Human Papillomavirus (HPV)

Human papillomavirus (HPV) refers to a group of similar viruses that have different effects on the body. Each specific type of virus in the group is called a strain.1,2 Some strains cause more serious issues than others.

How is HPV transmitted?

Low-risk strains may cause warts on the hands and genitals, and be transmitted through skin-to-skin contact. Several types of high- and low-risk strains can also be transmitted by sexual contact. This includes anal, vaginal, and oral sex.1,2

Lower-risk HPV types that are transmitted through sexual contact can cause genital warts. High-risk HPV strains are the main cause of cervical cancer. High-risk HPV strains can also cause vaginal, anal, oral, penile, and throat cancers.1,2

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Sexually transmitted HPV strains are the most common sexually transmitted infection (STI) in the United States. Research shows that nearly all sexually active people will come into contact with some form of HPV. Many will clear the infection on their own without any issues. However, strains that cause warts or cancer can lead to longer-term issues.1,2

HPV, cervical cancer, and HIV

HPV plays a big role in HIV care. The transmission of HIV and HPV share similar risk factors that can lead to them being transmitted at the same time or with similar infections.1-3Risk factors for both HIV and HPV include having sex with multiple partners and/or without condoms.

HIV viral supression and HPV

How well HIV is controlled may also affect the chances of getting HPV. For example, if a person’s viral load is suppressed with treatment, the chances of them getting or transmitting HPV may be lower.1-3

The ability of the body to clear HPV and prevent high-risk types from causing cancer depends on the immune system. If a person has untreated HIV, their immune system may not be strong enough to slow or stop cancer from developing. This means that people who are HIV-positive, especially those with higher viral loads, are at a higher risk of getting HPV-related cancers than others who are HIV-negative. The risk of cervical cancer is especially concerning.1-3

Signs and symptoms

HPV often causes no symptoms. In many cases, HPV may be cleared on its own without the person even knowing they had HPV.1,2

When a person does have symptoms, they are related to the type of HPV present. Warts on the hands or genitals may be a sign of HPV.1,2

If a person develops HPV-related cancer, their symptoms may take years to develop and will depend on the body part affected.1-4

Symptoms of cervical cancer may include vaginal bleeding after sex or random vaginal bleeding. Rectal cancer may cause bleeding or trouble having bowel movements. Throat or oral cancer may cause trouble speaking or swallowing.1-4

However, some strains of HPV can be present for years without causing any issues at all.

Testing

The goal of HPV testing is to find high-risk strains before they cause cancer. The main example of this is cervical cancer in women. The test for HPV-related cervical cancer is called the Papanicolaou test (also called Pap test or Pap smear).1-4

Doctors use different screening times and tests for different age and risk groups. For example, sexually active women between 21 and 29 years old should be screened every 3 years. Women between 30 and 65 should be screened every 3 to 5 years depending on what specific test is used and if they have had any positive high-risk HPV tests in the past.4

People who are HIV-positive may need to be screened more often than those who are HIV-negative.4

Negative HPV tests or positive tests with low-risk strains often require no additional testing or treatment, and screening can be continued as normal. If a person tests positive for a high-risk strain or for cervical cancer, treatment may be needed.1-4

Treatment

HPV treatment depends on the symptoms and type of HPV a person has. Genital warts caused by low-risk strains may be treated with topical (on the skin) medicines or other drugs.1-3

Screening tests for cervical cancer can detect a wide range of issues from pre-cancerous issues to advanced cancer. Treatment is based on the person’s age, specific strain, presence of advanced cancer, location of the cancerous cells, and more.4

In some cases, part of the cervix may need to be biopsied or removed. This may be enough to treat the cancer. In other cases, more aggressive surgery, radiation, or chemotherapy may be needed.sup>4

Cancers in other parts of the body caused by HPV are treated based on their location and how advanced they are.1-3

Prevention

Using condoms consistently can reduce the risk of getting HPV. This includes using a new condom after each sexual act and for the entirety of sex.1-3

Following the recommended screening schedule for your age and risk, especially if you have HIV, can lead to early detection and treatment. This can prevent advanced cervical cancer from developing.1-4

There is a vaccine that protects people against several of the most common HPV strains, including low- and high-risk strains. However, it does not protect people against all strains. Both men and women can get the vaccine. It is often given before a person has sex for the first time, as early as 11 or 12 years old.1-3

The HPV vaccine can also be given at older ages and after a person has become sexually active. This may help protect people who are active with new partners and at risk of coming into new HPV strains. Condom use is still encouraged even after vaccination. This can help reduce the chances of getting both genital warts and HPV-related cancer.1-3

Your doctor can help you decide if the HPV vaccine is right for you.

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Written by: Casey Hribar | Last reviewed: February 2021