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HPV – Human Papillomavirus (HPV)
*There is now a vaccine for many forms of HPV – Anyone who is sexually active could benefit from the vaccine and, and all children ages 10-11 should receive the vaccine automatically before they become sexually active.
HPV is the most common sexually transmitted infection (STI). HPV is a different virus than HIV and HSV (herpes). HPV is so common that nearly all sexually active men and women get it at some point in their lives. There are many different types of HPV. Some types can cause health problems including genital warts and cancers. But there are vaccines that can stop these health problems from happening.
How is HPV spread?
You can get HPV by having vaginal, anal, or oral sex with someone who has the virus. It is most commonly spread during vaginal or anal sex. HPV can be passed even when an infected person has no signs or symptoms.
Anyone who is sexually active can get HPV, even if you have had sex with only one person. You also can develop symptoms years after you have sex with someone who is infected making it hard to know when you first became infected.
Health Problems
In most cases, HPV goes away on its own and does not cause any health problems. But when HPV does not go away, it can cause health problems like genital warts and cancer.
Genital warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. A healthcare provider can usually diagnose warts by looking at the genital area.
Does HPV cause cancer?
HPV can cause cervical and other cancers including cancer of the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils (called oropharyngeal cancer).
Cancer often takes years, even decades, to develop after a person gets HPV. The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers.
There is no way to know which people who have HPV will develop cancer or other health problems. People with weak immune systems (including individuals with HIV/AIDS) may be less able to fight off HPV and more likely to develop health problems from it.
How can I avoid HPV and the health problems it can cause?
Get vaccinated! HPV vaccines are safe and effective. They can protect males and females against diseases (including cancers) caused by HPV when given in the recommended age groups (see “Who should get vaccinated?” below). HPV vaccines are given in three shots over six months; it is important to get all three doses.
Get screened for cervical cancer. Routine screening for women aged 21 to 65 years old can prevent cervical cancer.
If you are sexually active
• Use latex condoms the right way every time you have sex. This can lower your chances of getting HPV. But HPV can infect areas that are not covered by a condom – so condoms may not give full protection against getting HPV;
• Be in a mutually monogamous relationship – or have sex only with someone who only has sex with you.
Magnitude of the Problem
Human papillomavirus (HPV) infection is the most common sexually transmitted infection in men and women in the United States. Most sexually active persons will acquire HPV in their lifetime. Recent data indicate that approximately 79 million persons are currently infected with HPV, and 14 million persons are newly infected each year in the United States (1).
Of the more than 150 different types of HPV, approximately 40 are transmitted through sexual contact and infect the anogenital region and other mucosal sites of the body. Mucosal HPV types are classified as either high-risk HPV (oncogenic) (e.g., types 16 and 18) or low-risk HPV (e.g., types 6 and 11). High-risk HPV causes many cancers of the cervix, vagina, vulva, penis, and anus. HPV16 is linked to many oropharyngeal cancers. Low-risk HPV causes anogenital warts and recurrent respiratory papillomatosis, a rare but important condition in which warts grow in the throat and airway. Most infections cause no symptoms and are not clinically significant, but persistent infection can lead to disease or cancer.
Recent U.S. population-based studies conducted by CDC show that 66% of cervical cancers, 55% of vaginal cancers, 79% of anal cancers, and 62% of oropharyngeal cancers are attributable to HPV types 16 or 18. Each year in the United States, an estimated 26,000 new cancers are attributable to HPV, about 17,000 in women and 9,000 in men (2).
Disparities exist in HPV-associated cervical cancer rates by race/ethnicity, with higher incidence rates among Hispanic, black, and American Indian/Alaskan Native women than among whites. HPV-associated vaginal cancers are slightly more frequent among blacks, and vulvar cancers are more frequent among whites. HPV-associated oropharyngeal cancers have been increasing in frequency among both sexes, more among males than females, as well as among most racial/ethnic groups, with the exception of blacks (3). HPV-associated anal cancers have increased among males and females across all racial/ethnic groups (3).
Evidence-Based HPV Prevention
Two HPV vaccines (bivalent and quadrivalent) are licensed by the Food and Drug Administration (FDA). Both vaccines are directed against HPV16 and HPV18, types that cause cervical cancers and other HPV-associated cancers. Quadrivalent vaccine is also directed against HPV6 and HPV11, types that cause anogenital warts. Data from clinical trials show that both vaccines, when given as a 3-dose series, have very high efficacy for prevention of vaccine type–associated cervical precancers (4–6) (Table). Quadrivalent HPV vaccine has been shown to prevent HPV16- and HPV18-associated vaginal, vulvar, and anal precancers (7,8) and HPV6- and HPV11-associated anogenital warts (9). The vaccines are prophylactic and do not prevent progression of existing infection to disease or treat existing disease (10). No clinical trial data are currently available to demonstrate efficacy for prevention of oropharyngeal or penile cancers. However, because many of these are attributable to HPV16, the HPV vaccine is likely to offer protection against these cancers as well.
The Advisory Committee on Immunization Practices (ACIP) recommends that girls and boys be routinely vaccinated at age 11 or 12 years; vaccine may be given starting at age 9 years (11–13). In addition, for those who were not vaccinated when they were younger, all girls/young women through age 26 years (12) and all boys/young men through age 21 years should be vaccinated (13). ACIP recommends that gay, bisexual, and other men who have sex with men be vaccinated through age 26 years (13). ACIP considered data on vaccine efficacy and safety, disease burden attributable to HPV, cost-effectiveness of vaccination, and programmatic issues to develop recommendations.
The HPV vaccine is covered by most private health insurance and government insurance programs. For uninsured, Medicaid-eligible children of American Indian/Alaska Native descent and underinsured persons aged ≤18 years, the Vaccines for Children Program (VFC) provides federally purchased vaccines recommended by ACIP at no cost to those eligible. Approximately 39% of adolescents aged 13–17 years are eligible for VFC vaccines; nationally, approximately 44,000 vaccination provider sites are enrolled in the VFC program (14). Most vaccine being used in the United States is quadrivalent HPV vaccine.
HPV infection causes warts. There are more than 100 varieties of human papillomavirus (HPV). Different types of HPV infection can cause warts on different parts of your body. There are more than 40 different strains of HPV that specifically affect the genital area. Most HPV infections don’t lead to cancer, but some types of genital HPV can cause cancer of the cervix — the passage between the vagina and the uterus. HPV is one of the most common causes of sexually transmitted disease in the world. Nearly 24 million Americans are infected with HPV. Some cause common skin warts, while about one third of the HPV types are transmitted by sexual contact and reside in genital tissue without causing warts. HPV infection often shows no symptoms—it is estimated that almost half of the women infected with HPV have no obvious symptoms.
The virus invades nerves cells and can reside there for life, causing periodic symptoms. Genital herpes infection is acquired by sexual contact with a partner having an outbreak of herpes sores in the genital area. Oral herpes can be transmitted to the genital area of a partner during oral sex. Some herpes infections may make people more likely to get an HIV infection if exposed to the virus. Reliable tests for HSV antibodies are now readily available. In addition, PCR tests can be used to detect herpes infection.
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