10 Things You Should Know About Human Papillomavirus (HPV)

The human papillomavirus (HPV) is a viral infection transmitted via intimate contact with another person. There are more than 100 strains of HPV. At least 14 of them have been linked to cancer. Cervical and anal cancer in particular are associated with these high-risk strains of HPV. Penile cancer and oropharyngeal cancer (cancer of the middle part of the throat behind the tongue) also are linked to high-risk strains.

Despite increased awareness about HPV, there remains a fair amount of confusion about the virus as well as about the vaccine that can help to prevent it. Having an understanding of basic key facts about both can go a long way toward ensuring you don't miss signs of the infection, spread it to others, or put yourself at risk.

1

HPV Is More Common Than You May Think

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It is estimated that over 79 million Americans are infected with HPV, making it the most common sexually transmitted disease in the U.S.

According to the Centers for Disease Control and Prevention (CDC), among adults between the ages of 18 and 59, 42.5% are infected with a genital HPV and 7.3% are infected with an oral HPV.

It is so common, in fact, that researchers believe almost all sexually active people will get the virus at some point in their lives. 

2

You Don't Need to Have Intercourse to Get HPV

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

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

3

Not All Types of HPV Cause Cancer

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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.

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

There is a common misconception among many that genital warts are a precursor to cancer. This is not the case. The HPV strains responsible for genital warts are not known to cause cancer.

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 higher risk strains.

4

There Is a Vaccine, but No Cure for HPV

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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 the underlying virus.

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

5

Most People With HPV Do Not Have Symptoms

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You cannot know if someone has HPV by looking at them or searching for genital warts. It doesn't work that way. Most people, in fact, have no signs of infection and may only become aware of the condition if they have an abnormal Pap smear result.

But, even for people who do have symptoms, they are often either overlooked or misunderstood.

6

The HPV Vaccine Does Not Protect Against All Strains

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Gardasil 9 Package. Merck

There are three HPV vaccines that can protect against some but not all of the high-risk strains:

  • Gardasil protects against four of the most common types and the two that cause 9% of all genital warts.
  • Gardasil 9 protects against all 4 common types and an additional five strains.
  • Cervarix protects against the two most common high-risk strains but provides no protection against genital warts.

The only HPV vaccine available in the United States is Gardasil 9.

While these vaccines typically provide ample protection, they may fall short in women with HIV who develop cervical cancer as a result of an atypical HPV type.

7

HPV Testing Is Different for Women and Men

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The HPV test can be performed on females 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:

  • Females 21 to 65 should have a Pap test and an HPV test every three years.
  • Those under 21 and over 65 do not need HPV screening but may be tested in the event of an abnormal Pap smear result.

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 ccess to HPV primary testing, Pap tests every three years is regarded as acceptable.

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

8

Some Doctors Are Reluctant to Do HPV Testing

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One of the reasons why health agencies are reluctant to issue routine testing recommendations is that the benefits of HPV testing are still largely uncertain.

While a negative HPV test is a good indication that you won't get cancer, a positive result often means nothing. This is because the majority of HPV infections go away in two years without any complications. As such, a positive result may cause more distress than necessary or direct medical investigations that are not needed.

HPV Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Woman
9

HPV Vaccination Is Not Just for Young People

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The CDC recommends HPV vaccination for all females at age 11 or 12 as well as for those 13 through 26 who have not been previously who likely will need a third dose to improve efficacy.

For certain individuals over 26, vaccination may still be beneficial. The CDC recommends gay and bisexual men, transgender people, and immune-compromised persons (including those with HIV) be immunized even if they're older as they run a higher risk of anal and cervical cancer than the general population.

The ACS guidelines for HPV vaccination differ from those of the CDC. In 2020 ACS began recommending routine HPV vaccination begin at age 9 to help support earlier vaccination rates overall. ACS also began recommending against vaccination in people older than 27 due to the low expected benefit and to shortage of the vaccine.

If you are older than 26 and believe you may be at increased risk for cervical or anal cancer, don't hesitate to ask your doctor about getting vaccinated. It will cost around $100. which your insurance may cover.

10

Getting the HPV Vaccine Does Not Mean You Can Skip Cancer Screening

Even if you get the HPV vaccine, you need to be vigilant about getting screened for cervical cancer. The vaccine shows a reduction in more advanced precancers, but it has not been around long enough to provide the 20 years of data required to indicate a reduction in actual cancer cases.

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Article Sources
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  1. World Health Organization. Human papillomavirus (HPV) and cervical cancer. Updated January 24, 2019.

  2. American Society of Clinical Oncology. HPV and cancer. Updated February 2019.

  3. Centers for Disease Control and Prevention. Genital HPV infection - fact sheet. Updated August 20, 2019.

  4. Sabeena, S., Bhat, P., Kamath, V., and G. Arunkumar. Possible non‐sexual modes of transmission of Human Papilloma Virus. Journal of Obstetrics and Gynecology Research. 2017. 43(3):427-435. doi:10.1111/jog.13248

  5. Centers for Disease Control and Prevention. HPV vaccine information for young women. Updated December 28, 2016.

  6. Centers for Disease Control and Prevention. Human papillomavirus (HPV) vaccination: What everyone should know. Updated November 22, 2016.

  7. Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. Jul 30, 2020. doi:10.3322/caac.21628

  8. Centers for Disease Control and Prevention. HPV and men - fact sheet. Updated December 28, 2016.

  9. Saslow D, Andrews KS, Manassaram-baptiste D, et al. Human papillomavirus vaccination 2020 guideline update: American Cancer Society guideline adaptation. CA Cancer J Clin. 2020; doi:10.3322/caac.21616