Human papillomavirus (HPV) is a group of more than 200 related viruses that can infect the skin and mucous membranes, such as the cervix, genitals, anus or oral cavity (mouth). It can be transmitted through sexual activity and is the most common sexually transmitted infection (STI) in the world.
It may also be passed by nonsexual skin-to-skin contact, or HPV may be passed by mother to newborn in the process of giving birth. The infection typically clears with no negative effects for the baby.
Most people are exposed to HPV at some point in their lives.
Most HPV infections go undetected, don’t cause symptoms or health problems and are self-limited because the immune system gets rid of this virus within one or two years. Your immune system can clear HPV infection at any age — but as you get older, the immune system is not as strong and may be less efficient at clearing infections. It is not known how long HPV can be contagious.
Some types of HPV can lead to serious health problems.
There are two main categories of HPV:
- Low-risk: Low-risk HPV can cause benign conditions like genital warts and warts on other parts of the body.
- High-risk: High-risk HPV types are linked to various cancers, including cervical, anal and penile cancers and cancers of the oral cavity.
It’s important that you contact your doctor if you notice any unusual symptoms or growths. Low-risk HPV infections that show up as genital warts can be treated. If you are female, you should get age and risk-appropriate cervical cancer screenings. Pre-cancerous lesions on the cervix can be treated to prevent them from turning into cancer. Early discovery and treatment of cervical and other types of HPV-related cancer can lead to good outcomes.
HPV Symptoms
It’s possible to be symptom-free for weeks or even months after you are infected. Genital warts may appear years after infection.
HPV infections may be detected as genital warts (vulva, penis, scrotum), or they can grow on other areas of the body, including the anus. They can look different: Some are raised, while others are flat, and they may be small or large. HPV infection can also cause warts on the skin on almost any part of the body.
Men don’t typically have symptoms but can still pass the infection to a sexual partner.
Oral HPV infection does not have symptoms.
HPV Screening
The only standard screening for HPV-related cancer is cervical cancer screening.
While there aren’t FDA-approved screenings for all the cancers HPV can cause, it’s important to get regular check-ups with your doctor and dentist and to monitor yourself for abnormal symptoms or growths involving the genitals, anus, or oral cavity (mouth). This can help you and your doctor or dentist manage precancerous lesions or find HPV-related cancers early so you can get appropriate treatment.
Cervical Cancer Screening
- If you are 21 to 29 years old
Start getting Pap tests at age 21. If your Pap test result is normal, your doctor may tell you that you can wait three years until your next Pap test.
- If you are 30 to 65 years old
Talk to your doctor about the test that is right for you:- HPV test only. This is called primary HPV testing. If the result is normal, your doctor may tell you that you can wait five years until your next screening test.
- HPV test with a Pap test. This is called co-testing. If both results are normal, your doctor may tell you that you can wait five years until your next screening test.
- Pap test only. If the result is normal, your doctor may tell you that you can wait three years until your next Pap test.
- If you are older than 65
Your doctor may tell you that you don't need to be screened anymore if:- You have had at least three Pap tests or two HPV tests in the past 10 years, and test results were normal or negative, and …
- You have not had a cervical precancerous lesion in the past, or …
- You have had your cervix removed as part of a total hysterectomy for benign (not cancer) conditions, like fibroids.
Anal Cancer Screening
People who are at high risk for developing anal cancer can work with their doctor to set a schedule for screening with a digital rectal exam and an anal Pap test. If abnormal cell or tissue changes are found, your doctor will recommend a biopsy to test for cancer. Populations at high risk include men who have sex with men, women with cervical or vulvar cancer, people who have had organ transplants and people who are HIV positive.
Head and Neck Cancer Screening
Your dentist will check your mouth (oral cavity) for abnormalities during a routine dental check-up. If anything abnormal is found, your dentist will refer you to a specialist for diagnosis and treatment as needed.
Penile Cancer
There aren’t any standard screenings for penile cancer, but call your doctor right away if you notice anything different on your penis such as small bumps or growths. They are more likely to be genital warts caused by HPV, which don’t lead to cancer but still need to be treated.
Vaginal and Vulvar Cancers
There aren’t any standard screenings for cancer of the vagina or vulva, but your doctor may find cell changes during a routine gynecologic exam.
HPV Prevention and Vaccination
While limiting sexual partners and using condoms and dental dams during sexual contact remain very important in protecting you from some sexually transmitted diseases like HIV (human immunodeficiency virus), gonorrhea and chlamydia, these practices are not proven to protect you from HPV infections and cancer.
The best way to prevent cervical cancer and other HPV-related cancers is by getting vaccinated.
HPV vaccines, which are shots given in the muscle of the arm, protect against the most common high-risk and low-risk types of HPV, including HPV infections that can turn into cancer.
HPV vaccines are very safe. Scientific research shows the benefits of HPV vaccination far outweigh the possible risks.
It’s important to know that vaccination can prevent new infections, but it will not treat current HPV infections.
Recommended HPV Vaccine Schedule
The Advisory Committee on Immunization Practices recommends the following HPV vaccination schedule for people who are not pregnant. Pregnant women should not have the HPV vaccination, as use in this population has not been studied. Talk with your doctor.
If you are older than age 26, check with your insurance company about coverage for HPV vaccination.
- Ages 11 – 12: This two-dose series can be given as young as age nine. A second vaccination should follow six to 12 months after the first.
- Ages 13 – 26: Vaccination is recommended for people in this age group who have not been vaccinated before or who did not complete the two-dose series vaccination.
- Ages 15 – 45 or immunocompromised people: A three-dose series, with the second dose one or two months after the first. The third dose is given six months after the second dose.
- Ages 27 and older: Vaccination is not recommended for everyone older than age 26. If they did not get adequately vaccinated when they were younger, some people ages 27 through 45 might decide to get the HPV vaccine based on discussion with their doctor or clinician. HPV vaccination of people in this age range provides less benefit for several reasons, including that more people in this age range have already been exposed to HPV.
- Ages 46 and older: HPV vaccines are not recommended for adults older than age 45 as most adults have been exposed to the virus by that age.
Vaccine Side Effects
A lot of people experience no side effects at all after the vaccine, and no serious adverse events have been associated with an HPV vaccine. Like all medical interventions, vaccines can have some side effects. Side effects people report most often include:
- Soreness or pain, redness or swelling in the arm (site of the shot)
- Headache or fatigue
- Fever
- Nausea
- Pain or achiness in muscles or joints
- Fainting
HPV Treatment
While there is treatment for HPV-related diseases, there is no cure for HPV. HPV can cause changes to cells. These changes are called dysplasia, some of which can turn into cancer if left untreated.
HPV Infection of the Cervix
With screening, your doctor can find and treat pre-cancerous dysplasia affecting the cervix. Treatment will depend on the grade, which can be low or high grade. While low-grade dysplasia often goes away when your body clears the infection, high-grade dysplasia needs treatment. This may involve a loop electrosurgical excision procedure (LEEP). During the LEEP procedure, a heated wire loop is passed through a speculum inserted in the vagina. The loop is used to remove a thin layer of abnormal cells and tissue, which are sent to a pathologist for analysis.
HPV Genital Warts
Your doctor or clinician can diagnose genital warts from how they look. Genital warts can appear on the vulva, the penis or the scrotum. The types of HPV that cause most genital warts do not typically cause cancer. During a routine exam, your doctor will examine your genitals and possibly, the inside of the vagina, anus or urethra to determine the extent of the infection. They will then recommend treatment, which could vary depending on the appearance and location of the warts. Treatment may need to be repeated over a number of weeks or months.
Possible treatments include:
- Topical treatments like creams and ointments
- Cryotherapy to remove growths by freezing them
- Surgery to remove the growths
HPV-Related Cancers
HPV can cause several different types of cancer, including the following. If you have been diagnosed with HPV-related cancer, your care team will recommend the most effective treatment plan.
