Everything You Should Know About HPV That You Weren't Taught In School
Unless your Google calendar says you've got an upcoming Pap test or HPV vaccine appointment, odds are you aren't actively sitting there thinking about HPV. Still, given the statistics on just how prevalent the virus is, maybe you should.
HPV, or human papillomavirus, is the most common sexually transmitted infection in the United States. Currently, 42 million people are infected with the virus in the United States, with 13 million new Americans being diagnosed with it each year. Even more sobering: "Nearly everyone will get HPV at some point in their life," according to the Centers for Disease Control and Prevention (CDC).
But what exactly is HPV? What are the symptoms? And how do you test and treat the infection? All important questions about HPV. Get the answers below.
What Is HPV, Exactly?
Specifically, HPV is caused by a family of viruses called human papillomavirus, of which there are currently more than 200 different strains.
The part of the body the virus infects, the accompanying symptoms (if any), treatment, and how long it lasts all vary based on the exact strain(s) someone has, says Emily Rymland, D.N.P., F.N.P.-C., clinical development manager at telehealth platform Nurx.
As it goes, the types of HPV are usually broken down into two broad categories: low risk and high risk. Low-risk strains of HPV are unlikely to cause problems (infertility, cancer, etc.) down the line. High-risk strains of HPV have the potential of causing cancers, such as cervical cancer, penile cancer, anal cancer, and esophageal cancers. To be clear: Low risk is not synonymous with asymptomatic, but more on this below.
How Do You Get HPV?
Roughly 40 of the strains of HPV can be contracted by having sex with a person who has HPV. Transmitted through skin-to-skin contact, it can be spread through anal sex, vaginal intercourse, oral sex, scissoring, and other sex acts that involve bare skin, according to the CDC. There's also some research that shows the virus can live on sex toys made of silicone and elastomer for up to 24 hours — even after a proper cleaning — which suggests that sharing sex toys can also transmit the virus. What's more, the virus can be transmitted through sexual acts regardless of whether symptoms are present.
The other strains of HPV are not caused exclusively by sexual contact, and can result in common warts such as hand warts and plantar warts, says Rymland. These are the types of warts your parents were warning against when they told you to wear flip-flops on the pool deck, she adds. Note: This article is specifically covering the strains of HPV that can be transmitted sexually.
The Signs and Symptoms of HPV
While most strains of the virus are asymptomatic, when HPV symptoms do appear, they can often come in the form of warts, according to Rymland. Known as genital warts, these warts are small, flesh-colored bumps that show up most often on the vulva, taint, penis, cervix, or along the anal or vaginal canal. Certain strains of HPV can also cause oral warts or lesions, according to the CDC. It's uncommon for HPV warts — no matter where they pop up on the body — to be accompanied by any other symptoms, such as pain, itching, or discomfort, says Rymland. (Related: Everything You Need To Know About Genital Warts)
"The strains that cause warts aren't those that are associated with cancer," explains Rymland. So, while the warts might be annoying or unsightly, the HPV strains that cause warts are considered low-risk. But don't read it wrong: Just because your strain doesn't cause warts, that doesn't mean it's high risk. Only some of the strains of HPV that don't cause warts can lead to cancer, she says. Indeed, some strains cause neither warts nor cancer — hence the commonality of asymptomatic cases. ICYWW: The strains associated with genital warts are stains 6 and 11. Meanwhile, the strains that could cause cancer are 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 28, according to the National Cancer Institute.
That said, it's possible to have more than one strain of HPV at the same time. Sometimes, the presence of warts will lead someone to get tested for HPV, and find out that they have an additional strain of HPV as well, says Rymland. Your practitioner will be able to identify exactly which strain(s) you have, if any, so you can receive the proper HPV treatment.
How to Test for HPV
If someone has a strain of HPV that is actively causing genital warts, "sometimes health care providers will diagnose genital warts from appearance alone," sexual health expert Amy Pearlman, M.D., with Promescent, a sexual health product retailer previously told Shape. Other times, the provider will remove a tiny piece of the wart to biopsy, or test it, for any abnormality, according to Dr. Pearlman. A biopsy allows the provider to rule out other similar-looking conditions such as skin tags or moles.
However, if you don't have any visible HPV symptoms (as most people won't), you'll need to be tested for the virus via a vaginal or anal pap. In fact, even people who do have genital or anal warts should still be screened for HPV because this doesn't necessarily rule out infection with a high-risk asymptomatic strain, or multiple strains of the virus, says Rymland.
So, what does an HPV test entail? Also known as getting HPV screened, testing for HPV varies based on sex and genital make-up, as well as the type of sex you're having (if any).
If you have a cervix, you'll typically get screened for HPV at the same time that you get a Pap test from your gynecologist. These tests require the provider to put a speculum into the vaginal canal, then collect a sample of cervical cells with a soft brush and/or small scraping device. The provider will send this collection of cells to the lab to test for precancerous lesions caused by HPV or for cellular abnormalities that suggest that cancer is at its early stages. Another option is to take an at-home HPV-testing kit, such as those through Nurx or Everlywell, which require a quick swab of the vaginal canal (you won't need to reach the cervix). However, at-home HPV tests only test for certain strains of the virus. Carefully read the product description to learn exactly what strains the at-home HPV test is able to find. The Everlywell HPV Test, for example, screens for strains 16, 18, and 45, while the Nurx HPV test looks for 14 strains of HPV (including types 16 and 18, which are higher-risk).
Regardless of your gender or sex, if you enjoy receptive anal or oral sex, your doctor may recommend an anal pap smear to look for precancerous changes, says Rymland. To note, there are currently no FDA-approved tests for oral HPV. The only way doctors are currently able to tell if you have oral HPV is if you have a strain that causes oral legions that are visible during an oral exam).
"It's really unfortunate that there isn't an approved regular screening for any body part other than the cervix because HPV-related cancers of the anus, penis, and throat are all on the rise, and affect all genders and sexual orientations," she says.
How Often to Test for HPV
How often you should get an HPV test depends on your age, your sexual and medical history, and the results of your last HPV test. "It's recommended that people don't test for HPV until age 30," according to Rymland (and the CDC, FTR). The reason? "When you're younger it's likely that if you do have a strain it will go away on its own [thanks to the immune system] and won't cause any problems down the line."
Between the ages of 30 and 65, people with cervices should get an HPV test every five years, according to The American College of Obstetricians and Gynecologists. After that, individuals who have not tested positive for cancer-causing strains do not need to continue getting screened. As always, however, it's best to talk to your practitioner about your specific sexual practices and any other risk factors to get HPV test recommendations tailored to you.
"People with cervices should get their screenings on the recommended schedule, but unlike other STIs, you don't need to test for it annually," she says.
What Is the Treatment for HPV?
"There is no cure for the human papillomavirus itself," says Rymland. But the immune system often clears it on its own within two years of infection, she says.
If you have a strain of HPV that causes genital warts (and they haven't gone away on their own), you can get them removed by your doctor, usually with a process known as cryosurgery, which essentially involves freezing off the warts. Just keep in mind that removing HPV warts does not rid the body of the virus itself, and warts could return.
As for HPV treatments if you have a strain that can cause cancer that the body doesn't clear on its own? Health-care providers will simply treat any precancerous changes, such as with the cells that line the cervix, caused by the virus, explains Rymland. These can be monitored and detected by cervical screenings and pap smears, as well as oral and anal HPV testing, she adds.
Good news: Even if cancer has developed, it's usually treatable if caught early, she says. Treatments for these cells vary, but can include excision, lasering, or freezing of the abnormal cells, or impacted tissues. "Getting screenings on schedule is important because it allows us to catch if/when the virus has led to precancerous changes, and then provide treatment before it turns into cancer."
How to Protect Against HPV
The number one thing people can do to protect against HPV is to get the HPV vaccine, according to Rymland. Known as the Gardasil vaccine, the HPV vaccine protects against 9 strains of the vaccine (strains 6, 11, 16, 18, 31, 33, 45, 52, and 58) and is FDA-approved for people of all genders over the age of 9. People should get the vaccine prior to the age of 26, as early protection offers the best protection, according to the CDC. If you're between the ages of 27 and 45 and have not yet received the HPV vaccine, talk to your provider, as they may still recommend it as a way to protect against strains of the virus you have not been exposed to yet. Worth knowing: The age you are when you get the vaccine will impact how many doses of the vaccine you get — only two doses are needed for those who get the first vaccine before their 15th birthday, while those who get their first dose after that may need three doses, each six to 12 months apart.
Beyond the HPV vaccine, the usual safer sex practices apply here. That means knowing your own status, staying up to date on STI testing, and communicating your status with any new partner — ideally before you have sex for the first time.
It also means using barriers (dental dams, finger cots, condoms, etc) with any partner who is HPV-positive, does not know their current HPV status, or has a previous partner that has known HPV. As you now know, this can go for most pleasure-seekers, so play it safe.