HPV (Human Papillomavirus)

What is human papillomavirus (HPV)?

Human papillomavirus (HPV) is a common virus that can affect different parts of your body. There are over 100 types of HPV, including strains of HPV that cause warts on your hands, feet and face. About 30 HPV strains can affect your genitals, including your vulva, vagina, cervix, penis and scrotum, as well as your rectum and anus. This includes the type of HPV that causes genital warts.

HPV that affects your genitals is a sexually transmitted infection (STI) that gets passed through skin-to-skin contact, most often during sexual activities. Many people cringe at the thought of STIs, but most genital HPV strains are harmless.

HPV is the most common viral STI in the United States. Roughly 14 million people get the infection each year. HPV is so common that most sexually active people who aren’t vaccinated against HPV will become infected at some point in their lives. Most never know they have it.

Some strains of HPV are high-risk and can lead to cancers, like cervical, vulvar and vaginal cancers. Early detection (with a Pap smear or HPV screening) and treatment of precancerous cells can usually prevent this from happening.

How is HPV related to cervical cancer?

Certain strains of HPV (most often types 16 and 18) can cause changes in the cells of your cervix, a condition called cervical dysplasia. Left untreated, cervical dysplasia sometimes advances to cervical cancer.

If you’re under 30, most HPV infections clear up on their own. By age 30, finding HPV during a Pap smear can determine how often you should receive follow-up testing. If you test positive, you may be at a higher risk and need more frequent testing.

Getting regular Pap smears to screen for cervical cancer is important (usually beginning at age 21). But it’s important to remember that just because you have HPV or cervical dysplasia doesn’t mean you’ll get cancer.

How long does it take for HPV to turn into cancer?

The virus itself doesn’t turn into cancer. But high-risk strains of HPV infection can cause precancerous cell changes. These cell changes can eventually lead to cancer if they aren’t managed. This process, though, can take years or decades to happen. Screenings, like Pap smears, can help detect these precancerous cells before they turn to cancer.

What are the symptoms of HPV?

HPV that affects your genitals doesn’t usually cause symptoms. When symptoms do occur, the most common sign of the virus is warts in your genital area. Genital warts are rough, cauliflower-like lumps that grow on your skin. They may also appear like skin tags. They may appear weeks, months or even years after you’ve been infected with low-risk HPV. Genital warts are contagious (like all forms of HPV). They can also be itchy and very uncomfortable.

High-risk forms of HPV often don’t cause symptoms until they’ve progressed to cancer.

Are all warts HPV?

Yes. And this can be confusing — especially when you’re trying to understand the difference between the HPV that causes the wart on your finger or genitals and the HPV that may lead to cervical cancer.

The HPV strains that cause warts, including genital warts, are nuisances. After all, no one wants warts, least of all on their genitals. Still, these types of HPV are harmless. HPV types 6 and 11 most often cause genital warts. Other types of HPV cause warts on other parts of your body. These warts are:

• Flat warts.
• Plantar warts.
• Periungal and subungual warts.

All warts are caused by HPV, but not all strains or types of HPV cause warts. The type of HPV that can progress to cancer doesn’t cause warts.

How do you spread HPV?

Genital HPV spreads through skin-to-skin contact during intercourse, oral sex and anal sex. You can get the infection if your genitals — including your vulva, vagina, penis and scrotum, as well as your rectum and anus — come into contact with these same body parts on an infected partner.

It’s possible to spread the virus through hand-to-genital contact, like fingering and handjobs. This type of transmission is less likely and less is known about it as compared to genital-to-genital contact.

How easy is it to spread HPV?

HPV is highly contagious, in part, because it’s transmitted through skin-to-skin contact. You don’t have to exchange body fluids with someone for you to contract the virus or spread it to someone else. You can infect your partner, or your partner can infect you even if no one ejaculates.

Who does HPV affect?

Anyone can become infected with HPV if they have sex or close skin-to-skin genital contact with a partner with the virus. Similarly, anyone with the virus can spread it to their partner during intercourse, oral sex, anal sex or other close genital contact.

If you’re HIV positive, your immune system may have a harder time fighting HPV infections. If you’re a person with a penis who has sex with other people with penises, you may be at greater risk of contracting high-risk HPV strains that can progress to cancer. In this case, your provider may recommend an anal Pap test. Anal Pap tests don’t test for HPV, but they can test for cell changes that may lead to cancer. Ask your healthcare provider if you should get tested.

Regardless of your reproductive anatomy, it’s important to prevent the spread of HPV by getting vaccinated and by practicing safer sex (correct and consistent use of condoms or dental dams).

HPV in people assigned female at birth

In general, HPV poses the greatest risk to women and people assigned female at birth (AFAB) because high-risk HPV can progress to cervical cancer if it’s not treated. Pap smears and HPV tests can detect precancerous cell changes early to prevent cancer in your cervix. HPV can also cause genital warts in people AFAB.

HPV in people assigned men at birth

HPV poses fewer health risks to men and people assigned male at birth (AMAB). If you’re AMAB, HPV can cause genital warts, but most infections clear on their own. HPV can lead to cancers of your penis, anus, head and neck, but these cancers are rare. As a result, HPV tests and Pap tests aren’t generally recommended for people who are AMAB.

What are the complications of HPV?

The most serious complication of HPV is cancer. Cervical cancer is the most common type of HPV-related cancer. Other types of cancer are much rarer. They include:

• Anal cancer.
• Penile cancer.
• Throat cancer.
• Vaginal cancer.
• Vulvar cancer.

It’s important to remember that having HPV — even a high-risk strain — doesn’t mean that you’ll develop these cancers.

Another complication of HPV infection are genital warts. Genital warts can be itchy and uncomfortable and interfere with your daily life. Other than those symptoms, genital warts don’t cause much harm.

What tests can be done to diagnose an HPV infection?

A healthcare provider will typically be able to diagnose genital warts and other bodily warts just by looking. High-risk forms of HPV don’t cause symptoms, which means you’ll likely learn about an infection through a routine Pap smear or HPV test.

• Pap smear: A Pap smear screens for cervical cancer and precancerous cells that may become cancer if left untreated. Cervical cancer is almost always caused by high-risk HPV.
• HPV test: HPV tests can detect the high-risk strains of the virus that may lead to cervical cancer if left untreated.

Other procedures that can detect abnormal cells likely caused by an HPV infection include:

• Colposcopy: Your provider may order a colposcopy if your Pap smear shows signs of abnormal cells or if you tested positive for HPV. During this procedure, a lighted instrument called a colposcope magnifies your cervix, bringing abnormal cells into view. Your provider may remove the cells and have them tested in a lab for signs of precancer or cancer (biopsy).
• Visual inspection with acetic acid (VIA): Providers may use VIA if they’re providing care in areas without access to Pap smears or HPV tests. With VIA, your provider places a vinegar-based solution on your cervix. The solution turns abnormal cells white so that they’re easier to identify.

What is the treatment for HPV?

Treatments can’t rid your body of the virus. They can remove any visible warts on your genitals or other body parts, and abnormal cells in your cervix. Treatments may include:

• Cryosurgery: Freezing warts or destroying abnormal cells with liquid nitrogen.
• Loop electrosurgical excision procedure (LEEP): Using a special wire loop to remove warts or abnormal cells on your cervix.
• Electrocautery: Burning warts off with an electrical current.
• Laser therapy: Using an intense light to destroy warts or any abnormal cells.
• Cold knife cone biopsy: Removing a cone-shaped piece of cervical tissue that contains abnormal cells.
• Prescription cream: Applying medicated cream directly to your warts to destroy them. These creams may include imiquimod (Aldara®) and podofilox (Condylox®).
• Trichloroacetic acid (TCA): Applying a chemical treatment that burns off warts.

Only a small number of people with high-risk HPV will develop abnormal cervical cells that require treatment to prevent the cells from becoming cancer.

Can HPV be prevented?

The only way to prevent HPV is to abstain from sex. For many people, more realistic goals include reducing the risk of contracting HPV and preventing cervical cancer while still enjoying a healthy sex life.

You can reduce your risk if you:

• Get the HPV vaccine. The best way to protect against HPV is to get vaccinated before becoming sexually active (around age 11 or 12). If you’re sexually active, getting vaccinated may protect you from HPV strains you haven’t been exposed to. Ask your provider if they recommend you get vaccinated.
• Get screened and tested regularly. Early detection of HPV and abnormal cells prevents cervical cancer. You should begin getting regular Pap smears at age 21. Talk to your provider about the screening schedule that makes sense for you.
• Practice safer sex. Condoms and dental dams are less effective at preventing HPV than protecting against STIs that spread through semen or vaginal fluid. Still, using them correctly each time you have sex can reduce your risk of an HPV infection.
• Protect your partner(s). Let your partner know if you have HPV so that they can get tested, too. You may need to stop having sex while you’re getting treated for genital warts or high-risk forms of HPV. Talk to your provider about the precautions you should take with an HPV infection.

What can I expect if I have HPV?

The outlook for HPV is generally very good. It depends on what strain of HPV you have and how able your body is to fight off the infection. If you have a lower-risk strain of HPV and you’re in good health, chances are your body will clear the infection within 12 to 24 months.

Certain strains are more likely to lead to cancer. Your healthcare provider will monitor these strains and recommend further testing or treatment. Early detection of high-risk strains and follow-up screenings such as frequent Pap tests can prevent HPV from causing cervical cancer.

Is HPV curable?

No. There isn’t a cure for HPV. Still, your immune system is incredibly efficient at getting rid of the virus for you. Most HPV infections (about 90%) are cleared within a year or two.

Is HPV contagious for life?

Not necessarily. You’re contagious for as long as you have the virus — regardless of whether or not you have symptoms. For example, even if your genital warts have disappeared, you can still spread the HPV that caused them if the virus is still in your body.

When should I see my healthcare provider?

Contact your healthcare provider if you have any of the following:

• Genital warts. These are cauliflower-like warts that may appear on your vagina, anus or mouth.
• Abnormal pap smear results. Getting abnormal results on a Pap may indicate you need further testing for HPV.

You should also ask your healthcare provider about how frequently you should have tests that may indicate an HPV infection like Pap smears. Discuss any concerns you have about HPV with your healthcare provider, especially if you have a health condition that weakens your immune system. This can make it harder for your body to fight the virus.

What questions should I ask my healthcare provider?

It’s natural to have some questions about HPV. You may want to ask:

• Do I need treatment for HPV?
• Is this type of HPV a high-risk strain?
• Should I get screened for HPV more often?
• Can I spread HPV to others?
• Can I get the HPV vaccine?

Should my partner be worried if I have HPV?

HPV is very common. Almost everyone has had or will have HPV at some point in their life. Most HPV infections clear up on their own because your body fights the virus.

It’s hard to say if your partner got HPV from you or someone else, as it can take years to show symptoms of HPV (if you show symptoms at all). The best thing you can do is be proactive about getting regular health screenings and then share your health history with your partner.