What is human papilloma virus (HPV)?
Human papilloma virus (HPV) is a contagious virus that is spread by skin-to-skin contact. It is the most common sexually transmitted infection in Canada.
HPV can infect the outer layer of skin and the smooth, moist linings of the mouth, the rectum, the anus and genital areas of people of all sexes and genders.
There are over 100 types of HPV. Many of these types cause the common warts that appear on hands and feet. Other low-risk types, usually HPV 6 and 11, cause genital warts. High-risk types such as HPV 16 and 18 have been linked to cancer, particularly cancer of the cervix.
For some people, HPV may go away without treatment. For many people, though, once you have an HPV infection, the virus stays in your body for a period of time. This means it is possible to have and pass on HPV, even if you do not have any symptoms.
What are genital warts?
Genital warts can appear in different forms, sometimes weeks, months or years after being infected with HPV. There can be one or many in the genital areas or around the anus. They can be flat or raised. When the warts are raised, they may look like cauliflower. The warts can be pink, brown or the same colour as your skin.
Genital warts can disappear or reappear over time.
What can increase the risk of a person getting an HPV infection?
- Being very young at the time you first have sexual intercourse
- A high number of sexual partners
- If your sexual partner has had many sexual partners
- A history of sexual abuse
- If you use tobacco and/or marijuana
- If your immune system is suppressed either by another condition or medications
- If you have an HIV infection
HPV is passed on by contact with the virus
HPV is passed on by skin-to-skin contact. Genital HPV infections are usually passed on by sexual contact with an infected person involving the mouth, throat, genital and/or anal area. HPV is the most common sexually transmitted infection. It affects up to three-quarters (75%) of sexually active people over a lifetime. Using a condom during sexual intercourse can protect some areas of the skin from HPV infection.
Once HPV is spread from partner to partner there are three ways in which the infection can present in the human body:
- Asymptomatic: a person may be infected and have no symptoms and not know they even have the infection. However, this does not stop the infected person from spreading the infection to their sexual partners.
- Genital warts: these are painless cauliflower-like growths or flesh-coloured bumps of different sizes that can grow around the genital area (e.g., the vulva, the vaginal wall, the penile or scrotal area or around the anal region). Direct skin-to-skin contact with these warts can lead to their spread from one sexual partner to another.
- Cancerous changes: after an infection with a high-risk type of HPV, the infection can change your body’s cells in the infected area from normal to abnormal. If these changes are not detected and left untreated for a long time, they can lead to the development of cancer.
How can you find out if you have an HPV infection?
Testing for HPV
Most HPV infections come and go without any symptoms. There is no routine test for HPV. It is possible to test for HPV directly, but this is not usually recommended because HPV is so common. Testing to find out the type of HPV does not give any extra information about when or how you were infected.
The presence of genital and/or anal warts may indicate an infection, and there is treatment that is available for the management of warts.
Looking for cervical changes
In people who have a cervix, a health-care provider may use a test called a Pap smear to look for signs of problems that, if left unmonitored, could lead to cervical cancer. A Pap smear is not recommended until at least age 21 and often not until age 25 in most regions of Canada. To do a Pap smear, a health-care provider uses a small tool to collect cells from the cervix. The cells are then inspected under a microscope.
Treatment for genital warts
Once genital warts are diagnosed, your health-care provider and you decide together which approach is best. There are a number of options for treating genital warts. Some treatments work better than others. Some treatments have risks or side effects, including causing some pain. These treatments will usually be avoided unless necessary. Which treatment is chosen will usually be based on the number, site and size of the warts. It will also be based on what you prefer, the cost and the side effects. Some people may choose not to have any treatment.
Genital warts can be treated with medications that are used either by the infected person or are applied by a health-care provider.
Treatments you can use yourself include the following:
- Imiquimod (Aldara), a cream that is put on the warts.
- Podofilox, a liquid put on the warts using a cotton swab.
Treatments done by a heath-care provider include the following:
- Cryotherapy: this is when liquid nitrogen is applied to the wart, usually as a spray.
- Tricholoracetic acid (TCA), which your doctor puts on the warts using a cotton swab.
- In rare cases, surgery may be needed to remove the warts.
Genital warts may go away and come back
Without treatment, genital warts may go away by themselves, or they may last for years. Even if they have been treated, genital warts may come back in time.
Early detection and prevention
By reading this article, you have taken a really important step in educating yourself about sexually transmitted infections (STIs). You can help detect an HPV infection early by checking your body for signs such as warts on your external genitalia and anal region. If you do find any, talk to your health-care provider about treatment options.
Talk to your sexual partner about what their experience has been in terms of number of sexual partners and what their STI status is. Although this conversation may not be easy, it is important for you and your partner.
If you are sexually active, it is important to use condoms or other forms of barriers (e.g., an oral/dental dam) correctly and consistently to protect against the spread of STIs and prevent pregnancy. Remember that even though you may use a condom, there may be an area of skin (e.g., the inner thigh or scrotal area) not covered by the condom that may have the HPV infection, which can still lead to its spread.
There are vaccines that protect against HPV
There are three vaccines on the market in Canada: Gardasil, Gardasil 9 and Cervarix.
The Gardasil vaccine provides immunity to two strains of HPV that are linked to cervical cancer (HPV 16 and 18) and two strains that are linked to genital warts (HPV 6 and 11). Gardasil 9 covers the same strains of HPV as regular Gardasil, as well as five additional strains. This is the vaccine recommended by the Canadian Pediatric Society and covered by most public vaccination programs. Both Gardasil and Gardasil 9 can be given to a person of any sex.
The Cervarix vaccine provides immunity to two strains, HPV 16 and HPV 18, and can be given to people who have a cervix.
All three vaccines are made up of small, non-infective particles of a virus that is like HPV.
It is ideal to have the vaccine before beginning sexual activity, but the vaccines are still important even if you are already sexually active. For more information, see the article on Human papillomavirus (HPV) vaccine.
