An Overview of Human Papillomavirus (HPV)

Common Viral Infection Linked to Cervical and Anal Cancer

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The human papillomavirus (HPV) the most common sexually transmitted infection in the world today. It is actually made up of more than 150 related viruses, 30 of which are associated with different types of cancer. Depending on the strain you are exposed to, HPV can cause warts on various parts of the body, including the anus and genitals, although many who carry the virus don't even know it.

There is currently no cure for HPV.

More than 50 percent of sexually active adults are believed to be infected with at least one strain of the virus, while up to 80 percent of sexually active women will have been exposed to the virus by the time they turn 50.

According to statistics from the Centers for Disease Control and Prevention, more than 30,000 cancers in the United States are directly attributed to HPV each year. While HPV is most commonly associated with cervical cancers and anal cancers (96 percent and 93 percent of cases, respectively), it has also been linked to penile cancerthroat cancer, and even lung cancer.

The risk of these cancers is related to, among other things, the HPV strain and the mode of sexual transmission. Other risk factors, such as smoking and co-existing sexually transmitted infections (including HIV), can further increase a person’s likelihood of developing cancer.

If you or a loved one has been diagnosed with HPV, it may cause distress and even alarm, but there are things you can do to not only reduce your risk but avoid further spread of the virus. There are even vaccines that can help prevent infection in the first place.

Learning the facts is the first step to reducing your risk of infection or illness.

Symptoms

Symptoms of HPV, if they arise, typically appear in the form of a cauliflower-like growth called genital warts. Warts can also be flat. They can be found in or around of the vagina, anus, mouth, and throat, as well as on the penis and groin. These growths can take weeks or even years to develop after the initial exposure.

The absence of warts does not mean that you are clear of HPV, however. Warts can often be internalized—and, therefore, impossible to notice—and, in some cases, there may be no physical manifestation of the disease at all.

As such, the appearance or presence of a wart (or lack thereof) is never a good way to determine whether or not you have been infected with HPV, and the same goes for a partner. Only diagnostic tests can tell you that.

Causes

HPV is caused by vaginal, anal, or oral sex with a partner who already has, and who then transmits, the virus via skin-to-skin contact.

The strain of HPV is what dictates the risk of an infection progressing to cancer. Strains can be broadly divided into two categories:

  • Low-risk strains can cause genital warts but are considered "non-oncogenic" because they are not associated with the development of cervical cancer or anal cancer.
  • High-risk strains are most worrisome, as they can cause cancer-related cell changes (dysplasia).

If warts do appear, it doesn't necessarily suggest that you will get cancer. In fact, the vast majority of genital warts are benign and non-threatening.

Diagnosis

One of the key tools for HPV diagnosis is the Pap smear—for both men and women.  The diagnostic recommendations vary for each:

  • For women, a routine pelvic exam and Pap smear are the best means to identify an HPV infection. An HPV test, which checks for the actual virus, may be performed as well.
  • For men, a physical exam and anal Pap smear can be performed; this is most often done in gay or bisexual men who are at a disproportionately high risk of anal cancer. Unfortunately, there is no HPV test approved for men. Moreover, anal cancer screening is not recommended for anyone other than, perhaps, men who have sex with men (MSM) who engage in receptive anal sex.

    If a wart looks suspicious, the doctor may perform a biopsy. This involves the removal of tissue for analysis in the lab. A biopsy is typically performed as part of a visual examination of the cervix, vagina, and vulva (using a colposcope) or the anal canal (using an anoscope).

    Treatment

    The treatment of HPV will depend on the symptoms and clinical findings. In many cases, the doctor will take a watch-and-wait approach and recommend regular follow-up exams.

    While often unsightly and uncomfortable, the majority of genital warts do not cause any major health problems. Most can be treated at home with topical creams prescribed by a doctor. Other methods include freezing (cryotherapy), burning (cautery), or surgically removing the wart. Laser and trichloroacetic acid treatments are also available.

    Unlike other types of viruses affecting the skin, there are no antiviral medications available to treat genital warts.

    Moreover, the removal of a wart is not considered curative. Removal simply treats the symptom, not the virus. In some cases, the wart may return. Therefore, the goal of treatment is to monitor for complications of HPV infection including the development of warts, dysplasia, and cancer.

    In the unlikely event that cancer is diagnosed, you would be referred to an oncologist to stage the disease and decide upon the appropriate course of treatment.

    Prevention

    Prevention of HPV is central to reducing your risk of infection or further spread of the virus.

    Safer sex practices can significantly reduce the risk of transmission. This includes maintaining a low number of sex partners and the consistent use of condoms (even during oral sex).

    There are also three different vaccines available to prevent many of the high-risk strains of HPV:

    • Cervarix, which protects against HPV 16 and 18
    • Gardasil, which protects against HPV 6, 11, 16, and 18
    • Gardasil 9, which protects against HPV 6, 11, 13, 31, 33, 45, 52, and 58

    HPV vaccination is not recommended for everyone. It is routinely advised for girls and boys starting from the age of 11 (and even as young as nine). It can be routinely used up to the age of 26 in women and 21 in men. High-risk individuals, such as MSM and people with HIV, can be vaccinated at any age.

    Coping

    Remember that most HPV infections go away on their own. If you are waiting for one to clear or are dealing with recurrent infections or related genital herpes, the best things you can do to cope involve helping your body clear the virus and making sure that you don't pass it to a partner (who can end up passing it back to you).

    Get clear instructions from your doctor as to if sex should be avoided for a period of time (and for how long), when you should be re-tested, and what treatment, if any, you need to follow. Help boost your immune system by quitting smoking, eating nutritious foods, and keeping stress under control. 

    And though HPV is the most common sexually transmitted infection, consider your diagnosis a prompt to evaluate your safe sex practices, so you can make sure you're doing all you can to stay healthy.

    A Word From Verywell

    While it is natural to feel worried when faced with a genital wart, it is important to never make assumptions. Rather, see your doctor as soon as possible and have it looked at.

    The HPV diagnosis process is relatively fast and pain-free. And if you test positive, it's likely that your case is not serious. In the unlikely event that it is, effective cancer treatments are available that offer high cure rates if started early.

    The one thing you should never do is ignore a genital wart. As with any type of cancer, early diagnosis always translates to greater treatment success.

    Sources:

    Centers for Disease Control and Prevention. "How Many Cancers Are Linked with HPV Each Year?" Atlanta, Georgia; updated March 3, 2017.

    Meites, E.; Kempe, A.; and Markowitz, L. "Use of a 2-Dose Schedule for Human Papillomavirus Vaccination—Updated Recommendations of the Advisory Committee on Immunization Practices ." MMWR Morb Mortal Wkly Rep. 2016;65(49);1405-8.

    National Cancer Institute. "The Link Between HPV and Cancer." Rockville, Maryland; updated December 16, 2016.