HPV: Those three little letters can certainly cause a lot of confusion. Maybe you’ve heard your mom or your friends or characters on the HBO TV show GIRLS talk about it, but what the heck is it, anyway? How do you get it? Is it fatal? You probably know that it has something to do with sex, but chances are, you’ve got questions. No worries. We’ve dug up the answers to just about every question that you could ever think to ask about HPV. Read up so you can separate fact from fiction, educate yourself about the virus, and wow your classmates in the school cafeteria with everything that you learned.
What is HPV?
HPV stands for human papillomaviruses. That’s right—there’s more than just one strain. Believe it or not, there are more than 100 strains of HPV! About 60 of the strains are not sexually transmitted and cause warts on the hands, feet and other body parts, just by skin-to-skin contact. There needs to be a tiny cut, abrasion or tear in the outer layer of the skin for transmission to occur. More than 40 of the strains can be transmitted from person-to-person through vaginal sex, oral sex and anal sex. Unlike some sexually transmitted viruses, HPV isn’t transmitted through semen or vaginal secretions, but again through direct skin-to-skin contact whenever there is a nick in the outer layer of the skin. That’s a bummer, because it means that even if you rub your vagina against a penis (without having actual intercourse), there’s a chance that you can still contract HPV. That’s the main way that people get HPV. It’s technically also possible for a pregnant woman with genital HPV to pass the virus to her baby during delivery, but that’s rare.
When you contract HPV, it doesn’t infect your entire body. The virus doesn’t enter the bloodstream, so you can have an infection in one part of your body (like in your vagina, anus or mouth) but not in others. Another fast fact: It’s possible to be infected with more than one strain of HPV. As you’ll see in the next section, some strains are no big deal, but others are serious business.
Why is HPV potentially dangerous?
Some strains of the virus cause warts that you might get on your fingers or on the bottoms of your feet. These aren’t pretty, but they won’t seriously hurt you and they can usually be removed fairly easily with an over-the-counter remedy or by having a dermatologist freeze them off. Rare cases may require minor surgery. So are warts annoying? Yeah. But are they worth stressing about? Nah.
Other strains of the virus (which are usually dubbed “low-risk” strains) can cause genital warts. These are a little more severe than regular warts, because you can spread them to others during sexual activities. There’s also a chance that genital warts can cause problems during pregnancy. If the warts enlarge, they can make it hard to urinate. Warts on the walls of the vagina may not allow the vagina to stretch as much as it should during childbirth. There’s even a rare chance that a baby being delivered from a mom with genital warts can get warts in his or her throat, which could block the child’s airway. “Plus, sometimes they bleed and they can make you feel generally unclean,” says Jill Maura Rabin, M.D., a professor of obstetrics and gynecology at Hofstra North Shore-LIJ School of Medicine in Long Island, New York.
Genital warts are not life-threatening and they’re generally not painful, but the point is: They’re icky and you don’t want them. Then there are at least a dozen strains (which are commonly labeled “high-risk” strains) that can cause cancer. In women, they can cause cervical cancer, vaginal cancer or cancer of the vulva. In men, they can cause cancer of the penis. In women or men, they can cause cancer of the anus or oropharynx (that’s a fancy word for the soft palate, the base of the tongue and the tonsils), as well as oesophagal cancer (cancer of the throat). Cancer, of course, is the most serious consequence of all, since it can be fatal—especially if it’s not caught and treated early. Check out these startling stats to see just how much HPV is linked with cancer:
- Almost all cervical cancers are caused by HPV infections. Two strains in particular, 16 and 18, are the major culprits and cause roughly 70% of them.
- About 85% of anal cancers are caused by strain 16.
- Approximately half of penile, vaginal and vulvar cancers are caused by strains 16 and 18.
- More than 50% of cancers in the oropharynx are caused by strain 16.
I know. That’s a lot to take in, and it’s all pretty scary. So here’s some good news that might perk you up: Even if you do get infected with a “high-risk” strain, most “high-risk” strains disappear on their own within 1 to 2 years, and though they might cause some abnormal cell changes, they won’t cause cancer. When a “high-risk” strain sticks around for several years, that’s when an infection is more likely to progress into cancer. The other thing to keep in mind is that there are easy ways to reduce your risk of getting HPV in the first place, so you don’t have to deal with any of this (more on that below!).
Who is at risk for HPV?
Well, anyone who has vaginal, anal or oral sex (or even rubs their genitals against someone else’s genitals, as I mentioned earlier) can become infected with HPV. It can happen whether you’re straight or gay. “You might think that you’re invincible when you’re a teenager, but nobody is. Anybody can get infected with HPV,” says Dr. Rabin. It’s also worth noting that people who have weak immune systems (like those with HIV infections) and are infected with HPV are at higher risk of complications. They may be less able to fight off an HPV infection and therefore are more likely to develop health problems from it.
How common is HPV?
It’s super common, so if you develop an HPV infection, you’re definitely not alone. HPV infections are the most common STIs (sexually transmitted infections) in the country. More than 50% of sexually active people will contract HPV at some point in their lives. And get this: About 79 million Americans are currently infected with HPV. Whoa.
How can I prevent an HPV infection?
The truth is, abstaining from sexual contact of any kind (i.e. not having vaginal sex, anal sex, oral sex or even rubbing your genitals on another person’s genitals) is the only foolproof way to prevent HPV, but there are ways to have safe sex that will reduce your risk. Having only one sexual partner (especially one who is a virgin, has gotten an HPV vaccination and doesn’t cheat) or keeping your number of sexual partners low decreases your odds of getting HPV because it limits your exposure. But just to be clear: It is possible to get infected from even just one sexual partner. Just like with pregnancy, it takes only one time.
You might think: Why don’t I just look for symptoms on a guy or ask a guy if he has HPV before we get busy? That’s a smart idea. The only problem? Unless a guy has genital warts that you can see, most guys don’t exhibit any symptoms of HPV if they’re infected. To make matters worse, there is no HPV test for men, so if they have it, they won’t even know. Using a condom every single time you have sex of any kind (vaginal, anal or oral) is a MUST. Condoms aren’t perfect, because they don’t cover every inch of a guy’s skin down there, but studies show that they decrease the chances of HPV transmission. (Condoms, of course, also help prevent unplanned pregnancy and other sexually transmitted infections, such as HIV. So using one is a total no-brainer!)
The other really, really important thing that you can do to help protect yourself is get an HPV vaccination from your doctor. By the way, consider yourself super lucky, because the first-ever HPV vaccination got approved by the Food and Drug Administration (FDA) only eight years ago! Tons of generations before you didn’t have this opportunity, but you do, so do yourself a favor and take advantage of it. Any girl between the ages of 9 and 26 can—and should—receive an HPV vaccination. The national Advisory Committee on Immunization Practices recommends that girls get it at age 11 or 12. Why so early? “The younger you are, the better your antibody response will be,” says Dr. Rabin. “Plus, the vaccination is most effective before you become sexually active.” In other words, once you’re exposed to HPV, the vaccination doesn’t work as well.
That said, “Getting the vaccination at any age is still better than not getting it, because it’ll still provide some protection,” says Ricki Pollycove, M.D. a gynecologist in private practice in San Francisco, California. There are two types of HPV vaccines that have been approved by the FDA. One is called Gardasil, and it helps prevent cervical, anal, vulvar and vaginal cancer, as well as precancerous lesions in these tissues and genital warts. The other is called Cervarix and it helps prevent cervical cancer and precancerous cervical lesions (but not the other stuff). An HPV vaccination is given over the course of six months as a series of three shots in the upper arm or upper thigh. The ideal schedule is to get the second shot two months after the first shot and then the third shot six months after the first shot. “It’s best to get all three shots within six months or at least within a year, because that momentum enables your body to produce more antibodies,” says Dr. Rabin.
Why are some people freaked out by the HPV vaccination?
There is a lot of misinformation out there about HPV vaccination, so don’t believe everything that you hear. Sometimes chain emails float around that say frightening things, but they’re not usually backed up by facts. For instance, some moms worry that getting their daughters vaccinated will make their little girls want to become sexually active. Researchers studied this claim and found there was no significant difference in pregnancy rates, pregnancy testing or contraceptive counseling among girls who got the HPV vaccine and girls who didn’t. Translation: It’s a bogus argument!
Some people think that the vaccine doesn’t work, but studies have shown the exact opposite—that it works incredibly well. One report found that in the three years before Gardasil (the first-ever HPV vaccine) existed, prevalence of HPV among girls between the ages of 14 and 19 was 11.5%. In the three years after, prevalence in that age range was cut by more than half, down to 5.1%. And only one third of those girls got the HPV vaccination! If all of them had been vaccinated, the drop probably would have been much steeper.
Others think that the vaccine isn’t safe, which is false. Study after study has shown that getting the HPV vaccination isn’t riskier than getting any other type of vaccination. Since 2006, over 57 million doses have been given to girls. There is an extremely rare chance (about 0.29 percent) of experiencing a “serious” side effect, such as headache, nausea, vomiting, fatigue, dizziness, fainting and general weakness. The CDC even investigated claims that some deaths were attributed to getting the HPV vaccination, but investigators found that there was nothing linking the girls’ deaths to the HPV vaccination.
One researcher who helped with Gardasil’s clinical trials (Diane Harper, MD) has pointed out that the vaccine’s protection may fade after five years—and this is a possibility. The long-term effectiveness of the HPV vaccine is unknown because it’s fairly new, but that’s not a reason to resist getting vaccinated. It just means that if future studies show that the vaccine’s effectiveness wears off later in life, you might need a booster shot.
Another argument you might hear: “You can get a Pap smear to prevent cervical cancer, so why bother getting an HPV vaccination?” That’s incorrect. A Pap smear helps you detect cervical cancer, but it doesn’t stop you from getting cancer in the first place. And lots of women don’t get Pap smears as regularly as they should, because they cost money. Besides, HPV can infect other areas of your body besides the cervix. The bottom line: Lots of research shows that the HPV vaccination is extremely safe and extremely effective. “It protects you very, very well from getting genital warts and cervical cancer—and neither of those is fun,” says Dr. Rabin.
Can my boyfriend get the vaccine?
Yep! One of the two HPV vaccinations, Gardasil, is recommended for boys who are 11 and 12 years old and for any boys between the ages of 13 and 21 who didn’t get the shots when they were younger. Men who are gay or bisexual can get the vaccination until they’re 26 years old. The vaccination can help protect against genital warts and anal cancer.
How do I know if I have a low-risk or high-risk HPV infection?
If you develop any symptoms of genital warts, that’s one way to know that you have a low-risk infection. You’d see a small bump or a group of bumps on or around your genitals. They might be little or big, raised or flat, or shaped like a cauliflower. These warts might develop within weeks or even months of sexual contact with an infected person (even if that person did not have genital warts when you had sex with him or her). Remember that it’s a bad idea to diagnose yourself—see a doctor to make sure. (For information on how to treat genital warts, keep reading.)
Cervical cancer caused by high-risk HPV strains doesn’t usually cause symptoms until it’s advanced, so getting regular screenings is key. Women should start getting a regular Pap test at age 21, because that helps a gynecologist detect any precancerous or cancerous lesions caused by HPV in the cervix. Ladies should also start getting an HPV test, which checks for “high-risk” HPV strains that may cause cervical cancer, at age 30. Your gynecologist will examine the results of these two tests to figure out whether you need more frequent monitoring or treatment. There are not currently any routine screenings to help detect other high-risk HPV-related cancers.
What happens if I get genital warts or high-risk HPV?
If you get genital warts, there are various types of treatments that may provide relief. The first line of treatment is usually a prescription medicine that’s applied to the skin. For example, there is Imiquimod, a cream that boosts your immune system’s ability to fight them. There are plant-based resins called podophyllin and podofilox, which destroy genital wart tissue. There is also trichloroacetic acid, which burns off the genital warts. (Do not use over-the-counter treatments for regular warts on genital warts! The genital area is moist, so doing this may cause pain and irritation.)
The second line of treatment, a doctor might freeze them off, use an electrical current or laser to burn them off, or extract them surgically.
If you don’t treat genital warts, they might go away, they might stay the same or they might grow or increase in number. Every person is different. When it comes to having a high-risk HPV infection, in many cases, a gynecologist will suggest that you simply wait it out and come back for another exam in six months to see if your body clears the infection on its own.
If the infection causes abnormal cell changes or precancerous lesions in the cervix, then your gynecologist might need to perform a colposcopy or a biopsy. A colposcopy is like a more intense version of a Pap smear, where a gynecologist uses an instrument called a colposcope to examine your cervix, vagina and vulva for signs of disease. It’s done in the doctor’s office while you’re lying on your back and your feet are in stirrups and it takes about 10 minutes. A biopsy is when a doctor takes a small pieces of your cervix to test it in a lab.
If you have precancerous cervical lesions, your gynecologist might treat them using cryosurgery (freezing), loop electrosurgical procedure (uses a hot wire), surgical conization (surgery with a laser or scalpel) or laser vaporization conization (uses a laser). If you have precancerous lesions that aren’t on the cervix but are on the vagina, vulva, penis or anus, then a doctor might use topical chemicals, drugs, surgery, cryosurgery, electrosurgery or laser surgery to get rid of them.
Worst case scenario: If a high-risk HPV strain lingers and your doctor detects cervical cancer, then more tests are likely necessary, which could include X-rays, CT scans, MRIs and PET scans to see if the cancer has spread beyond your cervix. Treatment of cervical cancer may involve surgical removal of the cancer, uterus and cervix (which makes getting pregnant afterwards impossible). Radiation and/or chemotherapy could also be used.
If you have a high-risk HPV infection that’s not in the cervix, it’s unfortunately harder to detect because there are no regular screenings for the other types of cancer that HPV causes. You’d just have to look out for any unusual symptoms in the throat, vagina, vulva, anus, or penis and tell a doctor as soon as possible.
If I get an HPV infection, how can I prevent complications?
Women can lower their risk of developing cervical cancer by getting routine gynecological screenings starting at age 21. The earlier cervical cancer is caught, the easier it is to treat. You can reduce your risk of oropharyngeal cancer by not smoking and by limiting alcohol intake.
Is HPV the same thing as HIV or Herpes? No. They all start with “H,” they’re all viruses and they can all be spread during sexual acts, but they’re different types of infections. HIV is the virus that causes AIDS. Herpes causes uncomfortable (but not life-threatening) outbreaks of blisters around the genitals, rectum or mouth.
How can I find out more about HPV?