What is human papillomavirus (HPV)?

Human papillomavirus (HPV) is a virus that causes skin changes and warts in different parts of the body. There are more than 200 kinds of HPV. About 40 of these are transmitted by sex. Here, we will focus on HPV that causes genital warts and some forms of cancer. 

HPV is the most common sexually transmitted infection (STI). Most people are exposed to it within a couple of years after starting to have sex. But not everyone will get warts or cancer.  

Although the names may sound similar, HPV is not the same as HSV (herpes simplex virus). HSV is the virus that causes herpes. Both viruses are transmitted by sex, but they have different effects. There are also other forms of HPV that cause warts on your hands or other parts of the body.

Transmission

HPV spreads through contact with cells that have the virus in them. The HPV virus lives in your skin or mucosa. The mucosa lines parts of the body like the mouth, intestines, and vagina. This means you can come into contact with it during oral sex, genital sex, or anal sex. 

The virus lives inside the body for a while, usually without symptoms. And this makes it easy to spread it to others. If you have it, it’s hard to know when you were exposed. Unless you’re vaccinated, about 80% of people will be infected with HPV at some point. In most people, their immune system clears the virus within a few years.

You can’t get HPV through casual contact. This means that it does not spread by:

• Sharing food, drinks, or utensils
• Hugging or holding hands
• Not washing or being clean enough
• Using public bathrooms or a shared toilet seat

There are a few factors that make exposure to HPV more likely: 

• Starting to have sex in your teens
• Having many sexual partners
• Having sex with someone who has HPV or who has had many sexual partners

HPV and cancer

There are about 14 types of HPV that are considered high risk, meaning they can cause cancer. But even with these high-risk types of HPV, many people don’t have symptoms. This is why routine screening with a Pap smear is so important. 

HPV detection is key because, without treatment, it can progress to cancer. HPV is associated with:

• Cervical cancer: HPV can cause changes in the cells of the cervix that sometimes progress to cancer if they aren’t treated. Often, there are no symptoms with these precancerous changes. But a healthcare provider should check any abnormal bleeding, pain, or discharge.
• Anal warts and cancer: If the skin cells around the anus are infected with a high-risk type of HPV, those cells can also show precancerous changes over time. Be sure to get a checkup for any new growths, rectal bleeding, pain or irritation, or changes in stool.
• Throat cancer: HPV is the most common cause of throat cancer. Anyone who has oral sex may become infected with HPV. Concerning symptoms include a sore throat that doesn’t get better, ear pain, hoarseness, weight loss, trouble swallowing, or swollen lymph nodes.
• Penile cancer: Cancer of the penis has become less common in many parts of the world. But HPV causes it. If you have any new growths, warts, or rashes, be sure to schedule a checkup with a healthcare provider.

Human papillomavirus (HPV) is a virus that causes skin changes and warts in different parts of the body. There are more than 200 kinds of HPV. About 40 of these are transmitted by sex. Here, we will focus on HPV that causes genital warts and some forms of cancer. 

Many people who have HPV don’t have any symptoms. But some people develop genital warts from the virus. These bumps on the skin can appear around the:

• Vagina
• Vulva
• Penis
• Scrotum
• Groin
• Thigh
• Anus

There might be just a few warts, or they might look like a larger growth. Around 1% of people have genital warts. The risk of having them at some point is about 10%.

For many people — especially those without symptoms — HPV is only diagnosed during a test for precancer or cancer, like a Pap smear. 

Here’s the good news: For 9 in 10 people, the immune system clears an infection with HPV within a couple of years. But sometimes the immune system can’t fully contain the virus. Risk factors that might make it more difficult for your body to clear HPV include:

• Health conditions or medications that affect the immune system
• Smoking
• Infection with other types of STIs
• Diet low in fruits and vegetables 

Diagnosis

A blood or urine test can diagnose most STIs. But there is no routine blood or urine test for HPV.  

For people who have a cervix, you may get a test for HPV every time you have a Pap smear. But sometimes people only get an HPV test if the Pap smear is abnormal. So if you’re concerned that you may have HPV, be sure to let your provider know. An HPV test will show if the virus is present or not, and it can also check for high-risk strains that are more likely to cause cancer.

For people who have anal intercourse, an anal Pap smear can check for precancerous areas and HPV. Your healthcare provider can help to figure out if this is the right test for you.

A clinical exam by a healthcare provider is the best way to diagnose genital warts or other growths. A biopsy, or a small sample of tissue, can check for precancer or cancer caused by HPV.

Treatment

For genital warts, there are some treatments that you apply at home over a period of weeks or months. A healthcare provider will prescribe these after diagnosing HPV. These medications may include:

• Imiquimod (Aldara)
• Podofilox (Condylox)
• Sinecatechins (Veregen)

You may have seen over-the-counter treatments for warts in the store. But you should not use these to treat genital warts.

If there are many warts, or if they are large or in an area that is hard to reach, a provider may treat you in the clinic. Some of these treatments include:

• Topical medications, like podophyllin, trichloroacetic acid, or bichloroacetic acid
• Cryotherapy (freezing)
• Surgical removal

A colposcopy will check precancer on a Pap smear. This is like having a Pap smear, but the provider uses a magnifying device to get a better look at the cervix. If this shows precancer, a procedure such as a loop electrosurgical excision procedure (LEEP) can treat the affected areas.

Your provider can also check for precancer and treat any growths in the throat, penis, vagina, or anus. Surgery can remove cancerous areas.

Prevention

Prevention measures are important for anyone who is sexually active — regardless of whether you or your partner(s) have HPV. Here are a few things you can do to stay healthy:

• Communicate with your partner. It isn’t possible to know when someone was first exposed to HPV. So a new diagnosis doesn’t mean that someone was “cheating.” Most long-term partners will share HPV, so clear communication is key. And practicing safer sex with new partners is always a good idea.
• Practice safer sex. HPV spreads through intimate skin-to-skin contact. So barrier methods can decrease your risk and also help protect against other STIs. Practicing safer sex and using condoms, internal condoms, or dental dams lowers the risk of spread to yourself and others.
• See your healthcare provider regularly. Checking in about your body and getting recommended vaccines and screening tests goes a long way when it comes to staying healthy. For HPV, it’s especially important for anyone with a cervix to get a Pap smear as recommended.
• Practice a healthy lifestyle. You can’t always prevent exposure to HPV. But avoiding smoking and maintaining a healthy diet and exercise routine help your immune system to suppress or get rid of the virus.
• Get vaccinated. The HPV vaccine is one of the best ways to prevent infection with the virus.

Vaccine

It’s almost impossible to completely prevent any virus. But the HPV vaccine does an excellent job of decreasing the risk of infection.

The CDC recommends that most people get two doses of the HPV vaccine between the ages of 9 and 15. That’s because it works best before exposure to HPV. But even if you didn’t get it as a child, or if you have HPV already, the vaccine can help prevent infection with other strains of the virus. The vaccine is approved for adults up to age 45.