Human Papillomavirus Infection or HPV Infection: Causes, Symptoms, Tests and Treatment

Over 30 varieties of human papillomavirus (HPV) can infect the genital area. Some strains are harmless and may lead to genital warts. However, only a few particular types of HPV are known as “high risk” due to their potential to cause cervical cancer. Vaccination against HPV and routine Pap smear tests are potent measures to prevent cervical cancer.

What is Human Papillomavirus or HPV?

Human papillomavirus (HPV) is a widespread virus that can infect various parts of the body. There are over 100 different types of HPV, some of which trigger warts on the hands, feet, face, and other areas. Approximately 30 types of HPV can infect the genital region, including the vulva, vagina, cervix, penis, scrotum, rectum, and anus.

Genital HPV is a sexually transmitted infection (STI) that transmits through skin-to-skin touch. Although the idea of STIs can be unsettling, most genital HPV strains are not harmful, including those that lead to genital warts.

However, some high-risk HPV strains can lead to cancers, such as cervical cancer. With early detection and appropriate treatment, these outcomes are often preventable.

Are all warts HPV?

Yes, they are. It surely can be confusing when you are trying to distinguish between the HPV that causes warts on your fingers or genitals and the HPV that may result in cervical cancer.

HPV strains that lead to warts, including genital warts, are generally just troublesome. These HPV types are usually not dangerous. HPV types 6 and 11 are most commonly responsible for genital warts. Other HPV types may cause:

• Flat warts
• Plantar warts
• Common warts
• Periungual and subungual warts

While all warts are triggered by HPV, not all HPV forms cause warts. Interestingly, the types of HPV that have the potential to progress to become cancer do not cause warts.

Relation between HPV and cervical cancer?

Certain strains of HPV, particularly types 16 and 18, can lead to changes in the cells of the cervix, known as cervical dysplasia. The cervix is responsible for connecting the vagina and the uterus in women’s bodies. If cervical dysplasia is not treated, it may develop into cervical cancer.

For individuals under 30, most HPV infections resolve on their own. By age 30, detecting HPV during a Pap smear (a screening test for cervical cancer) can help determine the frequency of future tests. A positive result may indicate a higher risk, necessitating more frequent screenings.

Regular Pap smears are crucial for cervical cancer screening. However, you should remember that having HPV or cervical dysplasia does not mean you will develop cancer.

Whom does HPV affect?

Anyone can contract HPV through sexual activity or close skin-to-skin genital contact with an infected partner. Likewise, an individual with the virus can transmit it to their partner during vaginal, oral or anal sex, or any other intimate genital contact.

HPV in women

HPV generally presents the highest risk to women, as a few particular high-risk types of HPV strains can cause cervical cancer if left untreated. Pap smears and HPV tests are essential for early detection of precancerous cell changes, helping to prevent cervical cancer. Additionally, non-dangerous forms of HPV can cause genital warts in women.

HPV in men

HPV poses fewer health risks to men. For men, HPV can cause genital warts, but most infections resolve on their own. While HPV can also cause cancers of the penis, anus, head, and neck, these occurrences are rare. Consequently, HPV tests and Pap tests are generally not recommended for men.

However, if you are HIV positive, your immune system may struggle more with HPV infections. Men who have sex with men (MSM) are at a higher risk of contracting high-risk HPV strains that can progress to cancer. In such cases, your doctor might suggest an anal Pap test, which checks for cell changes that could lead to cancer, though it does not test for HPV itself.

It is advisable to consult your healthcare provider about the necessity of testing.

Regardless of gender, it is important to prevent the spread of HPV through vaccination and practicing safer sex.

Symptoms of HPV Infection

HPV infections often do not cause noticeable symptoms or health issues.

According to the CDC, 90 percent of HPV infections clear up on their own within two years. However, during this period, the virus remains in the body, and individuals may unknowingly transmit it to others.

When HPV does not resolve on its own, it can lead to serious health problems, such as genital warts and warts in the throat, known as recurrent respiratory papillomatosis.

HPV can also lead to cervical cancer and other cancers of the genitals, head, neck, and throat. The HPV types that cause warts are different from those that cause cancer, so having genital warts does not mean you will develop cancer.

HPV-related cancers often do not show symptoms until they are in advanced stages. Regular screenings can detect HPV-related health issues early, improving prognosis and increasing survival rates.

HPV symptoms in men

Many men who contract HPV experience no symptoms, though some may develop genital warts. If you notice any unusual bumps or lesions on your penis, scrotum, or anus, you should immediately consult your doctor.

Certain HPV strains can lead to penile, anal, and throat cancers in men. Those at higher risk for HPV-related cancers include men who indulge in anal sex and those with weakened immune systems.

The HPV strains that cause genital warts are different from those that cause cancer.

HPV symptoms in women

As per an estimate, 80 percent of all women will contract at least one type of HPV during their lifetime. Similar to men, many women with HPV show no symptoms, and the infection often resolves without causing any health issues.

Some women may notice genital warts, which can appear inside the vagina, around the anus, on the cervix, or on the vulva.

If you observe any unexplained bumps or growths in your genital area, make an appointment with your doctor.

Certain HPV strains can lead to cervical cancer and cancers of the vagina, anus, or throat. Regular screening can detect changes related to cervical cancer. Additionally, DNA tests on cervical cells can identify HPV strains associated with genital cancers.

Causes of HPV Infection

HPV infection occurs when the virus enters the body, typically through a cut, abrasion, or small tear in the skin. The primary mode of transmission is through skin-to-skin contact.

Genital HPV infections are acquired through sexual intercourse, anal sex, and other skin-to-skin contact in the genital area. Some HPV infections that lead to oral or upper respiratory lesions are contracted through oral sex.

If you are pregnant and have an HPV infection with genital warts, there is a possibility of passing the infection to your baby. In rare cases, the infection may result in a noncancerous growth in the baby’s voice box (larynx).

Warts are contagious and can spread through direct contact with a wart. They may also spread when someone comes into contact with an object that has been in contact with a wart.

How easily does HPV transmit?

HPV is extremely contagious, mainly due to its transmission through skin-to-skin contact. Unlike many other infections, no exchange of body fluids is necessary for either you or your partner to contract the human papillomavirus. Even without ejaculation, you can infect your partner, or they can infect you.

HPV Diagnosis and Tests

The tests to diagnose HPV vary for men and women.

Women

Updated guidelines from the US Preventive Services Task Force (USPSTF) advise women to undergo their initial Pap test, or Pap smear, at age 21, irrespective of their sexual activity history.

Regular Pap tests aid in the detection of abnormal cells in women, which may indicate cervical cancer or other HPV-related issues.

Between ages 21 to 29, women should have a Pap test every three years. From ages 30 to 65, women should opt for one of the following options:

• Undergo a Pap test every three years
• Undergo an HPV test every five years, which screens for high-risk types of HPV (hrHPV)
• Undergo both tests together every five years, known as co-testing

The USPSTF recommends standalone tests over co-testing.

If you are younger than 30 and your Pap results show abnormalities, your doctor may also suggest an HPV test.

There are at least 14 HPV strains linked to cancer. If you test positive for one of these strains, your doctor may recommend regular monitoring for cervical changes. This might entail more frequent Pap tests or additional procedures like colposcopy.

Cervical changes that precede cancer often develop over many years, and HPV infections frequently resolve without progressing to cancer. Therefore, instead of immediate treatment for abnormal or precancerous cells, your doctor might suggest a period of watchful waiting.

Men

It is crucial to understand that the HPV DNA test is exclusively available for diagnosing HPV in women. At present, there is no FDA-approved test for diagnosing HPV in men.

As per the CDC, routine screening for anal, throat, or penile cancer in men is not currently recommended.

However, certain doctors may conduct an anal Pap test for men at elevated risk of developing anal cancer. This category includes men who engage in anal sex and those with HIV.

What is the treatment for HPV?

Usually, warts disappear on their own, especially in children, without requiring treatment. Nonetheless, since there is no cure for the virus, they may reappear in the same location or elsewhere.

Medications

Medications for getting rid of warts are typically administered directly to the affected area and often require multiple applications for effectiveness. Here are some examples:

• Salicylic acid: Over-the-counter treatments containing salicylic acid gradually remove wart layers. However, they may cause skin irritation and are not recommended for facial use.
• Imiquimod: This prescription cream can enhance the immune system’s response to HPV. Common side effects include redness and swelling at the application site.
• Podofilox: Another prescription topical treatment, podofilox, works by destroying genital wart tissue. It may induce burning and itching at the application site.
• Trichloroacetic acid: Utilized to burn off warts on the palms, soles, and genitals, this chemical treatment can result in local irritation.

These medications are most often used by healthcare practitioners to treat HPV infection patients, but you should never self-medicate as it may worsen your situation. These medications should only be taken after a thorough examination by your doctor.

Surgical and other procedures

When medications fail to produce desired results, your doctor may recommend wart removal using one of these methods:

• Freezing with liquid nitrogen (cryotherapy)
• Burning with an electrical current (electrocautery)
• Surgical excision
• Laser surgery

Treatment for HPV in the cervix

If your HPV or Pap test returns abnormal results, your doctor will likely conduct a colposcopy procedure. Using a colposcope, which provides a magnified view of the cervix, your doctor will closely examine the cervix and take biopsy samples of any areas that appear abnormal.

Treatment is necessary for any precancerous lesions. Options include cryosurgery (freezing), laser therapy, surgical removal, loop electrosurgical excision procedure (LEEP), and cold knife conization. 

LEEP involves removing a thin layer of the cervix using a thin looped wire charged with an electric current, while cold knife conization is a surgical procedure that removes a cone-shaped piece of the cervix.

Integrated Treatment for HPV Infection

Integrated treatment for HPV infection means a combination of modern medicine with the ancient goodness of ayurvedic practices. Here at Dr Monga’s clinic in Delhi, the team of doctors provides you two prescriptions – one with the modern approach of treating the condition with medicines, and the second of Ayurvedic medicines which aim at improving your doshas – to provide you quick recovery.

Prevention of HPV Infection

The only foolproof way to prevent HPV is through abstinence from sexual activity. However, for many individuals, a more realistic approach involves minimizing the risk of contracting HPV and preventing cervical cancer while maintaining a healthy sexual lifestyle.

To lower your risk, consider the following:

• HPV vaccination: The most effective method of HPV prevention is getting vaccinated before becoming sexually active. There are three FDA-approved vaccines for HPV prevention, with Gardasil9® being the sole option available in the U.S. since 2017. Gardasil9® guards against HPV strains responsible for cervical cancer and genital warts and is approved for individuals aged 9 to 45. Vaccination may offer protection against HPV strains you haven’t encountered. Consult your healthcare provider to determine if vaccination is suitable for you.
• Regular screening and testing: Early detection of HPV and abnormal cell changes is crucial for preventing cervical cancer. Commence regular Pap smears at age 21 and adhere to the recommended screening intervals based on your results. Between ages 30 to 65, you may require routine Pap smears, HPV tests, or a combination of both. After age 65, continued screening may or may not be necessary, depending on individual circumstances. Discuss your screening schedule with your doctor.
• Safer sex practices: While condoms and dental dams provide limited protection against HPV compared to other sexually transmitted infections, consistent and correct use can decrease the risk of HPV transmission during sexual activity.
• Partner communication and protection: Inform your partner(s) if you have HPV to encourage them to undergo testing. Depending on your HPV status and treatment, you may need to temporarily halt sexual activity. Consult your healthcare provider for guidance on managing an HPV infection.

HPV and pregnancy

HPV does not decrease your chances of getting pregnant. If you are pregnant and have HPV, you may be advised to delay the treatment until after childbirth. However, there are instances where an HPV infection can lead to complications.

During pregnancy, hormonal changes can cause genital warts to increase in size, and they may occasionally bleed. If the genital warts are extensive, they can complicate a vaginal delivery.

You may have to undergo a C-section If genital warts obstruct your birth canal.

In rare instances, a pregnant woman with HPV can pass the virus to her baby, leading to a serious condition known as recurrent respiratory papillomatosis, where the child develops growths in the airways due to HPV.

During pregnancy, you may still experience cervical changes, making it very critical to continue regular screenings for cervical cancer and HPV. 

HPV facts and statistics

Here are some more facts and statistics about HPV infection:

• The CDC reports that around 79 million Americans are currently infected with HPV, most of whom are in their late teens or early 20s.
• Approximately 14 million people in the United States are newly infected with HPV each year.
• HPV is responsible for more than 33,000 cancer cases annually in men and women in the U.S.
• An estimated 95 percent of anal cancer cases are due to HPV, primarily caused by HPV type 16.
• HPV types 16 and 18 are linked to at least 70 percent of cervical cancer cases. Vaccination can help prevent these specific strains.
• Since the introduction of the HPV vaccine in 2006, there has been a 64 percent decline in the prevalence of vaccine-covered HPV strains among teenage girls in the United States.

Is HPV curable?

No, there is no cure for HPV. You, however, can manage it very effectively through proper treatment and precautionary measures. 

Moreover, your immune system is highly effective at eliminating the virus. Most HPV infections (approximately 90%) are cleared by the body within one to two years.

You, however, should not wait for it to clear on its own as the later you begin the treatment, the worse it can get. Hence, you should get in touch with your doctor whenever you observe the first sign of an HPV infection.

Living With HPV Infection

Living with HPV can be very difficult in certain cases, as not only it can potentially cause cancer, it also manifests genital warts, which are not only troubling but embarrassing too. Hence, you should book a consultation with a doctor at the earliest to begin your treatment and avoid development of any complications.

Is HPV contagious for life?

Not exactly. You can still spread HPV as long as the virus remains in your body, even if you don’t have symptoms. For instance, even after genital warts have cleared, you can still transmit the virus if it is still present in your system.

You will no longer be contagious once your immune system has completely eradicated the virus.

Risk factors

HPV infections are quite prevalent. Factors that increase the risk of contracting HPV include:

• Number of sexual partners: The risk of genital HPV infection increases with the number of sexual partners you have. Engaging in sexual activity with a partner who has had numerous partners also raises your risk.
• Age group: Common warts are predominantly seen in children, whereas genital warts are most common among teenagers and young adults.
• Compromised immune system: Individuals with weakened immune systems, such as those with HIV/AIDS or those taking immunosuppressive medications post-organ transplant, are at a higher risk for HPV infections.
• Damaged skin: Skin that has been cut, punctured, or otherwise damaged is more susceptible to developing common warts.
• Direct contact: Coming into direct contact with someone’s warts or touching surfaces contaminated with HPV, like those in public showers or swimming pools, without adequate protection, can increase the risk of infection.

Complications

The most common complications of HPV infection include:

• Oral and upper respiratory lesions: Certain HPV infections lead to lesions on the tongue, tonsils, soft palate, as well as within the larynx and nasal passages.
• Cancer: Specific strains of HPV are linked to cervical cancer and may also play a role in cancers of the genitals, anus, mouth, and upper respiratory tract.

Preparing for your appointment

You probably will start by visiting your primary care doctor. Based on where your warts are situated, you may be referred to a specialist such as a dermatologist for skin conditions, a podiatrist for foot issues, or a gynecologist or urologist for problems related to the reproductive organs.

Here are some details to help you prepare for your appointment:

What you can do

Before you go for the appointment with your doctor, you should prepare a list of the following:

• Your symptoms, even those that may not seem connected to the main reason for your visit
• Important personal details, such as significant stresses, recent life changes, and your sexual history
• A list of all medications, vitamins, or supplements you are taking, along with their dosages

Questions you may want to ask your doctor

For an HPV infection, consider asking your doctor the following questions:

• What is the most likely cause of my symptoms?
• Are there other possible explanations for my symptoms?
• Do I need to undergo any tests?
• How can I protect myself from HPV in the future?
• Do you have any brochures or printed materials I can take with me? 
• Which websites would you recommend for more information?

Feel free to ask any additional questions you may have.

What to expect from your doctor

Your doctor may ask you the following questions:

• When did you first notice your symptoms?
• Are you in a monogamous sexual relationship? Is your partner?
• Where are the lesions located?
• Are the lesions causing pain or itching?
• Is there anything that seems to alleviate your symptoms?
• Is there anything that seems to make your symptoms worse?

Takeaway

HPV infection is a widespread and often asymptomatic virus that can lead to significant health issues, including genital warts and various cancers. Understanding the risk factors, preventive measures like vaccination, and the importance of regular screenings can help manage and reduce the impact of HPV. Early detection and treatment are crucial for preventing serious complications. Stay informed and proactive about your sexual health to minimize the risks associated with HPV.

Dr Monga’s in Delhi has a team of highly experienced and skilled doctors who have treated thousands of patients with HPV infection. If you are also noticing some symptoms or have suspicion of being exposed to the Human Papillomavirus, book an appointment with Dr Monga’s today and embark on your healing journey.