What is HPV?

HPV is the most common STD and at least 50% of sexually active people will get it at some time in their lives.

The body usually clears HPV on its own without causing any problems, but HPV can lead to certain kinds of cancer.

HPV is a different virus than HIV and HSV (herpes). 79 million Americans, most in their late teens and early 20s, are infected with HPV.

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.

Symptom Overview

There are more than 100 different types of HPV. Most of the time there are no symptoms and the virus clears on its own, but several types can cause genital warts or lead to vaginal, anal, throat and cervical cancer.

The types of HPV that cause warts do not cause cancer, but they can indicate a higher risk for having the types of HPV that are linked to cancer. The types of HPV that can cause cancer do not show any signs.

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.

How do men get HPV?

You can get HPV by having sex with someone who is infected with HPV. This disease is spread easily during anal or vaginal sex, and it can also be spread through oral sex or another close skin-to-skin touching during sex. HPV can be spread even when an infected person has no visible signs or symptoms.

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.

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?

All boys and girls ages 11 or 12 years should get vaccinated.

Catch-up vaccines are recommended for boys and men through age 21 and for girls and women through age 26 if they did not get vaccinated when they were younger.

The HPV vaccine is also recommended for the following people if they did not get vaccinated when they were younger:

  • young men who have sex with men, including young men who identify as gay or bisexual or who intend to have sex with men through age 26;
  • young adults who are transgender through age 26; and
  • young adults with certain immunocompromising conditions (including HIV) through age 26.

What does having HPV mean for me or my sex partner’s health?

See a healthcare provider if you have questions about anything new or unusual (such as warts, growths, lumps, or sores) on your own or your partner’s penis, scrotum, anus, mouth or throat.

Even if you are healthy, you and your sex partner(s) may also want to get checked by a healthcare provider for other STIs.

If you or your partner have genital warts, you should avoid having sex until the warts are gone or removed. However, it is not known how long a person is able to spread HPV after warts are gone.

What does HPV mean for my relationship?

HPV infections are usually temporary. A person may have had HPV for many years before it causes health problems.

If you or your partner are diagnosed with an HPV-related disease, there is no way to know how long you have had HPV, whether your partner gave you HPV, or whether you gave HPV to your partner.

HPV is not necessarily a sign that one of you is having sex outside of your relationship. It is important that sex partners discuss their sexual health and risk for all STIs, with each other.

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): About 79 million Americans are currently infected with HPV. About 14 million people become newly infected each year.

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:

  1. 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.
  2. 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.
  3. Other HPV-related cancers are also more treatable when diagnosed and treated early.

Can I get tested for HPV?

No, there is currently no approved test for HPV in men.

Routine testing (also called ‘screening’) to check for HPV or HPV-related disease before there are signs or symptom, is not recommended by the CDC for anal, penile, or throat cancers in men in the United States.

However, some healthcare providers do offer anal Pap tests to men who may be at increased risk for anal cancer, including men with HIV or men who receive anal sex. If you have symptoms and are concerned about cancer, please see a healthcare provider.

Prevention

HPV Vaccines

There are several HPV vaccines licensed in the United States: a bivalent vaccine (Cervarix) that prevents infection with HPV types 16 and 18, a quadrivalent vaccine (Gardasil) that prevents infection with HPV types 6, 11, 16, and 18, and a 9-valent vaccine that prevents infection with HPV types 6, 11, 16, and 18, 31, 33, 45, 52, and 58.

The bivalent and quadrivalent vaccines offer protection against HPV types 16 and 18, which account for 66% of all cervical cancers, and the 9-valent vaccine protects against five additional types accounting for 15% of cervical cancers.

The quadrivalent HPV vaccine also protects against types 6 and 11, which cause 90% of genital warts.

All HPV vaccines are administered as a 3-dose series of IM injections over a 6-month period, with the second and third doses given 1–2 and 6 months after the first dose, respectively.

The same vaccine product should be used for the entire 3-dose series. For girls, either vaccine is recommended routinely at ages 11–12 years and can be administered beginning at 9 years of age; girls and women aged 13–26 years who have not started or completed the vaccine series should receive the vaccine.

The quadrivalent or 9-valent HPV vaccine is recommended routinely for boys aged 11–12 years; boys can be vaccinated beginning at 9 years of age.

Boys and men aged 13–21 years who have not started or completed the vaccine series should receive the vaccine. For previously unvaccinated, immunocompromised persons (including persons with HIV infection) and MSM, vaccination is recommended through age 26 years.

In the United States, the vaccines are not licensed or recommended for use in men or women aged >26 years.

HPV vaccines are not recommended for use in pregnant women. HPV vaccines can be administered regardless of history of anogenital warts, abnormal Pap/HPV tests, or anogenital precancer.

Women who have received HPV vaccine should continue routine cervical cancer screening if they are aged ≥21 years.

The HPV vaccine is available for eligible children and adolescents aged <19 years through the Vaccines for Children (VFC) program (information available by calling CDC INFO [800–232–4636]).

For uninsured persons aged 19–26 years, patient assistance programs are available from the vaccine manufacturers. Prelicensure and post-licensure safety evaluations have found the vaccine to be well tolerated.

Impact-monitoring studies in the United States have demonstrated reductions of genital warts, as well as the HPV types contained within the quadrivalent vaccine.

Settings that provide STD services should either administer the vaccine to eligible clients who have not started or completed the vaccine series or refer these persons to another facility equipped to provide the vaccine.

Clinicians providing services to children, adolescents, and young adults should be knowledgeable about HPV and HPV vaccine (https://www.cdc.gov/vaccines/who/teens/for-hcp/hpv-resources.html).

HPV vaccination has not been associated with the initiation of sexual activity or sexual risk behaviors or perceptions about sexually transmitted infections.

Abstaining from sexual activity is the most reliable method for preventing genital HPV infection.

Persons can decrease their chances of infection by practicing consistent and correct condom use and limiting their number of sex partners.

Although these interventions might not fully protect against HPV, they can decrease the chances of HPV acquisition and transmission.

Diagnostic Considerations

HPV tests are available to detect oncogenic types of HPV infection and are used in the context of cervical cancer screening and management or follow-up of abnormal cervical cytology or histology (see Cervical Cancer, Screening Recommendations).

These tests should not be used for male partners of women with HPV or women aged <25 years, for diagnosis of genital warts, or as a general STD test.

The application of 3%–5% acetic acid, which might cause affected areas to turn white, has been used by some providers to detect genital mucosa infected with HPV.

The routine use of this procedure to detect mucosal changes attributed to HPV infection is not recommended because the results do not influence clinical management.

Treatment

Treatment is directed to the macroscopic (e.g., genital warts) or pathologic precancerous lesions caused by HPV. Subclinical genital HPV infection typically clears spontaneously; therefore, specific antiviral therapy is not recommended to eradicate HPV infection.

Precancerous lesions are detected through cervical cancer screening (see Cervical Cancer, Screening Recommendations); HPV-related precancer should be managed based on existing guidance.

The body will usually clear HPV infections on its own within a couple of months. Warts can be treated in several different ways:

  1. A patient can apply creams, gels, and solutions (prescribed by a health care provider)
  2. A health care provider can freeze them off with liquid nitrogen
  3. A health care provider can burn them off with trichloroacetic acid or bichloroacetic acid
  4. A health care provider can apply a tincture or ointment that will remove the warts
  5. A health care provider can cut off the warts using a scalpel, scissors, curette or electro-surgery

All of these options may take multiple treatments to completely remove warts.

Cancer-causing HPV can be monitored in females through regular Pap tests, but there is no specific treatment to eliminate HPV from the body.

If the HPV causes abnormal cells to form, a health care provider will likely remove the cells and biopsy them.

Depending on the type of abnormalities, the provider may recommend a colposcopy (a special exam that magnifies the walls of the vagina and cervix) or LEEP (a procedure to remove the abnormal cells before they can cause cancer).

Type of Test

Genital warts are typically diagnosed through a visual examination. Your health care provider may apply a weak vinegar solution because the acidity will make warts turn white and become more visible.

The cancer-causing types of HPV can be diagnosed through a sample taken during a Pap test. There is no general test for HPV.

Test Timing

If warts are present, they can be diagnosed immediately through a visual inspection. HPV results associated with a Pap test will likely be available with the Pap results, usually within a week.

Counseling

Key Messages for Persons with HPV Infection

General

An anogenital HPV infection is very common. It usually infects the anogenital area but can infect other areas including the mouth and throat. Most sexually active people get HPV at some time in their lives, although most never know it.

Partners who have been together tending to share HPV, and it is not possible to determine which partner transmitted the original infection. Having HPV does not mean that a person or his/her partner is having sex outside the relationship.

Most persons who acquire HPV clear the infection spontaneously and have no associated health problems.

When the HPV infection does not clear, genital warts, precancers, and cancers of the cervix, anus, penis, vulva, vagina, head, and neck might develop.

The types of HPV that cause genital warts are different from the types that can cause cancer.

Many types of HPV are sexually transmitted through anogenital contact, mainly during vaginal and anal sex.

HPV also might be transmitted during genital-to-genital contact without penetration and oral sex. In rare cases, a pregnant woman can transmit HPV to an infant during delivery.

Having HPV does not make it harder for a woman to get pregnant or carry a pregnancy to term.

However, some of the precancers or cancers that HPV can cause, and the treatments needed to treat them, might lower a woman’s ability to get pregnant or have an uncomplicated delivery. Treatments are available for the conditions caused by HPV, but not for the virus itself.

No HPV test can determine which HPV infection will clear and which will progress. However, in certain circumstances, HPV tests can determine whether a woman is at increased risk for cervical cancer.

These tests are not for detecting other HPV-related problems, nor are they useful in women aged<25 years or men of any age.

Prevention of HPV

Two HPV vaccines can prevent diseases and cancers caused by HPV. The Cervarix and Gardasil vaccines protect against most cases of cervical cancer; Gardasil also protects against most genital warts.

HPV vaccines are recommended routinely for boys and girls aged 11–12 years; either vaccine is recommended for girls/women, whereas only one vaccine (Gardasil) is recommended for boys/men. These vaccines are safe and effective.

Condoms used consistently and correctly can lower the chances of acquiring and transmitting HPV and developing HPV-related diseases (e.g., genital warts and cervical cancer).

However, because HPV can infect areas not covered by a condom, condoms might not fully protect against HPV.

Limiting number of sex partners can reduce the risk for HPV. However, even persons with only one-lifetime sex partner can get HPV.

Considerations

HPV is extremely common and there is no general test for the virus’ many forms. Although there is no cure, the body will usually clear the HPV infection on its own.

Protecting Yourself

As with all STIs, the most effective protection is to abstain from sexual activity or to be monogamous with one long-term partner who is not infected with HPV.

There is a vaccine that can prevent most types of HPV that cause genital warts and lead to cancer in males and females.

For women, regular Pap tests can detect HPV and abnormal cells before cancer can form. Currently, there is no approved test to detect HPV in the throat or mouth.

Using dental dams or latex condoms for penetrative or oral sex can help reduce the risk of contracting or spreading the infection.

But because HPV is spread through skin-to-skin contact, condoms and dental dams do not fully protect against the spread of the virus.

Since HPV is so common, and almost every sexually active person will get HPV at some time in their lives, it is important to protect against the possible health effects of it.