Human Papillomavirus (HPV)

HPV and Cervical Cancer

HPV is a viral infection that is transmitted sexually or through other skin-to-skin contact. In many cases an HPV infection causes no symptoms, and most people don’t know they have it. People assigned male at birth can’t be tested for HPV. People assigned female at birth are tested during routine Pap smear and HPV screening.

Most HPV infections often go away on their own within two years and do not cause any symptoms or long-term effects. However, when an HPV infection persists, it can cause warts on the skin or mucous membranes. Certain types of HPV can also cause cells in the cervix (the lower end of the uterus that connect to the vagina) to become abnormal. If the abnormal cells are present for many years, they can eventually turn into cervical cancer.

The vast majority of sexually active individuals will contract HPV at some point in their lifetime, but most will never develop cancer.

While most HPV infections cause no symptoms, symptoms may include:

• Warts in the genital area that appear as flat lesions or cauliflower-like bumps.
• Warts or unusual growths in the mouth or throat.
• Common warts with a rough surface, often appearing on the hands or fingers.
• Plantar warts on the feet or heels.
• Unusual growths, lumps or sores in the genital area.
• Abnormal vaginal bleeding outside the normal menstrual period.

HPV Risk Factors

Risk factors for developing a persistent HPV infection include:

• Sexual contact. This risk increases with the number of sexual partners or having sex with someone with multiple sexual partners.
• Weakened immune system.
• Unprotected contact with another person’s warts.
• Cigarette smoking.

How is HPV Diagnosed?

Regular Pap tests can detect abnormal cervical cells that can be a precursor to cervical cancer. Because cervical cancer typically has no symptoms, a Pap test is the best way of identifying these pre-cancerous changes. An HPV screening test can be performed along with a Pap smear or on its own. This screening tests for the high-risk strains of HPV that can increase your risk of cervical cancer.

Both Pap tests and HPV screenings are done by swabbing the cervix and examining the samples in a lab. However, they differ in that a Pap test does not identify the presence of HPV, but rather looks for abnormalities that can be caused by HPV.

Pap and HPV Screening Recommendations

Individuals with a cervix should have a Pap test every three years from ages 21–29. From ages 30–65, screening should include a Pap test every three years or HPV-based testing every five years. After age 65 testing may be discontinued in low-risk individuals. Anyone who has had their cervix removed during a hysterectomy can also stop screening, provided they are at low risk for cervical cancer.

If you test positive for HPV but your Pap test is normal, your provider may recommend repeating a Pap and HPV screening after one year. HPV will often resolve on its own over time, resulting in a negative screening after a year.

If you continue to test positive for HPV or have an abnormal Pap test result, a colposcopy procedure may be recommended. During this exam, your provider examines your cervix or vagina with a specialized instrument (a colposcope) to look for abnormalities.

HPV Prevention

You can reduce your risk of contracting HPV infections that cause common warts or plantar warts by:

• Avoiding picking at warts to reduce the spread and prevent new warts from forming.
• Wearing water shoes or sandals in places like locker rooms and public pools.

Reduce your risk of HPV infections that cause cancers or genital warts by:

• Getting the HPV vaccine.
• Using latex condoms when engaging in sexual activity, though condoms cannot fully protect against HPV transmission.

HPV Vaccine

The best way to prevent HPV infections that can cause genital warts and cancer is by getting the FDA-approved HPV vaccine Gardasil. The Centers for Disease Control and Prevention recommends routine HPV vaccination for all children at 11–12 years old, although it can be given as early as age 9. The vaccine is most effective at preventing HPV and cervical cancer when it is received before a person becomes sexually active. Studies find that receiving the vaccine at an early age is not linked to earlier sexual activity in adolescents.

Children under 15 should receive two doses of the vaccine at least six months apart. Teens or young adults who start the series after age 15 should receive three doses of the vaccine. The FDA has approved the HPV vaccine for all people ages 9–45, so if you did not receive it as an adolescent, talk to your doctor about whether it is right for you.