What is HPV?
HPV, or human papillomavirus, is a group of more than 100 viruses that commonly cause harmless growths on the skin, known as warts. The types of HPV that cause warts on hands and feet are often spread by walking on contaminated surfaces. Approximately 40 types of HPV are sexually transmitted and can cause genital warts, while other types can cause cancer (CDC, 2022). Sexually-transmitted HPV is an extremely common virus; it is estimated that 80% of sexually active men and women will have it in their lifetime (CDC, 2021). While most people clear the virus in a few months, sometimes the infection can persist in your body and become a chronic infection.
What is HPV?
Sexually-transmitted HPV is a virus that affects almost everyone at some point. The virus spreads so easily because most people do not notice they have it, and it can spread through any skin-to-skin sexual contact, including in areas condoms cannot cover. HPV can take months or years to show symptoms, making it difficult to know when and where you acquired the infection. Additionally, there are limited testing options for HPV- the only available tests are for high-risk infections in women. However, there is good news: more than 90% of HPV infections will go away without treatment within two years (WHO, 2022). Learning more about how HPV works can help remove fear and worry around the virus, as well as help you stay healthy.
Low-risk HPV
Most low risk HPV infections cause no symptoms at all and disappear on their own. They also have no association with cancer. Certain low-risk types can cause genital warts on the vulva, penis, cervix, vagina, scrotum, or anus. They may also occur around the mouth, tongue and throat. HPV types 6 and 11 cause more than 90% of all genital warts (NYU Health). While there is no cure for HPV other than waiting for your body to clear the infection, genital warts can be treated using medications or methods of physical removal (Mayo Clinic, 2022). You may consider removing genital warts if they are causing discomfort, you are concerned about spreading them, or there are many of them.
High-risk HPV
HPV is considered high-risk if it is associated with cancer. An HPV infection that does not clear itself from the body can eventually turn normal cells into cancer cells. There are fourteen types of HPV associated with cancer. Two of these types, type 16 and 18, are responsible for the majority of these cancers (NIH, 2022).
Cervical cancer is the main type of cancer caused by HPV. More than 95% of cervical cancer cases are caused by HPV (WHO, 2022), and approximately 10% of women with an HPV infection of the cervix will develop a long-lasting HPV infection that could put them at risk of cancer (CDC, 2022). HPV also causes the majority of cancers of the vagina, vulva, penis, and anus, as well as most oropharyngeal cancers (the base of the tongue and tonsils) (CDC, 2022). Although HPV has historically been considered a risk for women’s health, many of these cancers affect both women and men. That is why understanding HPV and limiting its spread is important for everyone.
Most HPV infections and precancerous lesions resolve spontaneously without treatment. However there is a risk that the infection will become chronic and progress into cancer. It usually takes 15-20 years for HPV to develop into cervical cancer in women with normal immune systems. In women with a weakened immune system, this can take 5-10 years (WHO, 2022).
Would you like to learn more about HPV’s link to cancer? Read our blog.
How common is HPV?
As mentioned, HPV is a very common virus. Most people will have the virus at some point in their life with no long-term health effects. If you receive an initial diagnosis of high-risk HPV or cell changes in your cervix, try not to worry too much. In most situations, the body causes the virus to go away, and even cell changes in the cervix can resolve themselves. This is why HPV screening for cervical cancer is only recommended to certain age groups- in most young women the infection or cell changes resolve themselves and require no treatment.
The introduction of a vaccine for the most common strains of HPV in 2006 has been seen to greatly reduce the number of HPV infections, genital warts, and HPV-related cancers over time (Drolet et al., 2019; Lei et al., 2020; NIH, 2016). As vaccination for HPV becomes more common, the prevalence of HPV-related cancer is expected to dramatically decrease.
Symptoms of HPV
HPV often does not cause any symptoms. Low-risk HPV may cause genital warts, which can cause pain, itching, or bleeding. High-risk HPV usually has no symptoms until cancer occurs. This is why screening for precancerous lesions on the cervix is key to catching high-risk HPV before it becomes cancer. If you have any of the following symptoms, speak to your doctor. Do not wait for a HPV test.
Symptoms of cervical cancer:
- Bleeding between periods or after menopause
- Menstrual bleeding that is longer or heavier than usual
- Pain during intercourse
- Bleeding after intercourse
- Pelvic pain
- A change in your vaginal discharge, such as more discharge or a strong or unusual colour/smell
Source: WHO, 2022
Other potential symptoms of HPV-related cancer are:
- Itching and bleeding in the affected area
- Pain in the affected area
- Swollen glands
Source: NIH, 2022
How can you get HPV?
HPV can be transmitted through sex or close skin-to-skin touching. This includes oral, anal, and vaginal sex (CDC, 2022). HPV can be transmitted even if a condom or other barrier is used, as the areas that can have genital warts are not always covered. HPV is usually spread because an infected person is not aware they have the virus.
Can men also get HPV?
Just like women, men can also get HPV, including genital warts and HPV-related cancers. While HPV most often causes cervical cancer in women, HPV can also cause cancers that affect men, such as penile and oropharyngeal cancer (CDC, 2022). In fact, HPV infections are believed to be driving the increase in oropharyngeal cancers over time, particularly in men (NCCID, 2014). This is why HPV vaccination is an important cancer-prevention measure in both women and men. So it is also important for both women and men to do STI testing.
Does HPV cause cancer?
A long-term infection with high-risk HPV that does not clear itself from the body can cause cancer. HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68 are currently considered high risk. Almost all cervical cancers are caused by HPV. Some cancers of the vulva, vagina, penis, anus, and oropharynx are also caused by HPV. Most people infected with high-risk HPV will clear the virus and not develop cancer. Vaccination is one of the best ways to prevent HPV-related cancer (CDC, 2021). For the vaccine to be most effective, it needs to be administered before an HPV infection occurs. This is why national programs offer the vaccine to children before they are sexually active.
How can you test for HPV?
There is no test for low-risk HPV. This is one of the reasons it can spread so easily- most people have no symptoms and there is no test or cure available. You will only know you have low-risk HPV if genital warts appear.
Testing for high-risk HPV is only widely available for women at this time. There are two testing options: a vaginal swab test that checks for HPV, and a Pap smear that checks for cancerous or precancerous cells in the cervix. Most countries offer routine HPV tests/Pap smears as part of national cervical cancer screening campaigns. HPV tests are usually done at the same time as a Pap smear. If the HPV test is positive, the Pap smear will be analyzed for cell changes (Mayo Clinic, 2022).
One benefit to an HPV test is that it can also be performed from home. Homed-IQ’s HPV Test for Women is a laboratory test for 14 high-risk types of HPV, including types 16 and 18. If you test positive for HPV using a home test, a follow-up Pap smear will need to be scheduled with your GP.
HPV testing is usually not recommended for very young women as infections and cell changes in this age group usually resolve themselves without treatment. This is why HPV testing guidelines usually recommend screening begins at 25 or 30. Testing young women too often for HPV does not reduce the rate of cervical cancer and can lead to unnecessary treatment (Mayo Clinic, 2022). If you are younger than the screening age and have concerns about HPV, speak to your GP.
How to prevent an HPV infection
HPV is difficult to prevent as limited testing options are available and many people do not know they have it. While not all HPV can be prevented through condom/dental dam use, safe sex can help reduce your risk of infection. The most robust way to prevent complications from HPV is getting vaccinated. Modern vaccines protect against HPV types that cause most genital warts, as well as the types most commonly associated with cancer. HPV vaccinations are recommended for children who are not yet sexually active. However, if you are already sexually active and not yet vaccinated, discuss with your GP whether an HPV vaccine would still be beneficial for you.
Treatment of HPV
While there is no cure for HPV, most infections resolve themselves without treatment. Treatment for HPV-related genital warts or cervical cell changes is available and should be discussed with your doctor.
References
Basic Information about HPV and Cancer | CDC. (n.d.). https://www.cdc.gov/cancer/hpv/basic_info/index.htm
Cancers Associated with Human Papillomavirus (HPV) | CDC. (n.d.). https://www.cdc.gov/cancer/hpv/basic_info/cancers.htm
Centers for Disease Control and Prevention. (2022, March 18). Why Get the HPV Vaccine. https://www.cdc.gov/hpv/parents/vaccine/six-reasons.html
Drolet, M., Bénard, L., Pérez, N., Brisson, M., Ali, H., Boily, M. C., Baldo, V., Brassard, P., Brotherton, J. M. L., Callander, D., Checchi, M., Chow, E. P. F., Cocchio, S., Dalianis, T., Deeks, S. L., Dehlendorff, C., Donovan, B., Fairley, C. K., Flagg, E. W., . . . Yu, B. N. (2019). Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. The Lancet, 394(10197), 497–509. https://doi.org/10.1016/s0140-6736(19)30298-3
Genital warts – Diagnosis and treatment – Mayo Clinic. (2022, January 14). https://www.mayoclinic.org/diseases-conditions/genital-warts/diagnosis-treatment/drc-20355240
HPV test – Mayo Clinic. (2022, May 17). https://www.mayoclinic.org/tests-procedures/hpv-test/about/pac-20394355
Lei, J., Ploner, A., Elfström, K. M., Wang, J., Roth, A., Fang, F., Sundström, K., Dillner, J., & Sparén, P. (2020). HPV Vaccination and the Risk of Invasive Cervical Cancer. New England Journal of Medicine, 383(14), 1340–1348. https://doi.org/10.1056/nejmoa1917338
National Collaborating Centre for Infectious Diseases. (2020, January 7). HPV Infections and Head and Neck Cancers. https://nccid.ca/publications/hpv-infections-and-head-and-neck-cancers/
National Institute for Health. (2022, September 12). HPV and Cancer. National Cancer Institute. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer
National Institutes for Health. (2016, March 9). HPV Infections Decrease in the U.S. National Cancer Institute. https://www.cancer.gov/news-events/cancer-currents-blog/2016/hpv-infections-decreased
NYU Health. (n.d.). Types of Human Papillomavirus. NYU Langone Health. https://nyulangone.org/conditions/human-papillomavirus/types
World Health Organization. (2022, February 22). Cervical cancer. https://www.who.int/news-room/fact-sheets/detail/cervical-cancer