What is human papillomavirus (HPV)?

HPV stands for human papillomavirus. It is a group of related viruses that can infect both males and females. HPV is the most common sexually transmitted infection (STI) worldwide. While some types of HPV may cause genital warts, other high-risk types can lead to various cancers, including cervical, anal, and throat cancer. It is important to get vaccinated against HPV and practice safe sex to reduce the risk of infection.

The World Health Organization (WHO) estimated that 625,000 women and 69,400 men across the world getting an HPV-related cancer each year. One of the most commonly seen HPV-related is cervical cancer, which has been one of the top five leading causes of cancer and cancer deaths in women.

Symptoms

Symptoms of HPV may appear years after the initial infection. Some types of the virus cause warts to form, while others can increase the risk of cancer. Specifically, HPV can cause:

Genital warts

A person may have one small skin bump, a cluster of bumps, or stem-like protrusions. These warts can range in size and appearance, and they may be:

  • large or small
  • flat or cauliflower-shaped
  • white, pink, red, purplish-brown, or skin-colored

They can form on the:

  • vulva
  • cervix
  • penis or scrotum
  • anus
  • groin area

These warts can cause itching, burning, and other discomfort.

Other types of warts

HPV can also cause common warts, plantar warts, and flat warts.

Common warts are rough, raised bumps that tend to form on the hands, fingers, and elbows.

Plantar warts are hard, grainy growths that often form on the feet, usually on the heels or balls of the feet.

Flat warts, meanwhile, are flat-topped, slightly raised lesions that are darker than the surrounding skin and often appear on the face or neck.

How HPV can lead to cancer

Most people with HPV do not develop cancer, but the infection can increase the risk, especially in people with weakened immune systems.

A high-risk strain of HPV can change the way that cells communicate with each other, and this can cause them to grow in an uncontrolled way.

In many people, the immune system defeats the unwanted cells. However, if the immune system is unable to do this, the cells can stay in the body and continue to grow. In time, this can lead to cancer.

It may take 10–20 years for a tumor to develop, according to the National Cancer Institute (NCI).

In the U.S., around 3% of all cancers in females and 2% of all cancers in males stem from HPV.

The infection can increase the risk of developing cancer of the:

  • cervix
  • vulva
  • vagina
  • penis
  • anus
  • oropharynx, including the base of the tongue and the tonsils

Routine screening can lead to an early diagnosis, and receiving prompt treatment can prevent the cancer from spreading.

The best course of treatment will depend on the type of cancer, its stage, and the age and overall health of the person.

Causes

HPV is a virus that transmits through skin-to-skin contact, often sexual contact. The infection can develop in anyone who is sexually active.

There may be no symptoms, or the symptoms may appear and disappear. HPV can pass from person to person regardless of whether symptoms are present.

The strains of HPV that cause warts are different from those that increase the risk of cancer.

In children

HPV can transmit to an infant during birth. However, research suggests that this risk is relatively low, as the immune system usually takes care of the infection in this situation.

Signs of an HPV infection in an infant include genital warts or lesions in the mouth.

If a young child develops HPV symptoms, it may indicate child sexual abuse.

Risk factors

Factors that increase the risk of HPV include:

  • having several sexual partners
  • having sex with someone who has had several sexual partners
  • having sex without using barrier protection, such as a condom or dental dam
  • having areas of broken or damaged skin
  • having contact with warts or surfaces where HPV exposure has occurred
  • not having the HPV vaccination

The risk of cancer is higher if a person has HPV and:

  • has other sexually transmitted infections, such as chlamydia
  • delivered their first baby at a young age
  • has given birth to many children
  • smokes tobacco products
  • has a weakened immune system

Diagnosis

If warts or lesions are visible, a doctor can usually diagnose HPV with a visual examination. Also, tests can confirm the presence of the virus.

When to get tested for HPV?

Tests for HPV or related cervical cellular changes include:

  • a Pap smear
  • a DNA test
  • a biopsy

A Pap smear, also called a cervical smear, involves collecting and testing cells from the surface of the cervix or vagina. It can reveal any cellular abnormalities that may lead to cancer.

A DNA test can evaluate for high-risk types of HPV, and a doctor may use it alongside a Pap smear.

A biopsy, which involves taking a sample of affected skin, may be necessary if a test reveals unusual cell changes.

There is currently no routine screening for HPV in males, and the range of testing options is limited. Some experts have called for more testing, especially for men who have sex with men.

If a person has receptive anal sex, a doctor may recommend an anal Pap smear.

A person can also test for HPV at home, but it is important to see a doctor to confirm the diagnosis. The home test cannot detect cancer.

Treatments

New hope

There have been significant advancements in the development of new treatments for HPV in recent years, offering hope for improved management and prevention of HPV-related complications.

Various immunotherapy approaches have been explored to target HPV infections and associated diseases. These treatments aim to boost the body’s immune response to clear the virus and prevent disease progression.

Other treatments

However, a person can take various steps to remove the warts that HPV can cause. It is also worth noting that these warts often go away without treatment.

Common warts

Over-the-counter salicylic acid products can treat common warts. Do not use these products on warts in the genital area, however.

For some people, a doctor may prescribe one of the following medications:

  • imiquimod (Aldara, Zyclara)
  • podofilox (Condylox)
  • trichloroacetic acid
  • podophyllin

Also, surgical intervention may be necessary.

Genital warts

Do not use over-the-counter products on genital warts. A doctor may recommend:

  • Cryotherapy: This involves using liquid nitrogen to freeze off warts.
  • Electrocautery: This involves using an electrical current to burn away the warts.
  • Laser or light therapy: This involves using a high-powered, targeted beam to remove the unwanted tissue.
  • Surgical removal: A surgeon can cut away warts in an outpatient procedure that involves a local anesthetic.

The best option will depend upon the type and location of the wart. Treatments can remove warts, but the virus will remain in the body and remain transmissible.

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