What Is Human Papillomavirus (HPV)?

Brandi Jones, MSN-ED RN-BC
Updated ·9 min read

Medically reviewed by Renita White, MD

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States. In fact, more than 42 million Americans have HPV and 13 million people get the infection per year in the U.S. Research suggests that over 80% of sexually active females and 90% of sexually active males will get HPV at some point.

There are multiple strains or types of HPV. Some strains cause genital warts, while others can cause certain types of cancer. However, some strains never cause symptoms and go away on their own. In cases like this, many people are unaware they have HPV. That said, the best way to prevent HPV is by getting vaccinated and practicing safe sex.

Related:Things You Should Know About HPV

Types

Research suggests that there are more than 150 strains of HPV. The strain or type of HPV that causes genital warts (low-risk) differs from the strains that cause some types of cancer (high-risk). Keep in mind: having one strain does not make you immune to other types.

Low-risk HPV


There are 12 types of low-risk HPV. Some low-risk HPV strains (e.g., types 6 and 11) cause genital warts. Other low-risk HPV types never cause symptoms and the condition goes away on its own within two years.

High-risk HPV

There are an estimated 14 specific types of high-risk HPV strains, including types 16 and 18, which can lead to certain cancers, including:

  • 90% of cervical cancers (cancer of the cervix)

  • 60% of penile cancers (cancer of the penis)

  • 90% of anal cancers (cancer of the anus)

  • 70% of oropharyngeal cancers (cancer of the mouth and throat)

  • 65% of vaginal cancers (cancer of the vagina)

  • 50% of vulvar cancers (cancer of the vulva)

Symptoms

Over 90% of those with HPV never have symptoms and the infection disappears on its own after a couple of years. If you do experience symptoms with a strain of HPV, the most common symptom is genital warts, or lumps and growths that occur in the genital area, inner thigh, anus, mouth, or throat.

You may be at a higher risk of developing genital warts if you have sex with someone who also has them. In fact, 75% of people who have sex with a partner with HPV-related genital warts will also develop warts within eight months.

It's important to note that some warts may increase in number and size, while others regress (lessen or disappear) within the first few months of the infection. However, most genital warts will come back within a few months, even after treatment.

Causes

The human papillomavirus causes HPV cells to enter your body through any mucous membrane—which are moist, inner linings of the mouth, genitalia, and anus. HPV most easily spreads through vaginal or anal sex. But, you may also develop the infection via oral sex and sexual skin-to-skin contact, such as fingering the vagina or anus.

Keep in mind: the transmission of HPV does not require you to exchange body fluids with your partner. Your risk of getting HPV increases with:

  • New or multiple sex partners

  • Having sex with someone with multiple sex partners

  • A weakened immune system

Diagnosis

If you start to notice genital warts, it's a good idea to see your healthcare provider. During your appointment, your provider will perform a physical exam to take a closer look at your genitals.

Usually, a physical exam is all that's needed for your provider to diagnose you with HPV. However, sometimes warts can be small or hard to notice. In such cases, your provider may conduct a pap smear and collect a fluid or tissue sample to send to a lab for testing. A pap smear is available for people with female genitalia. Most providers recommend that women aged 30 to 65 should get an HPV test with a pap smear every three to five years.

While 90% of men get HPV at some point in their lives, the infection typically resolves without symptoms. At this time, there is no recommendation for routine testing or screening for people with male genitalia. However, a healthcare provider may recommend an anal pap test for males participating in receptive anal sex.

Related:Where Can You Get Tested for STIs?

Treatment

While HPV treatment exists, there is no cure for the infection when it causes genital warts or cancer. Instead, the goal of treatment is to reduce the presence of warts and limit the symptom of HPV-related cancer. Your exact treatment plan will depend on the type of HPV you have and the severity of your condition.

Genital Wart Treatment

Treatment for genital warts is primarily cosmetic and focuses on removing the warty tissue. Genital wart treatment does not cure HPV. However, most genital warts return within three months of treatment.

The most common genital wart removal involves topical (on the skin) medications that you can apply at home. Generally, these medications come in the form of a gel or cream, and include:

  • Condylox (podofilox)

  • Aldara (imiquimod)

  • Veregen (sinecatechins)

  • Absorbica or Myorisan (isotretinoin)

Healthcare providers may also administer one or more of the following treatments under general anesthesia (sedation) or local anesthetic (numbing medication).

  • Trichloroacetic acid: A topical solution administered weekly

  • Cautery: Burning the wart using electricity

  • Cryotherapy: Uses below-freezing cold temperatures to remove warts

  • Surgery: Removal of the wart with a scalpel, scissors, and a scraper

  • Laser vaporization: Using light to heat the blood vessels, cutting off the wart's blood supply

  • Photodynamic therapy: Coating the area with a photosensitive solution that reacts to light wavelengths, causing the wart to shrink

Cervical Cancer Treatment

If you have a strain of HPV that increases your risk of cervical cancer, your provider will recommend treatment options that reduce the cancer symptoms. Treatment options vary, but may include one or more of the following treatments:

  • Cone biopsy: Removes the cone-shaped part of the cervix through cold knife conization (CKC) or a loop electrosurgical excision (LEEP)

  • Surgery: Surgical removal of some or all of the female reproductive organs, including the cervix

  • Lymph node removal: Removal and testing of your lymph nodes to see if cancer is spreading

  • Radiation therapy: High-energy radiation waves (kind of like an X-ray) that kill cancer cells

  • Systemic therapy: Medications such as chemotherapy and targeted immunotherapy to help reduce symptoms and the progression of the cancer

How To Prevent HPV

The good news about HPV: you can prevent the infection. There are three primary ways to limit your exposure to HPV, which include:

  • Getting vaccinated: Immunization is the most effective way to prevent being exposed to an HPV strain. The United States uses the HPV vaccine Gardasil-9, which protects from the strains that cause 90% of genital warts and the strains that cause 70% of genital cancers. The Centers for Disease Control and Prevention (CDC) recommends vaccinating children before they are sexually active. Most providers recommend giving the vaccine around age 11. If you do not receive the vaccination as a child, you can receive a catch-up vaccination as an adult.

  • Limiting sexual partners: There is a 70% chance of getting HPV through unprotected sex with someone who has HPV. Having sex with one person (who only has sex with you) or limiting sexual partners decreases your exposure to HPV.

  • Practicing safe sex: Using prevention devices such as condoms, finger cots, and dental dams correctly (every time you have sex) can lower your risk of getting HPV.

Related:Can Adults Get the HPV Vaccine?

Comorbid Conditions

The most common comorbid conditions (which are conditions or infections that commonly co-occur with HPV) include:

  • Other STIs: One study found that about 68% of women had another STI along with HPV. Additional STIs increase inflammation in your body and can contribute to the damage that HPV causes. This results in more HPV-related flare-ups and faster progression of cancer.

  • HIV: Genital HPV rates are 2.5 times higher in females who live with HIV. Anal HPV infections are three times higher in HIV-positive females and HIV-positive men who have sex with men. Those with HIV also have a more challenging time clearing the HPV virus because HIV weakens the immune system, especially if the condition is left untreated.

  • Cancer: Around 17,600 females and 9,300 males in the US receive a diagnosis of HPV-associated cancers every year.

Living With HPV

HPV is a highly preventable infection when you receive the vaccine before becoming sexually active. However, it's just as important to practice safe sex, limit the number of sexual partners, and get screened for STIs routinely to decrease your risk of experiencing HPV symptoms and HPV-related cancers.

If you have HPV, this does not mean you have to avoid sex altogether. But, you should be upfront with a potential sex partner about your condition. This allows your partner to ensure they have the proper vaccination and can employ prevention techniques to practice safe sex.

Frequently Asked Questions

Can HPV live on bed sheets?

HPV can live on many surfaces, including bed sheets, for several days. While there is theoretically a chance of getting HPV from linens, it is unlikely. The virus would have to touch your mucus membranes. That said, vaginal, anal, oral sex, and skin-to-skin sexual contact are the most common modes of HPV transmission.

Can you cuddle someone with HPV?

Yes, you can cuddle someone with HPV. But keep in mind that if cuddling progresses, you can get HPV from sexual skin-to-skin contact, finger-to-genital contact, and oral sex. Sexual intercourse does not have to occur to get HPV.

Can stress cause HPV to flare up?

The short answer: yes. Studies show that having multiple life stressors over several months can cause an HPV flare-up to occur. Stress hormones decrease your immune response and can reactivate dormant viruses, making it difficult for your body to fight the infection and its symptoms.

Should you tell someone if you are HPV positive?

You should tell someone you are HPV positive if you are—or plan to be—sexually active with them. This allows you to discuss vaccination and safe sex practices. Keep in mind that if you or your partner test positive for HPV, it does not mean that one of you had sex with another person outside of the current relationship. Many people carry HPV for a long time without knowing it.

How long can you have HPV before you test positive?

You can have HPV for years with no symptoms or health problems. For people assigned female at birth between ages 30-65, you should get an HPV test every five years. Early diagnosis leads to better outcomes if you have cervical pre-cancer or cancer.

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