HPV (Human Papillomavirus)

How HPV spreads

HPV spreads through close skin-to-skin contact, mainly during vaginal, anal or oral sex. It can spread:

• even when the infected person has no symptoms
• with any sexual partner, including the first one
• despite condoms, which reduce but do not fully prevent it, because HPV can infect skin they do not cover
• rarely, from mother to baby during birth, causing respiratory papillomatosis

Common skin warts on the hands and feet are caused by different HPV types and are not sexually transmitted.

Symptoms

Most people with HPV have no symptoms and never know they had it. When problems occur, they include:

Genital warts

Genital warts are soft, flesh-colored or gray growths on the genitals, anus, groin or thighs. They can be flat, raised or cauliflower-shaped, and appear weeks to months after exposure. They are usually caused by low-risk types 6 and 11 and do not turn into cancer.

Precancer

High-risk HPV can cause abnormal cell changes, such as cervical dysplasia. These have no symptoms and are found by screening.

Cancer

Persistent infection with high-risk HPV can lead to cancer, usually 10 to 20 years or more after infection. Each year in the US, HPV causes about 37,000 cancers.

Oropharyngeal cancer is now the most common HPV-related cancer in the US, and it mostly affects men.

HPV in men and women

• Women: cervical screening detects HPV and precancer. Most infections clear, but persistent high-risk infection needs follow-up.
• Men: there is no approved routine HPV test for men. Men can get genital warts and HPV-related cancers of the throat, anus and penis. Men who have sex with men and people with HIV have higher anal cancer risk and may be offered anal cancer screening.

Risk factors for persistent infection

• smoking
• weakened immune system, including HIV and organ transplant
• long-term use of birth control pills (small effect)
• having many children
• other sexually transmitted infections such as chlamydia

Testing and screening

There is no blood test for HPV. Testing is done on cervical cells.

Typical US cervical screening guidance for people with a cervix:

• Ages 21 to 29: Pap test (cytology) every 3 years.
• Ages 25 or 30 to 65: primary HPV test every 5 years (preferred by several guidelines), or co-testing (HPV plus Pap) every 5 years, or a Pap test every 3 years. Self-collected vaginal samples for HPV testing are now an option in many settings.
• Over 65: screening can stop after a history of adequate normal results.

Abnormal results may lead to a repeat test, colposcopy (a magnified look at the cervix) and biopsy. Precancerous areas are removed with a simple procedure such as LEEP, which prevents cancer. If you have just had a positive result, our guide to what a positive high-risk HPV test means walks through each result and the usual next step.

Treatment

There is no medicine that cures HPV itself, but the problems it causes are treatable:

• Genital warts: prescription creams (imiquimod, podofilox, sinecatechins), freezing, burning, laser or surgical removal
• Cervical precancer: LEEP, cone biopsy, cryotherapy or laser ablation
• HPV-related cancers: surgery, radiation and chemotherapy. HPV-positive throat cancers generally respond better to treatment than HPV-negative ones

Prevention

HPV vaccine

The 9-valent vaccine protects against the 7 high-risk types that cause most HPV cancers and the 2 types that cause most genital warts.

• Recommended routinely at ages 11 to 12 (can start at 9), for all genders
• 2 doses if started before age 15, 3 doses if started at 15 or older or with a weakened immune system
• Catch-up vaccination through age 26
• Ages 27 to 45: shared decision with a doctor, as benefit is lower because many have already been exposed

The vaccine is safe and highly effective. In countries with high coverage, cervical precancers and cancers in young women have fallen dramatically. The vaccine prevents new infections but does not treat existing ones.

Other measures

• regular cervical screening, even if vaccinated
• condoms and dental dams
• limiting the number of sexual partners
• not smoking

Frequently asked questions

Does HPV go away on its own?

Usually, yes. About 9 in 10 HPV infections are cleared by the immune system within 2 years without causing problems. Infections that persist, especially with high-risk types, are the ones that can lead to precancer and cancer.

What are the symptoms of HPV?

Most people have no symptoms. Some develop genital warts. High-risk types can cause precancerous changes that have no symptoms and are found on screening. Cancers caused by HPV may cause bleeding, lumps or sores years later.

Can men get tested for HPV?

There is no approved routine HPV test for men. Men are diagnosed when they have visible warts or, in some higher-risk groups, through anal screening. Vaccination is the best protection for men.

Who should get the HPV vaccine?

It is recommended for all children at 11 to 12 years (from age 9), and for everyone through age 26 who was not fully vaccinated. Adults aged 27 to 45 can discuss it with their doctor.

If I have HPV, will I get cancer?

Most people with HPV never develop cancer. Cancer can develop only after persistent infection with a high-risk type over many years. Regular cervical screening finds and treats precancerous changes long before cancer develops.