HPV

Human Papillomavirus (HPV) is a family of viruses that affect different parts of the body.  Some strains of HPV cause warts that appear on hands and fingers as well as other areas of the body, while other strains are sexually transmitted and cause warts that affect skin in the genital area -- the vulva, vagina, cervix, rectum, anus, penis, or scrotum. Over 40 different types of HPV are passed by sexual contact and affect both males and females.  Some virus types are considered low risk and develop into genital warts.  Some types are high risk and may affect the cervix and can lead to abnormal cell changes that may develop into cervical cancer.  High risk HPV types may also cause cancer of the vulva, vagina, anus, penis, the head and the neck.

HPV is not the same as herpes or HIV (the virus that causes AIDS). These are all viruses that can be passed on during sex, but they cause different symptoms and health problems.

Transmission

Any one who has ever had genital contact with another person can have genital HPV as it is passed by skin to skin contact. It is also passed through vaginal, anal or oral sex.  Since condoms do not cover the genital area entirely, they do not completely prevent infection, However, according to one study, women whose male partners used condoms consistently were 70% less likely to acquire HPV than women whose partners did not use condoms.

What are the signs and symptoms of HPV?

In 90% of those infected with HPV, most will not have any symptoms or other health problems and the body's immune system will actually clear the virus from the body in about two years. A person can have HPV even if years have passed since he or she had sexual contact with an infected person. Most infected persons do not realize they are infected or that they are passing the virus on to a sex partner. It is also possible to get more than one type of HPV. In those cases where the virus is not cleared, signs of infection include:

Genital warts: Approximately 12 types of HPV cause genital warts with type 6 and type 11 causing most of the cases. They usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. Health care providers can diagnose warts by looking at the genital area during an office visit. Warts can appear within weeks or months after sexual contact with an infected partner-even if the infected partner has no signs of genital warts. If left untreated, genital warts might go away, remain unchanged, or increase in size or number. They can be treated with medication that is applied to the area or by surgical removal. The type of treatment depends on where the warts are located.

Cervical Dysplasia: HPV can cause lesions of abnormal cells called cervical dysplasia, to grow on a women's cervix.  These lesions may develop into cancer cells later. The HPV infected cells will often clear up on its own, but cervical dysplasia if severe, will need to  be treated because it can lead to cervical cancer.

Cervical Cancer: the high risk HPV types 16 and 18 cause about 70% of all cervical cancers.  Types 16 and 18 have also been linked to penile cancer as well as anal cancer.  HPV can cause infections and lesions in other areas of the body, such as in the upper respiratory tract.

How does HPV cause cancer of the cervix?

The cervix is covered by a thin layer of tissue made up of cells. If one of the cancer-causing types of HPV is present, it may enter these cells. Infected cells may become abnormal or damaged and begin to grow differently. It usually takes several years for cervical cancer to develop. Cervical cancer screening done with pap smears can detect early signs of abnormal changes of the cervix and allows for early treatment so that they do not become cancer.

How common is HPV?

Genital human papillomavirus is the most common sexually transmitted virus in the United States. Approximately 20 million Americans are currently infected with HPV. Another 6 million people become newly infected each year. HPV is so common that at least 50% of sexually active men and women get it at some point in their lives.

Genital warts. About 1% of sexually active adults in the U.S. have genital warts at any one time.

Cervical cancer. Each year, about 12,000 women get cervical cancer in the U.S. Almost all of these cancers are HPV associated.

Other cancers that can be caused by HPV are less common than cervical cancer. Each year in the U.S., there are about:

  • 1,500 women who get HPV-associated vulvar cancer
  • 500 women who get HPV-associated vaginal cancer
  • 400 men who get HPV-associated penile cancer
  • 2,700 women and 1,500 men who get HPV-associated anal cancer
  • 1,500 women and 5,600 men who get HPV-associated oropharyngeal cancers (cancers of the back of throat including base of tongue and tonsils) [Note: Many of these cancers may also be related to tobacco and alcohol use.]

Certain populations are at higher risk for some HPV-related health problems. This includes gay and bisexual men, and people with weak immune systems (including those who have HIV/AIDS).

Treatment

There is no treatment for the virus itself, but there are treatments for the diseases that HPV can cause:

Visible genital warts: there are many ways to remove visible genital warts, depending on their size and location. A medical provider can get rid of smaller warts by freezing them off through cryotherapy, burning them off with an acidic chemical, or removing them through laser surgery. All three procedures may require multiple follow-up visits or treatments. Some patients with HPV are also able to use a cream at home to help treat the warts.  Some people choose not to treat warts, but to see if they disappear on their own which they do 40% of the time.. No one treatment is better than another.

Cervical cancer is most treatable when it is diagnosed and treated early. Women who get routine Pap tests and follow up as needed, can identify problems before cancer develops. Prevention is always better than treatment.

Prevention

Preventing genital warts: A vaccine (Gardasil) is available to protect against most genital warts in males and females.  You're less likely to experience genital wart recurrences if you take care of your health. This means that you maintain a strong immune system by eating right, getting exercise, getting enough sleep, managing your stress, and avoiding alcohol, tobacco, or other illegal drugs. Maintaining a healthy lifestyle will decrease the chances of recurrences, and in time, most people stop having any recurrences.

Preventing Cervical Cancer: There are two vaccines (Cervarix and Gardasil) that can protect women against most cervical cancers. Cervical cancer can also be prevented with routine cervical cancer screening and follow-up of abnormal results. The Pap test can find abnormal cells on the cervix so that they can be removed before cancer develops. An HPV DNA test, which can find HPV on a woman's cervix, may also be used with a Pap test in certain cases. Even women who got the vaccine when they were younger need regular cervical cancer screening because the vaccine protects against most, but not all, cervical cancers.

Key Points to Remember

  • Cervical cancer is preventable. Early detection of abnormal cell changes is important.
  • Almost all women and men will have HPV at some point, but very few women will develop cervical cancer. The immune system of most women will usually suppress or eliminate HPV. An HPV infection that does not go away over many years may lead to cervical cancer.

Don't blame yourself or your partner. Your HPV status is not a reliable indicator of your sexual behavior or that of your partner.