How Human Papillomavirus (HPV) Is Treated

In most cases, the immune system will be able to clear human papillomavirus (HPV) on its own within 18 to 24 months, usually with no long-term consequences, though that is not always the case. Because there are no drugs available to treat an active HPV infection, HPV treatment involves resolving HPV symptoms and monitoring for any changes in the skin or mucosal cells; in addition to causing genital warts, more than 30 of the approximately 150 viruses that make up HPV are linked to cervical, anal, and other cancers.

HPV treatment options are largely based on whether a person has one or more of the following features:

• Asymptomatic infection
• Genital warts
• Abnormal changes in cells (dysplasia) of the cervix, vagina, vulva, anus, penis, mouth, or throat

Let's look at each of these individually.

When an HPV infection is asymptomatic (without symptoms), no specific treatment is recommended. These infections are often identified if a person's sexual partner has developed genital warts.

If a woman tests positive for cervical HPV infection but has a normal Pap smear, the doctor may do one of two things:

• Schedule another round of tests in 12 months. If the results are normal, you can return to normal screening. If they are not, additional testing will be needed.
• Perform an HPV test to identify the two high-risk HPV strains (HPV 16 and HPV 18) that account for 70 percent of all cervical cancers. If the results are negative (meaning you have not been infected with these specific viruses), you can be retested in 12 months as a safeguard. If the results are positive, additional testing will be needed.

While there are no specific recommendations or HPV tests available for men, those considered to be at high risk—namely, men who have sex with men (MSM) who engage in receptive anal sex—could undergo an anal Pap smear to check for dysplasia. This is especially true for MSM who have HIV.

If you are confirmed to have HPV but have no symptoms, you may be advised to get an HPV vaccination to protect you against the most common high-risk strains of HPV. Vaccination is recommended up until the age of 26 for women and 21 for men.

People at high risk can get vaccinated at any time. Sexual partners should also consider getting vaccinated.

Though unsightly and uncomfortable, genital warts generally do not pose any major health risk. Most are caused by two low-risk strains, known as HPV 6 and HPV 11, which account for around 90 percent of all genital wart outbreaks.

Some genital warts may go away on their own, usually within a year. Others may need to be treated at home with topical creams prescribed by a doctor.

Other methods of genital wart treatment include:

• Cryotherapy (freezing warts with liquid nitrogen)
• Electrocautery (using electricity to burn warts away)
• Surgery
• Laser therapy
• Trichloracetic acid (applied topically to gradually remove a wart)

Genital warts should never be considered normal, and you should not treat them at home without first seeing a doctor. While most warts will turn out to be benign, others may require further investigation, particularly if they are bleeding, inflamed, spreading, resistant to treatment, or have an atypical appearance.

Infection with certain high-risk HPV strains can lead to abnormal changes in the tissues of the genitals or anus. Known as dysplasia, these changes can vary in severity from mild (low-grade) to serious (high-grade). While mild dysplasia usually resolves on its own, moderate to severe dysplasia may progress to an early form of cancer known as carcinoma in situ (CIS).

The diagnosis can be made by performing a biopsy and analyzing the tissues in the lab.

• For persons with low-grade dysplasia, doctors will typically take a watch-and-wait approach.
• For persons with moderate- to high-grade dysplasia, treatment would involve the removal of affected tissue using either a loop electrosurgical excision procedure (LEEP), cone biopsy, cryotherapy, or other surgical techniques.

It is important to remember that dysplasia is not cancer. The removal of tissue is simply to reduce the risk of dysplastic cells becoming neoplastic (cancerous).

Treating dysplasia (whether of the cervix, anus, penis, or larynx) only treats the symptoms of the infection, not the infection itself. People who have been diagnosed with dysplasia will need to be monitored closely for recurrence. This is especially true if an HPV infection lasts for more than two years.

While an HPV infection can be distressing, it provides you the opportunity to catch a problem before it can become serious or even life-threatening.

By and large, HPV treatments have few complications. Many of the treatments are covered, at least in part, by health insurance. Patient assistance and co-pay programs are available to assist with vaccination costs.

Women who require more frequent treatments and biopsies may be at an increased risk of pre-term labor or low birth weight babies. But, on its own, HPV treatment will not directly affect a woman's chance of getting pregnant. Moreover, HPV is rarely passed from a mother to her baby during pregnancy.

In the unlikely event that cancer is diagnosed, remember that getting early treatment gives you the greatest chance at the best outcome. As you address your HPV diagnosis, be sure to tell those you love about prevention strategies that can help them stay well.