To quote the CDC and PubMed, “HPV may be the most widespread, misunderstood, and potentially dangerous epidemic that you probably know very little about.”

The Epidemiology Snapshot

Human Papillomavirus, also called HPV, is a sexually transmitted virus that is linked to cervical cancer in women and throat cancer in men. According to the CDC “About 79 million Americans are currently infected with HPV and about 14 million people become newly infected each year.” In other words, HPV is spreading faster than a juicy rumor at a high school.

There are several reasons why HPV is spreading so rapidly. First off, while condoms reduce the risk, you can still get HPV when wearing a condom. Secondly, while there is a HPV vaccine, it is not a completely effective as it only protects against 4 of the 170 strands. Another cause is the test we use for screenings, it is only effective for women and does not show all the stains of HPV so you can still have an infection even if tested negative.

So let’s go over what HPV is and what we can do to reduce our risks.

What is HPV?

Human Papillomavirus is used to describe a group of viruses that are most commonly found on the genitals and anus, but can also infect the mouth and throat.

HPV is the most common sexually transmitted infection. Approximately 75% of sexually active individuals will have at least one HPV infection in their lifetime, with the highest rates of HPV infection occurring in young people aged 15 to 24.

There are more than 170 strains of HPV with at least 40 strains linked to genital warts or cancer. Low-risk strains of HPV, which cause genital warts, often clear on their own. The 13 cancer-causing HPV strains, the most common being types 16 and 18, can also go away on their own, but if the infection lingers it can lead to cancer.

Cervical cancer in women and throat cancer in men are the most common cancers caused by Human Papillomavirus infection. Statistics show that around 70% of all cervical cancer cases are a direct consequence of an HPV infection.

HPV infection is also linked to cancers of the anus, penis, vagina, and vulva, but these cancers are rare.

Symptoms of HPV

Very often people with HPV infections do not have any visible signs or symptoms. Genital warts are the only symptom that is visible to the naked eye.

Genital Warts

These are small growths that appear on or inside the sex organs several weeks, months, or even years after sexual contact. They often look like small, red or white cauliflowers; they may be flat or feel like raised bumps. Warts can come as only one or there could be many.

In women, genital warts appear on the vulva, urethra, cervix, vagina, anus or thighs. In men, warts can appear on the penis, scrotum, anus or thighs. Genital warts are not precancerous and are usually painless, but can sometimes cause itching or burning. When genital warts are visible, it can cause embarrassment and affect relationships.

Genital warts symptoms:

• Itchiness
• Discomfort during intercourse
• Bleeding with intercourse or with shaving
• Warts on the penis or vulva, which appear as small cauliflower-like growths
• During pregnancy, warts may increase in size and number and then regress/resolve after delivery

Cervical Cancer

In case HPV becomes a chronic infection, it is important to know the symptoms of cervical cancer as HPV can lead to cancer. Cervical cancer often has no symptoms until later stages.

Symptoms can include abnormal vaginal bleeding, pain during sexual intercourse, increased discharge from the vagina, pain in the pelvic area or lower back, weight loss, lack of energy and shortness of breath.

It is important to remember that the signs of cervical cancer can also be caused by other health conditions so always discuss your concerns with your doctor rather than trying to self diagnose.

Testing of HPV

Most genital warts are diagnosed by visual inspection. If there is any doubt, a biopsy can be taken. Unfortunately when it comes to non wart causes there is are no HPV tests for men. Women, on the other hand, can detect HPV on pap screening.

A Pap test is a simple screening method that uses a cotton swab to obtain a sample of the cells on the cervix. The cells are sent to the lab where changes in your cervix cells can be detected. Regular Pap tests are the best way to find abnormal cervical cells early and treat them before they develop into cervical cancer.

The U.S. Food and Drug Administration (FDA) approved the first DNA test for HPV in 2014. An HPV DNA test is generally recommended for women over 30 whose Pap test results show specific abnormalities. However, testing recommendations differ by geographic location.

There are HPV tests that can be used to screen for cervical cancer also. These tests are only recommended for screening in women aged 30 years and older. HPV tests are not recommended to screen men, adolescents, or women under the age of 30 years.

Most people with HPV do not know they are infected and never develop symptoms or health problems from it. Some people find out they have HPV when they get genital warts. Women may find out they have HPV when they get an abnormal Pap test result (during cervical cancer screening). Others may only find out once they’ve developed more serious problems from HPV, such as cancers.

Updated guidelines recommend that women have their first Pap smear at age 21 and be tested for HPV at the same time, regardless of the onset of sexual activity. After that, women aged 21 to 29 should undergo a Pap test every three years. Regular Pap tests help to identify abnormal cells in women. These can signal cervical cancer or other HPV-related problems.

Women ages 30 to 65 should then be screened every five years with Pap and HPV tests at the same time. If you’re younger than the age of 30, your doctor or gynecologist may also request an HPV test if your Pap smear results are abnormal.

If you have one of the 15 strains of HPV that can lead to cancer, your doctor may want to monitor you for cervical changes. You may need to get a Pap test more frequently.

Cervical changes that lead to cancer often take 10 or more years to develop and HPV infections often go away on their own in one or two years without causing cancer. You may want to follow a course of watchful waiting instead of undergoing treatment for abnormal or precancerous cells resulting from an infection.

Your doctor may also want to do some follow-up testing with a colposcopy. This procedure uses an instrument (a colposcope) to examine your vagina and cervix more closely to look for abnormal areas.

If you have new warts or notice other changes after sexual activity, contact your doctor for an assessment.

Prevention of HPV

HPV is spread by skin-to-skin contact. This can be during oral, vaginal or anal sex, or during any other sexual activity in which skin-to-skin contact takes place. You can do several things to lower your chances of getting HPV.

Get vaccinated. The HPV vaccine is safe and effective. It can protect against diseases (including cancers) caused by HPV when given in the recommended age groups. The recommendation for 9-26year olds is to get two doses of HPV vaccine to protect against cancers caused by HPV. Vaccination works best before you are sexually active or have already become infected or exposed to an HPV virus, but can help reduce the risk of HPV-related disease at any time, even after an abnormal Pap test.

Get screened for cervical cancer. Routine screening for women aged 21 to 65 years old can prevent cervical cancer.

Practice safe sex

• Use latex condoms every time you have sex. This can lower your chances of getting HPV, but HPV can infect areas not covered by a condom – so condoms may not fully protect against getting HPV
• Be in a mutually monogamous relationship and maintain a low number of sexual partners

Treatment of HPV

There is no treatment for the virus itself. However, there are treatments for the health problems that HPV can cause:

Genital warts

Warts can be treated by using topical medication or freezing them off. Topical creams are usually applied to the area over a 4 to 16-week period. The length of treatment may vary depending upon the severity of warts and the treatment that is used.

These treatments do not get rid of the HPV infection; a person who has been treated may still pass it on, even if the warts are no longer visible. If left untreated, genital warts may go away, stay the same, or grow in size or number.

Caution: Do not use nonprescription wart removal products to treat genital warts. These products are not intended for use in the genital area and may cause serious burning.

Pre-Cancerous Changes

Women who get routine Pap tests and follow up as needed can identify problems before cancer develops. Cervical and other HPV-related cancer patients have higher chances of survival when diagnosed and treated early also. 

If your HPV infection lingers your doctor may need to take a biopsy. If the biopsy is abnormal then a procedure to scrape the cells off the cervix, which is known as an endocervical curettage, may be performed. Prevention is always better than treatment.