Everything You Need to Know About HPV
Whether you’ve had a friend who was diagnosed with human papillomavirus (HPV) or you’ve simply glanced at a pamphlet while waiting in your gynecologist’s office, you’ve likely heard about HPV. That’s because it’s the most common sexually transmitted infection — 79 million Americans currently have HPV, according to the Centers for Disease Control and Prevention (CDC).
But just because HPV is common doesn’t mean it’s well understood. After all, the CDC notes that HPV is a group of more than 150 related viruses, which means it’s not exactly easy to suss out the basics.
Here you’ll find an HPV breakdown, including who it affects, what it has to do with cervical cancer, and whether or not you should get the vaccine for prevention.
What Is HPV?
According to the World Health Organization (WHO), HPV is the most common viral infection of the reproductive tract, affecting most sexually active men and women at some point in their lives with the peak time for acquiring it being shortly after becoming sexually active.
But while HPV is sexually transmitted, penetrative sex is not required for transmission, says Steve Vasilev, M.D., a gynecologic oncologist and medical director of Integrative Gynecologic Oncology at John Wayne Cancer Institute at Providence Saint John’s Health Center. Vasilev says skin-to-skin contact is also “a well-recognized mode of transmission.”
“In the vast majority of cases, HPV infections clear within six to 12 months,” Vasilev says.
What Are HPV Symptoms?
“Unfortunately, infection with low- or high-risk HPV strains do not produce any symptoms unless the infection has already produced a disease, including warts, pre-cancer (dysplasia) and cancer,” Vasilev says. “At that point, there may be findings of a small skin lump, itching, irritation and bleeding."
The more likely chain of events is that a woman goes in for a routine pap test — which is where you get checked for abnormal cells on your cervix — and is diagnosed with HPV at the same time.
As for cervical cancer symptoms, Vasilev says there aren’t really any reliable signs. Cervical cancer has usually progressed by the time it produces symptoms, like abnormal bleeding or discharge, which makes regular checkups that much more important.
“It is possible that some early cancers or even pre-cancers (called dysplasia) can bleed or produce these symptoms too,” he says. “Thus, getting checked earlier than later is prudent.”
For men, HPV is rarely diagnosed, according to the Cleveland Clinic, because it does not produce symptoms. Because it can be an invisible infection, your HPV risk rises the more male sex partners you have. “However,” Vasilev says, “sexual activity timing could be such that the infection is passed back and forth between a monogamous couple for a prolonged period of time.”
Testing For and Treating HPV
The CDC offers the following guidelines for routine pap testing: Women ages 21 to 29 should have one every three years, regardless of whether or not they are sexually active or exhibit other risk factors; women ages 30 to 65 should have one every five years with the HPV co-test. While the pap test checks for cell changes, the HPV test checks for the actual virus, according to the American Cancer Society. Results can also be found with a colposcopy — a test that involves a vinegar solution that turns problematic cervical cells white, according to the Cleveland Clinic, though this is usually done after a pap has identified some abnormal cells in the first place.
More often than not, HPV can appear and disappear without notice, says G. Thomas Ruiz, M.D., an OB-GYN at MemorialCare Orange Coast Medical Center. “HPV infections can last months to years, he says. “It is not uncommon for the body’s immune system to handle the problem without medical treatment.”
In fact, according to the Cleveland Clinic, “70 to 90 percent of cases of the HPV infection are cleared from the body by the immune system.”
If HPV does lead to a non-resolving disease, then Ruiz says there are a number of treatments available to remove visible warts and abnormal cervical cells, including freeze therapies (cryosurgery), laser therapy, or a loop electrosurgical excision procedure (LEEP), which uses a wire loop to remove the abnormal cells. Prescription medication is also available for HPV-related genital warts.
Should I Get The HPV Vaccine?
Of course, the ultimate question is how do you prevent HPV, and there’s a clear answer — and it’s not just condoms. Because the virus can be present on multiple genital areas, Vasilev says, “other than vaccination at an early age, before exposure to the virus, there is no reliable medical way to prevent spread.” So, yes, the vaccine is a great idea.
According to the CDC, there are three licensed HPV vaccines available in the United States — Gardasil, Gardasil 9 and Cervarix. The National Cancer Institute noted that Gardasil and Cervarix were found to provide nearly 100 percent protection against persistent cervical infections with HPV types 16 and 18 — the two forms of HPV that are responsible for approximately 70 percent of all cases of cervical cancer. As indicated by the name, Gardasil 9 protects against nine different types of HPV, four of them being the types of HPV that Gardasil already targets.
“Vaccines against the HPV virus help prevent infection but only before sexual exposure to the most troublesome HPV types,” Vasilev says. “Obviously, how effective it is depends on when sexual activity starts.” He says the vaccines are most effective when given to children between the ages of 9 and 13.
Vasilev says in general, the vaccine — which is administered in a series of shots — should be given after age 11 and before the age of 26 in women, as per the CDC. But the Food and Drug Administration (FDA) announced in October that Gardasil 9 had been approved for both men and women between the ages of 27 and 45, reported Time.
According to the CDC, HPV vaccines provide close to 100 percent protection against cervical precancers and genital warts. And there has been a “64 percent reduction in vaccine-type HPV infections among teen girls in the United States,” as well as fewer young women diagnosed with precancerous conditions — like HPV-related dysplasia — as a result of the vaccine.
If you already have HPV, then it’s important to note that, while the vaccine will not treat it the particular type of HPV you have, it can still protect you from other types of the virus.
HPV And Cancer
While most cases of HPV resolve on their own, there are some that lead to more serious conditions, like cervical cancer. In these instances, an HPV induced infection causes abnormal cell growth that eventually leads to the formation of precancerous cells which ultimately turn into cancer, according to the National Cancer Institute.
Contributing factors that may increase the risk of developing cancer as a result of high-risk HPV include smoking, a weakened immune system, multiple pregnancies, and long-term oral contraceptive use, the National Cancer Institute noted.
Based on data from a 2011 to 2015 CDC report, about 42,700 new cases of HPV-associated cancers occurred in the United States each year, including about 24,400 among women (with cervical cancer being the most common) and about 18,300 among men. But a report published this year showed a 29 percent decrease compared to the four years before the vaccine was introduced. That means the shots are working and, in time, they'll only protect more people from getting to know those three letters more intimately than they'd ever want to.