What Is HPV? Symptoms, Causes, Diagnosis, Treatment, and Prevention
The human papillomavirus (HPV) is best known as a sexually transmitted infection that can lead to cervical cancer, as well as anal, vaginal, and mouth and throat cancers. While it is often spread through sexual contact, HPV can be transmitted in other settings, too.
HPV can also cause genital warts, which are caused by different types of the virus than those that can lead to cancer.
Still other types of HPV can cause common skin warts or plantar warts, which grow on the bottoms of your feet.
HPV is actually a group of more than 150 related viruses. Each virus in the group has an assigned number, which is known as its HPV type (or serotype).
While both skin warts and genital warts may be distressing or even painful — and can be transmitted from one person to another, or even from one area of the body to another — the most concerning types of HPV are those that can cause precancerous changes in the cells they infect.
These precancerous changes, known as dysplasia, can occur in the cervix, vagina, vulva, anus, penis, or oropharynx (the area at the back of your mouth and throat that includes the base of your tongue and your tonsils).
Virtually all sexually active individuals are infected with one or more types of HPV in their lifetime. But many people never know they have HPV because they never develop any symptoms or experience other consequences of the infection.
While the body often clears an HPV infection within months to years, the infection may persist in some people. There is no treatment available that can rid the body of HPV, but some of the symptoms and consequences of HPV can be treated.
HPV lives in cells found on the surface of the skin and in the moist mucous membranes that line many areas of the body, such as the mouth and throat, cervix, vagina, and anus. How an HPV infection appears (or doesn’t) depends on the type of HPV and the location of the infection.
In healthy people, the immune system can usually fight off the viruses that cause skin warts — limiting the number of warts people typically develop and making them eventually go away.
But this is often not the case in people whose immune systems are compromised, such as by human immunodeficiency virus (HIV), drugs to prevent organ rejection or to treat autoimmune diseases, or simply older age. In these people, HPV infection of the skin may cause more extensive warts that persist.
Warts from the same HPV types may also occur in the following areas:
Mucosal HPV types are categorized as either low risk or high risk.
Low-risk HPV types can cause genital warts, which may occur around the genitals and anus, as well as in the mouth and throat.
But most low-risk HPV types don’t cause any symptoms and are generally not a reason for anyone to be concerned.
High-risk HPV types can cause changes in mucosal cells that lead to cancer.
HPV 16 and 18 are types of HPV that have been shown to significantly increase the risk of developing cervical cancer as well as genital cancers in men and women.
The HPV vaccine protects against HPV types 16 and 18, as well as several other cancer-causing types of the virus and the two main HPV types in women and men that cause genital warts.
Different types of HPV and different locations of infection in the body can cause different symptoms.
Skin warts — which can vary in size, shape, and appearance — are growths on the skin surface that may range from fairly flat to protruding. It’s not always possible to know if a skin growth is a wart.
Precancerous cell changes in the cervix cause no symptoms but can be detected with the Pap test, in which a sample of cells is collected and examined under a microscope.
Early vaginal, vulvar, and cervical cancers related to HPV may cause no symptoms, but advanced-stage cancer can lead to abnormal vaginal bleeding or discharge and pain during intercourse.
Signs and symptoms of oropharyngeal cancer may include persistent sore throat, a lump in the neck, and persistent ear pain.
Vocal cord cancers typically cause hoarseness or a change in the voice.
Early penile cancer may cause changes in skin color and thickening of the skin.
You should see your doctor if you have any signs or symptoms of HPV-related cancers.
Mucosal HPV types are transmitted through intimate skin-to-skin contact — most commonly through vaginal or anal sex but also through oral sex. Anyone who is sexually active is at risk for getting HPV, even if you’ve had only one sexual partner.
You’re at higher risk for genital or oral HPV if you:
Symptoms from HPV may develop years after you become infected, so it’s often impossible to know who transmitted the virus to you. Even with no symptoms, you can pass HPV on to other people, and you can get HPV from someone who doesn’t show any symptoms.
Skin warts and genital warts can usually be diagnosed on sight during a physical examination, but your doctor may also refer you to a dermatologist to be sure your skin condition is a wart. Your dermatologist may take a biopsy, or small tissue sample, to examine under a microscope.
To help diagnose genital warts, your doctor may apply an acetic acid solution to the area to lighten the warts, making them more visible.
If you’re a woman with detectable genital warts, your doctor may also perform a colposcopy (a procedure that uses a light and a low-power microscope) to find genital warts on your cervix that are too small to see with the naked eye.
Women can be screened for HPV infection of the cervix with the HPV test, which is done by removing some cervical cells with a swab and testing them for the presence of HPV. The test can detect HPV types 16 and 18 and provide broad results for other high-risk (cancer-causing) HPV types in cervical tissue.
In many cases, the immune system fights off HPV, so a person may have no symptoms and test negative on the relevant HPV tests.
In other cases, the immune system does not prevent the virus from infecting the cells, but the infection doesn’t immediately cause symptoms. In fact, it may never cause symptoms, but the virus can be transmitted to another person through skin-to-skin or sexual contact.
And in still other cases, an HPV infection causes abnormal changes in the infected cells that can eventually develop into cancer. The time between an infection and the development of precancerous changes or cancer may be years or even decades.
The earlier HPV-related symptoms are found, the more likely they can be treated successfully.
How HPV is treated depends on how it is affecting you.
If you have a skin wart, you may choose to leave it until it goes away on its own, treat it with an over-the-counter product, or see your doctor for treatment.
For genital warts, your doctor can prescribe several topical medicines to apply to external warts at home. Genital warts may also be treated in a doctor’s office with topical medication, cryotherapy (freezing the warts), or surgical removal. Topical medication may need to be applied repeatedly for weeks or even months to fully treat genital warts. Cryotherapy may need to be repeated multiple times.
And cancers caused by HPV in women and men are treated with standard cancer therapies, including chemotherapy, radiation therapy, and surgery.
The best way to protect yourself against genital warts and cancer caused by HPV is to get the HPV vaccine.
The HPV vaccine currently used in the United States, Gardasil 9, protects against HPV types 6 and 11, which cause most cases of genital warts; 16 and 18, which cause most cases of HPV-related cancer; as well as five other types that can cause cancer (31, 33, 45, 52, and 58).
In the United States, the HPV vaccine is approved for children and adults ages 9 to 45. Routine vaccination is recommended at age 11 or 12, and through age 26 if you didn’t receive the full vaccine schedule before that.
A research analysis examined the impact of HPV vaccination, using data from 60 million people in 14 countries that had set up HPV vaccine programs in the previous 10 years. It showed that high-risk HPV infections dropped by 83 percent among girls and women ages 13 to 19, and by 66 percent among women ages 20 to 24. For genital warts, the incidence dropped by 67 percent among girls and women ages 15 to 19, by 54 percent among women ages 20 to 24, and by 31 percent among women ages 25 to 29. Precancerous cervical lesions also dropped, by 51 percent among girls and women ages 15 to 19, and by 31 percent among women ages 20 to 24.
The most serious potential complication of HPV infection is cancer. But most HPV types aren’t known to cause cancer, and most cases of any HPV type are cleared by the body within two years.
HPV is believed to cause over 90 percent of cases of cervical and anal cancer, about 70 percent of cases of vaginal and vulvar cancer, and about 60 percent of cases of penile cancer, according to the Centers for Disease Control and Prevention (CDC).
Cervical Cancer
Cervical cancer was once a leading cause of cancer deaths for women in the United States, but this death rate has dropped substantially since the development of the Pap test, which looks for precancerous changes to cells in the cervix.
More recently, the HPV test was developed to directly test for HPV infection in the cervix, even before any precancerous changes take place. Both the Pap test and HPV test may be used for cervical cancer screening.
Even though cervical cancer is now almost entirely preventable, the American Cancer Society estimates that in 2024 about 13,820 new cases of invasive cervical cancer will be diagnosed and about 4,360 women will die from cervical cancer.
Oropharyngeal cancer develops on the back and sides of the throat, tonsils, and base of the tongue.
It’s believed that people get oral HPV from oral sex, although why men develop HPV-associated oropharyngeal cancer so much more than women is not known.
It’s difficult to estimate how many people have genital HPV at any given time, since the infection often causes no symptoms and the only widely used screening test is for the cervix.
For most people, the first sign of a mucosal HPV infection is the appearance of genital warts or the signs and symptoms of some form of HPV-related cancer — the most serious consequence of HPV infection.
The incidence of oropharyngeal cancer has increased by about 1 percent since the mid-2000s, according to the American Cancer Society.
HPV can infect anyone, but different populations within the United States have been found to have different rates of infection in various areas of the body, as well as different rates of HPV-related cancers.
Such variability may reflect differences in prevailing community behavior, biology, or unequal access to screening tests and medical care.
According to estimates from the CDC:While rates of HPV vaccination have been on the rise, there are differences in this rate by race and ethnicity, including adults ages 18 to 26:
Using data from cancer registries, the CDC also publishes estimates of new cases of HPV-associated cancers among Americans of different races and ethnicities. Key findings include:
HPV is one of several common sexually transmitted infections (STIs), also called sexually transmitted diseases. Others include chlamydia, gonorrhea, syphilis, herpes, and HIV/AIDS.
Unlike HPV, which is a viral infection, chlamydia, gonorrhea, and syphilis are caused by bacteria. All three bacterial STIs can be cured by antibiotics, although some strains of the bacteria that cause gonorrhea have become resistant to most antibiotics.
Like HPV, genital herpes and HIV/AIDS are caused by viruses and cannot be cured, although they can be treated — both to reduce symptoms in the person who is infected and to reduce the likelihood of spreading the virus to others.
American Sexual Health Association: HPV and Relationships
Centers for Disease Control and Prevention: HPV Vaccine Information for Young Women
Mayo Clinic: Plantar Warts
National Cancer Institute: Human Papillomavirus (HPV) Vaccines
National Cervical Cancer Coalition: Cervical Cancer Overview
U.S. Department of Health and Human Services Office of Women’s Health: Genital Warts
Learn More About Sexual Health Resources
Additional reporting by Quinn Phillips.
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