Human Papillomavirus (HPV)


There is certainly nothing wrong with being able to discuss matters of pleasure, as this is partly why many people have sought colloquialization of sexual issues, but discussing the health aspect of sexuality should always take priority – one consideration that was unfortunately overlooked by many.

Sexual health is a topic that many people struggle with as they still consider the issue uncomfortable – what with all the unpleasant images and thoughts that come to mind when we consider the conditions that plague the genitalia, from infectious ones to more inherent diseases. As such, it is essential that even with little steps such as educating the public and providing knowledge regarding such conditions, we can contribute towards the normalization of such discussions – promoting a habit of understanding such conditions considering that these sometimes even cause specific life-long ailments and problems.

While it is not necessarily a license that will allow you to fully maneuver your treatment approach and resolve your condition on your own without prior consultation with your physician, perhaps such outlines and measures will go a long way in providing you with the necessary knowledge that you can use to supplement the prescribed management strategy for you, recognize the potential condition and seek out a professional who can help at the soonest time possible, and employ the appropriate preventive measures that could prevent further infections or exacerbations.

One topic that we can perhaps start with is commonly experienced by many but, most often than not, goes unrecognized or misdiagnosed due to its tendency to mimic other presentations or not provide any presentations throughout its duration. Once again, we would like to emphasize that this does not promote any instances of self-medication, and this only encourages the proper recognition of your manifestations for a more streamlined diagnosis and treatment procedure.

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Perhaps you’d be delighted to learn more about the common pathogen that causes the stereotypical genital wart – human papillomavirus infections or HPV.

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Understanding Human Papillomavirus Infections

To begin with, when planning to understand how a particular condition holds up when being experienced by affected individuals, the most obvious thing to do is to flesh out the several aspects of the disease and understand each one and how it comes to be like such. While there might be certain instances wherein the observation will be slightly different due to the variety of processes that occur within the human body on top of the varied responses of our immune system to such invasions, it still stands those conditions, particularly ones that affect the genitalia, follow a specific trend, albeit one that overlaps with the trend of other diseases, that we can follow thoroughly for a more in-depth analysis of the condition.

Once again, while there is a particular trend and process that we can observe among HPV infection cases, there are still certain instances that might mimic the same presentations – requiring another test or parameter that could provide a more conclusive characterization. Sure, the outline does not, in any way, offer a direct path toward the answer, but it does give the pool of possibilities that you then screen to determine if you have the condition indeed.

The Prevalence of Infections

According to the Centers for Disease Control and Prevention, their records that have long noted the number of HPV infection cases globally noted around 43 million HPV infections in 2018. In addition to that, the CDC was also able to note that on top of the 43 million HPV infections reported, 13 million new conditions have been observed until the end of 2018.

With this in mind, it becomes apparent that HPV infections are statistically highly prevalent because they can spread to millions of people in a matter of months – highlighting several factors that might affect its transmission and diagnosis, such as underreporting symptomatic cases.

The Human Papillomavirus, or the causative microorganism in HPV infections, is likewise notorious for causing not only the common genital warts that seem to plague most of the population but cervical cancer in women as well – making it more important that persons who are at risk are eagerly protected or at least, diagnosed immediately for the condition to avoid the progression of the disease to such extent.

In terms of these resulting presentations, the CDC has recorded around 340,000 to 360,000 cases per year, and an estimate of genital warts being present in about 1 in 100 sexually active adults in the US. While this was recorded before the release of HPV vaccines, the increase in sexual comfort makes it possible for the number to stagnate or increase, making it hard to rule out a much higher prevalence at the time of this writing.

On the one hand, cervical cancer cases are noted in around 12,000 women who are living in the US per year. Unfortunately, about 4000 of these recorded women still die despite being screened and treated imperatively.

Persons at Risk for an HPV Infection

Diagnosis would usually require you to approach your physician yourself, and in most cases, no one usually approaches their physician unless they were able to see something unusual, or in much rarer cases, unless it is time for their routine physical exam. To start the recognition of a potential disease on a much better foot, it might be more efficient that you are likewise knowledgeable about the several risk factors that could signify that you are prone to such infections and that you should be tested more often.

People Who Are Consistently Sexually Active or Having Multiple Sexual Partners

Sexual activity is perhaps a no-brainer in this condition, as HPV in genital warts is observed primarily within the genitalia. However, the actual risk factor that comes into play for potential HPV infections is having multiple sexual partners concurrently.

Although having multiple sexual partners might be pleasurable for some, having multiple instances or sources of infection in the first place automatically puts you at a higher risk of contracting the condition. Think about it as such: if you are not at the crime scene, there is no way that you will get shot at by the criminal. However, if you intentionally expose yourself to several crime scenes, then the risk of you getting hit just skyrocketed.

The same principle can be applied in the case of conditions that can be transmitted through sexual contact.

Participating in Unprotected Sex

Another factor that might increase the odds of you contracting the disease from someone who might or might not know about their condition is the absence of any protective measures during intercourse. It has been repeatedly emphasized among educational drives and advertisements that condoms are used to prevent unwanted pregnancies, but you probably should know that they also serve as a barrier between the surfaces of your genitalia during intercourse. Several sexually transmitted conditions are spread through a simple contact between an infected and healthy tissue, and using a condom allows you to limit the contact or prevent it at all – making you safe, at least relatively so, from contracting a potential STD.

If you still prefer unprotected sex, then perhaps it might be time to consider having one partner that you trust and know instead so that you can track your sexual health status and inform the other if any issues within the genitalia are present in one or the other.

Being Immunocompromised

While this is somehow a more generic answer compared to the more specific risk factors that might come to your mind, it is undeniable that being immunocompromised or having a damaged or weak immune system might make it easier for the virus to take hold of your system and induce a full-blown infection within your genitalia. There is no one way to determine whether you are immunocompromised as damages to the immunes system can be caused by multiple processes, but having AIDS, taking steroids, or being on other immunosuppressant medications such as cancer drugs are just some of the situations wherein the patient’s immune system is crippled and weak.

Having Intercourse with Someone who has an HPV Infection

Considering that the primary mechanism by which HPV is transmitted is through contact with someone who has an active HPV infection – which might have manifested even in the form of simple genital warts – then having contact with someone who has the infection, whether they are aware of it or not, will significantly increase the risk of your disease, particularly since you have just been directly exposed to the pathogen. Sure, it is not always easy to assess your partner’s sexual health status, especially in the case of a wildly asymptomatic condition like HPV infections, but at least being aware that exposure could increase your risk significantly would go a long way in preparing you for what might come.

Concurrent STI

Similar to the concept commonly observed among immunocompromised individuals, having another STI significantly increases the risk of being infected by HPV due to the effects that most STIs produce within your genitalia. In most cases, STIs develop lesions and openings within the skin of the genitalia – resulting in accessible entry points for the virus once contact with an infected person happens.

With this in mind, make sure that you are likewise safe and healthy before participating in questionable “activities,” as this could result in a much higher risk of contracting another condition.

Oh, and please do not have sex if you know that you have an STD, or at least until your treatment regimen is done and settled.

Common Management Approach for HPV Infections

There are several management strategies that you can employ when attempting to resolve an HPV infection, but this would primarily rely on the subsequent effects of the infection on your body and how extensive its effect is within your system.

In unfortunate cases, it is known that HPV infection may cause something as simple as common warts or even genital warts to something as severe as cervical cancer. To treat each of these secondary conditions, the management strategy is tailored to each manifestation.

For instance, when attempting to resolve genital warts, physicians may prescribe a particular medication that could either stop the growth of warts, stop the spread, or start removing them from your body. This is sometimes supplemented with cryotherapy; wherein liquid nitrogen is applied to visible warts to “kill off” the excess tissue and be safely removed without causing extensive damage to the skin of the genitalia.

On the one hand, if you have developed something more severe such as cervical cancer throughout your infection, you may be referred to an oncologist for the appropriate approach for your condition. This may include radiotherapy and chemotherapy, but the exact management technique involved in this case varies from each affected person.

Are HPV Infections Considered as STDs?

When looking at the entire pathophysiology of HPV infections, it becomes apparent that the virus is primarily transferred to another host through the direct contact between infectious warts and lesions with the healthy tissue of another individual. As such, when we consider the mechanism involved in its transfer, we can safely consider HPV infections as a sexually transmitted disease or infection.

Preventing an HPV Infection

There are several ways by which one can minimize the risk of contracting the infection, and most of these can be integrated into your daily routine without the need for a massive change or shift in your original process. However, please note that while these processes may minimize the risk associated with an HPV infection, it is not able to remove the risk entirely, and the chance for infection is still eminent without abstinence or removal of exposure.

Using Condoms

As a polar opposite of a previously discussed risk factor, using a condom is an excellent start towards minimizing the risk of contracting an HPV infection. Similar to what was mentioned, HPV is transmitted when there is direct physical contact between an infected lesion or wart and another host’s healthy tissue, implying minimal to no risk of transmission between the two partners without direct contact. A condom serves as a physical barrier between the two individuals that, even though the coverage of a condom is not extensive as one would usually need for complete protection, minimizes the risk of transmission, especially when one or the other is unaware of an existing infection. Recent studies conducted and published in the New England Journal of Medicine has shown that some measure of protection is provided by condom against the transmission of Human Papilloma Virus (HPV) – showing a 70% risk reduction rate when a condom is used before intercourse.

Abstinence

Essentially, when there is no exposure, there is no transmission – it is as simple as that. When you abstain from any sexual contact, there is essentially no way for the virus to be transferred to another person, virtually making you safe completely from the sexually transmitted condition.

Abstinence remains the most important means of preventing transmission, but it is, unfortunately, the one with the lowest adherence rate as it employs the complete removal of sex from the equation – one factor which most people are not happy about.

Generally Practicing Safe Sex Hygiene

Employing safe sex, utilizing proper and safe sex practices, and ensuring that you are clean before and after sex will go a long way in minimizing the risk of potential transmission. While this can vary depending on what is suitable for your genitalia’s environment, understanding what safe sex practices are and employing them during each interaction will significantly reduce the risk of infections that are preventable through these measures in the first place.

HPV Vaccination

Like any other condition, a vaccine helps boost your immune system against the particular causative microorganism of the condition for which the vaccine is indicated. If you are sexually active and have never taken the HPV vaccine before, then perhaps taking the shot can protect you against the infection throughout its effective period.

There are two types of human papillomavirus vaccines available, Cervarix and Gardasil. Although both vaccines are fairly similar, only Gardasil provides extra protection against HPV types 6 and 11.

Young adults between the ages of 11 and 12 years old are recommended to receive the HPV vaccination in a series of three doses. The second dose is typically given at least one month after the first, while the third is administered at least six months after the first. The HPV vaccine can still be given between the ages of 13 and 26 if not administered as a pre-teen.

According to the CDC, though, the HPV vaccine is not recommended for individuals older than 26 years old, as there is only minimal benefit from using the vaccine within this age range. However, it can still be used among people between the ages of 27 to 45 if they had not received the vaccine during their preteen years (11 or 12 years old, starting at 9 years old) when the vaccine was highly recommended to be taken.

The CDC has conducted testing of the HPV vaccination in thousands of individuals world-wide with no serious side effects resulting. Pain at the shot location, along with fever, headache and nausea are all considered common side effects.

Pregnant women should not be given the HPV vaccine, along with those under the age of nine and over the age of 26. Consult your doctor regarding the best course of HPV prevention if you are within these incompatible groups.

Preventing Exacerbation of the Infection

HPV infections usually cause genital warts as their primary manifestation in symptomatic patients. To prevent the further spread of warts, you can employ the following measures and warnings:

Stop Touching the Warts

While it will not necessarily spread significantly if you touch the warts, you still risk moving the pathogen around your genital area when touching the infected lesions consistently. Avoid touching it at all to localize the effect as much as possible.

Avoid Shaving the Area with Warts

Shaving the area with warts may cause bleeding – resulting in the introduction of a new opening that could allow the HPV to enter your systemic circulation and take root in your system.

Always Wash your Hands

If you are having difficulties avoiding touching warts in your genitalia, then washing your hands will go a long way in preventing the transmission of the virus among surfaces and other parts of your body.

Avoid Sharing Personal Items

Personal items such as towels and underwear are always in contact with the infected areas if there are any. Sharing them with someone could infect the person who you’re sharing them with, or you may be exposed to someone who has an active infection.

Who Should Be Considered for HPV Vaccination?

According to the Centers for Disease Control and Prevention, the HPV vaccine is highly recommended among male and female preteens aged 11 or 12 years. The vaccination process may be started at around 9 years old, but any time before the age of 26 could typically get the full effect of the vaccine.

Those beyond 26 years old may still opt to take the vaccine if they haven’t before, but the effect may already be minimal or insignificant by then.

Human Papillomavirus: Pathogenesis and Mechanism of Spread

An HPV infection is caused by the microorganism known as human papillomavirus, hence the name HPV. HPV or the Human Papillomavirus is a virus group. HPV infections commonly result in genital warts, but it remains undiagnosed or misdiagnosed due to the high prevalence of asymptomatic cases and symptoms that often mimic other conditions' manifestations, respectively.

HPV infections are spread through direct contact with infected tissue, lesion, or wart – resulting in the transmission of the causative microorganism from an infected individual to their healthy partner. In most cases, since the manifestations usually occur within the genitalia, people can get HPV through sexual contact, whether it is oral, penetrative vaginal, or anal sex, albeit vaginal and anal sex is more common precursors than oral sex.

Considering that the transmission of the virus occurs during physical contact between two individuals, the transmission is not exclusively sexual in nature, and intercourse is not entirely necessary to infect another individual. However, it is still categorized under STDs and STIs since the primary mechanism through which it is transmitted is sexual in nature.

It might also be essential to note that transmission is still possible even if your partner does not have any symptoms – explaining the virus's high prevalence and transmission rate even when sexual literacy is slowly gaining traction within the public. It is also possible for a mother with an active HPV infection to transmit the virus to their baby during delivery, causing a condition known as recurrent respiratory papillomatosis.

HPV can be classified as either high risk or low risk. The low-risk types can cause the development of genital warts. The high-risk strains are the ones that can cause the development of cancerous lesions in your penis, anus, vulva, and vagina. HPV strains which cause the development of genital warts are not the same ones that can the development of cancer. However, if you have genital warts, then you could have already been exposed to strains of HPV that may induce cancer.

HPV is extremely common in the sense that everyone is bound to be infected by the virus at some point in their lives. In 9 out of 10 cases, the body will destroy the HPV naturally after 2 years. However, in the case of people with HIV, the infection can severely weaken the immune system – making them more prone to HPV infections.

A study recently showed that the risk of HPV in women with HIV is approximate 3 out 4 or 75%.. Women who have HIV and HPV are more likely to have:

  • High Risk HPV that develops into cancer.
  • High Risk HPV that develops into cervical or anal cancer.
  • Several strains of HPV at once.
  • HPV that does not respond well to treatment. Multiple therapies are needed using various methods.
  • Once HPV is cleared, it comes back after successful treatment.
  • Hard time naturally killing the infection.

Human Papillomavirus: Signs and Symptoms of an Infection

Although the symptoms and manifestations of HPV infections sometimes overlap with the presentations of other conditions, in the small portion of the population that is symptomatic, to boot, it might still be wise to be aware of the possible signs and symptoms that you can watch out for if you are sexually active or at risk for an infection.

HPV in Men

HPV infections in men remain widely asymptomatic, but in cases where it does present symptoms, the most common observation is the presence of genital warts within the areas that came in contact with another infected tissue. They can appear as small bumps or a group of bumps within the genital area, and the sizes vary depending on the progression of the condition.

HPV in Women

A high percentage of women are at a higher risk of developing an HPV infection at least once in their lifetime; albeit similar to men, most infected individuals likewise remain asymptomatic as the infection progresses. However, there are certain instances wherein infected patients may observe the development of genital warts within the vagina, in or around the anus, and on the cervix or vulva.

HPV Complications

Although most HPV infections resolve on their own in around 2 years, there are certain instances wherein the repeated damages caused by the microorganism causes the development of cancerous cells within the genitalia.

Cervical Cancer

Women need to be prudent in routinely testing for possible HPV infections as they are at an increased risk of developing cervical cancer due to the infection. Only certain strains of HPV develop such a complication, but regular screening and DNA tests on cervical cells can help prevent the development of such a problem later on.

Other HPV-Related Cancer

Although women are the ones who are more at risk for cancers, men with HPV infections may also develop certain types of cancer such as penile, anal, and throat cancer, particularly those who participate in male-to-male anal intercourse along with a weakened immune system.

Human Papillomavirus: Indicated Testing Procedures

To entirely rule out any other differential diagnosis and determine that HPV is causing your manifestations, the following tests are commonly indicated for potentially infected cases:

Testing in Women

· Pap Test: It is recommended that women between the ages of 21 and 29 get a pap test or pap smear every three years to identify any development of abnormal cells within the vagina, mainly since they are at risk of developing cervical cancer and other HPV-related issues.

· HPV Test: High-risk HPV tests are indicated for women every five years to rule out any dangerous HPV strains that might be present in their genitalia.

· Co-Testing: The general rule of thumb is that you should be able to get both a pap test and an HrHPV test every five years to ensure that you are not at risk for developing any severe complications.

Testing in Men

Unfortunately, there are currently no FDA-approved tests indicated for routine screening in males, in contrast to the availability of a pap test and HPV DNA test in women. According to the CDC, it is also not yet recommended to perform a routine test for penile, anal, or throat cancer in men as the limitations and outcomes of these tests often do not justify their use in the first place.

However, if you are at an increased risk of developing an infection, your doctor may perform an anal pap test, mainly if you are at risk of developing anal cancer.

Human Papillomavirus: Common Management Strategies

There is currently no standardized treatment strategy for HPV infections as the condition's manifestation varies from each person. However, some acceptable methods are being favored in practice as they have shown to be consistently beneficial among people who were able to use them.

Genital Warts

Genital warts are typically removed using cryotherapy or the application of liquid nitrogen to freeze off the elevated tissue. Burning it off with an electrical current applies a similar theory, allowing both processes to remove the wart without damaging the skin underneath safely. However, please note that removing warts does not treat the infection itself, and it is still possible for warts to recur.

HPV-Related Cancer

There is no one way to resolve cancer cases as it would depend on the progression and type of cancer the patient is currently suffering from. However, in most cases, you will be referred to an oncologist who will be able to provide you with a tailored plan that is meant to resolve your condition while likewise making it manageable for your quality of life throughout the treatment.

To confirm whether your HPV infection has caused cancerous complications, the following confirmatory tests may be order by your physician:

  • Loop Electrosurgical Excision Procedure
  • Cryotherapy
  • Colposcopy

Frequently Asked Questions (FAQs)

Can HPV infections resolve on their own?

In some cases, yes, HPV infections may resolve in around 2 years without any treatment.

Apart from genital warts, can HPV infections cause another type of presentation?

HPV may also cause common warts, plantar warts, and flat warts in other body parts.

How long does it usually take before potential cancer cases due to HPV develop tumors?

The progression of cancerous cells may vary, but according to the National Cancer Institute, a tumor may be formed after around 10 to 20 years of development.

What is recurrent respiratory papillomatosis?

It is a condition caused by the vertical transmission of HPV from an infected mother to their baby during delivery, wherein warts can develop within the throat or airways.

Should men be routinely screened for HPV as well?

Routine screening is not yet recommended for men as they are typically not at risk for severe complications.

Additional Resources

National Cancer Institute

Cleveland Clinic

American Society of Colon and Rectal Surgeons

References

  • Centers for Disease Control and Prevention. (n.d.). Genital HPV Infection – Fact Sheet. https://www.cdc.gov/std/hpv/stdfact-hpv.htm
  • Gabbey, A. (2021). Everything You Need to Know About Human Papillomavirus Infection. https://www.healthline.com/health/human-papillomavirus-infection
  • Mayo Clinic. (n.d.). HPV infection. https://www.mayoclinic.org/diseases-conditions/hpv-infection/diagnosis-treatment/drc-20351602
  • NHS. (n.d.). Human papillomavirus (HPV). https://www.nhs.uk/conditions/human-papilloma-virus-hpv/
  • Planned Parenthood. (n.d.). Human Papillomavirus (HPV). https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/hpv
  • Smith, L. (2020). What is human papillomavirus (HPV)? https://www.medicalnewstoday.com/articles/246670
  • WebMD. (2020). HPV. https://www.webmd.com/sexual-conditions/hpv-genital-warts/hpv-virus-information-about-human-papillomavirus
  • World Health Organization. (2022). Cervical Cancer. https://www.who.int/news-room/fact-sheets/detail/cervical-cancer

Written by Mark Riegel, MD

Quick Snapshot

Can it be cured?

Yes. Viruses don't have cures, but symptoms can be controlled with proper treatment.

Type of Infection

Viral. The human papillomavirus is the cause of the infection.

How is it treated?

The virus itself has no treatment. However, various treatments exist for the genital warts it sometimes causes.

Recovery Time

As there is no treatment for the virus, it will most likely be carried for life, and thus there is no time line for recovery.

Can I have sex?

Yes. However, partners should be informed of your condition and condoms should always be used.

Can I get re-infected?

Yes. There are many strains of HPV and even if you carry one strain, you can still be infected with another.

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