HPV

Overview

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, face, etc. About 30 HPV strains can affect your genitals, including your vulva, vagina, cervix, penis and scrotum, as well as your rectum and anus.

HPV that affects your genitals is a sexually transmitted infection (STI) that gets passed through skin-to-skin contact. Many people cringe at the thought of STIs, but the majority of genital HPV strains are harmless. This includes the type of HPV that causes genital warts.

Some strains of HPV are high-risk and can lead to cancers, like cervical cancer. Early detection and treatment can usually prevent this from happening.

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:

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

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

Certain strains of HPV (most often types 16 and 18) can cause changes in the cells of your cervix, a condition called cervical dysplasia. Your cervix is the opening between your vagina and your uterus. 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 (a test that screens for cervical cancer) can determine how often you should get tested. If you test positive, you may be at a higher risk and need more frequent testing.

Getting regular Paps to screen for cervical cancer is important. But it’s important to remember that just because you have HPV or cervical dysplasia doesn’t mean you’ll get cancer.

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.

HPV in women

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. Harmless forms of HPV can also cause genital warts in people who are AFAB.

HPV in men

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.

Still, 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 (MSM), 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.

How common is HPV?

HPV is the most common STI in the United States. Roughly 14 million people become infected each year. According to the U.S. Centers for Disease Control and Prevention (CDC), 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 the virus.

Symptoms and Causes

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 appear weeks, months or even years after you’ve been infected with HPV. Genital warts are contagious (like all forms of HPV), but they’re harmless.

High-risk forms of HPV often don’t cause symptoms until they’ve progressed to cancer. Cervical cancer is the most common type of HPV-related cancer. Other types of cancer are much rarer. They include:

As with cervical cancer, it’s important to remember that having HPV — even a high-risk strain — doesn’t mean that you’ll develop these cancers.

How do you get HPV?

Genital HPV spreads through skin-to-skin contact during intercourse, oral sex and anal sex. You can get infected if your genitals — including your vulva, vagina, cervix, 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 has been researched less.

How easily transmitted is HPV?

HPV is highly contagious, in part, because it’s transmitted through skin-to-skin contact. No body fluids have to be exchanged for you or your partner to contract the virus. You can infect your partner, or your partner can infect you even if no one ejaculates (cums).

Diagnosis and Tests

What tests can be done to diagnose an HPV infection?

A healthcare provider will typically be able to diagnose genital 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 (cervical dysplasia) 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. There aren’t any U.S. Food and Drug Administration (FDA)-approved tests for identifying HPV on the vulva, vagina, penis, scrotum, rectum or anus. HPV-related cancers on these body parts are much less common than cervical cancer.

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 in geographic regions without access to the resources needed for regular 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.

Management and Treatment

What is the treatment for HPV?

Treatments can’t rid your body of the virus. They can remove any visible warts on your genitals 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 (conization): 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 infected with high-risk HPV will develop abnormal cervical cells that require treatment.

Prevention

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. There are three FDA-approved vaccines to prevent HPV. Since 2017, only Gardasil9® is available in the U.S. Gardasil9® prevents the strains of HPV that cause cervical cancer and genital warts and is approved for everyone from ages 9 to 44. Even if you’re older than 44, 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. Depending on your results, you may need another Pap every one to three years or more. Between ages 30 to 65, you may need routine Pap smears only, routine HPV tests only or a combination of both. If you’re older than 65, you may or may not need continued screening. 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.

Outlook / Prognosis

Is HPV curable?

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

Living With

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.

Once your immune system destroys the virus, you’re no longer contagious.

A note from Cleveland Clinic

HPV prevention is essential to fighting cervical cancer. This is why everyone should follow the CDC’s recommendations for getting vaccinated. If you’ve recently learned you have HPV, don’t assume that you’ll get cancer, though. Not all forms of HPV are created equally. The HPV that causes genital warts may cause embarrassment, but the virus is harmless. Your body can clear most HPV infections. In those cases where your body can’t fight the infection, your provider can monitor cell changes in your cervix. Getting regular Pap smears and HPV tests as recommended can prevent HPV from becoming cancer.

Last reviewed by a Cleveland Clinic medical professional on 08/04/2022.

References

  • Centers for Disease Control and Prevention. Human papillomavirus (HPV). (https://www.cdc.gov/std/hpv/default.htm) Multiple pages viewed. Accessed 8/4/2022.
  • Malagón T, Louvanto K, Wissing M, et al. Hand-to-genital and genital-to-genital transmission of human papillomaviruses between male and female sexual partners (HITCH): a prospective cohort study. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404546/) Lancet Infect Dis. 2019;19(3):317-326. Accessed 8/4/2022.
  • National Cancer Institute. Human Papillomavirus (HPV) Vaccines. (https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet) Accessed 8/4/2022.
  • Shanmugasundaram S, You J. Targeting persistent human papillomavirus infection. (https://pubmed.ncbi.nlm.nih.gov/28820433/) Viruses. 2017;9(8):229. Published 2017 Aug 18. Accessed 8/4/2022.

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