Hpv untreated: STD Facts – Human papillomavirus (HPV)
STD Facts – Human papillomavirus (HPV)
Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Some health effects caused by HPV can be prevented by the HPV vaccines.
What is HPV?
HPV is the most common sexually transmitted infection (STI). HPV is a different virus than HIV and HSV (herpes). There were about 43 million HPV infections in 2018, many among people in their late teens and early 20s. There are many different types of HPV. Some types can cause health problems including genital warts and cancers. But there are vaccines that can stop these health problems from happening.
How is HPV spread?
You can get HPV by having vaginal, anal, or oral sex with someone who has the virus. It is most commonly spread during vaginal or anal sex. HPV can be passed even when an infected person has no signs or symptoms.
Anyone who is sexually active can get HPV, even if you have had sex with only one person. You also can develop symptoms years after you have sex with someone who is infected. This makes it hard to know when you first became infected.
Does HPV cause health problems?
In most cases, HPV goes away on its own and does not cause any health problems. But when HPV does not go away, it can cause health problems like genital warts and cancer.
Genital warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. A healthcare provider can usually diagnose warts by looking at the genital area.
Does HPV cause cancer?
HPV can cause cervical and other cancers including cancer of the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils (called oropharyngeal cancer).
Cancer often takes years, even decades, to develop after a person gets HPV. The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers.
There is no way to know which people who have HPV will develop cancer or other health problems. People with weak immune systems (including those with HIV/AIDS) may be less able to fight off HPV. They may also be more likely to develop health problems from HPV.
How can I avoid HPV and the health problems it can cause?
You can do several things to lower your chances of getting HPV.
Get vaccinated. The HPV vaccine is safe and effective. It can protect against diseases (including cancers) caused by HPV when given in the recommended age groups. (See “Who should get vaccinated?” below) CDC recommends HPV vaccination at age 11 or 12 years (or can start at age 9 years) and for everyone through age 26 years, if not vaccinated already. For more information on the recommendations, please see: https://www.cdc.gov/vaccines/vpd/hpv/public/index.html
Get screened for cervical cancer. Routine screening for women aged 21 to 65 years old can prevent cervical cancer.
If you are sexually active
- Use latex condoms the right way every time you have sex. This can lower your chances of getting HPV. But HPV can infect areas not covered by a condom – so condoms may not fully protect against getting HPV;
- Be in a mutually monogamous relationship – or have sex only with someone who only has sex with you.
Who should get vaccinated?
HPV vaccination is recommended at age 11 or 12 years (or can start at age 9 years) and for everyone through age 26 years, if not vaccinated already.
Vaccination is not recommended for everyone older than age 26 years. However, some adults age 27 through 45 years who are not already vaccinated may decide to get the HPV vaccine after speaking with their healthcare provider about their risk for new HPV infections and the possible benefits of vaccination. HPV vaccination in this age range provides less benefit. Most sexually active adults have already been exposed to HPV, although not necessarily all of the HPV types targeted by vaccination.
At any age, having a new sex partner is a risk factor for getting a new HPV infection. People who are already in a long-term, mutually monogamous relationship are not likely to get a new HPV infection.
How do I know if I have HPV?
There is no test to find out a person’s “HPV status.” Also, there is no approved HPV test to find HPV in the mouth or throat.
There are HPV tests that can be used to screen for cervical cancer. These tests are only recommended for screening in women aged 30 years and older. HPV tests are not recommended to screen men, adolescents, or women under the age of 30 years.
Most people with HPV do not know they are infected and never develop symptoms or health problems from it. Some people find out they have HPV when they get genital warts. Women may find out they have HPV when they get an abnormal Pap test result (during cervical cancer screening). Others may only find out once they’ve developed more serious problems from HPV, such as cancers.
How common is HPV and the health problems caused by HPV?
HPV (the virus): CDC estimates that there were 43 million HPV infections in 2018. In that same year, there were 13 million new infections. HPV is so common that almost every person who is sexually-active will get HPV at some time in their life if they don’t get the HPV vaccine.
Health problems related to HPV include genital warts and cervical cancer.
Genital warts: Before HPV vaccines were introduced, roughly 340,000 to 360,000 women and men were affected by genital warts caused by HPV every year.* Also, about one in 100 sexually active adults in the U.S. has genital warts at any given time.
Cervical cancer: Every year, nearly 12,000 women living in the U.S. will be diagnosed with cervical cancer, and more than 4,000 women die from cervical cancer—even with screening and treatment.
There are other conditions and cancers caused by HPV that occur in people living in the United States. Every year, approximately 19,400 women and 12,100 men are affected by cancers caused by HPV.
*These figures only look at the number of people who sought care for genital warts. This could be an underestimate of the actual number of people who get genital warts.
I’m pregnant. Will having HPV affect my pregnancy?
If you are pregnant and have HPV, you can get genital warts or develop abnormal cell changes on your cervix. Abnormal cell changes can be found with routine cervical cancer screening. You should get routine cervical cancer screening even when you are pregnant.
Can I be treated for HPV or health problems caused by HPV?
There is no treatment for the virus itself. However, there are treatments for the health problems that HPV can cause:
- Genital warts can be treated by your healthcare provider or with prescription medication. If left untreated, genital warts may go away, stay the same, or grow in size or number.
- Cervical precancer can be treated. Women who get routine Pap tests and follow up as needed can identify problems before cancer develops. Prevention is always better than treatment. For more information visit www.cancer.orgexternal icon.
- Other HPV-related cancers are also more treatable when diagnosed and treated early. For more information visit www.cancer.orgexternal icon.
Where can I get more information?
Cervical Cancer Screening
CDC’s National Breast and Cervical Cancer Early Detection Program
STD information and referrals to STD Clinics
In English, en Español
CDC National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
E-mail: [email protected]
American Sexual Health Association (ASHA)external icon
P. O. Box 13827
Research Triangle Park, NC
E-mail: [email protected]
Human papillomavirus (HPV) and cervical cancer
What is HPV?
Human papillomavirus (HPV) is the most common viral infection of the reproductive tract. Most sexually active women and men will be infected at some point in their lives and some may be repeatedly infected.
The peak time for acquiring infection for both women and men is shortly after becoming sexually active. HPV is sexually transmitted, but penetrative sex is not required for transmission. Skin-to-skin genital contact is a well-recognized mode of transmission.
There are many types of HPV, and many do not cause problems. HPV infections usually clear up without any intervention within a few months after acquisition, and about 90% clear within 2 years. A small proportion of infections with certain types of HPV
can persist and progress to cervical cancer.
Cervical cancer is by far the most common HPV-related disease. Nearly all cases of cervical cancer can be attributable to HPV infection.
The infection with certain HPV types also causes a proportion of cancers of the anus, vulva, vagina, penis and oropharynx, which are preventable using similar primary prevention strategies as those for cervical cancer.
Non-cancer causing types of HPV (especially types 6 and 11) can cause genital warts and respiratory papillomatosis (a disease in which tumours grow in the air passages leading from the nose and mouth into the lungs). Although these conditions very rarely
result in death, they may cause significant occurrence of disease. Genital warts are very common, highly infectious and affect sexual life.
How HPV infection leads to cervical cancer
Although most HPV infections clear up on their own and most pre-cancerous lesions resolve spontaneously, there is a risk for all women that HPV infection may become chronic and pre-cancerous lesions progress to invasive cervical cancer.
It takes 15 to 20 years for cervical cancer to develop in women with normal immune systems. It can take only 5 to 10 years in women with weakened immune systems, such as those with untreated HIV infection.
Risk factors for HPV persistence and development of cervical cancer
- HPV type – its oncogenicity or cancer-causing strength;
- immune status – people who are immunocompromised, such as those living with HIV, are more likely to have persistent HPV infections and a more rapid progression to pre-cancer and cancer;
- coinfection with other sexually transmitted agents, such as those that cause herpes simplex, chlamydia and gonorrhoea;
- parity (number of babies born) and young age at first birth;
- tobacco smoking
Global burden of cervical cancer
Worldwide, cervical cancer is the fourth most frequent cancer in women with an estimated 570 000 new cases in 2018 representing 7.5% of all female cancer deaths. Of the estimated more than 311 000 deaths from cervical cancer every year, more than 85%
of these occur in low and middle income countries. Women living with HIV are six times more likely to get cervical cancer compared to women without HIV, and an estimated 5% of all cervical cancer cases are attributable to HIV (2).
In high income countries, programmes are in place which enable girls to be vaccinated against HPV and women to get screened regularly. Screening allows pre-cancerous lesions to be identified at stages when they can easily be treated.
In low and middle income countries, there is limited access to these preventative measures and cervical cancer is often not identified until it has further advanced and symptoms develop. In addition, access to treatment of such late-stage disease (for
example, cancer surgery, radiotherapy and chemotherapy) may be very limited, resulting in a higher rate of death from cervical cancer in these countries.
The high mortality rate from cervical cancer globally (Age Standardized Rate: 6.9/100,000 in 2018) could be reduced by effective interventions.
Cervical cancer control: A comprehensive approach
The Global strategy towards eliminating cervical cancer as a public health problem adopted by the WHA in 2020, recommends a comprehensive approach to cervical cancer prevention and control. The recommended set of actions includes interventions across
the life course.
The life-course approach to cervical cancer interventions
| Girls 9-14 years
||Women 30 years old or older
|| All women as needed
|Girls and boys, as appropriate
||Treatment of invasive cancer at any age
It should be multidisciplinary, including components from community education, social mobilization, vaccination, screening, treatment and palliative care.
Primary prevention begins with HPV vaccination of girls aged 9-14 years, before they become sexually active.
Women who are sexually active should be screened for abnormal cervical cells and pre-cancerous lesions, starting from 30 years of age in the general population of women. Screening for sexually active women living with HIV should start at an earlier age,
once they have tested positive for HIV.
If treatment of pre-cancer is needed to excise abnormal cells or lesions, cryotherapy or thermal ablation both destroy abnormal tissue on the cervix) is recommended and is performed in outpatient clinic.
If signs of cervical cancer are present, treatment options for invasive cancer include surgery, radiotherapy and chemotherapy and patients need to be referred to the right level of services.
There are currently 3 vaccines that have been prequalified, all protecting against both HPV 16 and 18, which are known to cause at least 70% of cervical cancers. The third vaccine protects against five additional oncogenic HPV types, which cause a further
20% of cervical cancers. Given that the vaccines which are only protecting against HPV 16 and 18 also have some cross-protection against these other less common HPV types which cause cervical cancer, WHO considers the three vaccines equally protective
against cervical cancer. Two of the vaccines also protect against HPV types 6 and 11, which cause anogenital warts.
Clinical trials and post-marketing surveillance have shown that HPV vaccines are very safe and very effective in preventing infections with HPV infections, high grade precancerous lesions and invasive cancer (3).
HPV vaccines work best if administered prior to exposure to HPV. Therefore, WHO recommends to vaccinate girls, aged between 9 and 14 years, when most have not started sexual activity. The vaccines cannot treat HPV infection or HPV-associated disease,
such as cancer.
Some countries have started to vaccinate boys as the vaccination prevents genital cancers in males as well as females, and two available vaccines also prevent genital warts in males and females.
WHO recommends vaccination for girls aged between 9 and 14 years, as this is the most cost- effective public health measure against cervical cancer
HPV vaccination does not replace cervical cancer screening. In countries where HPV vaccine is introduced, screening programmes may still need to be developed or strengthened.
Screening and treatment of pre-cancer lesions
Cervical cancer screening involves testing for pre-cancer and cancer, more and more testing for HPV infection is performed. Testing is done among women who have no symptoms and may feel perfectly healthy. When screening detects an HPV infection
or pre-cancerous lesions, these can easily be treated, and cancer can be avoided. Screening can also detect cancer at an early stage and treatment has a high potential for cure.
Because pre-cancerous lesions take many years to develop, screening is recommended for every woman from aged 30 and regularly afterwards (frequency depends on the screening test used). For women living with HIV who are sexually active, screening should
be done earlier, as soon as they know their HIV status.
Screening has to be linked to treatment and management of positive screening tests. Screening without proper management in place is not ethical.
There are 3 different types of screening tests that are currently recommended by WHO:
- HPV DNA testing for high-risk HPV types
- Visual inspection with Acetic Acid (VIA)
- conventional (Pap) test and liquid-based cytology (LBC)
For treatment of pre-cancer lesions, WHO recommends the use of cryotherapy or thermal ablation and Loop Electrosurgical Excision Procedure (LEEP) when available. For advanced lesions, women should be referred for further investigations and adequate management.
Management of invasive cervical cancer
When a woman presents symptoms of suspicion for cervical cancer, she must be referred to an appropriate facility for further evaluation, diagnosis and treatment.
Symptoms of early stage cervical cancer may include:
- Irregular blood spotting or light bleeding between periods in women of reproductive age;
- Postmenopausal spotting or bleeding;
- Bleeding after sexual intercourse; and
- Increased vaginal discharge, sometimes foul smelling.
As cervical cancer advances, more severe symptoms may appear including:
- Persistent back, leg and/or pelvic pain;
- Weight loss, fatigue, loss of appetite;
- Foul-smell discharge and vaginal discomfort; and
- Swelling of a leg or both lower extremities.
Other severe symptoms may arise at advanced stages depending on which organs cancer has spread.
Diagnosis of cervical cancer must be made by histopathologic examination. Staging is done based on tumor size and spread of the disease within the pelvis and to distant organs. Treatment depends on the stage of the disease and options include surgery,
radiotherapy and chemotherapy. Palliative care is also an essential element of cancer management to relieve unnecessary pain and suffering due the disease.
The World Health Assembly adopted the global strategy to accelerate the elimination of cervical cancer as a public health problem and its associated goals and targets for the period 2020–2030 (WHA 73.2) (4). The global strategy to
eliminate cervical cancer has set targets to accelerate the elimination:
- a threshold of 4 per 100,000 women-year for elimination as a public health problem
- 90–70–90 targets that need to be met by 2030 for countries to be on the path towards cervical cancer elimination
- 90% of girls fully vaccinated with the HPV vaccine by age 15.
- 70% of women are screened with a high-performance test by 35, and again by 45 years of age.
- 90% of women identified with cervical disease receive treatment (90% of women with pre-cancer treated; 90% of women with invasive cancer managed).
WHO has developed guidance and tools on how to prevent and control cervical cancer through vaccination, screening and management of invasive cancer and a knowledge repository will make them available through a single point. WHO works with countries and
partners to develop and implement comprehensive programmes in line w the global strategy.
(1) Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F (2018). Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Available from: https://gco.iarc.fr/today
(2) Stelzle D, Tanaka LF, Lee KK, et al. Estimates of the global burden of cervical cancer associated with HIV. Lancet Glob Health 2020; published online Nov 16. DOI:S2214-109X(20)30459-9
(3) Lei et al (2020) HPV Vaccination and the Risk of Invasive Cervical Cancer. N Engl J Med 2020;383:1340-8. DOI: 10.1056/NEJMoa1917338
(4) World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem https://www.who.int/publications/i/item/9789240014107
HPV: 5 Things All Women Should Know
Women Don’t Need to Feel Ashamed About HPV
“Anyone who’s ever had sex may have been exposed to HPV,” says Trimble, adding that she wishes she knew how to get rid of the unnecessary stigma associated with the disease.
“Raising awareness can give you choices, and knowing you have choices is empowering.”
Certain Types of HPV Are Linked with Cervical Disease
While more than 100 types of HPV exist, only about a dozen of them are associated with cervical disease. “Together, HPV 16 and HPV 18 account for 70 percent of all cervical disease,” says Trimble. Genital warts are a form of low-risk HPV, and they do not cause cancer.
Doctors monitor HPV with Pap tests that look for abnormal cervical cells called lesions. Low-grade lesions — where the changes are only mildly abnormal — often clear up on their own. These are not considered precancerous.
All cervical cancers arise from untreated, high-grade lesions, which do contain precancerous cells. If your immune system is healthy, it typically takes about 10 to 15 years for cervical cancer to develop from a high-grade lesion. But not all high-grade lesions become cancer — a person’s own immune system can eliminate them.
HPV Very Rarely Becomes Cervical Cancer
While HPV does cause cervical cancer, the risk of developing cervical cancer from the virus is still quite low.
For 90 percent of women with HPV, the condition will clear up on its own within two years. Only a small number of women who have one of the HPV strains that cause cervical cancer will ever actually develop the disease.
Cervical dysplasia, where cell changes occur in the cervix at the opening to the uterus, is a more common outcome from HPV infection.
“I have a huge group of patients with persistent HPV infection who have never had any reason to need treatment,” Trimble says. “So if you have HPV, you can put it on your nuisance list and take it off your worry list.”
HPV Causes Head and Neck Cancers Too
One of the biggest — but lesser-known — dangers of HPV involves the risk of head and neck cancer, with HPV spreading to the throat via oral sex.
“The rate of cancers in the back of the throat is skyrocketing,” Trimble says. “Experts are using the word epidemic to describe it. It’s on track to outpace cervical cancer.”
While women can get these cancers, most of the people who get it are heterosexual males. There is currently no way to screen for it, making it all the more important that parents get their children — including boys — vaccinated.
Vaccines Save Lives
Trimble thinks it’s sad that there’s so much controversy over the HPV vaccine, which has overwhelmingly been proven safe and can prevent devastating cancers linked with HPV. In fact, Trimble has dedicated her research to developing therapeutic vaccines capable of fighting HPV once someone has contracted the virus. (Preventive vaccines are given to healthy people to ward off infections; therapeutic vaccines are used to help people who already have a disease.) In a recent study using a therapeutic vaccine, she and her team were able to successfully treat half of patients who had high-grade lesions, and they’re working on raising that number.
“At least 20 percent of human cancers are caused by a specific infection,” says Trimble. “That implies it would be possible to prevent or treat disease by helping the immune system recognize infection. Once you’ve done that, you’ve won.”
Ultimately, Trimble says HPV is a wimpy infection, and she’s encouraged by the huge immune responses these therapeutic vaccines can trigger.
As she explained in a TED talk called “Kicking Cancer’s Butt,” Trimble says, “My goal is to cure cancer, and it’s beginning to look like that’s possible.”
HPV and Cancer – National Cancer Institute
What is HPV (human papillomavirus)?
HPV is a group of more than 200 related viruses, some of which are spread through vaginal, anal, or oral sex. Sexually transmitted HPV types fall into two groups, low risk and high risk.
- Low-risk HPVs mostly cause no disease. However, a few low-risk HPV types can cause warts on or around the genitals, anus, mouth, or throat.
- High-risk HPVs can cause several types of cancer. There are about 14 high-risk HPV types including HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. Two of these, HPV16 and HPV18, are responsible for most HPV-related cancers.
HPV infection is common: Nearly all sexually active people are infected with HPV within months to a few years of becoming sexually active. Around half of these infections are with a high-risk HPV type.
HPV can infect both males and females. Both men and women can become infected with HPV and develop HPV-caused cancers.
Most HPV infections don’t cause cancer: Your immune system usually controls HPV infections so they don’t cause cancer.
High-risk HPV infections that persist can cause cancer: Sometimes HPV infections are not successfully controlled by your immune system. When a high-risk HPV infection persists for many years, it can lead to cell changes that, if untreated, may get worse over time and become cancer.
HPV vaccination can prevent cancer: HPV vaccines can prevent infection with disease-causing HPV types, preventing many HPV-related cancers and cases of genital warts.
What Cancers Are Caused by HPV Infection?
Long-lasting infections with high-risk HPVs can cause cancer in parts of the body where HPV infects cells, such as in the cervix, oropharynx (the part of the throat at the back of the mouth, behind the oral cavity that also includes the back third of the tongue, the soft palate, the side and back walls of the throat, and the tonsils), anus, penis, vagina, and vulva.
HPV infects the squamous cells that line the inner surfaces of these organs. For this reason, most HPV-related cancers are a type of cancer called squamous cell carcinoma. Some cervical cancers come from HPV infection of gland cells in the cervix and are called adenocarcinomas.
HPV-related cancers include:
In the United States, high-risk HPVs cause 3% of all cancers in women and 2% of all cancers in men. Each year, there are about 45,000 new cases of cancer in parts of the body where HPV is often found, and HPV is estimated to cause about 36,000 of these, according to the Centers for Disease Control (CDC).
Worldwide, the burden of HPV-related cancers is much greater. High-risk HPVs cause about 5% of all cancers worldwide, with an estimated 570,000 women and 60,000 men getting an HPV-related cancer each year. Cervical cancer is among the most common cancers and a leading cause of cancer-related deaths in low- and middle-income countries, where screening tests and treatment of early cervical cell changes are not readily available.
How is HPV Transmitted?
HPV passes easily between sexual partners. It can be transmitted through any intimate skin-to-skin contact, including vaginal–penile sex, penile–anal sex, penile–oral sex, vaginal–oral sex, and use of sex toys or other objects. The infection passes easily between sexual partners. Condoms and dental dams can lower the chance of HPV transmission but do not prevent it completely.
Does HPV Infection Cause Symptoms?
Infection with high-risk HPV does not usually cause symptoms. The precancerous cell changes caused by a persistent HPV infection at the cervix rarely cause symptoms, which is why regular cervical cancer screening is important. Precancerous lesions at other sites in the body may cause symptoms like itching or bleeding. And if an HPV infection develops into cancer, the cancer may cause symptoms like bleeding, pain, or swollen glands. Learn more about signs and symptoms of cervical, vaginal, vulvar, penile, anal, and oropharyngeal cancers.
HPV Vaccination: Preventing HPV Infection
The HPV vaccine Gardasil 9® protects against infection from nine HPV types: the two low-risk HPV types that cause most genital warts, plus the seven high-risk HPV types that cause most HPV-related cancers.
HPV vaccination is recommended by the Centers for Disease Control and Prevention (CDC)’s Advisory Committee on Immunizations Practices (ACIP) to prevent new HPV infections and HPV-associated cancers and other diseases.
HPV vaccination provides strong protection against new HPV infections. Vaccination is prevention and does not cure an infection once you have it. The HPV vaccine is not used to treat HPV infections or diseases caused by HPV. HPV vaccination offers the most protection when given at ages 9-12. HPV vaccination is estimated to prevent up to 90% of HPV-related cancers.
Who should get the HPV vaccine?
The HPV vaccine series is recommended for girls and boys, at the age of 11 or 12, and the series can be started at age 9. It is important for males as well as females to get vaccinated, because both men and women can develop cancers of the mouth and throat, anal cancers, and genital warts. Women are also at risk for cervical cancer, and men for penile cancer. Vaccination can also reduce the spread of HPV that causes cancer to other people.
Children who start the vaccine series before age 15 need two doses to be protected. For young people who weren’t vaccinated within the age recommendations, HPV vaccination is recommended up to age 26. Those who receive their first dose at age 15 or older need three doses to be protected.
Can the HPV vaccine be given at older ages?
Yes, the vaccine can be given to adults between the ages of 27 and 45 who didn’t receive all vaccine doses earlier. Adults in this age group benefit less from the vaccine because they are more likely to have been exposed to HPV already. Therefore vaccination is not routinely recommended for people in this age group. If you are concerned that you are at risk for a new HPV infection, talk with your health care provider about whether HPV vaccination may be right for you.
Learn more about the human papillomavirus (HPV) vaccine.
Screening for HPV and Cell Changes Caused by HPV
Screening tests are used to check for disease when there are no symptoms. The goal of screening for cervical cancer is to find precancerous cell changes at an early stage, before they become cancer and when treatment can prevent cancer from developing.
Currently, cervical cancer is the only HPV-caused cancer for which FDA-approved screening tests are available. Screening for cervical cancer is an important part of routine health care for people who have a cervix. This includes women and transgender men who still have a cervix. Cervical cancer screening tests include the HPV test that checks cervical cells for high-risk HPV, the Pap test that checks for cervical cell changes that can be caused by high-risk HPV, and the HPV/Pap cotest that checks for both high-risk HPV and cervical cell changes.
Learn more about HPV and Pap testing and find out about next steps after an abnormal Pap test or positive HPV test.
Sometimes an HPV infection can become active again after many years. Learn more about what it means if a woman has a positive HPV test after many years of negative tests.
Screening for Other HPV-Related Cancers
There are no Food and Drug Administration (FDA) approved tests to detect HPV infections or HPV-caused cell changes in anal, vulvar, vaginal, penile, or oropharyngeal tissues. Research studies are ongoing to identify tests that can detect precancers in these areas or find cancer in an earlier, more treatable stage.
Anal cancer screening: Among populations that are at higher risk for HPV infection, such as men who have sex with men or men who are HIV positive, some research has found that an anal Pap test (also called an anal Pap smear) may help to detect early cell changes or precancerous cells. Research is ongoing to see if treating anal precancer prevents anal cancer.
Learn more about Anal Cancer Prevention (PDQ®).
Oral cancer screening: Currently, there are no standard screening tests for oral cancer. The United States Preventive Services Task Force (USPSTF) has found that the current evidence is insufficient to assess the balance of benefits and harms of screening for oral cancer in asymptomatic adults. However, the American Dental Association (ADA) recommends dentists check for signs of oral and oropharyngeal cancer as part of a routine dental check-up in all patients.
Learn more about Oral Cavity, Pharyngeal, and Laryngeal Cancer Screening (PDQ®) and about symptoms in Oropharyngeal Cancer Treatment (Adult) (PDQ®).
Treatment for Cell Changes Caused by HPV Infection
Although HPV infection itself cannot be treated, there are treatments for the precancerous cell changes caused by infection with high-risk HPV.
Precancerous cervical cell changes: Most women who have precancerous cervical cell changes are treated with the loop electrosurgical excision procedure (LEEP), which is a method to remove the abnormal tissue.
Learn more about treatments for abnormal cervical cell changes.
Precancerous vaginal, vulvar, penile, and anal lesions and genital warts: Treatment methods include topical medicines, surgical excision, cryosurgery, and laser therapy.
HPV-related cancers: Individuals who develop an HPV-related cancer generally receive the same treatment as patients with tumors at the same site that are not related to HPV infection. However, patients with HPV-positive oropharyngeal cancer may receive different treatments than patients whose oropharyngeal cancers are not caused by HPV.
Learn more about treatment options for oropharyngeal cancer, including targeted therapy and new types of treatment such as immunotherapy being tested in clinical trials.
How Does HPV Cause Cancer?
HPV infection causes cells to undergo changes. If not treated these cells can, over time, become cancer cells.
Credit: National Cancer Institute
Once high-risk HPV infects cells, it interferes with the ways in which these cells communicate with one another, causing infected cells to multiply in an uncontrolled manner. These infected cells are usually recognized and controlled by the immune system. However, sometimes the infected cells remain and continue to grow, eventually forming an area of precancerous cells that, if not treated, can become cancer. Research has found that it can take 10 to 20 years, or even longer, for HPV-infected cervical cells to develop into a cancerous tumor.
Among women whose cervical cells are infected with high-risk HPV, several factors increase the chance that the infection will be long lasting and lead to precancerous cervical cells. These include:
- Having a very aggressive HPV type, particularly HPV 16 or HPV 18. If you have either of these HPV types, make sure you receive diagnostic testing with a colposcopy.
- Smoking cigarettes. Quitting smoking can help your body to fight HPV.
- Having a weakened immune system. If you have HIV or are taking medicines that suppress your immune system, talk to your health care provider about diagnostic testing and follow-up.
NCI and HPV-Related Research
Clinical trials are an important step in learning about better ways to prevent, diagnose, and treat diseases, such as cancers caused by HPV. NCI’s Cancer Information Service can help you learn about HPV-related trials in the United States.
The National Cancer Institute is conducting and funding research to learn more about HPV:
- The Division of Cancer Epidemiology and Genetics (DCEG) conducts research into cervical and other HPV-related cancers to advance our understanding of how HPV causes cancer, evaluates screening practices to determine the most effective methods to detect precancerous changes early, develops and tests new approaches to screening that may be easier to use in low-resource settings, and refines tools for risk assessment in the clinic to help health care providers follow up on abnormal screening test results. Investigators in DCEG conducted the first population-based clinical trial of HPV vaccines.
- The Division of Cancer Prevention (DCP) conducts and fosters the development of research on the prevention and early detection of human papillomavirus (HPV)-related cancers and related conditions.
- The Division of Cancer Control and Population Sciences (DCCPS) supports research-tested intervention programs related to HPV and the investigation of implementation strategies to promote the HPV vaccine in regions with low HPV vaccine rates.
- The Center for Cancer Research (CCR) is home to scientists and clinicians who are exploring the cutting-edge of cancer-related research. CCR scientists work on a wide spectrum of biological and biomedical problems, including HPV. Investigators in CCR conducted the research that led to the initial development and characterization of the human papillomavirus (HPV) vaccines.
Causes, Testing, Treatment & Prevention
Female pelvic anatomy
What is human papillpoma virus (HPV)?
HPV stands for human papilloma virus. It is a very common virus. There are about 100 types of HPV that affect different parts of the body. About 30 types of HPV can affect the genitals — including the vulva, vagina, cervix, penis and scrotum — as well as the rectum and anus. Of those, about 14 types are considered “high risk,” for leading to cervical cancer.
Male pelvic anatomy
How common is HPV?
HPV that affects the genitals is very common. Approximately 79 million Americans are currently infected with HPV, with roughly 14 million people becoming newly infected each year. Most men and women — about 80 percent of sexually active people — are infected with HPV at some point in their lives, but most people never know they have the virus.
Can men get HPV?
Yes. In men, genital warts most often appear on the penis, on the scrotum, in or around the anus, or on the groin. For men, HPV infection — including those that can cause cellular changes — cause no symptoms, so diagnosing HPV in men is difficult. The diagnosis of HPV in men is made when external genital warts are seen.
Since there is no treatment for HPV that has no symptoms, most men with the infection are not treated. Sometimes, a healthcare provider can see small warts that might have otherwise gone unnoticed. In general, HPV infection does not place a man at a much higher risk for health problems. However, HPV prevention is still important for men, as the virus has been linked to uncommon cancers such as penile, anal, and head and neck.
How is HPV related to cervical cancer?
Certain strains of HPV can cause changes in the cells of the cervix, a condition called cervical dysplasia. If it is not treated, dysplasia can advance to cervical cancer. HPV is almost always the cause of cervical cancer. However, just because a woman has HPV or cervical dysplasia does not necessarily mean she will get cervical cancer.
Regular Pap tests are the best protection against cervical cancer. The test detects pre-cancerous changes and cervical cancer. Cervical cancer is almost always preventable or cured if pre-cancerous changes are detected and treated early, before cancer develops.
Before age 30, HPV infection is usually transient (gets better on its own). By age 30, finding HPV during Pap screening can help determine how often to be screened. The absence of high-risk HPV types usually means that a woman is at low risk for developing cervical changes related to the risk of cervical cancer. In this case, the period between Pap test screenings is usually five years for most women.
If a woman tests positive for high-risk HPV types, her healthcare provider will perform more frequent Pap tests to check for any cell changes that might be pre-cancerous or that need to be treated .
What is cervical cancer?
Cervical cancer is a condition in which the cells in the lining of the cervix — the narrow, outer end of the uterus — change and grow very fast, producing a grouping of cells called a tumor. This condition usually develops over time. It can affect women of any age, but it is most common in women in their mid-40s. A type of virus, called HPV, is the cause of most cases of cervical cancer.
Symptoms and Causes
How do you get human papilloma virus (HPV)?
Genital HPV is spread through contact with (touching) the skin of someone who has an HPV infection. Contact includes vaginal, anal, and oral sex. Some types of HPV cause genital warts, which are hard, rough lumps that grow on the skin. Anyone who is sexually active can get HPV and genital warts.
In women, genital warts most often appear in the following areas of the body:
- On the vulva (the outer female genital area)
- In or around the vagina
- In or around the anus
- On the groin (where the genital area meets the inner thigh)
- On the cervix
What are the symptoms of HPV?
In many cases, HPV causes no symptoms. When they do occur, the most common symptom is warts in the genital area. Signs of infection can appear weeks, months, or even years after the person has been infected with the virus.
Diagnosis and Tests
How is human papilloma virus (HPV) diagnosed?
There are no blood tests for HPV, but some tests can help your healthcare provider diagnose the infection:
- Pap test: During this test, the healthcare provider removes a sample of cells from the cervix. The cells are then examined under a microscope to look for any changes in the cells, even if the patient does not have genital warts.
- Colposcopy: For this test, a healthcare provider uses an instrument — called a colposcope — that shines a light and enlarges the view of the cervix. A vinegar solution is placed on the cervix. The solution turns abnormal cells that are infected with HPV white, so they can be seen more easily.
- HPV DNA test: This test looks directly for the genetic material (DNA) of the HPV within a sample of cells. The test can detect the type of HPV connected to cervical cancer. The sample used for this test is generally collected at the same time as a Pap test.
Management and Treatment
How is human papilloma virus (HPV) treated?
There is no cure for the virus itself, but many HPV infections go away on their own. In fact, about 70 to 90 percent of cases of HPV infection are cleared from the body by the immune system.
When treatment is needed, the goal is to relieve symptoms by removing any visible warts and abnormal cells in the cervix. Treatments might include:
- Cryosurgery: Freezing the warts off with liquid nitrogen.
- Loop electrosurgical excision procedure (LEEP): Using a special wire loop to remove the abnormal cells.
- Electrocautery: Burning the warts off with an electrical current.
- Laser therapy: Using an intense light to destroy the warts and any abnormal cells.
- Prescription cream: Applying medicated cream directly to the warts. (Do not use over-the-counter wart treatments on the genital area.)
In some cases, no treatment is needed. However, your doctor will closely watch any cell changes during your regular screening appointments.
Only a small number of women infected with HPV will develop cellular changes that need to be treated.
Can human papilloma virus (HPV) be prevented?
Using condoms correctly every time you have sex can help reduce the risk of HPV. You should be aware, however, that condoms do not cover all of the genital skin, so they are not 100 percent effective in protecting against the spread of HPV. A person with genital warts should not have sex until the warts are removed. This might help reduce the risk of spreading HPV.
Here are some other ways of reducing the risk of HPV:
- Women should have regular Pap tests to look for abnormal changes in the cervix that might be pre-cancer.
- Men and women should stop having sexual contact as soon as they know or think they have genital warts, and they should seek treatment immediately.
- Get vaccinated with one of the three available HPV vaccines. Gardasil® and Gardasil9® protect against the development of cervical cancer and genital warts. They are approved for girls and women ages 9 to 26, as well as for boys and men ages 9 to 26 to protect against genital warts. The third vaccine, called Cervarix®, is approved for women only to protect against cervical cancer (does not protect against several of the HPV strains that cause warts).
It is best to get the vaccine before the start of sexual activity. The vaccine consists of a series of three shots, with the second shot coming two months after the first, and the third coming six months after the first. If you already have HPV, the vaccine does not treat or cure, but can still help protect against other types of HPV infections.
Glossary of terms
- Cervical dysplasia: A pre-cancerous condition that occurs when the human papilloma virus (HPV) leads to changes in the cells of the cervix
- Cervix: The tip of the uterus, where the vagina meets the uterus
- Genital warts: Hard, rough lumps that develop on the skin
- Groin: Where the genital area meets the inner thigh
- Vulva: The outer female genital area
What You Need to know about HPV
New guidelines, issued in February by the Centers for Disease Control and Prevention, urge vaccination against the human papilloma virus for all boys aged 11-12. Vaccination for girls aged 11-12 has been recommended since 2006. We offer this review of the facts about HPV to help parents make an informed decision for their children.
Genital human papillomavirus (HPV) is currently the most common sexually transmitted infection in the United States. Approximately 20 million Americans are already infected with HPV and each year another 6 million become newly infected. It’s estimated that at least 50 percent of sexually active men and women will get HPV at some point in their lives.
HPV used to be thought of simply as the cause of common skin and genital-area warts. In the late 1970s, however, studies began linking HPV infection to cervical cancer. These studies, which earned their author the Nobel Prize in Medicine, led to further research into the potential dangers of HPV infection. We now know that HPV is responsible for many of the cancers affecting the sexual organs and for oropharyngeal cancers, that is, cancer at the back of the throat, base of the tongue, or of the tonsils.
Signs and Symptoms
Since most people with HPV do not experience noticeable symptoms or health problems, they are unaware that they have the infection, and unaware that they are transmitting it. In 90 percent of cases, the virus will be naturally cleared by the body’s immune system within about two years. However, when the HPV infection lingers, symptoms and health risks can develop.
Genital warts are the most noticeable symptom, and can appear within weeks or months of contact with an infected partner, even if he or she showed no signs. These warts are caused by a “low-risk” type of HPV, one that does not develop into cancer. Without treatment, some genital warts will go away, some will remain unchanged, while others will grow in size and number. It is not possible to predict the development of individual cases, and the longer genital warts go untreated, the more likely they are to return.
Almost all cases of cervical cancer are caused by HPV. More than 50 percent of vulvar or vaginal cancer, and 95 percent of anal cancers are linked to HPV. A study published this January reveals that HPV is responsible for more oropharyngeal cancers than is tobacco use and estimates that”by 2020, there will be more HPV-positive oral cancers among men than cervical cancers among women in the US.”
Why Vaccinate ?
There is currently no cure for HPV, just treatment for symptoms. The FDA has approved two HPV vaccines, Gardasil and Cervarix, both highly effective in preventing persistent infection with the “high-risk” HPV types that cause 70 percent of cervical cancers and also effective with HPV-linked cancers at other sites. Gardasil, the only vaccine available to men, is also effective against the HPV types that cause nearly all (90 percent) of genital warts.
To be fully effective, the HPV vaccine must be given before any HPV infection. That’s why public health experts recommend it be given in the pre-teen years of 11 or 12.
The Dangers of Untreated HPV: Asia Mohsin, MD: OBGYN
Did you know that almost 80 million Americans have the human papillomavirus (HPV), and 6 million more contract it each year? These numbers make HPV the most common sexually transmitted disease in America.
Multiple types of HPV exist, and not all of them have symptoms. In fact, many people with HPV don’t know they have it and let it go untreated. This leads to the virus spreading to more people who may also go untreated.
At Progressive Women’s Health in Friendswood, Texas, Asia Mohsin, MD, and our entire team are dedicated to giving patients the best in comprehensive clinical care in a welcoming environment. Our compassionate team respects your privacy and offers confidential STD screenings to ensure your optimal health and treatment.
What is HPV?
The human papillomavirus, or HPV, is a group of 150 related viruses. The different strains have different symptoms, and some have no symptoms at all. Some of the viruses can cause genital warts, some can cause cancer, but all are transmitted sexually.
Fortunately, there’s now a vaccine available for the cancer-causing strains of HPV. This vaccine is recommended for people under age 26, and Dr. Mohsin is able to administer it at your appointment.
How does HPV spread?
The human papillomavirus spreads through skin-to-skin contact. The most common way it’s transmitted is through vaginal, anal, or oral intercourse. Other than abstaining, there is no way to completely eliminate getting or transmitting the virus. You can, however, minimize your risk by using condoms and other barriers during sexual contact.
Factors that lead to an increased risk of contracting or spreading HPV include:
- Skipping regular OB/GYN appointments
- Lacking access to health insurance or education
- Being asymptomatic and not knowing you need treatment
- Having multiple sexual partners
- Not using a barrier method when having sexual intercourse
It’s possible to have more than one type of HPV and still be symptom-free. Sometimes symptoms won’t appear for years after you’ve been infected, meaning you could spread the disease to multiple people without knowing it.
What are the dangers of untreated HPV?
Fortunately, most strains of HPV aren’t deadly. In many cases, HPV resolves on its own without any treatment. However, some types of HPV can cause a number of health conditions, such as genital warts and cancer.
Genital warts can be removed by a doctor. Cancer is the most serious threat posed by untreated HPV. Without treatment, HPV can lead to anal, vaginal, penile, and throat cancer.
It’s important that you maintain regular OB/GYN exams with Dr. Mohsin. During your regular visit, Dr. Mohsin will check for signs of cancer and will run any necessary lab work. This can ensure an early diagnosis of cancer, which can improve your chances of successful treatment.
At Progressive Women’s Health, your health is our top priority. To learn more about HPV screenings and treatment, book an appointment online or over the phone today.
90,000 Human papillomavirus (HPV) and cervical cancer
What is HPV?
Human papillomavirus (HPV) is the most common viral infection of the genital tract. Most sexually active women and men acquire the infection at some point in their lives, and some may be reinfected.
The peak infection period for both women and men begins shortly after they become sexually active. HPV is sexually transmitted, but penetrative sex is not required to transmit the virus.Bodily genital contact is a well established route of transmission.
Many types of HPV do not cause problems. HPV infections usually go away on their own, without any intervention, a few months after infection, and about 90% go away within 2 years. A small proportion of infections with certain types of HPV can persist and lead to the development of cervical cancer.
Cervical cancer is by far the most common HPV-related disease.Almost all cases of cervical cancer can be attributed to HPV infections.
Infection with some types of HPV can also lead to cancers of the anus, vulva, vagina, penis and oropharynx, which can be prevented using the same primary prevention strategies as for cervical cancer.
HPV types that do not cause cancer (especially types 6 and 11) can lead to genital warts and respiratory papillomatosis (a disease in which tumors grow in the airways leading from the nose and mouth to the lungs).Although these conditions very rarely lead to death, they can often lead to illness. Genital warts are widespread, highly infectious, and have a negative impact on sex.
How does HPV infection lead to cervical cancer?
Although most HPV infections and precancerous lesions go away on their own, there is a risk for all women that HPV infection can become chronic and precancerous lesions develop into invasive cervical cancer.
Women with normal immune systems develop cervical cancer within 15–20 years. In women with weakened immune systems, such as those with HIV infection if untreated, it may take as little as 5-10 years to develop.
Risk factors for the persistence of HPV and the development of cervical cancer
- HPV type – its carcinogenicity, or the ability to cause cancer;
- immune status – people with weakened immune systems, such as people with HIV infection, are more likely to have persistent HPV infections that develop more rapidly into precancer and cancer;
- co-infection with other sexually transmitted pathogens such as herpes simplex, chlamydia and gonorrhea pathogens; 90,033 90,032 number of births (number of children born) and early first births;
- tobacco use.
Global burden of cervical cancer
Cervical cancer is the fourth most common cancer among women globally, with an estimated 570,000 new cases in 2018, accounting for 7.5 % of all female deaths from cancer. It is estimated that more than 85% of the more than 311,000 annual deaths from cervical cancer occur in low- and middle-income countries. Women with HIV are six times more likely to develop cervical cancer than women who are not HIV infected, and an estimated 5% of all cervical cancer cases are HIV-related (2) .
High-income countries have programs that provide opportunities for girls to get the HPV vaccine and women for regular screening. Screening detects precancerous lesions at stages where they can be easily treated.
In low- and middle-income countries, access to such preventive measures is limited, and cervical cancer is often only diagnosed late, when symptoms develop. In addition, access to treatment for the disease at such advanced stages (eg, surgery, radiation therapy and chemotherapy) can be very limited, resulting in high mortality rates from cervical cancer in these countries.
High global mortality from cervical cancer (age-standardized rate: 6.9 / 100,000 in 2018) can be reduced through effective interventions.
Tackling cervical cancer: an integrated approach
The WHA’s Global Strategy to Accelerate Elimination of Cervical Cancer as a Public Health Issue in 2020 recommends a comprehensive approach to the prevention and control of cervical cancer. The recommended set of measures includes activities covering the entire life cycle.
|Primary prevention||Secondary prevention||Tertiary prevention|
| Girls 9-14 years
||All women as needed|
| Girls and boys as appropriate
|| Treatment of invasive cancer at any age