Literally Everything You Need to Know About HPV

If you’re well past the age of 12, you’re probably not spending too much time thinking about HPV—you got the vaccine or you didn’t, so you’re either safe or not, right?

Not so fast—an HPV vaccine isn’t a “get out of jail free” card, just like an HPV diagnosis isn’t a death sentence for your sex life. And the HPV misconceptions don’t stop there—here’s everything you need to know about this super-common (but preventable and treatable) STD.

Let’s start with the basics: What is HPV?

HPV is the most common STD, according to the Centers for Disease Control and Prevention—79 million Americans are currently infected with HPV, mostly teens and those in their early twenties.

There are about 200 types of HPV according to the National Cancer Institute—40 of which can be spread through direct sexual contact and can cause oral and genital warts, and may even lead to cancer.

The other types of HPV are less scary and cause your standard, run-of-the-mill, non-genital warts, commonly found on hands and feet; these types aren’t passed on through sex, and instead can be picked up if you walk around barefoot in a public shower, for example. (For the purposes of this article, the term HPV will refer to those types that are passed on through sexual contact.)

While the idea of contracting a virus that can cause warts on your private parts—or worse, lead to cancer down the road—is more than a tad disturbing, don’t freak out. If you already have HPV, there are ways to treat warts and to help reduce the chance of infecting a partner. If you’ve dodged HPV so far, there are ways to help prevent infection and the health issues that can result.

How does HPV spread?

First off, know this: You can get infected with HPV by having any kind of sex—vaginal, anal, and oral—with an infected partner, even if they’re not showing signs or symptoms (like genital warts).

The virus is spread mainly through skin-to-skin contact (not through blood or bodily fluids). So genital-to-genital contact without penetration can also spread HPV, according to the American Cancer Society.

Yes, that means even kissing can potentially spread the HPV virus, says Lois Ramondetta, M.D., HPV expert and professor at the University of Texas MD Anderson Cancer Center in the Department of Gynecologic Oncology and Reproductive Medicine.

“It’s rare,” she says, but notes that 5 to 15 percent of people in the U.S. carry HPV in their mouths, in the mucous membranes, tongue, and throat. Cases of oral HPV typically don’t show symptoms, and there is no way to test for it at this point, she adds; it can, however, lead to oropharyngeal cancer.

Also important to note: Anyone who has had any kind of sexual contact—even just with one person—can get HPV. And it’s tough to tell for sure where or when you got it, since symptoms can develop years after having sex with someone who’s infected, notes the CDC.

The upside: You can’t pick up HPV in a hot tub or pool, from a toilet seat, or by sharing food.

Who’s most at risk for getting HPV?

Short answer: Pretty much anyone who’s hooking up—gay or straight; in a longterm committed relationship or playing the field.

“It’s an extremely common virus. More than 80 percent of people get exposed during their lives,” says Ramondetta. “Definitely the more partners you have, the higher the risk of you being exposed,” she adds, but says framing it that way can be misleading because, again, even if you’ve only ever had one sexual partner, you are also at risk.

Both women and men are at risk. Among sexually active women, those between the ages of 20 and 24 are most likely to have HPV at any given time, according to one study by CDC researchers conducted in the early 2000s (pre-vaccine). However, it’s important to note that there are currently no FDA-approved tests to detect HPV infections in men, per the National Cancer Institute.

What do the symptoms of HPV look like?

Usually there are no symptoms, but it also depends on the type of HPV you’ve been exposed to.

“There are many strains of HPV that affect the genital organs. We divide them into high-risk and low-risk strains,” says Brigham and Women’s Hospital ob-gyn Kari Braaten, M.D., M.P.H.

The low-risk strains can cause genital warts. “Typically, they’ll crop up as little fleshy, painless bumps about one or two millimeters in size,” says Braaten, pointing out that the types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers. The warts are more of a nuisance, she says.

Warts usually appear in the genital area within a few months after you’ve been exposed to someone with HPV, says Ramondetta who notes that in some patients, wart clusters can spread. She’s seen them as large as five to seven centimeters.

“High-risk subtypes can cause cervical cancer,” Braaten says, but it doesn’t typically show up for years, even decades, after infection.

The good news: Most high-risk subtypes of the virus will resolve on their own, without ever progressing to cancer.
Be wary if you’re immunocompromised, though, say the experts. People with weaker immune systems—those with HIV, on chemotherapy or steroids, or those taking transplant medications, for example—are more at risk for persistent infection or inability to clear the virus.

An irregular Pap test, which can detect changes in the cervix, might be the first red flag that you were ever infected. For the record, high-risk HPVs can also cause vaginal and vulvar cancer in women, and cancers of the penis and scrotum in men, and can lead to anus cancers and rarely, head and neck cancers, in both sexes.

If you’ve developed an HPV-related precancer, sometimes it can cause irregular bleeding and bleeding after sex, Ramondetta adds.

How long does an HPV infection last?

“For most people [HPV infections] go away on their own in the course of about two years and don’t require any special treatment,” says Braaten. This includes both high- and low-risk types. But the status of a woman’s immune system can determine whether she’ll clear the virus or not, she says.

Other lifestyle factors may impact HPV infection. “There’s a concern that smoking is related to persistence of infection, too,” Ramondetta says.

How is HPV treated?

Warts can go away on their own, but if a patient wants them removed for cosmetic reasons, or they’re spreading significantly, treatment is similar to the way warts on your hands or feet would be squelched.

“They can be removed by freezing, burning, or laser,” says Ramondetta. Large clusters can be surgically removed. But there’s always the risk that they’ll come back, she says.

There are also some topical creams that can reduce the size of warts.

If an irregular Pap test occurs, your physician may want to perform a colposcopy—a way to see a close-up of your cervix through a magnifying device called a colposcope—to get a better look at any cell abnormalities. Patients should return for a follow-up Pap test based on their doctor’s recommendation.

Is there any way to prevent HPV?

Wearing a latex condom can help reduce the odds of infection, but condoms only offer partial protection because skin-to-skin contact at the base of the penis and the outer genital area can still occur.

Getting vaccinated is the best prevention, say experts. The CDC recommends girls and boys 11 to 12 years old get two doses of HPV vaccine (six to 12 months apart) to protect against cancers caused by HPV.

Teens and young adults who start the vaccine series later, between the ages of 15 and 26, need three doses of HPV vaccine to protect against cancer-causing HPV infection. Since the vaccine was first recommended in 2006, HPV infections and warts have gone down in the U.S., according to a 2016 study by CDC researchers published in the journal Pediatrics.

There have been three versions of the vaccine and all three protect against the two HPV types—16 and 18—that cause most HPV cancers. The latest vaccine available in the U.S., the Gardasil 9 vaccine, protects against nine different HPV types.

“The vaccine is very, very good. It’s incredibly effective. Not enough people are getting vaccinated though,” says Braaten, who attributes part of the reason to anti-vaccine sentiments in the U.S., and to some parents who worry preteen HPV vaccination sends the wrong message to young women. (Though, fact: It doesn’t.)

Vaccinating with the HPV vaccine is really about cancer protection, says Ramondetta.

I’ve already had unprotected sex—do I need to worry?

“If you’ve already had regular unprotected sex with a partner, you’ve likely already gotten what you’ve gotten,” Braaten says. But moving forward, don’t let it keep you from protecting yourself from infection with other strains of HPV and protecting your partner.

If your partner hasn’t been sexually active with anyone yet, you can help reduce their future odds of HPV infection by using a condom or suggesting they get the vaccine series before you become sexually active as a couple.

Also, if you’re under 26, there’s still time to get the HPV vaccine. The vaccine is not recommended, however, for those over 26; the best way to prevent cervical cancer in that age group is to get routine cervical cancer screenings (a Pap test every three years, as a general recommendation from the CDC).

But, most important: “Patients shouldn’t feel anxious and stigmatized about HPV. It’s incredibly common,” Braaten says.

What women with HPV want you to know:

“I was diagnosed with HPV, strand 18, about three years ago. After they initially detected it, they did a second examination that revealed lesions on my cervix. The biopsy came back negative, thankfully, and for the next three years, I went to the gynecologist to have a Pap smear every three months. After all this time, all this uncomfortable poking, having pieces of my cervix clipped out for examination, having to have ‘that talk’ with the men in my life, I feel thankful to have a clean bill of health.” –Reddit user andtq

“Having HPV severely affected my self esteem and everyday life. There were many times that I would just come home and lock myself in a room and cry all day. I didn’t understand why my body was unable to clear the infection and I felt gross and like I was unworthy of love because of my condition. I was working part time and in school for most of these years so I also had racked up a good amount of medical debt from this. This only contributed to my bouts of feeling depressed and hopeless..” — Reddit user thrraway

“About a year ago my Pap smear came back as ‘low-grade changes.’ My doctor said it means I have HPV, and that they’ll have to monitor me yearly to make sure it doesn’t become cancerous. I have no warts. My doctor said that this is very common, that many women have it and that all it means is that I’ve had unprotected sex.” — Reddit user iloveh900

“Remind yourself of that whenever you’re feeling anxious; you’ll be just fine! I don’t know if you’re feeling this, but I know that when I found out I have HPV I felt really dirty. All I could think was ‘God, I have an STD. What the hell is wrong with me?’ But this is in no way a reflection on you; most women go through life with it at some point or another and most men get it and it passes through their system before they even realize it’s there.”

Source: Womens Health Magazine

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