Human papillomaviruses (HPV)


Fact: Every year in the U.S., 27,000 people get cancer caused by HPV

What is HPV?
HPV stands for human papillomavirus (pronounced pap ah LO mah), but there are actually more than 100 related viruses in this group. Each HPV virus is given a number or type. The term "papilloma" refers to a kind of wart that results from some HPV types.
HPV lives in the body's epithelial cells. These are flat and thin cells found on the skin's surface and also on the surface of the vagina, anus, vulva, cervix, penis head, mouth, and throat.

Of the 100 HPV types, about 60 types cause warts on areas such as the hands or feet. The other 40 or so types of HPV are sexually transmitted and are drawn to the body's mucous membranes, such as the moist layers around the anal and genital areas.
Infection with the HPV virus infects at least 50% of all people who have sex at some time in their lives. Often, people don't have any symptoms and the HPV infection goes away on its own. Some types of HPV can lead to cervical cancer or cancer of the anus or penis.

Symptoms
In most cases, your body's immune system defeats an HPV infection before it creates warts. When warts do appear, they vary in appearance depending on which variety of HPV is involved:

  • Genital warts. These appear as flat lesions, small cauliflower-like bumps or tiny stem-like protrusions. In women, genital warts appear mostly on the vulva but can also occur near the anus, on the cervix or in the vagina.
    In men, genital warts appear on the penis and scrotum or around the anus. Genital warts rarely cause discomfort or pain, though they may itch.
  • Common warts. Common warts appear as rough, raised bumps and usually occur on the hands, fingers or elbows. In most cases, common warts are simply unsightly, but they can also be painful or susceptible to injury or bleeding.
  • Plantar warts. Plantar warts are hard, grainy growths that usually appear on the heels or balls of your feet. These warts might cause discomfort.
  • Flat warts. Flat warts are flat-topped, slightly raised lesions darker than your skin. They can appear anywhere, but children usually get them on the face and men tend to get them in the beard area. Women tend to get them on the legs.

Cervical cancer
It's important to remember that being vaccinated against HPV infection can protect you from cervical cancer. For those who aren't vaccinated, most cases of cervical cancer are caused by HPV strains that usually don't cause warts, so women often don't realize they've been infected. Early stages of cervical cancer typically cause no signs or symptoms.

Over time, repeated infection of certain HPV strains can lead to precancerous lesions. If not treated, these lesions can become cancerous. That's why it's important for women to have regular Pap tests, which can detect precancerous changes in the cervix that might lead to cancer.

Causes
HPV infection occurs when the virus enters your body, usually through a cut, abrasion or small tear in your skin. The virus is transferred primarily by skin-to-skin contact.

Genital HPV infections are contracted through sexual intercourse, anal sex and other skin-to-skin contact in the genital region. Some HPV infections that result in oral or upper respiratory lesions are contracted through oral sex.

If you're pregnant and have an HPV infection with genital warts, the warts might enlarge and multiply during pregnancy. Treatment might have to wait until after delivery.

Large genital warts can block the birth canal, complicating vaginal delivery. The infection might be linked to a rare, noncancerous growth in the baby's voice box (larynx). Warts are contagious. They spread by contact with a wart or with something that touched the wart.

Risk factors
HPV infections are common. Risk factors for HPV infection include:

  • Number of sexual partners. The more sexual partners you have, the more likely you are to contract a genital HPV infection. Having sex with a partner who has had multiple sex partners also increases your risk.
  • Age. Common warts occur mostly in children. Genital warts occur most often in adolescents and young adults.
  • Weakened immune systems. People who have weakened immune systems are at greater risk of HPV infections. Immune systems can be weakened by HIV/AIDS or by immune system-suppressing drugs used after organ transplants.
  • Damaged skin. Areas of skin that have been punctured or opened are more prone to develop common warts.
  • Personal contact. Touching someone's warts or not wearing protection before contacting surfaces that have been exposed to HPV — such as public showers or swimming pools — might increase your risk of HPV infection.

Complications

    • Oral and upper respiratory lesions. Some HPV infections cause lesions on your tongue, tonsils, soft palate, or within your larynx and nose.
    • Cancer. Certain strains of HPV can cause cervical cancer. These strains might also contribute to cancers of the genitals, anus, mouth and upper respiratory tract.

How Common Is HPV?
About 80 million people in the U.S. are infected with HPV at any time, according to the CDC. And three-fourths of sexually active people between ages 15 and 49 have been infected at some point in their lives, according to estimates from the American Social Health Association.

You're more likely to get HPV if you:

  • Have sex at an early age
  • Have many sex partners
  • Have a sex partner who has had multiple partners

While many people think HPV is mostly a problem for teens or young adults, HPV can infect men and women of any age. In fact, the latest statistics from the CDC found that:

  • 19% of women ages 50 to 59 were infected with HPV virus
  • 27% of women ages 20 to 24 were infected with HPV virus
  • 45% of women ages 14 to 19 were infected with HPV virus

Reducing the Risk of Getting HPV
The only way to absolutely avoid the risk of HPV infection is to abstain from sex. You can also limit the number of sexual partners you have. And you can choose partners who've had few or no sexual partners before you. However, while a long-term monogamous relationship lowers your risk, it's important to remember that many people are infected and never know it.

There are three vaccines to protect against HPV which are available to boys and girls as young as nine and adults up to age 26. It is believed that overtime, the vaccines Cervarix, Gardasil, and Gardasil-9 will help reduce the spread of the HPV virus. Each protects against HPV 16 and 18, while Gardasil and Gardasil-9 are also effective against HPV 6 and 11 which cause 90% of all genital warts. Gardasil-9 also covers against the high risk strains: 31, 33, 45, 52, 58.

Diagnosis
Your doctor might be able to diagnose HPV infection by looking at your warts.

If genital warts aren't visible, you'll need one or more of the following tests:

  • Vinegar (acetic acid) solution test. A vinegar solution applied to HPV-infected genital areas turns them white. This may help in identifying difficult-to-see flat lesions.
  • Pap test. Your doctor collects a sample of cells from your cervix or vagina to send for laboratory analysis. Pap tests can reveal abnormalities that can lead to cancer.
  • DNA test. This test, conducted on cells from your cervix, can recognize the DNA of the high-risk varieties of HPV that have been linked to genital cancers. It's recommended for women 30 and older in addition to the Pap test.


Treatment
Warts often go away without treatment, particularly in children. However, there's no cure for the virus, so they can reappear in the same place or other places.

Medications
Medications to eliminate warts are typically applied directly to the lesion and usually take many applications before they're successful. Examples include:

  • Salicylic acid. Over-the-counter treatments that contain salicylic acid work by removing layers of a wart a little at a time. For use on common warts, salicylic acid can cause skin irritation and isn't for use on your face.
  • Imiquimod (Aldara, Zyclara). This prescription cream might enhance your immune system's ability to fight HPV. Common side effects include redness and swelling at the application site.
  • Podofilox (Condylox). Another topical prescription, podofilox works by destroying genital wart tissue. Podofilox may cause pain and itching where it's applied.
  • Trichloroacetic acid. This chemical treatment burns off warts on the palms, soles and genitals. It might cause local irritation.

Surgical and other procedures
If medications don't work, your doctor might suggest removing warts by one of these methods:

  • Freezing with liquid nitrogen (cryotherapy)
  • Burning with an electrical current (electrocautery)
  • Surgical removal
  • Laser surgery

​Information on this page taken directly from:
Centers for Disease Control (CDC)
Mayo Clinic
WebMD

Want to learn more?
The following are organizations and/or websites dedicated to providing information and education surrounding HPV. These organizations are dedicated to research, education, awareness, and/or support. They are listed in Alphabetical order without any preference or prejudice. Listing these organizations is not a recommendation or referral in any regard for seeking treatment or consultation or support for treatment.

Centers for Disease Control (CDC)
Mayo Clinic
MedlinePlus
Planned Parenthood
WebMD