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Human Papillomavirus, HPV

Human Papillomavirus, HPV

Medically Reviewed by Nancy R. Berman, MSN, ANP-BC, NCMP, FAANP

Nurse Practitioner Michigan Healthcare Professionals
Farmington Hills, MI
Clinical Instructor
Department of Obstetrics and Gynecology
Wayne State University School of Medicine
Detroit, MI

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Overview

If the three letters H-P-V make you recoil, they shouldn't. Chances are, you have been infected by one or more types of the human papillomavirus (HPV) and didn't even realize it. In fact, according to the U.S. Centers for Disease Control and Prevention (CDC), most people will become infected by at least one type of HPV at some point in their lives. The CDC reports that 79 million people are currently infected with HPV.

The good news is, in most cases, HPV causes no symptoms or health problems and goes away on its own. HPV is a skin cell virus with more than 100 identified types. That includes low-risk types that may cause genital warts and high-risk types that may cause precancer and cancer.

If HPV causes cells to become abnormal, most return to normal on their own. However, when high-risk types of HPV persist, precancer and cancer may occur. The American Cancer Society estimates that about 13,170 cases of invasive cervical cancer will be diagnosed in the United States in 2019, killing about 4,250 women.

HPV is the cause of nearly all cases of cervical cancer, but cervical cancer is preventable. Screening by Pap and HPV testing can detect precancerous changes that can be treated to prevent cancer from developing.

HPV can also lead to anal cancer in both men and women, a cancer that affects about 5,530 women and 2,770 men per year and causes 760 deaths in women and 520 in men and is on the rise. Notably, anal intercourse is not required for HPV to infect the anal skin cells.

Other health problems can result from HPV infection as well, including genital warts; recurrent respiratory papillomatosis, a rare condition where warts grow in the throat of babies who have been delivered through the birth canal of a mother with genital warts; and other less common but potentially serious cancers, including cancer of the vulva, vagina and penis, and oropharyngeal cancer, a type of head and neck cancer that affects the back of the throat, base of the tongue and the tonsils.

The HPV family of viruses is called papillomavirus because they tend to cause warts, or papillomas—benign (noncancerous) tumors. There are more than 150 strains of HPV and at least 40 HPV types that can infect the anus or genitals. Warts may appear on the hands and feet or on the genital and anal areas. The strains of HPV that cause warts to grow on hands and feet, however, are rarely the same type that cause warts in the genital and anal areas.

The high-risk HPV subtypes most likely to cause cancer are HPV-16, HPV-18, HPV-31, HPV-33, HPV-45, HPV-52 and HPV-58. HPV-16 and HPV-18 cause 70 percent of cervical cancer and HPV 16 causes 90 percent of anal cancer. (HPV 16 is also seen as a cause of some oropharyngeal cancers.)

Two types of HPV—HPV 6 and 11—cause 90 percent of genital warts, though they have almost no risk of causing cancer and therefore are commonly referred to as low-risk types.

There is currently one HPV vaccine approved by the U.S. Food and Drug Administration (FDA), called Gardasil 9, which can protect women against the HPV types that cause most cervical cancers. Gardasil 9 also protects women against vaginal and vulvar cancers and protects both men and women against most genital warts and anal cancers. (See Prevention section for more information.)

In addition to the HPV vaccine for primary prevention, the Pap test and the HPV test are important screening tools to prevent cervical cancer in women. When combined with a Pap test in women age 30 and older, the HPV test is better at identifying women at risk for developing cervical cancer than the Pap test alone. The HPV test is also approved by the FDA to be done alone for women 25 and older, however, most medical organization guidelines call for its use alone in women 30 and older. (See Diagnosis section for more information.) There is no FDA-approved HPV screening test for men.

Because of early detection and treatment of cell changes, the death rate for cervical cancer has decreased by more than 50 percent over the last 40 years.

Conversely, the number of new anal cancer cases has been steadily rising, with most cases occurring in adults. The average age at diagnosis is in the early 60s. Anal cancer affects women more often than men.

How does HPV spread?

HPV spreads via skin-to-skin contact with an HPV-infected area. Infections can be subclinical, meaning the virus lives in the skin without causing symptoms. Hence most people with HPV do not know they have it or that they could spread it. For a person exposed to a partner who has a low-risk genital wart–causing strain of HPV, such as HPV 6 or 11, it takes about six weeks to three months for genital warts to appear. However, most people who are infected by HPV 6 and 11 do not develop genital warts. The most common HPV infections are by high-risk types, and there are no visible symptoms. These infections can only be detected on HPV tests or because of abnormal cell changes detected on Pap tests.

Condoms don't always protect against the virus because the virus can grow on areas of the genitals not covered by a latex barrier.

It is thought that HPV 6 and 11 may be more easily spread to partners when genital warts are present then when they have been cleared. Therefore, avoiding contact with a new partner until warts are cleared is recommended. HPV most easily gets to the female cervix through penetrative intercourse; however, any skin-to-skin contact may allow the virus to spread.


Diagnosis

Because human papillomavirus (HPV) infections often cause no symptoms in men or women and are hard to identify, you must see a health care professional for diagnosis.

Genital warts are the least common problem caused by HPV infection. They can be flesh-colored and hidden inside the cervix, vagina, penis, scrotum or anus. They can be small or large, alone or in clusters, flat or round. They can spread along the groin or thigh or be found in the mouth.

Genital warts are a visible change caused by HPV. They can be seen with the naked eye and are on the surface of the skin.

The more common change from HPV are lesions of the cervix that are not visible to the naked eye and are detected through screening with Pap and HPV testing. These changes, called squamous intraepithelial lesions, are not visible to the naked eye and are only visible after vinegar has been applied to the cervix and the clinician looks through a microscope. This is called colposcopy. The screening by Pap and HPV tests identifies women who may have these lesions and need a closer look at the cervix through the colposcope.

Specific HPV types cause genital warts, known as condyloma acuminata. Each HPV type has been numbered and divided into high-risk or low-risk categories depending on whether the virus is associated with the development of cancer.

For example, HPV types 6 and 11, which are usually associated with genital warts, are considered low-risk. HPV types 16, 18, 31, 33, 45, 52 and 58, found on the genitals and in the anus, have been linked to most HPV-related cancers in both men and women and are therefore considered high-risk.

If you notice warts, see your health care professional. You should also seek an examination if:

  • You see any unusual growths, bumps or skin changes on or near the penis, vagina, vulva or anus.

  • You see any raised growth on the genital skin that is red, white or darkly pigmented as that could be precancer and should be evaluated by your health care professional.
  • You experience unusual itching, pain or bleeding in the genital or anal area.

  • You have a sexual partner who tells you that he or she has genital HPV or genital warts.

Sexual history does not determine the need or frequency for screening by Pap and HPV testing. Established guidelines apply to all women regardless of sexual history.

All women should have cervical cancer screening, according to guidelines. The Pap test is a simple procedure. For a Pap test, a health care professional uses a special brush and/or spatula to collect cells from the cervix and places them on a glass slide or in a liquid preservative, which is then sent to a laboratory for evaluation. When the sample is sent in the liquid vial, the remaining liquid can be tested for 14 types of HPV, using one of five FDA-approved HPV tests.

There is also an anal Pap test that is much like the Pap test for cervical cancer. It involves swabbing the anal lining and looking at the swabbed cells under a microscope. The anal Pap test is relatively new and hasn't been studied well enough to determine when, how often and on whom it should be performed, or if it actually reduces risk of anal cancer. Some experts recommend it be done regularly in men who have sex with men.

There are different classifications for abnormal results for the cervical Pap test, but the most common is called atypical squamous cells of undetermined significance (ASC-US). This is a borderline abnormal category and most women with this Pap result do not have abnormal cells. In women ages 21 to 24, a repeat Pap is ordered 12 months later. In women ages 25 to 65, an HPV test will be done to determine whether colposcopy is required or whether a woman needs a follow-up Pap and HPV test in three years. Women with an ASC-US Pap and a positive test for high-risk HPV types will require a closer look at the cervix with the microscope.

Routine follow-up after a negative Pap and HPV is five years.

The other abnormal Pap categories include low-grade (mild) change and high-grade (moderate to severe) change, which is considered precancer.

In conjunction with the Pap test, which screens for abnormal cells once cell changes have taken place, there are tests that look specifically for HPV. These tests can detect the presence of HPV in the cells, which may allow for the detection of abnormal cells that were missed by the Pap and also identifies women with future risk who need to be followed closely as long as the virus persists. There are currently five FDA-approved HPV tests. All but one is able to report the presence or absence of a panel of 12 types of HPV and can genotype specifically for HPV 16 and 18, which cause the majority of cervical cancer. Guidelines for screening and management are different in some cases when HPV 16 or 18 is present.

At this point, HPV tests are also FDA-approved for reflex testing for women whose Pap test reveals ASC-US (borderline abnormal) cells, to determine the need for colposcopy in women who are HPV positive and for cervical cancer screening in combination with a Pap test in women over age 30.

Two tests that report HPV 16 and 18 on every test are now approved for primary HPV testing, which may mean your health care professional will order only an HPV test and not a Pap test initially. If a Pap test result is abnormal, then a colposcopy is recommended. If a Pap test result is not abnormal then an HPV test is repeated in one year. If the HPV test is negative, it is repeated in three years, according to published guidance. In 2018, the U.S. Preventative Services Task Force recommended HPV stand-alone testing with a repeat if negative in five years.

There are currently no recommended screenings or FDA-approved tests that detect HPV infection in men, but research is continuing.

Along with medical history and evaluation of other risk factors, the HPV test helps health care professionals determine what follow-up might be necessary if there is an abnormal result from a Pap test. When a Pap test is high-grade abnormal, the HPV test doesn't alter the virus management, which is a look at the cervix through the colposcope.

Pap Test Screening Guidelines for Women

The American Cancer Society, the American College of Obstetricians and Gynecologists and the U.S. Preventive Services Task Force recommend the following guidelines for Pap tests and early detection of cervical cancer:

  • All women should begin screening at age 21.

  • Women ages 21 to 24 should have a Pap test every three years. They should not have an HPV test. If an HPV test is done in the lab and is positive, it doesn't change the management of borderline and mild abnormal Pap tests. The Pap is repeated in 12 months. High-grade abnormal Pap tests require colposcopy.

  • Women ages 25 to 29 should have a Pap test every three years. If the Pap is borderline abnormal (ASC-US), then an HPV test is used to determine whether that woman should have colposcopy or a three-year follow-up. ASC-US with positive HPV test result requires a colposcopy.

  • Women ages 30 to 65 should have both a Pap test and an HPV test every five years, a Pap test alone every three years or an HPV test alone every three or five years. (The organizations have some variances in preference for type of tests and frequency; talk with your health care professional about what's best for you.)

  • Women over age 65 who have been screened previously with normal results in the previous 10 years (three Pap tests or two Pap and one HPV tests with no abnormal results) should stop getting screened. Women with cervical precancer should continue to be screened until they have completed 20 years of follow-up.
  • Women who have had a total hysterectomy, with removal of their uterus and cervix, and have no history of cervical cancer or precancer should not be screened. Many women who have had a hysterectomy do not know if they still have their cervix. It should not be assumed that the cervix was removed along with the body of the uterus. If the cervix was left behind, screening should continue according to guidelines.

  • Women who have received the HPV vaccine should still follow the screening guidelines for their age group.

  • Women in special populations including HIV positive, immunosupressed, and DES-exposed are not included in the guidelines for the general population.

If your health care professional identifies any unusual cell changes, he or she will recommend a plan of action, depending on the result and your health history. That may include, a repeat Pap test, an HPV test, or a colposcopy which is a more thorough examination and biopsy of any abnormal area. If the Pap reveals ASC-US and the HPV test is positive, a colposcopy will be the next step. A health care professional will also order a colposcopy if the Pap results signal any other more serious changes.

Further screening and treatments will depend on the results of the colposcopy. In most cases, mild dysplasia (CIN 1) will not be treated, but your health care professional will follow up according to guidelines based on the severity of the screening test. This may include co-testing with Pap and HPV after 12 months, or after 12 and 24 months with any abnormal Pap or positive HPV test leading to a repeat colposcopy. For CIN 2, CIN2,3 or CIN 3, further treatment will be needed to remove the abnormal cells. In young women, CIN 2 or 2,3 may be followed before treatment is done.

Regular age-related cervical cancer screening by Pap and HPV testing is equally important for lesbians and bisexual women who, studies find, may be less likely to seek routine health care because of the discomfort they feel discussing or revealing their sexual orientation to health care professionals. They also may not want to undergo screening because they feel they are not at risk. However, lesbian and bisexual women are also at risk for HPV infection and cervical cancer (for example, through prior male partners, vibrators and other sexual aids or skin-to-skin contact with an infected partner).

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Treatment

There is no cure for HPV, but most infections are cleared to levels that are no longer detected. However, there are treatments for genital warts.

Young women may be vaccinated against some common strains of HPV, including the types that cause most HPV-related cervical cancers. (See Prevention section for details.) The HPV vaccine is now approved for men and women up to the age of 45.

The best defense against HPV is to minimize your risk of exposure. Using condoms, limiting your number of sexual contacts and continuing to have regular cervical cancer screening with Pap and HPV tests are important steps to reducing risk.

Most people with HPV infections never know the virus has been present and don't require treatment. Your body's immune system simply gets rid of the virus on its own. Only a small number of women develop problems that require treatment, ranging from warts to precancer or cervical cancer.

When women seek treatment for genital warts, it's usually because they don't like the way the warts look or because of symptoms. The treatment does not prevent the warts from recurring or the individual from transmitting the infection to someone else. In fact, genital wart recurrence is common, especially within the first three months.

Studies also find that small warts of short duration (less than one year) respond better to therapy than large warts of long duration. All wart treatments may cause mild local irritation.

When it comes to treating genital warts, no single treatment is ideal for all women. If you suffer from genital warts and want treatment, it's important that you communicate openly with your health care professional, so you fully understand your options.

If you don't have visible warts, you do not need treatment. In fact, there is no treatment available for subclinical genital HPV infection (i.e., no visible warts diagnosed by colposcopy, biopsy, acetic acid application or HPV laboratory tests). There is no certain way to diagnosis subclinical genital HPV infection and no effective therapy to treat it. The good news is, infection with all types of HPV will eventually go away on its own.

Today, there are a wide variety of treatments that can be administered by you or your health care professional. You may also use a combination of the two. Treatments range from cryotherapy, which freezes the warts with liquid nitrogen, to electrocautery, which burns off the warts, to creams or gels you apply at home.

The goal of treatment should be to remove visible genital warts and relieve annoying symptoms or to remove warts that are obstructing the birth canal in a pregnant woman.

Available treatments include the following:

Self-applied treatments:

  • Podofilox (Condylox). This 0.5 or 0.15 percent solution or gel is a relatively cheap, safe, easy-to-use treatment. It is applied directly to the warts every day for three weeks or twice a day for three days, followed by four days of no therapy, for a total of three to four weeks. Warts may return after treatment.

  • Imiquimod (Aldara). This 5 percent cream treats external genital warts and perianal warts, which appear around the anus. It is safe, effective and easy to use. The cream is applied three times a week for up to 16 weeks and works by stimulating the immune system to target the warts. Warts may recur after treatment.

  • Sinecatechin (Veregen). This is a 5 percent ointment made from a green tea extract applied directly to warts three times a day until they disappear. The active ingredients in sinecatechin are components in green tea called catechins.

People tolerate these three therapies differently, so podofilox may work better for you while imiquimod or sinecatechin works better for someone else. Talk with your health care professional about which therapy you should try. Side effects of all three drugs may include tenderness, irritation and localized burning. None has been deemed safe to use during pregnancy.

Treatments applied by health care professionals:

  • Cryotherapy (freezing off the wart with liquid nitrogen). This treatment is relatively inexpensive. It is usually performed without anesthesia, and it may cause some discomfort. It may take several treatments a week for up to six weeks to remove all warts.

  • Trichloroacetic acid (TCA) (10 percent to 25 percent) or bichloracetic acid (BCA) (80 percent to 90 percent). These are two chemicals that are applied to the surface of the wart once a week for up to four consecutive weeks. These chemicals are stronger forms of the over-the-counter acids used to remove external warts. This treatment is safe to use during pregnancy.

  • Podophyllin resin 10 percent to 25 percent. This treatment is not recommended due to potential toxicity. This solution requires application once a week, typically for up to four weeks. It must be washed off within one to four hours after application to reduce local irritation. It is more likely to cause side effects than podofilox which is a purified resin of podophyllin. There's no evidence that it's safe for use during pregnancy.

  • Laser therapy (using an intense light to destroy the warts) or surgery (cutting off the warts) can get rid of warts in a single office visit. However, treatment can be expensive, and the health care professional must be well trained in these methods. If not performed correctly, laser therapy can cause burning and scarring.

Because HPV is a virus, your immune system plays a role in whether or not your warts return. When it's not active, the virus travels to a deeper level of tissue where it can remain indefinitely. If you've had HPV in the past, you should be on the lookout for recurrences, which occur most frequently during the first three months after treatment.

Eating a balanced diet, exercising regularly and avoiding illegal drugs, tobacco and alcohol are simple ways to help keep your immune system strong.


Prevention

The U.S. Centers for Disease Control and Prevention estimates that most sexually active adults will have acquired an infection with one of the genital HPV strains by the time they reach 50.

The U.S. Food and Drug Administration (FDA) currently licenses one HPV vaccine, called Gardasil 9. It can protect against the HPV types that cause most cervical cancers and protects against most strains of genital warts, as well as anal, vaginal and vulvar cancers.

Vaccination should be given before an infection occurs, ideally, before a girl or boy becomes sexually active. The vaccine is approved for children as young as nine and is routinely recommended as a series of shots for girls and boys at age 11 or 12.

Vaccinations also are recommended for females ages 13 to 26 and males ages 13 to 21 who did not receive the vaccine when they were younger. Gardasil 9 is approved for women and men up to age 45. Getting vaccinated as an adult is a decision to be made between an individual and their health care professional after discussing risks and benefits.

Gardasil 9 is given in two or three doses, depending on the recipient's age. It is important to get all recommended doses for the best protection. If the vaccine is started before age 15, it is only two doses; after age 15, it is three doses.

Vaccination doesn't protect against all HPV strains. Therefore, continued lifelong screening with Pap tests and the HPV test if appropriate is necessary. The vaccines are also not effective for a particular strain of the virus if a person is already infected with that HPV type. For this reason, getting vaccinated before you become sexually active and exposed to the virus is optimal to provide the greatest protection.

Women age 30 and older who test positive for HPV are more likely to have a persistent infection that was not cleared by the immune system. Only women with persistent infections with HPV are at risk for developing cellular changes that can lead to cervical cancer. Therefore, when combined with a Pap test in women 30 and older, the HPV test is better at identifying women at risk for developing cervical cancer than the Pap test alone. (See Diagnosis section for guidelines on Pap tests and HPV tests.)

Regular testing with Pap tests and the HPV test is the best way to identify the virus once a woman has contracted it, but, ultimately, avoiding HPV in the first place is a woman's best bet. Health experts advise women to use one or more of the following options to reduce contact with the virus, which is transmitted via skin-to-skin contact:

  • Use condoms whenever you are intimate with a new sexual partner. Latex condoms, when used correctly and consistently from start to finish each time you have sex, can provide some protection if they cover the area of HPV infection. Note, however, that while condoms will decrease the risk of HPV infection, they won't prevent it entirely because HPV can infect cells anywhere on the skin of the genital area.

  • Be aware that spermicidal foams, creams and jellies are not effective against any sexually transmitted disease, including HPV. The FDA has advised consumers that using vaginal contraceptives containing nonoxynol-9 can increase vaginal irritation, thus increasing the risk of infection.

  • For oral sex, use a dental dam, plastic wrap or a split and flattened unlubricated condom. These materials provide a moisture barrier between the mouth and the vagina or anus during oral sex. Avoid brushing or flossing your teeth right before having oral sex, which may tear the lining of your mouth, increasing your exposure to viruses.

  • Be careful about sharing sexual toys. It's possible that HPV could be transmitted via sexual toys that are inserted in the vagina but aren't thoroughly cleaned before being used on your partner.

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Facts to Know

  1. If you have human papillomavirus (HPV), you are not alone. Most of the reproductive-age population has been infected with one or more types of sexually transmitted HPV at some point in their lives. The U.S. Centers for Disease Control and Prevention estimates that 79 million people are currently infected with HPV.
  2. The peak age of having HPV is in the mid-twenties. The virus is usually cleared by the immune system in eight or nine months, and the majority of HPV infections are cleared by 24 months.

  3. Having a positive HPV test does not mean that a partner has been unfaithful. It is never possible to know when an HPV infection was acquired.

  4. Most HPV infections have no symptoms and are hard to identify. Warts are caused by low-risk strains of the virus and can be flesh-colored and hidden inside the cervix, vagina or anus. They can be small or large, alone or in clusters, flat or round. They can spread along the groin or thigh or be found in the mouth. High- risk cancer-causing strains of HPV cause no symptoms and are detected by an abnormal Pap test or HPV test.

  5. HPV infection is a direct cause of cervical cancer. Cervical cancer was once one of the most common causes of cancer death for American women but is now one of the most preventable, with fatality rates dropping because of early detection and treatment.

  6. In addition to cervical cancer, other health problems can result from HPV infection as well. These include recurrent respiratory papillomatosis, a rare condition where warts grow in the throat generally due to infection of a baby who has delivered through the birth canal of an infected mother, and other less common but potentially serious cancers, including cancer of the vulva, vagina, anus and penis, and oropharyngeal cancer, a type of head and neck cancer that affects the back of the throat, base of the tongue and the tonsils.

  7. In most cases, the body's immune system clears the infection within two years. Because the virus travels to lower-level tissues where it may remain indefinitely, researchers don't know if the virus is completely eliminated or just suppressed to such a low level that it's hard to detect with routine screening. However, women who test negative for the high-risk strains of HPV using the HPV test have almost no chance of developing serious cell changes in the near future. This can provide tremendous peace of mind.

  8. Women who are 30 and older who have persistent HPV infection are at risk as long as the virus persists. The Pap test can miss disease as much as half the time, while HPV tests are very accurate. If a woman tests positive for HPV 16 or 18, she will need colposcopy; if a woman tests positive for the other 12 types of HPV two times in a row, she will need further testing, even if her Pap test is normal.
  9. In conjunction with the Pap test, the HPV test can be used in women age 30 and older to help detect HPV infection. When combined with a Pap test in women of this age group, the HPV test is better at identifying women at risk for developing cervical cancer than the Pap test alone.

  10. The U.S. Food and Drug Administration has approved primary HPV testing for women ages 25 and older, which means that the sample is collected into the liquid vial. Only the HPV test is performed, and further evaluation or follow-up is determined by whether HPV is present and whether there is HPV 16 or 18.

  11. It is important that you work with your health care professional to determine which HPV treatment (whether for low-risk HPV–causing genital warts or for high-risk HPV–causing dysplasia) is most appropriate for you.
  12. Because HPV is so common, and it is impossible to determine when someone was infected, notifying a partner of a prior HPV infection is not mandatory. If you have an active infection with genital warts, however, you should use protection and notify your partner, who may choose to forego sex because the condom isn't completely protective, and the genital wart virus is highly infectious.
  13. Genital warts are uncommon in children. When they occur, they are most often the result of sexual abuse.

Questions to Ask

Review the following Questions to Ask about human papillomavirus (HPV) so you're prepared to discuss this important health issue with your health care professional:

  1. How can I tell whether I have HPV? How does it affect my risk for developing cervical cancer and other diseases?

  2. Am I a good candidate for the HPV test?

  3. What procedures can you do if I have an abnormal Pap test? Does that mean I have cancer? Which follow-up tests should I have?

  4. Please explain the treatment you recommend. Given the wide variety of treatment options available, why is one better for me than the others?

  5. How much will each treatment cost, and how many treatments will it take to permanently remove my warts?

  6. What are the side effects of this treatment?

  7. What should I do if my symptoms or treatments become painful?

  8. Can I have sex during the treatment period?

  9. If I'm pregnant, or plan to get pregnant, how will HPV affect me and my baby?

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Key Q&A

  1. How can I tell if I'm infected with human papillomavirus (HPV) if I don't have genital warts?

    If you or your partner do not have warts, it is virtually impossible for you to determine whether you have low-risk types of HPV. Women are tested for high-risk HPV as a cancer prevention strategy. The purpose of HPV testing is to find women who are at risk due to persistent HPV and identifying those who should be followed carefully as long as the virus persists. According to the CDC, an estimated 79 million Americans are currently infected with HPV, but many are unaware they have it.

    Occasionally, people may notice itching or skin changes, but more often HPV is a silent infection. For this reason, women are strongly encouraged to see their health care professional for regular Pap and HPV tests according to age-related guidelines. Men should also see their health care professional to learn as much as possible about this disease.

    Because HPV is a predictor of the presence or future development of cervical precancer or cancer, it is preferred that all women 30 and older have an HPV test along with their Pap. There is also FDA approval for testing for HPV alone on all women 25 and older as a different screening option, however, most medical organization guidelines call for its use alone in women 30 and older. Research continues on the most effective testing methods.

  2. Can I get HPV from someone performing oral sex on me?

    Yes. HPV spreads via skin-to-skin contact, primarily during sexual contact, even if a wart is not visible. HPV infections are most commonly found in the genital area, anus and mouth. An increasing number of oral and tonsillar cancers are caused by high-risk strains of HPV thought to be related to an increase in oral sex.

  3. If I have a wart removed, will it come back?

    Because HPV is a virus, your immune system plays a role in whether your warts recur. In the majority of cases, the infection clears within two years. However, because the virus hides in lower-level tissue, it is impossible to know if the virus is gone or just suppressed to such a low level that it's hard to detect.

  4. If I use a condom, can I still get (or spread) HPV?

    Yes. Studies have shown that condoms reduce the risk of HPV infections but are not completely protective. Condoms do not provide complete protection against HPV because they do not cover all the possible infection sites, which include the genital area, anus and mouth. This does not mean you should not use them. While condoms are not foolproof, they provide the best available protection, especially for those who have multiple sexual partners.

  5. If I have HPV, does that mean I am at risk for other sexually transmitted infections or cervical cancer?

    Yes. Having HPV increases the likelihood that a woman may have other sexually transmitted diseases or cervical cancer. Although only certain types of HPV cause cervical cancer, it is important that women of all ages have regular gynecologic exams and all the recommended screening tests. These tests include those that screen for chlamydia, gonorrhea and HIV, if necessary. Talk with your health care professional about how often you should be tested.

  6. How does HPV affect my fertility?

    HPV is not like other sexually transmitted diseases (such as chlamydia) that can affect your fertility. Of greater concern is that a high-risk HPV strain can lead to cervical cancer. In addition, certain HPV treatments may cause scarring or damage the cervix (such as LEEP or cone biopsy), which may impair fertility or impact a pregnancy (for example, increased risk of premature delivery), so it is important to discuss the options with your health care professional. These complications are not common and, if treatment is needed, it is important to have it.

  7. What is the best treatment for HPV?

    There is no treatment for HPV. Treatment is for changes caused by HPV. Screening with Pap and HPV testing identifies women with precancerous cells and, rarely, cancer. Those abnormal changes are treated. Genital warts caused by HPV may be treated for cosmetic reasons and when warts obstruct the birth canal before a pregnant woman is close to delivery.

  8. If my partner is diagnosed with HPV, does that mean he or she has cheated on me?

    HPV is a group of more than 150 viruses, 40 of which can infect the genital area. HPV can take weeks, months or years to produce symptoms (if they appear at all). If your partner is diagnosed with HPV, it doesn't necessarily mean there has been infidelity. The most important thing you and your partner can do is to learn as much as possible about this disease. Most reproductive-age men and women have been infected with one or more types of HPV at some point, and most don't know it because not all viruses produce warts. In fact, genital warts are the least common problem caused by HPV. Furthermore, the immune system naturally fights off the virus and evidence of the virus goes away in one to two years.

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Lifestyle Tips

  1. Understand testing for human papillomavirus (HPV) infection

    HPV infections are very common and your immune system spontaneously clears most infections. Therefore, even if you have HPV, your risk of developing cervical cancer is extremely low. It's important, however, to have regular Pap test screenings according to guidelines established by the American Cancer Society. It recommends all women begin getting Pap tests at age 21 and be screened every three years. Starting at age 30, women may opt to stretch out screenings to every five years if they get both a Pap test and an HPV test. Women may stop screenings at age 65 if they've had regular screenings and are not at high risk for cervical cancer.

    Think of screening for HPV in much the same way you'd screen for cholesterol or other health risk factors: you want to determine what your risks are for having or developing the disease. For women with minor abnormalities on their Pap test, doctors use the HPV test to determine if they have a high-risk HPV infection and need further workup such as a colposcopy. Those who are not infected with high-risk strains of HPV need only regular Pap tests.

    For women 30 and older, the advantage of being screened with the HPV test in conjunction with their Pap test is that those women who are negative on both tests have a very low risk for persistent HPV infection or cervical cancer and probably don't need to be screened again for five years. In addition, four high-risk HPV tests have been approved by the FDA to screen for the HPV types most strongly associated with cervical cancer—HPV 16 and HPV 18. Ask your doctor about using one of these tests along with the Pap test.

  2. Take precautions for oral sex

    Most sexually transmitted infections, including HPV, can be spread via oral sex. To protect yourself, make sure your partner uses a condom if you're performing oral sex; if he's performing oral sex on you, or if you're having oral sex with a woman, use a dental dam, a flat piece of latex used during dental procedures, available in some medical supply stores. They provide a barrier between the mouth and the vagina or anus during oral sex. Household plastic wrap or a split and flattened, unlubricated condom can also be used. Also, don't brush or floss your teeth right before having oral sex. Either may tear the lining of your mouth, increasing your exposure to viruses.

  3. Practice the best protection

    The best protection against any type of sexually transmitted infection besides abstinence is a latex condom. However, it doesn't provide 100 percent protection against sexually transmitted diseases.

    If you use a condom, make sure you use it properly. Human error causes more condom failures than manufacturing errors. Use a new condom with each sexual act (including oral sex). Carefully handle it so you don't damage it with your fingernails, teeth or other sharp objects. Put the condom on after the penis is erect and before any genital contact. Use only water-based lubricants with latex condoms. Ensure adequate lubrication during intercourse. Hold the condom firmly against the base of the penis during withdrawal, and withdraw while the penis is still erect to prevent slippage.

  4. Get tested for STDs

    No one test screens for all sexually transmitted diseases. Some require a vaginal exam and Pap test; others a blood or urine test. And just because you have a negative test doesn't mean you don't have the disease. Chlamydia, for instance, may travel far up into your reproductive tract, so your doctor is unable to obtain an accurate culture. Or your body may not yet have developed enough antibodies to a virus like HIV to turn up in a blood test.

    Still, it's important to ask your health care provider to regularly test you for sexually transmitted diseases if you're sexually active in a relationship in which you or your partner is also sexually active with others.

    You can also get tested at your health department, community clinic or Planned Parenthood. Or call the CDC at 1-800-CDC-INFO (800-232-4636) for information on free or low-cost clinics in your area.

  5. Know whether you have an STD

    While some sexually transmitted diseases may have symptoms such as sores, ulcers or discharge, most have no symptoms. You can't always tell if you or a partner has an infection just by looking. So don't rely on a partner's self-reporting and assume that will prevent you from acquiring a sexually transmitted disease; many infected persons do not know they have a problem.

    Even if you have symptoms, they may be caused by something else, such as yeast infections, friction from sexual relations or allergies. Educate yourself about your own body and, in turn, learn about your own individual risk for contracting an STD. One way to do this is to schedule an examination with a nurse practitioner or other health care professional who can sit down with you and help you learn the principles for staying safe and sexually healthy. Don't allow fear, embarrassment or ignorance to jeopardize your future.

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Organizations and Support

For information and support on coping with HPV, please see the recommended organizations, books and Spanish-language resources listed below.

American Cancer Society (ACS)
Website: http://www.cancer.org
Address: 250 Williams Street
Atlanta, GA 30303
Hotline: 1-800-ACS-2345 (1-800-227-2345)
Phone: 404-315-1123

American College of Obstetricians and Gynecologists (ACOG)
Website: http://www.acog.org
Address: 409 12th Street, SW
P.O. Box 96920
Washington, DC 20090
Phone: 202-638-5577
Email: resources@acog.org

American Social Health Association (ASHA)
Website: http://www.ashasexualhealth.org/
Address: P.O. Box 13827
Research Triangle Park, NC 27709
Hotline: 1-800-227-8922
Phone: 919-361-8400
Email: info@ashastd.org

ASHA's STI Resource Center Hotline
Website: http://www.ashasexualhealth.org/premium-services-2/
Address: American Social Health Association
P.O. Box 13827
Research Triangle Park, NC 27709
Hotline: 1-800-227-8922
Phone: 919-361-8400

Association of Reproductive Health Professionals (ARHP)
Website: http://www.arhp.org
Address: 1901 L Street, NW, Suite 300
Washington, DC 20036
Phone: 202-466-3825
Email: arhp@arhp.org

AWARE Foundation
Website: http://www.awarefoundation.org
Address: 834 Chestnut Street, Suite 400
Philadelphia, PA 19107
Phone: 215-955-9847

CDC National Prevention Information Network
Website: http://www.cdcnpin.org
Address: P.O. Box 6003
Rockville, MD 20849
Hotline: 1-800-458-5231
Phone: 404-679-3860
Email: info@cdcnpin.org

Guttmacher Institute
Website: http://www.guttmacher.org
Address: 1301 Connecticut Avenue NW, Suite 700
Washington, DC 20036
Hotline: 1-877-823-0262
Phone: 202-296-4012
Email: info@guttmacher.org

National Cancer Institute (NCI)
Website: http://www.nci.nih.gov
Address: NCI Public Inquiries Office
6116 Executive Boulevard, Room 3036A
Bethesda, MD 20892
Hotline: 1-800-4-CANCER (1-800-422-6237)
Phone: TTY: 1-800-332-8615

National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
Website: http://www.cdc.gov/nchhstp
Address: Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
Hotline: 1-800-CDC-INFO (1-800-232-4636)
Email: cdcinfo@cdc.gov

National Cervical Cancer Coalition (NCCC)
Website: http://www.nccc-online.org
Address: 6520 Platt Ave., #693
West Hills, CA 91307
Hotline: 1-800-685-5531
Phone: 818-909-3849
Email: info@nccc-online.org

National Family Planning and Reproductive Health Association (NFPRHA)
Website: http://www.nfprha.org
Address: 1627 K Street, NW, 12th Floor
Washington, DC 20006
Phone: 202-293-3114
Email: info@nfprha.org

Planned Parenthood Federation of America
Website: http://www.plannedparenthood.org
Address: 434 West 33rd Street
New York, NY 10001
Hotline: 1-800-230-PLAN (1-800-230-7526)
Phone: 212-541-7800

Prevent Cancer Foundation
Website: http://www.preventcancer.org
Address: 1600 Duke Street, Suite 500
Alexandria, VA 22314
Hotline: 1-800-227-2732
Phone: 703-836-4412

Sexuality Information and Education Council of the United States (SIECUS)
Website: http://www.siecus.org
Address: 90 John Street, Suite 704
New York, NY 10038
Phone: 212-819-9770

Sexual Health: Questions You Have...Answers You Need
by Michael V. Reitano, Charles Ebel

Sex: What You Don't Know Can Kill You
by Joe S. McIlhaney, Marion McIlhaney

CDC - Human Papillomavirus
Website: https://www.cdc.gov/std/spanish/vph/stdfact-hpv-s.htm
Address: 1600 Clifton Road
Atlanta, GA 30333
Hotline: 1-888-246-2857
Phone: 404-639-3311

American Academy of Family Physicians
Website: https://es.familydoctor.org/condicion/virus-del-papiloma-humano-vph/
Email: aafp@aafp.org