Human Papillomavirus (HPV): Symptoms, Causes, Treatment

Human papillomavirus (HPV), depending on the strain, can cause genital warts or certain cancers. Getting vaccinated and practicing safe sex can help prevent HPV infection.

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). 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)

Over 90% of those with HPV never have symptoms. If you do experience symptoms with a strain of HPV, the most common symptom is genital warts, which are 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.

Some warts may increase in number and size, while others regress (lessen or disappear) within the first few months of the infection. Most genital warts will come back within a few months, even after treatment. 

The human papillomavirus enters your body through any mucous membrane, which is the moist inner lining of the mouth, genitalia, and anus. 

HPV most easily spreads through vaginal or anal sex. But, you may also develop the infection through oral sex and sexual skin-to-skin contact, such as fingering the vagina or anus.

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 who has multiple sex partners
• A weakened immune system 

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.

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 only available for people with female genitalia.

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.  

While there are HPV treatments, there is no cure for when it causes genital warts or cancer. Instead, the goal of treatment is to reduce the presence of warts and limit the symptoms 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, and most genital warts return within three months of treatment.

To remove the warts, your healthcare provider may recommend a topical (on the skin) medication 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

You can prevent an HPV infection. There are three primary ways to limit your exposure to HPV, which include: 

• Getting vaccinated: Immunization is the most effective way to prevent exposure 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, 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: 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.

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

• Other STIs: People with HPV are more prone to having other STIs. Furthermore, 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.
• Cancer: Around 17,600 females and 9,300 males in the US receive a diagnosis of HPV-associated cancers every year. 

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 your number of sexual partners, and get screened for STIs routinely.

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.