Human Papillomavirus (HPV) Infection Diagnosis and Treatment

Is HPV a sexually transmitted infection (STI)?

Yes, HPV is classified as a sexually transmitted infection because it is primarily spread through sexual contact. Its prevalence is high around the globe, with the majority of sexually active individuals contracting the virus at some point.

Is there a difference between genital and oral Human papillomavirus infection?

The same forms of human papillomavirus that cause infection in the genital region can also infect the mouth and throat. Certain oral human papillomavirus strains can lead to cancers in the mouth lining and throat cancers as well, while others may cause warts in these areas. Like genital HPV, most oral HPV infections resolve without causing significant issues.

How contagious is HPV, and how is it transmitted?

HPV is extremely communicable. The virus can be spread through direct contact with infected skin or surfaces, even in the absence of visible symptoms. This includes:

• Contaminated surfaces: Using communal areas, such as public showers or changing rooms, may pose a minor risk.
• Skin-to-skin contact: Touching infected areas.
• Sexual contact: Vaginal, anal, or oral sex with an infected person.

Can HPV affect pregnancy?

Although HPV infections can occur when a woman is pregnant, they rarely lead to complications such as premature birth or miscarriage. In very few cases, an active HPV infection can be transmitted to the baby during delivery, potentially causing respiratory papillomatosis, a condition where warts develop in the throat. Genital warts can typically be treated safely during pregnancy.

For how long will someone with HPV be contagious?

There is currently no cure for HPV itself, although most infections clear in due time. Treatments are available for conditions caused by the virus, such as warts and abnormal cervical cells.

Who is at risk of getting infected by the virus?

HPV is widespread, but certain factors can increase the risk of infection:

• A weakened immune system, such as in persons infected with HIV/AIDS.
• Having a partner with a history of multiple partners or having multiple sexual partners.
• Skin breaks, cuts, or abrasions which provide an entry point for the virus.

Symptoms of HPV in men and women

Women

Many women show no symptoms. Persistent HPV infections, however, can result in skin warts, genital warts, or cancerous and precancerous changes in the cells of the cervix. Regular cervical screening (such as Pap smears) can detect these changes early, preventing cervical cancer.

Men

Like women, most men experience no symptoms. However, some HPV strains can cause genital warts—raised lumps on the genital area that may vary in size and texture. Less commonly, HPV may lead to cancers of the anus, throat, or penis.

Are All Warts Caused by HPV?

Yes, all warts are caused by HPV, but it can get a bit tricky to understand. HPV is a group of viruses, and the strains that cause warts on your hands, feet, or genitals are different from the types that can lead to cervical cancer.

The strains of HPV responsible for warts, including genital warts, are generally harmless. For example, HPV types 6 and 11 are the most common causes of genital warts, while other strains are responsible for warts in different areas of the body, such as:

• Flat warts
• Plantar warts
• Periungual and subungual warts

It's essential to know that not all strains of HPV cause warts, and the types that may lead to cancer do not produce warts.

Testing for HPV

HPV testing is available as part of cervical screening programmes to detect the virus in the cervical cells. While these tests can confirm the presence of HPV, they cannot predict whether the infection will cause long-term issues.

Can HPV be treated or cured?

While the virus has no cure, there are medications available for HPV-related conditions:

• Abnormal cervical cells: Treated to prevent the development of cancer of the cervix.
• Genital warts: Treated with topical treatments like surgical removal, imiquimod or podofilox or freezing with liquid nitrogen
• Cancers: Early detection improves treatment outcomes significantly.

Can HPV cause cancer?

In some cases, certain HPV strains can cause cancers of the cervix, vagina, vulva, anus, penis, and oral cavity. Regular screenings and vaccination significantly reduce the risk.

How is HPV related to cervical cancer?

Some high-risk HPV strains, particularly types 16 and 18, can cause changes in cervical cells, a condition known as cervical dysplasia. If left untreated, cervical dysplasia can sometimes progress to cervical cancer.

In most cases, HPV infections clear up on their own in individuals under 30. However, in people over 30, detecting HPV during a Pap smear can indicate how frequently follow-up testing is needed. Testing positive for high-risk HPV doesn't mean you'll develop cancer, but it may increase your risk, requiring closer monitoring.

It's crucial to get regular Pap smears starting at age 21 to screen for cervical cancer. However, having HPV or cervical dysplasia doesn't necessarily mean you'll develop cancer—it's a precautionary measure to catch any changes early.

How long does it take for HPV to turn into cancer?

HPV itself doesn't directly cause cancer. Instead, some high-risk HPV infections can lead to precancerous cell changes, which may develop into cancer if left untreated. This process typically takes years or even decades. Routine screenings, such as Pap smears, can detect these changes early, allowing for timely treatment before cancer develops.

What tests can be done to diagnose an HPV infection?

Healthcare providers can often identify genital or other warts through a physical exam. However, high-risk HPV strains usually don't cause noticeable symptoms, meaning they are often detected during routine screenings like a Pap smear or HPV test.

• Pap smear: This test screens for cervical cancer and identifies precancerous cells that could potentially develop into cancer. Nearly all cases of cervical cancer are linked to high-risk HPV strains.
• HPV test: This test detects high-risk HPV strains that might lead to cervical cancer.

In some cases, additional procedures may be used to identify abnormal cells caused by HPV, such as:

• Colposcopy: A colposcope magnifies the cervix to identify and assess abnormal cells. Your provider may remove a sample for further testing (biopsy).
• Visual inspection with acetic acid (VIA): In areas without access to Pap smears, VIA involves applying a vinegar-based solution to the cervix. This solution highlights abnormal cells by turning them white.

How Is HPV Treated?

There is no treatment to eliminate the HPV virus itself, but treatments can remove visible warts or abnormal cervical cells. Common treatment options include:

• Cryosurgery: Freezing warts or abnormal cells with liquid nitrogen.
• Loop electrosurgical excision procedure (LEEP): Removing abnormal cells or warts using a thin wire loop.
• Electrocautery: Burning warts off with an electrical current.
• Laser therapy: Destroying warts or abnormal cells using a focused light beam.
• Cold knife cone biopsy: Removing a cone-shaped section of cervical tissue containing abnormal cells.
• Prescription creams: Applying medicated creams like imiquimod (Aldara®) or podofilox (Condylox®) to warts.
• Trichloroacetic acid (TCA): Using a chemical treatment to burn off warts.

It's worth noting that only a small number of people with high-risk HPV will develop abnormal cervical cells that need treatment to prevent cancer.

HPV vaccination

Vaccines, such as Gardasil 9 and Gardasil, provide protection against the prevalence of cancer-causing HPV types. Vaccination is recommended for boys and girls around the age of 11 or 12 before they become sexually active. The vaccine is safe and does not contain live virus, making it impossible to contract HPV from vaccination.

Vaccine Safety

HPV vaccines are generally well-tolerated, with mild side effects, including redness, swelling, or itching at the injection site. Rarely, some may experience dizziness, fainting, or mild fever, but these symptoms are temporary.

For more information about HPV, testing, or vaccination, contact us. Book an appointment with us today.