HPV - Everything You Need to Know

How is HPV spread? 

HPV can be transmitted even without penetrative sex, as these viruses can be spread with skin-to-skin contact of the genital area, as well as vaginal, anPlantar warts, or oral sex.

HPV symptoms

• Genital warts: These generally appear in the genital area as flat lesions, tiny protrusions, or small cauliflower-like bumps. In the case of women, most locate in the vulva, but can also occur near the anus, as well as in the cervix or vagina.
• Plantar warts: Plantar warts usually appear at the base of the toes, the forefoot, or the heel, causing discomfort.
• Cancer: Different types of cancer are caused by HPV, in the case of cervical cancer, at least 91% are caused by HPV. Other types of cancers in the genital area or nearby are alco caused in their majority by HPV, as it is the case with cancer in the vagina (75%), vulva (69%), penis (63%), anus (91%) and oropharynx (89%) with an estimated total of 36,000 cases per year.[3]

HPV in women

Most women with HPV do not experience symptoms, for this reason, regular Pap tests are recommended for women starting at the age of 21.[4]

HPV in men

Men can acquire HPV by the practice of sexual activities with another person who is infected with HPV, as the infection is easily spread during vaginal or anal sex, as well as oral sex and skin-to-skin contact,[5] this last mode of transmission is one of the main reason’s HPV can be spread even in a sexual activity involving condom usage.

In men, HPV can lead to specific forms of cancer as penile cancer, anal cancer, or oropharyngeal cancer, which is located around the back of the tongue.

Does HPV cause health problems?

HPV can cause genital warts and abnormal cell changes which can turn into cancer cells, these types of HPV viruses are classified as high risk. Each year, cervical cancer kills 3,700 to 4,200 women in the United States.[6]

Does HPV cause cancer?

Among the type of cancers related to HPV a variety can be found which are specially related to the genital zone, being these: cervical cancer, anal cancer, vulval cancer, vaginal cancer, penis cancer as well as others non-genital cancers on the head and the neck.

How to avoid HPV and its consequences in health

It is important to note that the number of lifetime sexual partners is the most important risk factor associated to genital HPV infection.

Thus, reducing the number of sexual partners is one of the single most effective prevention measures against HPV.[7]

If sexual activities are performed, practicing it only inside a faithful, long-term, and mutually monogamous relationship such as marriage with a person who has not had any previous sexual contact during lifetime or tested negative for STDs, including HPV, is the closest method to 100% to prevent yourself from any STD including HPV.

How do I know if I have HPV?

For the diagnosis of HPV, the physician may be able to perform the diagnosis by visual examination by searching for warts if they are visible in the body.

In the case of warts not being visible, tests can be performed to confirm the presence of HPV virus, which include:

HPV Test

• Pap test: A sample of cells is collected from the cervix or vagina and send to the laboratory for analysis. In this case, this type of test can be performed at the gynecologist consulting room or at the privacy of your home.
• DNA test: This test is conducted as well on cells from your cervix. The test recognizes the presence of high-risk forms of HPV in the DNA which can lead to genital cancers. Normally is recommended in addition to the Pap test, specially form women +30 years old.
• Vinegar (acetic acid) solution test: Within this test, a vinegar solution is applied to HPV general areas, the solution will turn white in the presence of lesions and will help identifying them. [8] This test should only be performed by a trained healthcare professional in the setting of a physical examination.

When to get tested for HPV

The best option is to get screened regularly in relation to the level of sexual activity and partners within a defined timeline, i.e., 1 year, as this will increase the probability of contracting STDs.

If regular testing is not possible with a primary test, then a Pap test every 5 years, or a co-test every 5 years are good options. In the case of testing, primary tests are better to prevent cervical cancer than Pap tests alone.

The American Cancer Society suggests you get screened regularly, no matter which test you get.[9]

How soon after an exposure to HPV can a test detect if I have the virus?

As the reaction of the body to the virus, as well as the manifestations of the virus in the body and the latency of HPV will be different from person to person.

It is difficult to provide an exact answer. Depending on the case, it can take weeks, months, or years after exposure before the virus is detected or symptoms develop. [10]

How often should you be checked for HPV?

The American Cancer Society recommends regular screening. This should begin at least at age 25 and include a primary test for HPV every 5 years.

In the case a primary test is not available, a co-test which includes HPV test and Papanicolaou (Pap) test is suggested every 5 years. Finally, another last option is receiving a Pap test alone every 3 years. [11]

HPV and pregnancy

Studies are still being performed to determine which are the possible effects of HPV in pregnancy [12], with some of them showing an association between HPV and:

• In very rare cases, a baby can get HPV from its mother as it passes through the birth canal and develop oropharyngeal lesions. Early membrane rupture, which means the amniotic sac surrounding the fetus breaks before labor begins, this can take place before 37 weeks of after, leading to preterm birth, increased risk of infection and abnormal fetal presentation. [13]
• Premature birth, which means the baby is born before 37th week of pregnancy. In the long term, premature birth may lead to cerebral palsy, impaired learning, vision or hearing problems, psychological problems, and chronic health issues. [14]
• Increased rates of miscarriages.

More research is needed on the area of HPV and its associations with pregnancy complications.

Besides, one thing is clear, preventing is always better than curing. For this reason, is important to state that the only ~100% way of preventing it is to practice sex activities inside a long term, stable, monogamous, and mutually faithful relationship such as marriage with another person who does not have HPV.

I am pregnant. Will having HPV affect my pregnancy?

HPV can cause problems during pregnancy, which include:

• Cervical cell changes: Abnormal changes in the cervical cells can take place during pregnancy. It is therefore advised to receive regular cervical cancer screening during and after pregnancy to help your physician find any abnormalities.
• Grown or bloody genital warts: Hormonal changes caused by pregnancy can influence genital warts causing them to bleed and grow both in size and number.
• Needed Cesarean: In case genital warts are blocking the birth canal, a cesarean (c-section) may be needed for delivery to take place. Please take note that natural birth should always be the first option of delivery and it causes less complications in the present and future both for the mother and the baby, for this matter, preventing caesarean to take place on the first place is one of the best steps for a safe pregnancy.
• Respiratory Papilloma: Babies and children may develop growths in their airways from mothers who had HPV. [15] This respiratory papilloma is a wart-like or growth tumour on the surface of the larynx of the baby which causes vocal cord damage and airway problems. Besides these tumours can be removed using surgery, they often come back. [16] In the U.S. alone, 1,000 new paediatric cases arise each year because of HPV.

Treatment for HPV 

As HPV states for the presence of a particular type of virus in the body, now there is no commercially available treatment for the virus itself. However, some treatments are available for its consequences:

• Genital warts: are usually treated with topic solutions as creams with imiquimod, podophyllin, trichloroacetic acid or snatchings which are applied to the warts or other genital tissues surrounding the area. [17]
• Cervical pre-cancer: Can be treated if women get routine Pap tests and can identify the problems before cancer develops, for this reason testing is crucial.

Cervical and other HPV-related cancers: Will be more treatable if diagnosed early, however, prevention is always better than cure, first avoiding HPV on the first place, and secondly testing regularly to catch early infection. In the case of cervical cancer, the 5-year survival rate for all women is 66%. [18]

Is HPV curable?

As HPV states for the presence of a particular type of virus in the body, now there is no commercially available treatment for the virus itself.

However, some treatments are available for its consequences depending if they are genital warts, cervical cancer, etc.

Can you get HPV non sexually?

It is important to state that the main source of transmission of HPV is sexual contact.

Sexual activities which can transmit HPV are not just limited to intercourse, with HPV showing a probability of transmission of 5% to 100% per sexual act, which includes vaginal, anal, and oral sex, as well as other close skin to skin contact sex activities.

Besides, because Human papillomavirus (HPV) accounts for more than 200 types of viruses which are classified from genome sequencing there are certain type of viruses which can be passed without sexual contact.

It is important to state that after analysis has been done on the warts, it can be determined if the HPV as come as the result of sexual contact or not.This differentiation is important as each type of HPV is associated with infections in a particular anatomical site and have a particular morphology (shapes, structures).

In the case of HPV of non-sexual acquisition, its transmission is possible for certain types of HPV as 1,2,3,4,7 and 10 which commonly cause plantar warts and common skin warts on other parts of the body.

Additionally, these can also affect the anogenital region when transmitted via 1) the hand of a caregiver during a nappy change for a baby 2) vertical transmission from mother to baby during vaginal delivery or 2) passing a viral wart from the mouth to other part of your body via hands contact.[19]

Written by Tommy Gonzales on January 6, 2021. Updated and republished in June 2021. 

References

[1] STD Facts - Human papillomavirus (HPV). (2019, August 20). Retrieved December 18, 2020, from https://www.cdc.gov/std/hpv/stdfact-hpv.htm

[2] (n.d.). Retrieved December 18, 2020, from https://www.nhs.uk/conditions/human-papilloma-virus-hpv/

[3] How Many Cancers Are Linked with HPV Each Year? (2020, September 03). Retrieved December 18, 2020, from https://www.cdc.gov/cancer/hpv/statistics/cases.htm

[4] Recommendation: Cervical Cancer: Screening: United States Preventive Services Taskforce. (2018, August 21). Retrieved December 18, 2020, from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening?ds=1

[5] STD Facts - HPV and Men. (2016, December 28). Retrieved December 18, 2020, from https://www.cdc.gov/std/hpv/stdfact-hpv-and-men.htm

[6] Jemal, A., Siegel, R., Ward, E., Murray, T., Xu, J., Smigal, C. and Thun, M.J. (2006), Cancer Statistics, 2006. CA: A Cancer Journal for Clinicians, 56: 106-130. https://doi.org/10.3322/canjclin.56.2.106

[7] Baseman JG, Koutsky LA.. The epidemiology of human … (n.d.). Retrieved December 18, 2020, from https://www.researchgate.net/publication/7981233_Baseman_JG_Koutsky_LA_The_epidemiology_of_human_papillomavirus_infections_J_Clin_Virol_32_S16-S24

[8] HPV infection. (2019, August 30). Retrieved December 18, 2020, from https://www.mayoclinic.org/diseases-conditions/hpv-infection/diagnosis-treatment/drc-20351602

[9] HPV and HPV Testing. (n.d.). Retrieved December 18, 2020, from https://www.cancer.org/cancer/cancer-causes/infectious-agents/hpv/hpv-and-hpv-testing.html

[10] HPV and Relationships. (n.d.). Retrieved December 18, 2020, from https://www.nccc-online.org/hpvcervical-cancer/hpv-and-relationships/

[11] The American Cancer Society Guidelines for the Prevention and Early Detection of Cervical Cancer. (n.d.). Retrieved December 18, 2020, from https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/cervical-cancer-screening-guidelines.html

[12] Pereira N;Kucharczyk KM;Estes JL;Gerber RS;Lekovich JP;Elias RT;Spandorfer SD;. (n.d.). Human Papillomavirus Infection, Infertility, and Assisted Reproductive Outcomes. Retrieved December 18, 2020, from https://pubmed.ncbi.nlm.nih.gov/26609434/

[13] Prelabor Rupture of Membranes (PROM) (Premature Rupture of Membranes). (n.d.). Prelabor Rupture of Membranes (PROM) - Gynecology and Obstetrics. Retrieved December 18, 2020, from https://www.msdmanuals.com/professional/gynecology-and-obstetrics/abnormalities-and-complications-of-labor-and-delivery/prelabor-rupture-of-membranes-prom

[14] Premature birth. (2017, December 21). Retrieved December 18, 2020, from https://www.mayoclinic.org/diseases-conditions/premature-birth/symptoms-causes/syc-20376730

[15] Human papillomavirus. (2019, March 22). Retrieved December 18, 2020, from https://www.womenshealth.gov/a-z-topics/human-papillomavirus

[16] Respiratory Papilloma. (n.d.). Retrieved December 18, 2020, from https://www.uofmhealth.org/conditions-treatments/ear-nose-throat/respiratory-papilloma

[17] Genital warts. (2019, November 20). Retrieved December 18, 2020, from https://www.mayoclinic.org/diseases-conditions/genital-warts/diagnosis-treatment/drc-20355240

[18] Cervical Cancer - Statistics. (2020, March 10). Retrieved December 18, 2020, from https://www.cancer.net/cancer-types/cervical-cancer/statistics

[19] Non-sexually acquired human papillomavirus infection: DermNet NZ. (n.d.). Retrieved December 18, 2020, from https://www.dermnetnz.org/topics/non-sexually-acquired-human-papillomavirus-infection/