9 Things You Should Know About Human Papillomavirus (HPV)

It is Very Common

It is estimated that over 42.5 million Americans are living with HPV, making it the most common sexually transmitted infection (disease) in the U.S.

It is so common that researchers believe up to 92% of all sexually active people will get the virus at some point in their lives. However, the numbers have decreased significantly since the HPV vaccination was introduced.

You Can Get HPV Without Having Sex

HPV is transmitted through skin-to-skin sexual contact. This shouldn't suggest, however, that intercourse is the sole route of transmission. In fact, no penetration of any sort is needed to transmit HPV, and any area not covered by a condom is vulnerable to HPV exposure.

By and large, vaginal and anal intercourse are the activities most associated with HPV transmission. Although less common, the virus can also be passed through oral sex.

The risk increases if you have multiple sex partners or have sex with someone who has had many partners. 

Most Strains Don't Cause Cancer

There are more than 100 different strains of HPV. Some are "high-risk" strains associated with cancer; others are "low-risk" types known to cause genital warts.

Two strains considered to be of high risk are types 16 and 18, which together cause 70% of cervical cancers and pre-cancerous cervical lesions.

With that being said, having a genital wart shouldn't suggest you are "safe." Persons can be infected with multiple HPV types, and the appearance of a wart should be a warning sign of possible exposure to high-risk strains.

There Is a Vaccine, but No Cure for HPV

The types of HPV that cause genital warts and cervical cancer can be managed but not cured. Similarly, genital warts can be treated by removing them, but their removal does not eradicate (cure) the underlying virus.

While there are vaccines today that can greatly reduce the risk of HPV in young people, they are not sterilizing vaccines and cannot neutralize the virus in people already infected.

Most People With HPV Display No Symptoms

You cannot know if someone has HPV by looking at them or searching for genital warts. Most people have no signs of infection and may only become aware of the condition if they have an abnormal Pap smear result.

If symptoms do appear they can be present on the vulva, penis, scrotum, anus, mouth, or throat and include:

• Genital warts (small bump or group of bumps)
• Unusual growths
• Lumps
• Sores

The HPV Vaccine Does Not Protect Against All Strains

Gardasil-9 is currently the only FDA-approved HPV vaccine available in the U.S. It protects against two low-risk HPV types (types 6 and 11) and seven high-risk types (types 16, 18, 31, 33, 45, 52, and 58).

While Gardasil-9 typically provides ample protection, it is less effective in preventing HPV-related disease in those who have already been exposed to one or more HPV types. While the vaccine does not treat existing HPV infections or associated diseases, it does protect against strains you've not already been exposed to.

It may also fall short in those assigned female at birth who are living with HIV. This population may develop cervical cancer as a result of an atypical HPV type.

You Can Test for HPV

The HPV test can be performed on those assigned female at birth in conjunction with a Pap smear during a routine gynecological exam. The U.S. Preventive Services Task Force (USPSTF) endorses routine HPV testing as follows:

• For women aged 21 to 29 years, a Pap smear is recommended every three years.
• For women 30 to 65, either a Pap smear can be performed every three years, high-risk human papillomavirus (hrHPV) testing alone can be done every five years, or co-testing with a Pap smear and hrHPV test can be performed every five years.

By contrast, the American Cancer Society (ACS) recommends people with a cervix undergo HPV primary testing—rather than a Pap test—every five years, starting at age 25 and continuing through 65. In doctors' offices and other healthcare facilities that do not have access to HPV primary testing, co-testing with a Pap test and hrHPV test can be performed every five years, or a Pap test can be done every three years.

There is no HPV test available to detect genital HPV in penises. However, some doctors may run an HPV test on an anal Pap smear in high-risk individuals who engage in receptive anal sex.

HPV Vaccination Is Not Just for Children

The CDC recommends routine HPV vaccination for all adolescents aged 11 and 12, although the vaccine can be administered as early as nine years old. "Catch-up" vaccination for those between 13 and 26 is also recommended.

For certain individuals over 26, vaccination may still be beneficial. The CDC recommends the HPV vaccine for some adults ages 27 to 45 based on shared clinical decision-making—a discussion between healthcare providers and their patients.

The CDC advises immune-compromised persons (including those with HIV) to be vaccinated regardless of age as well.

Vaccination Doesn't Replace Cancer Screening

Even if you get the HPV vaccine, you need to be vigilant about getting screened for cervical cancer. According to the CDC, getting vaccinated can prevent over 90% of cancers caused by HPV, including anal, vaginal, cervical, and vulvar precancers.

Summary

The human papillomavirus (HPV) is the most common sexually transmitted infection (STI). It is transmitted through skin-to-skin sexual contact so the transmission does not require sexual intercourse. 

It usually goes away after a couple of years. However, certain strains can cause genital warts and genital cancers which can be treated but not cured. Vaccination begins for HPV starts during the pre-teen years and helps prevent infection. It can also be given to some adults who are at increased risk or immunocompromised. 

For those who’ve had the HPV vaccine, screening for HPV through pap smears is still essential.

A Word From Verywell

Many people who get HPV feel nervous or ashamed. Keep in mind that HPV is so common that 85-92% of all sexually active people have it at some point in their life. Many never have symptoms and it resolves on it's own in a couple of years.

If you have symptoms such as genital warts or are concerned about cancer, talk to your healthcare provider about testing and treatment. It's also important to ask them how to share this information with intimate partners.