What is HPV?

HPV is a sexually transmitted viral infection which, according to the Centers for Disease Control and Prevention (CDC), “is so common that nearly all sexually active men and women get the virus at some point in their lives.” In fact, about 80 percent of sexually active people are infected with HPV at some point during their lives, but many of them never know it.

Each year, about 45,300 new cases of cancer are found in parts of the body where human papillomavirus (HPV) is often found. HPV causes about 35,900 of these cancers.

Types of HPV

Of the more than 200 different types of HPV, more than 40 types can infect the genitals as well as the lining of the head and neck. Of these 40-something types, 13 can lead to cervical cancer, and one of these types can also result in cancer of the anus, penis, throat, vagina, and vulva. These 13 are considered to be high-risk (cancer-causing) HPV.

The other types of HPV are referred to as low-risk (non-cancer causing). These HPV types can cause genital warts, which do not lead to cancer. 

The virus is associated with the development of various types of cancer that affect a significant number of people every year, according to the American Cancer Society. Yet according to a study (September 2019) conducted at the University of Texas, more than 70 percent of men and women in the United States are unaware that the viral infection can lead to vulvar, head and neck, cervical, penile, vaginal, and anal cancer. Clearly there is a disconnect among the public about the serious nature of HPV and its possible consequences.

Basically, exposure to HPV is a significant risk factor for all of the abovenamed cancers.

How common are these cancers? The American Cancer Society (ACS) keeps track of the numbers.

CERVICAL CANCER - ACS (American Cancer Society) estimates for cervical cancer in the United States in 2020 to be about 13,800 new cases of invasive cervical cancer, and about 4,290 women will die.

HEAD AND NECK - Some cancers of the oropharynx (back of the throat, including the base of the tongue and tonsils) have been linked to HPV. ASCO (American Society of Oncology) estimates about 3,500 new cases of HPV-associated oropharyngeal cancers (also known as head and neck cancer) are diagnosed in women and about 16,200 are diagnosed in men each year in the United States. These numbers are based on cancers in specific areas of the oropharynx and do not include cancers in all areas of the head and neck or oral cavity.

ANAL CANCER - The number of new cases of anal cancer has been rising in recent years. ACS (American Cancer Society) estimates for HPV related anal cancers in the United States in 2020 to be about 8,590 new cases (5,900 in women and 2,690 in men) and about 1,350 deaths.

VULVAR CANCER - ASCO (American Society of Oncology) estimates in 2020 that 6,120 women in the United States will be diagnosed with vulvar cancer. Vulvar cancer makes up about 6% of cancers diagnosed in a woman’s reproductive organs and less than 1% of all cancers in women. Recent research has shown that about 69% of vulvar cancers diagnosed from 2008 through 2012 were due to HPV, the latest available years of data. A woman’s risk for vulvar cancer continually increases with age. White women are most likely to be diagnosed with the disease. It is estimated that 1,350 deaths from vulvar cancer will occur this year.

PENILE CANCER - Penile cancer can be a deadly disease but usually is not. ASCO (American Society of Oncology) estimates in 2020 that 2,200 men in the United States will be diagnosed with penile cancer. Penile cancer is uncommon in the United States and makes up less than 1% of all cancer diagnosed in men. Many cases of penile cancer are related to HPV. Penile cancer is more common in some parts of Africa, Asia, and South America. About 440 men will die from the disease this year.

VAGINAL CANCER - Vaginal cancer is uncommon affecting 1 of every 1,100 women during their lifetime. ASCO (American Society of Oncology) estimates in 2020 that 6,230 women in the United States will be diagnosed with vaginal cancer. Research has shown that about 75% of vaginal cancers diagnosed from 2008 through 2012 (the latest data available) were due to HPV. A woman’s risk for vaginal cancer increases with age. Vaginal cancer is more common among groups of women who are less likely to have access to screening for cervical cancer. It is estimated that 1,450 deaths from this disease will occur this year.

SOURCES

American Cancer Society. Key statistics for oral cavity and oropharyngeal cancer. Oral cavity and oropharyngeal cancer. Accessed 2019 Sep 22.

American Cancer Society. Key statistics for penile cancer. Accessed 2019 Sept 22.

American Cancer Society. Key statistics for vulvar cancer. Accessed 2019 Sept 22.

American Cancer Society. Key statistics for vaginal cancer. Accessed 2019 Sept 22.

Centers for Disease Control and Prevention. Basic information about HPV and cancer. Accessed 2019 Sept 22

Suk R et al. Public knowledge of human papillomavirus and receipt of vaccination recommendations. JAMA Pediatrics 2019 Sep 16. Accessed 2019 Sept 22.

Who’s At Risk for HPV?

Nearly everyone who engages in sexual activity will contract HPV or has the potential to develop an HPV-related cancer during their lifetime. However, in most cases, the immune system clears an HPV infection away on its own within two years of infection without causing any health problems.

If your body is unable to eliminate high-risk HPV, the virus can infect the cells of the cervix, anus, penis, vulva, vagina, head and neck, and precancerous cells can form. If these abnormal cells are not detected and removed, they can eventually become cancer.

Did you know you can get the virus even if you don’t engage in vaginal or anal intercourse? One study of teenage girls and young women found that 11.6 percent of the females who had never had sexual intercourse were still infected with at least one strain of HPV. That’s because the virus can also be transmitted via hand-to-genital or genital-to-genital contact.

Are you at risk for HPV infection or an HPV-related cancer? Check out the following risk factors:

Number of sexual partners.  Your chances of contracting a genital HPV infection increase as your number of sexual partners rises. Also, even if you have had few sexual partners, if any of those partners have had multiple sex partners, your risk increases as well.

New sexual partner.  Regardless of your age, you are at risk of getting a new HPV infection when you get a new sexual partner. If you are already in a long-term, mutually monogamous relationship, you probably will not get a new HPV infection.

Age.  Genital warts most often develop in adolescents and young adults.

Compromised immune system.  If your immune system has been compromised by cancer treatment, malnutrition, HIV/AIDS, or use of immune system suppressing drugs following organ transplant, you are at greater risk of HPV infection.

Personal contact.  If you touch someone’s warts or don’t protect yourself from contact with surfaces that have been exposed to the virus, such as public swimming pools or showers, you are at increased risk of HPV infection.

Damaged skin.  The presence of open or punctured skin can make you more likely to develop warts if you come into contact with the virus.

Bottom line:  Nearly everyone who engages in some type of sexual activity, including vaginal sex, anal sex, and/or oral sex, is at risk of developing HPV infection, which includes genital warts and/or certain cancers.

Tell Me about Genital Warts

Genital warts are a common manifestation of infection with human papillomavirus (HPV) that can develop among individuals who engage in skin-to-skin contact with an infected person, typically during vaginal, oral, or anal sex. An estimated 360,000 people get this sexually transmitted condition every year. In rare cases, genital warts are passed along to an infant during childbirth from an infected mother.

Some good news about genital warts: the types of HPV that cause genital warts are not the same ones that can cause cancer. Other good news is that you don’t even need to treat them—they typically go away on their own. But treatment is an option—we’ll talk about that later.

Do I have genital warts?

Genital warts are whitish or skin-colored bumps that look like tiny cauliflower florets. They may appear singly or in bunches on the penis, vulva, vagina, cervix, scrotum, or anus. They can be tiny or big and may itch, but most of them are not painful.

Be aware that other skin conditions or infections, such as herpes and syphilis, can cause skin eruptions that look like warts. These and other warts need different treatment than do genital warts.

If you have genital warts, you are most likely to pass them along to your partner if you’re having symptoms. For all of these reasons, it’s important that you have a doctor examine any warts or wart-like growth to determine what you have and if you are at risk of passing the infection along to someone else.

How long does it take for warts to appear after infection?

Here’s the tricky part: it can take weeks, months, or even years after you have had sexual contact with an infected individual before the warts appear. That means it can be difficult to know who passed along the infection to you if you have been sexually active with more than one person during that time.

It also means that your current sexual partner may have gotten infected years ago, long before the two of you were active together. Therefore, if you get genital warts from your current partner, it does not mean that person has been cheating on you.

Here’s something else you should know: you may have the HPV type that causes genital warts and never shows any symptoms. However, you can still pass along the virus to your partner, and that person can develop the warts. Genital warts are truly a complicated condition!

Genital warts in men

The appearance of genital warts in men is usually how HPV infection is diagnosed in men, because the infection does not cause symptoms. Since there is no treatment for asymptomatic HPV, most infected men are not treated. Although HPV infection usually doesn’t place men at a higher risk for health problems, the virus is associated with uncommon cancers, including penile, anal, head and neck. 

Genital warts in women

The symptoms of genital warts in women are warts that can appear either inside or outside the vagina, on the cervix, or in or around the anus. That means the bumps are not always visible. Some women experience unusual vaginal discharge when they are infected with HPV.

Treating genital warts

First of all, your body’s immune system may eliminate the virus that causes the warts, which means you can forego treatment if you wish. However, if the warts are uncomfortable (e.g., itching, pain, burning). If you want to relieve discomfort or reduce the risk of passing along the infection to a partner, you may choose to have the warts removed. Note that removal reduces your chances of transmitting the virus to a sexual partner but does not entirely eliminate that possibility.

Also note that the warts are likely to return after treatment because there is no treatment for the virus itself.

You have several treatment options for genital warts. Discuss these options with your healthcare provider to determine which approach is best for you.

Warning: Do not use over-the-counter wart removal products designed for your hands or feet on genital warts!

Cryotherapy, involves freezing off the warts with liquid nitrogen. This is done in a doctor’s office or clinic. The wart tissue is frozen with liquid nitrogen, allowed to thaw, and then frozen again if necessary. Up to three treatments may be needed, depending on the size and thickness of the warts. The treatment can cause a mild to moderate burning sensation during the session.

Topical chemicals.  This treatment also is done in a doctor’s office or clinic once a week for several weeks. You have a few options.

  • Imiquimod seems to boost your immune system’s ability to fight off the warts. You need to avoid sexual contact while the cream is on your skin because it can irritate your partner’s skin. Side effects of this treatment may include rash, pain, fatigue, blisters, and cough.
  • Podophyllin and podofilox. The first is a prescription that must be applied by a physician, whereas the second can be applied by the patient. Both are made from a plant-based resin that eliminates genital wart tissue. Side effects may include pain, sores, and mild skin irritation.
  • Veregen cream is for external warts or those in or around the anal canal. Side effects are usually mild and may include reddening of the skin, pain, itching, or burning.
  • Trichloroacetic acid. This is a chemical treatment that burns off warts, both external and internal. Side effects can include pain, sores, and mild skin irritation.

Loop Electrosurgical Excision Procedure (LEEP). Involves using a small electrical wire loop that removes the warts.

Can you prevent genital wart recurrence after treatment?

Essentially, genital warts can be treated but not cured. Removing the warts does not eliminate the virus from the body, although it may go away eventually by itself. Therefore, some people experience genital warts again and some do not.

Sources

eMedicine Health. Genital warts (HPV infection)

Mayo Clinic. Genital warts