HPV

What is HPV?

HPV stands for human papillomavirus. It is not a single virus but a large group of related viruses, with more than 100 known types. Some types infect the skin and cause common warts on the hands or feet. Others infect the moist skin and lining of the genital area, anus, mouth, and throat. HPV is the most common sexually transmitted infection worldwide, and most sexually active people will come into contact with at least one type at some point in their lives.

Doctors usually divide the types that affect the genital area into two broad groups. Low-risk types, such as HPV 6 and HPV 11, can cause genital warts but are not linked to cancer. High-risk types, most notably HPV 16 and HPV 18, usually cause no visible signs but can, over many years, lead to abnormal cell changes that may develop into cancer. Cancers linked to persistent high-risk HPV include cancers of the cervix (the lower part of the womb), anus, vagina, vulva, penis, and the back of the throat (oropharynx).

It is important to understand that having HPV does not mean a person will develop cancer. In most people, the immune system clears the infection on its own within one to two years without causing any lasting harm. Problems arise mainly when a high-risk infection persists for a long time. HPV affects people of all genders and ages, although new infections are most common in adolescents and young adults soon after they become sexually active.

HPV symptoms

One of the challenges with HPV is that most infections cause no symptoms at all. Many people never know they were infected, and the virus is cleared before it causes any change that a doctor could see. When HPV symptoms do appear, they depend on the type of virus involved and where it is in the body.

Common signs and symptoms of HPV may include:

• Genital warts: small, flesh-colored, pink, or grayish growths on or around the genitals or anus, which may be flat, raised, single, or clustered in a cauliflower-like shape
• Itching, discomfort, or mild bleeding in the area of a wart
• Common warts: rough, raised bumps, usually on the hands or fingers
• Plantar warts: hard, sometimes painful growths on the soles of the feet
• Flat warts: slightly raised, smooth lesions, often on the face or legs
• Abnormal cervical screening results, which are a sign of cell changes rather than a symptom the person can feel

Genital warts caused by low-risk HPV may appear weeks or months after exposure, and sometimes much later. They are usually painless, although some people notice itching or irritation. Warts may go away on their own, stay the same, or increase in number.

High-risk HPV types typically produce no symptoms in the early stages. The cell changes they cause on the cervix, for example, cannot be seen or felt and are only found through screening. If persistent infection eventually leads to cancer, symptoms depend on the site. Cervical cancer may cause bleeding between periods or after sex, unusual vaginal discharge, or pelvic pain. Anal cancer may cause bleeding, pain, or a lump near the anus. Throat cancers linked to HPV may cause a persistent sore throat, a lump in the neck, hoarseness, or difficulty swallowing. These symptoms have many possible causes, and having them does not mean a person has cancer, but they should always be checked.

Causes and risk factors

The direct cause of HPV infection is contact with the virus. Genital HPV spreads mainly through skin-to-skin contact during vaginal, anal, or oral sex with someone who has the virus, even if that person has no visible warts or symptoms. Penetration is not required; close genital contact can be enough. Common skin warts spread through direct contact with a wart or with surfaces such as shower floors. Very rarely, HPV can pass from a mother to a baby during birth.

Because HPV is so common and often silent, it can be impossible to know when or from whom an infection was acquired. A person may have carried the virus for many years before it is detected, so a new HPV diagnosis in a long-term relationship does not necessarily indicate recent infection.

Factors that may increase the risk of acquiring HPV or of the infection persisting include:

• Having a higher number of sexual partners, or a partner who has had many partners
• Becoming sexually active at a young age
• Having a weakened immune system, for example because of HIV infection or medicines that suppress immunity after an organ transplant
• Smoking, which is associated with a higher chance of persistent infection and progression of cervical cell changes
• Damaged skin, which makes it easier for skin warts to take hold
• Not having received the HPV vaccine
• Missing regular cervical screening, which does not cause infection but means changes may go unnoticed

HPV diagnosis

How HPV is diagnosed depends on the type of infection and the part of the body involved. There is no single blood test that is routinely used to detect HPV.

Visual examination. Genital warts and skin warts are usually diagnosed by a doctor or nurse simply by looking at them. Occasionally a doctor may apply a dilute vinegar solution, which can turn flat lesions white and make them easier to see, or take a small tissue sample (a biopsy) if the appearance is unusual.

Cervical screening. For people with a cervix, high-risk HPV is most often found through routine screening. Two main tests are used, sometimes together. The HPV test checks a sample of cervical cells for the genetic material of high-risk HPV types. The Pap test (also called a Pap smear or cervical cytology) looks at the same kind of sample under a microscope for abnormal cells. Some programs use the HPV test alone, some use the Pap test alone, and some use both, which is called co-testing. Your doctor will follow the screening schedule recommended where you live.

Colposcopy. If a screening result is abnormal, the next step is often a colposcopy. This is an examination of the cervix with a magnifying instrument. The doctor may apply solutions that highlight abnormal areas and take small biopsies for laboratory analysis. The laboratory report describes any precancerous change, often graded as low-grade or high-grade, which helps guide treatment.

Other sites. There is currently no approved routine HPV test for the penis, mouth, or throat, and anal screening is generally offered only to people at higher risk. Suspected HPV-related cancers at these sites are diagnosed by examination, biopsy, and imaging such as CT or MRI scans when needed. At Acibadem, cervical screening and follow-up of abnormal results are managed by the Gynecology & Obstetrics department.

HPV treatment options

There is no medicine that removes the HPV virus itself from the body. Instead, HPV treatment focuses on the problems the virus causes: warts, precancerous cell changes, and, if they develop, cancers. In many cases the immune system clears the infection without any treatment.

Observation. For a positive high-risk HPV test with normal or only mildly abnormal cells, doctors often recommend watchful waiting with repeat testing after a set interval, commonly around one year. Many of these infections and minor changes resolve on their own. Small genital warts may also be left untreated if they are not bothersome, since they may disappear over time.

Medicines for warts. Several prescription creams and solutions can be applied to genital warts, either by the patient at home or by a healthcare provider in clinic. These include imiquimod, which stimulates the local immune response; podofilox, which destroys wart tissue; sinecatechins, a green-tea extract ointment; and trichloroacetic acid, a chemical applied by a clinician. Over-the-counter wart removers designed for hands and feet should not be used on the genital area. Treatment often takes several weeks, and warts may return, requiring further courses.

Procedures for warts. Warts may also be removed by freezing them with liquid nitrogen (cryotherapy), burning them with an electric current (electrocautery), destroying them with a laser, or cutting them out with a small surgical excision. The choice depends on the size, number, and location of the warts and on patient preference. Removing warts reduces symptoms but does not guarantee the virus is gone, and it does not fully eliminate the chance of passing HPV to a partner.

Treatment of precancerous cervical changes. If a biopsy shows high-grade changes, the abnormal tissue is usually removed or destroyed to prevent progression to cancer. Common procedures include the loop electrosurgical excision procedure (LEEP), in which a thin heated wire loop removes the affected area; cone biopsy, which removes a cone-shaped piece of the cervix; cryotherapy; and laser ablation. These are usually outpatient procedures. Follow-up testing afterwards is important because changes can recur.

Treatment of HPV-related cancers. If cancer develops, treatment follows the standard approach for that cancer type and stage and may involve surgery, radiation therapy, chemotherapy, or a combination. A team of specialists plans this care individually.

Vaccination. The HPV vaccine is a preventive measure rather than a treatment. It does not clear an existing infection but protects against types the person has not yet acquired. Your doctor may still discuss vaccination even after an HPV diagnosis, depending on your age and circumstances.

Living with HPV and outlook

For most people, the outlook after an HPV infection is reassuring. The great majority of infections, including those with high-risk types, are cleared by the immune system within a couple of years and never cause disease. Genital warts can be a source of distress, but they are not dangerous and can usually be managed, even though they may come back.

When a high-risk infection persists, it usually takes many years, often a decade or more, for cell changes to progress to cancer. This slow timeline is why regular screening is so effective: precancerous changes can be found and treated long before cancer develops. People who attend screening as recommended and follow up on abnormal results have a good chance of avoiding cervical cancer, although no screening program can prevent every case.

An HPV diagnosis can raise emotional questions about relationships and trust. It may help to remember that HPV is extremely common, can remain hidden for years, and does not indicate infidelity. Talking openly with a partner and with your healthcare provider can reduce anxiety. Using condoms lowers, but does not eliminate, the chance of transmission, because the virus can infect skin that a condom does not cover.

Stopping smoking, maintaining overall health, and keeping up with screening appointments are practical steps that may support the body’s ability to clear the infection and reduce the chance of complications. If you have a weakened immune system, your doctor may recommend more frequent monitoring.

Frequently asked questions

What are the first symptoms of HPV?

Most people with HPV have no symptoms at all, and the infection is often discovered only through cervical screening or not at all. When symptoms occur, the most recognizable early sign is genital warts, which are small growths on or around the genitals or anus. High-risk types generally cause no noticeable symptoms until cell changes are advanced, which is why screening matters.

What causes HPV, and can you get it without having sex?

Genital HPV is caused by skin-to-skin contact with an infected person, usually during sexual activity, including oral sex and genital touching without penetration. Non-genital warts on the hands and feet are caused by other HPV types and spread through direct contact with warts or contaminated surfaces. Transmission without any sexual contact is possible but far less common for genital types.

How is HPV diagnosed in men?

There is currently no approved routine HPV test for men. Genital warts in men are diagnosed by visual examination. Men at higher risk of anal cancer, such as those living with HIV, may be offered anal screening in some settings. A man may find out he is exposed to HPV only if a partner tests positive or if warts appear.

Is there a cure or treatment for HPV itself?

No medicine currently eliminates the HPV virus from the body. However, most infections clear on their own with time. Treatment is available for the conditions HPV causes, including warts and precancerous changes, and these treatments are often effective, although warts may recur. Vaccination can prevent infection with the types most likely to cause cancer and warts.

Does a positive HPV test mean I have cancer?

No. A positive high-risk HPV test means the virus is present, not that cancer is present. Most positive results do not lead to cancer. Your doctor may recommend repeat testing after an interval or a colposcopy to look more closely at the cervix. Cancer usually develops only after many years of persistent infection, and screening is designed to detect changes well before that stage.

Can HPV come back after treatment?

Yes. Treatment removes warts or abnormal cells but does not necessarily remove all traces of the virus, so warts or cell changes can recur. This is why follow-up appointments and repeat testing are recommended after treatment. In many cases the immune system eventually controls the infection, and recurrences become less likely over time.

Who should get the HPV vaccine?

Health authorities generally recommend routine vaccination for girls and boys around the ages of 11 to 12, and it can be given starting at age 9. Catch-up vaccination is recommended for people up to age 26 who were not vaccinated earlier. Some adults between 27 and 45 may benefit after discussing their individual situation with a doctor, since the vaccine is most effective before exposure.

When to see a doctor

Routine cervical screening is recommended for people with a cervix according to the schedule in your country, even if you feel well and have been vaccinated. Beyond routine care, you should arrange to see a doctor if you notice new growths or warts in the genital or anal area, if you receive an abnormal screening or HPV test result, or if a sexual partner has been diagnosed with HPV-related disease and you have questions about your own care.

Seek prompt medical evaluation if you experience any of the following warning signs:

• Vaginal bleeding between periods, after sex, or after menopause
• Unusual or persistent vaginal discharge, especially if bloody or foul-smelling
• Persistent pelvic pain or pain during sex
• Bleeding from the anus, a lump near the anus, or ongoing anal pain
• A sore throat, hoarseness, or difficulty swallowing that lasts more than a few weeks
• A lump in the neck that does not go away
• A sore, growth, or color change on the penis that does not heal
• Warts that bleed heavily, grow rapidly, or change in appearance

These symptoms can have many causes other than HPV or cancer, but they should not be ignored. A doctor can examine you, arrange any necessary tests, and explain the next steps based on your individual situation.