Human Papillomavirus (HPV)

Human Papillomavirus (HPV)

What is HPV (Human Papillomavirus)?

Pronounced: human pap-uh-loh-muh-vahy-ruh s

Human papillomavirus is a group of viruses that cause warts (condylomata acuminata) to form on your feet, hands, and genitals – depending on the type of HPV infection you contract.

The virus may enter your body through a small cut or abrasion on the skin after skin-to-skin contact with an infected person while genital HPV infections, some of which result in genital warts, are contracted through sexual intercourse.

There are more than known 100 types of HPV Strains of the virus, some of which can lead cancer, being cervical cancer, cancers of the anus, vulva or vagina as well as genital warts, however most infections do not result in these. Sixty types of the virus cause warts on the hands and feet and do not form warts on the genitals, the other 40 types of HPV are what cause genital warts.

HPV is a reality for many people, in the article that follows we will delve into the details of the disease and explore the symptoms, causes and more regarding the virus. Please note that this article is intended to be used only as a guideline and not as a professional opinion. It is always best to consult with a doctor or healthcare professional for that.

What is the difference between general HPV and the sexual strains of HPV?

It is important to note that general HPV infections are different to the sexual strains of the virus. The general infections can be spread through coming into contact with the warts of someone who has the warts on their hands, feet, joints and even their face. Whilst the sexual strains of the virus, being the most common sexually transmitted disease (STD), are passed through sexual intercourse, anal or oral sex (oral sex causing warts in the throat and mouth). The infection site of the virus is often used to determine the strain of it. Warts on your hands, for instance, cannot spread to the genitals, throat or mouth, and vice versa, this is because they are both caused by different types of HPV.

HPV and common warts

General infections of HPV (not resulting in genital warts), are infections in the top layer of skin, normally spread through a tiny scratch.

You get warts from someone else who has warts. Most people will have at least one infection of a common wart at some point in their lives.

Warts explained

 How are HPV common warts spread?

The spread of warts is the result of the rapid growth of cells in the outer layer of skin. If you develop a common wart, otherwise known as a skin wart, it means that you have come into contact with the virus, it may even take months for the wart to develop after exposure. You can get skin warts from shaking hands with someone who has a wart or various warts on their hands. It is also possible to contract the virus through touching inanimate objects that have been used by someone who has a wart, such as towels, razors and even shower floors.

It is important to note that you are more likely to contract general HPV when the virus, or wart comes into contact with skin that is cut or damaged. This is the reason why men commonly have warts in their beards, spreading from the nicks of shaving and hence women have them in their legs.

HPV as an STI

Being known as the ‘common cold’ of sexual activity, the emphasis is placed on the 40 HPV varieties affecting the genitals, throat or mouth that are transmitted through sexual contact. These strains of HPV are sexually transmitted diseases/infections (STI’s) and can affect men and women.

Four out of five sexually active people will have had some type of HPV infection in their life.

It is possible to contract the infection from even your first sexual encounter. The tiny breaks in the skin during sexual activity result in the spread of the virus. This normally happens without knowing or without showing any symptoms of the virus and sometimes the infection can resolve itself without causing any further complications.

How is HPV as an STI spread?

Sexually transmitted HPV strains are contracted through having oral, anal or vaginal sex with someone who is infected with the virus. It is most commonly spread through anal and vaginal sex.

Other strains of the virus are, however, also spread through skin-to-skin contact, meaning that intercourse is not always required to contract infection and can merely be spread by touching an infected person or through a small cut or abrasion on the skin. In some very rare cases, an infected mother is able to infect her baby during natural birth.

The virus lives in the body’s epithelial cells – the flat and thin cells which are found on the skin’s surface including surfaces of the anus, vulva, vagina, penis head, cervix, mouth and throat. HPV is attracted to the mucous membranes and moist layers of the genital areas and often results in genital warts. Genital warts are often very small and therefore not always easy to see, as such many people with these do not realise they have them.

Some infections of sexual HPV result in warts developing in the oral and upper respiratory regions, which are contracted during oral sex. The warts are contagious and spread through touching the wart or the fluid secreted when a wart is broken.

Using a condom does not fully protect you from the virus as a condom still leaves other areas of the skin open which can become infected.

Low-Risk and High-Risk HPV

Sexually transmitted strains of HPV are divided into two divisions:

  • Low-risk risk of HPVs, these do not result in cancer but normally cause warts in the genital, anus, mouth and throat regions. HPV types 6 and 11 have been known to cause about 90% of all warts that are genital. They also cause recurring respiratory papillomatosis, which is a rare disease where benign tumours begin to form in the air passageways starting from the nose, leading through the mouth and into the lungs.
  • High-risk types of HPVs which cause cancer. There are more than a dozen HPV types that are high-risk that have been identified so far. HPV types 16 and 18 have been documented to be the types of HPV responsible for cancers caused by HPV. Other common high-risk strains of HPV are 31, 33, 45, 52 and 58.

What are the symptoms of HPV?

While warts are the most common symptom of HPV, in most people, the body’s immune system will clear the virus naturally before the warts develop without treatment or other health problems occurring. In genital HPV types, this can mean that people who are infected may have passed the virus to their sexual partners unknowingly.

The level of infection and symptoms experienced depend on how long the virus is in the body. The longer you are infected, the higher your chance of further health issues developing such as cervical or anal cancer.

Research has shown that HPV related cancer can take between 10 and 30 years to develop.

Rarely, the virus can develop into severe health conditions such as warts forming in the throat as a result of engaging in oral sex with an infected person, this is known as recurrent respiratory papillomatosis (RRP). In more severe cases, the virus can result in cancer of the genitals, head and neck, tongue, tonsils and throat (oropharyngeal cancer).

Warts

The strains of the virus that cause cancer are different to the ones that cause genital warts. Therefore, if you have HPV genital warts it does not mean you will get cancer.

When warts appear, they often vary in their appearance which is dependent on the type of HPV infection. HPV warts are categorised as follows:

  • Common warts which appear as raised and rough bumps on the hands, elbows or fingers. These types of warts are often painful and unsightly. They are also susceptible to bleeding and injury. These are highly contagious and can be spread through just touching the wart.
  • Genital warts which are flat lesions, tiny upright protrusions or cauliflower-like bumps in the genital areas. They commonly appear on the vulva and can also form in the vagina, cervix and near the anus in women. In men, the warts will appear in the scrotum, penis and around the anus.

    Genital warts do not cause itching or pain and are often so small that one may not even know they have them.
  • Flat warts which are slightly raised bumps that are flat at the top and darker than the skin. These are common in children and tend to appear on their faces, with men they form in their beards and women on their legs.
  • Plantar warts which are grainy and hard growths that normally appear on the balls of feet and heels, they can cause some discomfort.

Cancer caused by the sexual strains of HPV

Vaccination against HPV can protect you from getting cancer. When unvaccinated, the majority of cancer cases are caused by HPV strains that normally don’t cause warts. Most people do not know they have even been infected until the later stages of the cancer as symptoms are not shown in the early stages. The virus can cause cancer of the cervix, vulva, anus, penis or oropharynx (middle of the throat).

Over a period of time, the repeated infection of specific strands of HPV can result in cancerous lesions. If these are not treated, they can become cancerous.

High-risk HPVs cause about 5% of cancer cases worldwide. High-risk HPVs are known to cause several different types of cancer:

  • Cervical cancer – all cervical cancer is caused by HPV. The HPV types 16 and 18 are responsible for roughly 70% of all reported cases of cervical cancer.
  • Anal cancer – 95% of all anal cancers are the result of HPV type 16.
  • Cancers of the mid throat, soft palate, tonsils and base of the tongue (oropharyngeal cancers) – 70% of these are caused by HPV and more than half of these cancers are a result of HPV type 16.
  • Rarer cancers – 65% of vaginal cancers are caused by HPV, as well as over 50% of vulvar cancers and 35% of penile cancers. Most of these types of cancers are also caused by HPV type 16.

How does HPV cause cancer?

HPV causes cancer when the epithelial cells, which are found in layers covering the outside surfaces of the body, including the genital tract, throat, anus and skin become infected with the virus. Once infected, the virus begins to produce encoded proteins which interfere with the functions of the cells, disrupting their ability to control their growth.

In some cases, these cells are detected and destroyed by the immune system. In others, the cells continue to grow and multiply in an uncontrollable manner. As they continue to grow, they begin to form cell mutations leading to precancerous cells being formed and ultimately, if left untreated, a cancerous tumour.

Who is at risk of HPV?

Everyone who comes into contact with an infected person is at risk of contracting the virus, although those with weakened immune systems do bear a greater risk. 

While children usually contract common warts, adolescents and young adults often get genital warts.

Sexually transmitted HPV infections occur as a result of skin-to-skin sexual contact through vaginal, oral or anal sex. HPV is more prevalent in those who have more than one sexual partner, however, you can still contract the virus if you only have one sexual partner as they may have been previously infected.

It is possible to have HPV for a number of years after infection without showing any symptoms, thus increasing your risk of passing it onto someone else without knowing.

It is best to always get checked regularly by a doctor so as to ensure proper detection and treatment.

Can HPV be treated?

Currently, there is no medical treatment for the HPV infection itself as there is no cure for the virus. However, warts, benign tumours in the respiratory tract and precancerous developments of the cervix can be treated. The idea behind the treatment of HPV is not to cure the infection itself, but rather to focus on treating the symptoms.

Abnormal cell changes of the cervix

Abnormal cell changes have five main treatment options:

  1. Close monitoring of the changes of the cell is sometimes recommended before actual treatment. These changes are known as cervical dysplasia, cervical intraepithelial neoplasia or precancerous changes of the cell. These often heal without treatment.
  2. Cryotherapy involves using liquid nitrogen to freeze the cells off.
  3. Conisation is a procedure that removes the abnormal areas. It is also referred to as cone biopsy.
  4. Laser therapy burns the abnormal cells off using light beams.
  5. LEEP, known as loop electrosurgical excision procedure, removes the cells through the use of an electric current.

Genital warts

The treatment of warts is dependent on where they appear in the genital regions. It is best to wait until the warts have all formed, as initial and aggressive treatment may result in repeat treatment as more warts begin to appear.

The HPV types 6 and 11 are commonly known to cause genital warts. They normally grow for a period of six months and then stop. They can also go away naturally. Prescription cream can also be given to apply at home such as Podofilox or Condylox as well as Imiquimod or Aldara.

Wart removal treatments (these can also include common warts caused by the general strains of HPV, not only sexual strains) can be administered such as:

  • Cryotherapy – using liquid nitrogen to freeze off the wart.
  • Trichloracetic acid – applying a chemical the wart to burn it off.
  • Electrocautery – using an electric current to burn off the warts.

Smaller warts are generally more responsive to treatment and larger warts are typically removed or burned off. If you find any warts on your genital regions, consult with your doctor.

How is HPV as an STI detected?

HPV can be detected in women through Pap smears. It is recommended that women have their first Pap test when they become sexually active or are 21 years of age. Pap smears, which are usually performed by a gynaecologist or family physician, are able to identify abnormal cells and can signal if there are precancerous cells, cancerous cells or HPV.

Women aged 30 to 65 should have a Pap smear every three to five years or when recommended by their doctor. Some doctors recommend an annual Pap smear as early detection of cervical cancer is the first step in beating the disease. If your test detects one of the 15 cancer causing strains of HPV, then your doctor may recommend you come for more regular Pap smears to monitor for cervical changes.

The changes that can lead to cancer have been known to take up to 10 years to develop and some can resolve by themselves.

If you do have an abnormal Pap smear result, your doctor may suggest further testing through a colposcopy. The procedure uses a colposcope, an instrument which is used to examine the vagina and cervix, to take a closer look at the abnormal areas.

The doctor may also suggest that an HPV test is performed on the Pap sample to detect the virus. In an HPV test, the doctor takes a swab of the cervix cells which are then sent to a lab for testing. This test can identify 13 or 14 of the high-risk types of HPV.

Note that there is no FDA-approved test for available for diagnosing men with HPV. If you notice warts forming or other changes after sexual activity, consult with a doctor for a professional assessment.

How can HPV be prevented?

Having sex increases your risk of contracting sexually transmitted HPV infections. Abstaining from sexual intercourse will lessen your risk of contracting the virus drastically (although this is not always a realistic preventative measure for most people). If abstinence is not an option for you, condoms, although not completely effective, will assist in lessening the spread of warts. Regular check-ups, screenings and Pap smears are recommended. 

Contracting general HPV strains often means you have touched the wart of someone who in infected on their hands, feet or joints. If you notice someone with common warts on these areas, try to avoid touching them as some warts are known to be highly contagious and spread easily through a small scratch or abrasion in the outer layer of skin.

If you have common warts, you are likely to re-infect yourself through scratching these open which results in the wart’s mucous spreading to other uninfected surrounding areas. If you have scratched a wart open, it is best to keep it covered with a plaster or bandage until it has healed.

It is advised to wash your hands thoroughly, clean gym equipment before use, try and refrain from biting your nails (this can cause cuts and hang nails which allow entry of the virus) and wear shoes in public places and showers to avoid plantar warts.

The HPV vaccine

There are three approved vaccines to prevent the infection of HPV. These being, Gardasil, Gardasil 9 and Cervarix. All children who are of the ages 11 and 12 should be vaccinated as this ensures a line of protection against the virus before higher risk periods later life in during which they may become sexually active.

 HPV Vaccine


It is also possible to get a catch-up vaccine until age 21 for males and 26 for females, if they were not vaccinated as children. It is also suggested that those who have a weakened immune system get vaccinated.

Why can you not get an HPV vaccine after 26?

The FDA has only approved the vaccine for males until the age of 21 and females aged 26.  The rationale behind this is that by these ages most people would have been sexually active enough to be exposed to the virus.

So, it is not that someone over the age of 26 can’t get the vaccine, this can be done at doctor’s discretion, it is just preferable to be vaccinated prior to being exposed to the virus in order to prevent it.

Any more questions?

What do the warts look like?

The warts formed are skin or mucous growths that develop into little bumps that look like a hard lump of skin. The warts, termed ‘Papilloma’ are how the human papillomavirus got its name.

How long does HPV last?

In many occurrences, people may contract the virus without even knowing that have it. This is because most strains of HPV, except for those that result in warts, do not show any symptoms. In the majority of these cases the immune system can combat and clear the virus itself within two years.

Do genital warts mean I have cancer?

Having genital warts does not necessarily mean you are at risk of cancer. Low-risk types of HPV are the cause of warts, which do not cause cancer. Genital warts are a common occurrence in many young people who have HPV.

Do genital warts cause itching?

Some people with HPV will only have a few warts in the genital area. They are often soft and can be slightly raised or flat. They do not cause any pain, itching or discomfort in the lower risk strains of the virus. It is advisable to be careful not to shave over or break the warts so as to prevent their spread.

In the higher risk strains of the virus, the warts may itch, and if they are broken, the spread of the cells will result in more warts forming.

Can warts on my hands spread to my genitals?

Warts on your feet or hands cannot spread to the genital area and vice versa as they are caused by different strains of HPV. However, HPV is the cause of all warts on the body.

Is HPV an STI?

Some strains of HPV are spread through sexual contact, therefore specific strains are regarded as sexually transmitted infections (STI’s). HPV is the most common sexually transmitted infection. It is so common in fact, that nearly all sexually active people may contract some form of the virus at some point in their lives.

Why do children get warts?

Warts are caused by HPV, they are non-cancerous growths on the skin which are formed when the virus invades the skin through a small cut or abrasion. The virus then results in the fast growth of cells on the outer layer of the skin. The strains of HPV that cause warts on the hands, feet and elbows are commonly passed from child to child. Once the skin is infected with the virus, it can take months for the warts to become visible.

Can toads and frogs cause common warts?

This is an old wives’ tale. You get warts from other people who have warts. Not from toads or frogs.

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