We asked a doctor everything you’ve ever wanted to know about HPV, the STI pretty much everyone has

There are a bunch of medical acronyms that can induce panic, and HPV—which stands for human papillomavirus—is one of them. Maybe you’ve heard how every sexually active person can get this virus. Or maybe you’ve seen those really intense commercials for the HPV vaccine that say how the virus can cause cancer. But what is HPV? To learn everything we could about this very common virus, HelloGiggles spoke with a specialist and got the 411 on HPV.

Even if you have HPV or have gotten the vaccine, you still may not understand exactly what HPV is. And you’re far from alone—many people don’t really know what HPV is (and yes, that includes the President of the United States). So HelloGiggles talked with gynecologic oncologist Deanna GK Teoh, MD, MS, who is an assistant professor at the University of Minnesota in the obstetrics, gynecology, and women’s health department, and she gave us answers to all the questions you’ve ever had about HPV.

The Centers for Disease Control and Prevention (CDC) notes that HPV is the most common sexually transmitted infection (STI) in the U.S., with 79 million people in their late teens and early 20s infected. STIs and sexually transmitted diseases (STDs) sound really scary, but there shouldn’t be a stigma around them—and that’s certainly the case for HPV, since nearly every person may come into contact with HPV at some point in their lives.

Not everyone who contracts the illness will experience symptoms, but HPV can cause genital warts and cancer. However, some people will get rid of HPV all on their own without it ever causing any issues. So learning about HPV and all its different forms will help you understand that you don’t have to live your life in fear.

What is HPV?

“HPV is the human papillomavirus. It is the virus responsible for 90% of cervical and anal cancers, 70% of vulvar cancers, 75% of vaginal cancers, 65% of penile cancers, and 70% of head/neck cancers.”

What are the different types?

“There are more than 100 types of HPV, but in general, the HPV types are divided into ‘high risk’ and ‘low risk.’ High-risk HPV strains are known to cause cancer, and the two most common types associated with cancer are HPV-16 and HPV-18. (They are responsible for 70% of cervical cancers; the other HPV high-risk types are responsible for the remaining 30%.) The low-risk HPV strains are not thought to cause cancer, but do cause genital warts.”

How is it spread?

“HPV is spread through sexual contact, and not just intercourse—manual, oral, and anal sexual acts are also responsible for transmitting HPV. Condom or other barrier use may decrease the risk, but does not eliminate it.”

What are the symptoms of HPV?

“HPV infection is asymptomatic. Almost all sexually active (unvaccinated) individuals will be infected with HPV at some point in their lives, and approximately 20% of women and men will have HPV detectable in the genital tract. Even when it is detectable in the genital tract, it is usually asymptomatic unless the infection has caused sequelae, such as genital warts, precancerous changes, or cancer. Precancerous changes or cancer can result in irregular vaginal bleeding, postmenopausal bleeding, or bleeding after sex, but can also be completely asymptomatic.”

If I don’t have HPV symptoms, do I need to worry about it?

“Yes, you still need to worry about HPV even without symptoms. As mentioned above, precancerous lesions may have no symptoms at all, but if left untreated they have a 30% risk of progression to cancer. However, if precancerous lesions are treated and monitored appropriately after treatment, they have a low risk of progressing to cancer.”

How does it impact women and men differently?

“Because men do not have a cervix and cannot get cervical cancer, women are at higher risk of HPV-related cancers than men. Although men are at risk of penile and anal cancer, these cancers are rarer than cervical cancer, and actually, a majority of individuals with anal cancer (60%) are women.

Despite this, it is notable that the prevalence of HPV-related head and neck cancers is increasing faster than the incidence of any other HPV-related cancer—and the prevalence has recently surpassed that of cervical cancer. The majority of individuals with HPV-related head/neck cancers are men. Unfortunately, at this time, there is no screening test for head/neck cancers.”

How do you treat HPV?

“There is no treatment for HPV. There are treatments available for genital warts, or for precancerous lesions of the cervix, vulva, vagina, and anus, which decrease the risk of progression to cancer. But because the virus is still present, individuals treated for these precancerous lesions need to continue long-term follow-up since they are at risk for recurrence of the precancerous changes.”

Is there a cure?

“There is no medical cure for HPV at this time. Ninety percent of individuals who are infected with HPV will clear the virus on their own. Non-smokers and individuals with an intact immune system are more likely to clear the virus spontaneously, but even some individuals without any risk factors will have persistent disease and be at risk for precancerous lesions or cancer.”

How can you prevent it?

“The best way to prevent HPV is to get vaccinated before you are exposed to the virus.”

Who should get the HPV vaccine?

“The HPV vaccine is recommended for both girls and boys 11-12 years of age, but can be started as young as 9 years. For those who start the vaccine series prior to age 15 years, only two shots of the vaccine are necessary. For men and women up to age 26 years who have not received the vaccine, vaccination is still recommended, but between ages 15-26 years three shots are recommended. The younger you are when you get the vaccine, the more efficacious it is. The FDA is currently reviewing whether to approve vaccination up to age 45 years, but at this time it is only recommended up to age 26 years.”

What does the HPV vaccine protect against?

“The four-strain HPV vaccine protects against HPV-6 and -11 (both low-risk types but the most common cause of genital warts) and HPV-16 and -18 (high-risk types and the most common causes of cervical cancer). The newer nine-strain vaccine covers the low-risk HPV-6 and -11, as well as the high-risk strains HPV-16, -18, -31,-33, -45-, 52, and -58. Studies have shown that the HPV vaccine is also protective against some strains not specifically targeted by the vaccine.”

Are there any side effects to the vaccine?

“The HPV vaccine is safe. The most common reactions are injection site reactions (pain, swelling, redness) and fainting. Neither of these side effects is specific to the HPV vaccine. Although there are reports of autoimmune diseases and premature ovarian failure following HPV vaccination, rigorous vaccine studies have not shown that these conditions are caused by the vaccine. The vaccine does not cause cancer.”

If you are diagnosed with HPV, what should you do?

“Currently, HPV is only tested for in the cervix and there are algorithms which guide management depending on the type of HPV, and whether or not there are associated cellular changes in the cervix. Women should begin cervical cancer screening with a Pap test (will test for changes in the cervical cells caused by HPV) starting at age 21 years, and should get HPV testing +/- Pap test starting at age 30 years. Your health care provider should give you recommendations about follow-up based on the results; if you have an abnormal result, it is important that you adhere to the follow-up recommendations to prevent cancer.

Because there are no HPV or other screening tests for cancers other than cervix, some key things which should prompt evaluation by a health care provider are: abnormal vaginal bleeding (bleeding between periods; bleeding after menopause; bleeding after sex), and persistent lumps or bumps on the vulva, inside the vagina, in or around the anus, or in the mouth/tongue/tonsils.”

As Dr. Teoh notes, you may not even know you have HPV. And you might not be able to avoid getting the cancer-causing strains of HPV if you are too old for the vaccine. But if women pay attention to changes in their bodies, get Pap tests regularly, and adhere to their health care providers’ advice, they have the best chance at staying healthy. And the more everyone understands about HPV and the importance of the vaccine, the better.

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