Discover HPV: causes, symptoms, prevention, and vaccination. Meri Sehat provides valuable insights to help you make informed decisions for your well-being.

Human Papillomavirus (HPV)

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Iqra Mazhar

Overview

The human papillomavirus (HPV) is a non-enveloped, double-stranded, circular DNA virus responsible for a number of epithelial lesions and cancers. 
&nbsp;

Human Papillomavirus (HPV) is a common sexually transmitted infection caused by a group of more than 100 related viruses. Most HPV infections are harmless and go away on their own, but some types can cause serious health problems, such as genital warts and cancer. The prevalence of Human Papillomavirus (HPV) varies based on several factors, including age, gender, sexual behavior, and geographic region.

HPV is the most common sexually transmitted infection (STI) worldwide, affecting more than 50% of sexually active young adults<a href="#accordion">[9]</a>. College-going students report the highest number of cases. Women are more likely to be infected with HPV than men, in part due to the greater likelihood of cervical exposure to the virus during sexual activity. The prevalence is highest among women aged 20-24 years (44.8%)<a href="#accordion">[9]</a>. Additionally, having unprotected sex with multiple partners or engaging in sexual activity at a young age increases the risk of HPV infection.

HPV prevalence varies widely by geographic region, with higher infection rates in developing countries, and among certain populations, such as men who have sex with men. According to the Centers for Disease Control and Prevention (CDC), an estimated 79 million Americans are currently infected with HPV, and about 14 million people become newly infected each year in the United States alone<a href="#accordion">[8]</a>.

The majority of people who contract HPV will not experience any symptoms and will clear the infection on their own, but some will go on to develop HPV-related health problems, such as genital warts or <a href="https://merisehat.pk/disease/cervical-cancer">cervical cancer</a><a href="#accordion">[2]</a>. 
&nbsp;

There are over 100 different types of Human Papillomavirus (HPV), but not all of them cause health problems. HPV types are classified into two categories: low-risk HPV and high-risk HPV. 
&nbsp;

<ol>
	<li>&nbsp;Low-risk HPV: This type of HPV is less likely to cause cancer but can cause genital warts and other benign (non-cancerous) growths. Examples of low-risk HPV types include HPV subtypes 6 and 11. 
	&nbsp;</li>
	<li>&nbsp;High-risk HPV: This type of HPV is more likely to cause cancer, particularly of the cervix, anus, oropharynx (back of the throat), and genitals. Examples of high-risk HPV types include HPV subtypes 16, HPV 18, HPV 31, HPV 33, and HPV 45. HPV 16 and 18 are responsible for approximately half of high-grade cervical pre-cancer cases<a href="#accordion">[3]</a>. 
	&nbsp;</li>
</ol>

It&#39;s important to note that having a high-risk HPV infection does not necessarily mean that a person will develop cancer. Most HPV infections, even those with high-risk types, will clear up on their own without causing any health problems. However, certain high-risk HPV types are more likely to persist and cause abnormal cell changes that can lead to cancer if left untreated. 
&nbsp;

Signs and Symptoms

The signs and symptoms of HPV vary depending on the body part that is affected. Moreover, oftentimes, HPV infection does not cause any symptoms. Approximately 90% of HPV infections spontaneously resolve on their own<a href="#accordion">[8]</a>. However, in some cases, the virus does not clear on its own, resulting in these warts: 
&nbsp;

<ul>
	<li>Genital Warts - These are small, flat cauliflower-like lesions. In women, they mostly develop on the vulva, but can also appear on the vagina, cervix, and near the anus. In men, genital warts mostly develop on the scrotum, penis, or around the anus. While genital warts can be itchy or tender, they rarely cause pain or discomfort.</li>
</ul>

<ul>
	<li>Common Warts - These are rough, raised lesions that mostly occur on the fingers and hands. Common warts can be painful and injure or bleed easily.</li>
	<li>Plantar Warts - Plantar warts typically occur on the heels or the balls of the feet. They are hard, grainy growths that might cause discomfort.</li>
	<li>Flat Warts - Flat warts can develop anywhere but are most common on the face in children. In men, the flat-topped, slightly raised lesions typically appear in the beard region, while on the legs in women. 
	&nbsp;</li>
</ul>

Important!

HPV infections are linked to several cancers. These include the following:

<ul>
	<li>Cervical Cancer - Although all cervical cancers are caused by HPV infections, it can take 20 years or more for an HPV infection to develop into cancer. Early cervical cancer does not typically appear with any noticeable symptoms. Therefore, regular screening tests are necessary to detect any precancerous cervical changes.</li>
	<li>Anal Cancer - Both men and women can develop anal cancer from an HPV infection. However, it is more common in HIV-infected individuals and men who have sex with other men. Rectal bleeding and an anorectal mass are common symptoms of anal cancer.</li>
	<li>Vulvar Cancer - Although rare, HPV can also result in vulvar cancer.</li>
	<li>Vaginal Cancer - A majority of precancerous vaginal lesions contain HPV. Vaginal cancers can also result from HPV infections.</li>
	<li>Mouth And Throat Cancer - Throat cancer, which affects the back of the throat, base of the tongue, and tonsils, is the most common HPV-related cancer in men.</li>
	<li>Penile Cancer - HPV infection can also cause cancer of the penis. 
	&nbsp;</li>
</ul>

Note: If you notice any abnormal growths or bumps near the anus or genital area, contact a healthcare professional. 
&nbsp;

Causes

The human papillomavirus generally enters the body through a cut, abrasion, or tiny skin rip. It is primarily spread by skin-to-skin contact. Direct contact with a wart can spread the virus further. Sexual activity, anal sex, oral sex, and other skin-to-skin contacts in the genital area can all lead to genital HPV infections. HPV infections are not contracted by sharing food or utensils, holding hands, swimming pools, toilet seats, or being unclean.

&nbsp;Furthermore, it&#39;s possible for pregnant women with genital warts and an HPV infection to pass the infection to their babies. Occasionally, the infection can result in a non-cancerous growth in the infant&#39;s voice box (larynx). 
&nbsp;

Screening for HPV typically involves testing for the presence of the virus in cervical cells, which is done through a Pap smear or HPV test: 
&nbsp;

<ol>
	<li>&nbsp;Pap Smear: During a Pap smear, a healthcare provider will use a small brush or spatula to collect a sample of cells from the cervix. The cells are then examined under a microscope to look for any abnormalities. While a Pap smear does not directly test for HPV, it can detect changes in the cervical cells that may be caused by an HPV infection.</li>
	<li>&nbsp;HPV Test: An HPV test looks for the presence of the virus in cervical cells. This test is typically recommended for women over the age of 30, as HPV infections in younger women often go away on their own. The HPV test may be done at the same time as a Pap smear, or a healthcare provider may collect a separate sample of cervical cells for the test. 
	&nbsp;</li>
</ol>

Both the Pap smear and HPV test are relatively simple procedures that can be done during a routine visit with a healthcare provider. It is important for individuals at risk for HPV to get screened regularly, as early detection can help prevent the development of cervical cancer.

Current guidelines suggest that regardless of when they first engage in sexual activity, women should undergo their first Pap smear at age 21. As per the US Preventive Services Task Force (USPSTF) guidelines, women aged 21 to 29 should have a Pap test every 3 years<a href="#accordion">[6]</a>. Whereas, women aged 30 to 65 years, can choose one of the following: 
&nbsp;

<ul>
	<li>Pap test every three years</li>
	<li>HPV test every five years; as it will screen for high-risk types of HPV</li>
	<li>Both tests together every five years; also known as co-testing 
	&nbsp;</li>
</ul>

The USPSTF prefers standalone tests over co-testing.

The HPV DNA test has only been approved for use in women. The CDC does not recommend routine screening for anal, throat, or penile cancers in men. For males who have a higher chance of developing anal cancer, some doctors may do an anal Pap test. 
&nbsp;

Diagnosis

A physical examination of the warts is often enough to diagnose an HPV infection. If genital warts are not visible, the doctor may order the following tests: 
&nbsp;

<ul>
	<li>Pap smear</li>
	<li>HPV DNA test</li>
	<li>Vinegar (acetic acid) solution test - A vinegar solution is applied to the genital areas to help identify non-obvious flat lesions. The HPV-infected area turns white and can then be evaluated using colposcopy.&nbsp; 
	&nbsp;</li>
</ul>

If abnormal cells are detected on a Pap test or HPV test, further testing or treatment may be recommended, such as a colposcopy (an exam of the cervix using a special magnifying device) or a biopsy (a sample of tissue is taken from the cervix for testing).

The doctor will check for cervical abnormalities if any of these strains are present. A colposcopy, for example, may be recommended as a follow-up procedure by the doctor.

Infections with HPV frequently fade away on their own without generating cancer, and cervical alterations that eventually result in cancer frequently take several years to manifest. Instead of receiving treatment for abnormal or precancerous cells, a careful waiting strategy can be adopted. 
&nbsp;

Treatment

There is no cure for Human Papillomavirus (HPV) infection, but there are treatments available for the health problems that can be caused by the virus. Treatment options for HPV-related health problems may include: 
&nbsp;

<ol>
	<li>&nbsp;Warts: Warts can be removed through various methods, such as topical creams, cryotherapy (freezing), electrocautery (burning), or surgery. Some common medications include salicylic acid, imiquimod, podofilox, and trichloroacetic acid.</li>
	<li>&nbsp;Cancer: Treatment options for HPV-related cancers may include surgery, radiation therapy, chemotherapy, or a combination of these. 
	&nbsp;</li>
</ol>

Prevention is key when it comes to HPV, as there is no cure for the virus. The HPV vaccine is highly effective at preventing infection with the most common high-risk HPV types, as well as the low-risk types that cause genital warts. Additionally, practicing safe sex, using condoms, and limiting sexual partners can help reduce the risk of HPV transmission. It&#39;s important to note that not all HPV infections require treatment. Many HPV infections will clear up on their own without causing any health problems, especially in young people with healthy immune systems. 
&nbsp;

Human Papillomavirus (HPV) can cause several complications, including: 
&nbsp;

<ol>
	<li>&nbsp;Cervical Cancer: Certain types of HPV can cause abnormal changes to the cells of the cervix, which can eventually lead to cervical cancer. Regular Pap tests can detect these changes early, allowing for early treatment and prevention.</li>
	<li>&nbsp;Other Cancers: HPV infection can also increase the risk of other types of cancer, such as anal, penile, vaginal, and oropharyngeal cancer.</li>
	<li>&nbsp;Recurrent Respiratory Papillomatosis (RRP): RRP is a rare condition in which HPV infects the respiratory tract, causing warts to grow on the vocal cords and other parts of the airway. This can lead to hoarseness, difficulty breathing, and other respiratory problems. 
	&nbsp;</li>
</ol>

There are several factors that can increase a person&#39;s risk of contracting Human Papillomavirus (HPV), including: 
&nbsp;

<ol>
	<li>&nbsp;Sexual Behavior: Having unprotected sex with multiple partners or engaging in sexual activity at a young age increases the risk of HPV infection.</li>
	<li>&nbsp;Weak Immune System: People with weakened immune systems, such as those living with HIV/AIDS or taking immunosuppressive drugs, are more susceptible to HPV infection and its complications.</li>
	<li>&nbsp;Smoking: Smoking cigarettes or using other tobacco products can weaken the immune system and make it more difficult for the body to fight off HPV infection.</li>
	<li>&nbsp;Gender: Women are at a higher risk of developing HPV-related health problems, such as cervical cancer, than men.</li>
	<li>&nbsp;Genetics: Certain genetic factors may make some people more susceptible to HPV infection or more likely to develop complications from the virus. 
	&nbsp;</li>
</ol>

There are several preventive measures that can reduce the risk of contracting Human Papillomavirus (HPV), including: 
&nbsp;

<ol>
	<li>&nbsp;Vaccination: HPV vaccines are available to protect against the most common types of virus that can cause cancer and genital warts. The CDC recommends routine HPV vaccination for boys and girls starting at age 11 or 12. The U.S. Food and Drug Administration has approved the HPV vaccine Gardasil 9 for use in both men and women to prevent genital warts and cervical cancer.</li>
	<li>&nbsp;Safe Sex Practices: Using condoms during sexual activity can reduce the risk of HPV transmission, although they are not 100% effective since the virus can be spread through skin-to-skin contact.</li>
	<li>&nbsp;Regular Pap Tests: Cervical cancer screenings, such as Pap tests, can detect abnormal cells early before they develop into cancer, allowing for early treatment and prevention.</li>
	<li>Healthy Lifestyle Choices: Maintaining a healthy immune system through proper diet and exercise, avoiding tobacco products, and quitting alcohol can help reduce the risk of HPV and other infections. 
	&nbsp;</li>
</ol>

A 2019 study published in the Journal of the National Cancer Institute explored the use of Artificial Intelligence algorithms to analyze cervical images and detect precancerous changes caused by HPV. The study found that the AI system was able to detect high-grade precancerous lesions with a higher accuracy rate than traditional Pap tests<a href="#accordion">[7]</a>. 
&nbsp;

Key Points

<ul>
	<li>A non-enveloped, double-stranded, circular DNA virus called the human papillomavirus (HPV) is responsible for a number of epithelial (cells that line the internal and external surfaces of the body) lesions and cancers.</li>
	<li>Most HPV infections are harmless and go away on their own, but some types can cause serious health problems, such as genital warts and cancer.</li>
	<li>HPV is most commonly found in sexually active people aged 15 to 24 years old, but it can affect people of all ages.</li>
	<li>According to the Centers for Disease Control and Prevention (CDC), an estimated 79 million Americans are currently infected with HPV, and about 14 million people become newly infected each year in the United States alone.</li>
	<li>HPV types are classified into two categories: low-risk HPV and high-risk HPV.</li>
	<li>Examples of low-risk HPV types include HPV 6 and HPV 11.</li>
	<li>Examples of high-risk HPV types include HPV 16, HPV 18, HPV 31, HPV 33, and HPV 45.</li>
	<li>&nbsp;Most HPV infections, even those with high-risk types, will clear up on their own without causing any health problems.</li>
	<li>The human papillomavirus generally enters the body through a cut, abrasion, or tiny skin rip. It is primarily spread by skin-to-skin contact. Direct contact with a wart can spread the virus further.</li>
	<li>Sexual activity, anal sex, oral sex, and other skin-to-skin contacts in the genital area can all lead to genital HPV infections.</li>
	<li>HPV infections are not contracted by sharing food or utensils, holding hands, swimming pools, toilet seats, or being unclean.</li>
	<li>Furthermore, it&#39;s possible for pregnant women with genital warts and an HPV infection to pass the infection to their babies. Occasionally, the infection can result in a non-cancerous growth in the infant&#39;s voice box (larynx).</li>
	<li>Screening for HPV typically involves testing for the presence of the virus in cervical cells, which is done through a Pap smear or HPV test.</li>
	<li>While a Pap smear does not directly test for HPV, it can detect changes in the cervical cells that may be caused by an HPV infection.</li>
	<li>An HPV test looks for the presence of the virus in cervical cells. This test is typically recommended for women over the age of 30, as HPV infections in younger women often go away on their own.</li>
	<li>It is important for individuals at risk for HPV to get screened regularly, as early detection can help prevent the development of cervical cancer.</li>
	<li>Just a Pap test should be performed every three years on women aged 21 to 29.</li>
	<li>Standalone tests are given preference over co-testing, as per the USPSTF recommendations.</li>
	<li>The HPV DNA test is only available to diagnose HPV in women, it&#39;s vital to remember that men can&#39;t currently be diagnosed with HPV using an FDA-approved test.</li>
	<li>For males who have a higher chance of developing anal cancer, some doctors may do an anal Pap test.</li>
	<li>There is no cure for Human Papillomavirus (HPV) infection, but there are treatments available for the health problems that can be caused by the virus.</li>
	<li>Warts can be removed through various methods, such as topical creams, cryotherapy (freezing), electrocautery (burning), or surgery.</li>
	<li>&nbsp;Treatment options for HPV-related cancers may include surgery, radiation therapy, chemotherapy, or a combination of these.</li>
	<li>RRP is a rare condition in which HPV infects the respiratory tract, causing warts to grow on the vocal cords and other parts of the airway.</li>
	<li>People with weakened immune systems, such as those living with HIV/AIDS or taking immunosuppressive drugs, are more susceptible to HPV infection and its complications.</li>
	<li>The CDC recommends routine HPV vaccination for boys and girls starting at age 11 or 12.</li>
	<li>The U.S. Food and Drug Administration has approved the HPV vaccine Gardasil 9 for use in both men and women to prevent genital warts and cervical cancer. 
	&nbsp;</li>
</ul>

[1] Luria L, Cardoza-Favarato G. Human Papillomavirus. [Updated 2022 Jan 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

[2] Std Facts - Human papillomavirus (HPV) (2022) Centers for Disease Control and Prevention. Centers for Disease Control and Prevention.

[3] Cervical cancer (no date) World Health Organization. World Health Organization.

[4] HPV and cancer (no date) American Cancer Society.

[5] Human papilloma virus (HPV) (2019) Harvard Health.

[6] HPV infection (2021) Mayo Clinic. Mayo Foundation for Medical Education and Research.

[7] Hu, L., Bell, D., Antani, S., Xue, Z., Yu, K., Horning, M. P., Gachuhi, N., Wilson, B., Jaiswal, M. S., Befano, B., Long, L. R., Herrero, R., Einstein, M. H., Burk, R. D., Demarco, M., Gage, J. C., Rodriguez, A. C., Wentzensen, N., … Zhang, W. (2019). An Observational Study of Deep Learning and Automated Evaluation of Cervical Images for Cancer Screening. Journal of the National Cancer Institute, 111(9), 923–932.