The STI Files: Human Papillomavirus (HPV)
Stat: As many as one in ten Americans have HPV, and some studies show that at least one-third of all sexually active young adults have genital HPV infections. It is often stated that more than half of all college-age women will become infected with HPV during their college career, and many sexual healthcare providers consider that HPV is simply a symptom of people being sexually active, because it's just that common - it's estimated that up to 75% of sexually active people will have at least one HPV infection in their lifetime.
What is it exactly? There are more than 40 different known strains of HPV that are sexually transmissible, some of which are potentially cancerous, and some which are direct causes of cervical cancer, which around 12,000 women each year develop in the US. HPV is often called genital warts, because when it is externally symptomatic, and a strain which causes warts (not all do), it appears as tiny cauliflower-like warts on the genitals. However, in most cases, HPV shows no external symptoms, though it is still present and highly contagious, and unfortunately, condoms do not offer complete protection against HPV. They do, however, offer far more protection than going without: major health organizations usually state that condoms can provide around 70% protection against HPV.
About how many people have it? About 20 million people in the United States at any given time, with about 6 million new infections occurring every year.
How is it spread? Through skin-to-skin or mucous membrane contact during oral, vaginal anal or manual sex, though it is most likely, by far, to be spread by direct genital-to-genital contact (vaginal intercourse, anal intercourse or rubbing two sets of genitals together without a latex barrier). There does not need to be exposure to body fluids, such as semen, to pass HPV to partners.
What are its symptoms? Typically, HPV does not present any symptoms, especially with high-risk strains (the ones which are associated with cancers). Wart strains may produce small, cauliflower-like warts on the vulva, vagina, anus, penis, inside the urethra, or in the throat. However, warts may go unnoticed, particularly if they are very small or inside the body, such as in the vagina or urethra.
How is it diagnosed? Through a microscopic exam of tissue samples (taken during a gynecological or urological exam) and the visual examination of warts, if they are present. For women, a PAP smear may reveal precancerous conditions likely to be caused by HPV, although a pap smear does not detect or test for the virus itself. There is also a DNA (digene) HPV test that can be done at the same time as a pap smear, or without a pap smear. When a visual exam is not sufficient, or when further investigation is warranted - for example if the results of a pap smear turn out to be 'abnormal' - a colposcope (a special magnifying instrument) can help to detect HPV. An HPV digene test can be done at this time as well, and can determine whether the type of HPV present is a high-risk strain. Unfortunately, diagnosing HPV in men is often difficult, so a man with a clear STI screening should not consider himself at no risk of having HPV. If people with penises have visible warts, HPV can be detected, but otherwise, there is currently no FDA-approved HPV test for men.
Is it treatable? Warts can be removed by various methods, namely by being frozen off (cryotherapy) or burned off (electrocauterized), via use of a patient-applied solution, dissolved with acid solutions, or removed by laser surgery. Overall, those methods are relatively painless, and are usually done in your gynecologists office, not in a hospital. Which method is used depends on the patient, the availability of methods, and the particular warts and strain in question.
Is it curable? No. Even when the warts are removed, the virus may still remain present in the body, and can be transmitted to partners when no warts are present, and/or cause long-term health problems like cervical cancer. Many people, however, are understood to shed the virus over time, particularly younger people with healthy immune systems.
From the Guttmacher Institute: "A study released in April by researchers from the National Cancer Institute found that more than half of infections clear within six months; other studies have found that nine in 10 infections are fought off within two years. Moreover, the simple and relatively inexpensive Pap test has been proven extremely successful in detecting cervical abnormalities long before they may develop into cancer and while they are easily treated. So, although HPV is so common that it can be seen as virtually a marker for sexual activity, cervical cancer is quite rare in this country: roughly 10,000 cases per year, resulting in 3,700 deaths."
The tricky thing is that it can be tough for doctors -- and certainly patients -- to know if and when they have shed the HPV virus, for those who do shed it. So, if you or someone else has been diagnosed with HPV, it's safest to simply assume you have it and may spread it, particularly in the first couple years after a diagnosis.
Can it affect fertility? If HPV causes cervical cancer, yes. Otherwise, probably not. HPV can also be transmitted to an infant during childbirth.
Can it cause death? HPV can cause cervical cancer, which can be fatal. But most cases of HPV will not cause death or serious illness.
How can we protect against it? Condoms offer a good deal of protection, but because condoms do not cover the entire genital area, it is somewhat limited. Protection against HPV rom condoms is generally estimated at around 70-75%. But because the use of condoms during vaginal or anal intercourse or oral sex, and dental dams during female oral sex can offer protection, far more than going without, for people who choose to be sexually active, latex barriers are the best way to help prevent sexually active people prevent HPV and other STIs.
Annual or semi-annual STI screenings and/or celibacy with partners until they have been screened for HPV can be of help, and annual pap smears for sexually active women are vital. People of all genders can also now be vaccinated to help prevent HPV. It's best to be vaccinated before having any sexual partnerships, but since many people will not have been exposed to all four strains of HPV the vaccines cover, people who have had sexual partnerships can still get protection from HPV vaccinations. Two vaccines are currently available: Gardasil, which has been approved for people of all genders, and Cervarix, for only women. Both protect against the strains of HPV understood to cause most cases of cervical cancer, and Gardasil also prevents the strains which cause most genital warts.
Avoiding direct genital contact with partners altogether is the best protection against HPV.
Once more with feeling: there is not yet an FDA-approved HPV test for men. So, even if you have a male partner who has been tested for all other STIs with negative results, you cannot know if a man does not have HPV at this time.