Human papillomavirus (HPV): Your Questions Answered

By Dr. Sonia

Let’s talk about HPV, baby. Let’s talk about you and me. 

March 4th is HPV Awareness Day, so what better time than NOW to discuss all you need to know about HPV and more. 

So, let’s get started… 

What is HPV? 

HPV stands for human papillomavirus. It is a viral infection that can commonly cause growths on our skin or mucous membranes, also known as warts. It is important to note that there are over 100 different types of HPV, some of which cause benign warts and others that can actually cause cancer. 

First off, don’t fret because the vast majority of HPV infections don’t lead to cancer. However, high-risk HPVs can cause several types of cancer including anal, penile, vaginal, vulvar, and oropharyngeal cancers. There are about 14 high-risk HPV types and two of these, HPV16 and HPV18, are responsible for most HPV-related cancers. 

So how does one get HPV to begin with? 

HPV is transferred primarily by skin-to-skin contact. One basic fact that is important to note: Warts are contagious. Period. The virus can spread through direct contact with a wart. It can also spread when someone touches something that had previously touched a wart–this makes warts highly contagious. Genital HPV infections are contracted through sexual intercourse, anal sex, and really any other skin-to-skin contact. Some HPV infections result in oral or upper respiratory lesions; this type of lesion can be contracted through oral sex. 

It is also important to note that if you are pregnant and have an HPV infection with genital warts, it is, in fact, possible for your baby to get the infection. Rarely, the infection may cause a noncancerous growth in the baby’s voice box (larynx). 

The good news? We have vaccines that can help protect against the strains of HPV most likely to cause genital warts or cervical cancer! 

So how do I know if I have HPV? 

In most cases, you may not! HPV is a virus, and often your body’s immune system defeats the infection before it creates visible warts–the human body is so amazing, isn’t it? BUT…when and if warts do appear, their appearance is often variable. They can appear as small cauliflower-like bumps with small “stemlike” protrusions. These are known as genital warts and can appear in the vulva, on the cervix, in the vagina, or near the anus. For penis owners, they can be found on the shaft, on the scrotum, or on the anus. Generally, genital warts are not painful, although they can often cause itchiness. Some warts can appear as rough, raised bumps, and can be found anywhere on the body, frequently on the hands and fingers. These are known as common warts. Other warts may be hard and grainy often found on the heels or balls of feet–these are known as plantar warts. Last but not least, some warts may appear as flat warts which are flat lesions that can be found anywhere on the body, even in children. 

Regardless of how a wart may look or appear, understanding HPV is important not just because it can cause unsightly warts but because nearly all cervical cancers are caused by HPV infections. Certain strains can also contribute to cancers of the genitals, anus, mouth, and upper respiratory tract. Wowza! But don’t be alarmed by this fact because we do have ways of protecting ourselves from HPV. How so? By getting vaccinated. 

Let’s delve. 

One thing that is vital to understand when discussing HPV and cancer is that it doesn’t occur immediately. Meaning: While nearly all cervical cancers are caused by HPV infections, cervical cancer may take 20 years or longer to develop after exposure to the virus and HPV infection. The hardest part is that HPV infection and early-stage cervical cancer typically doesn’t cause noticeable symptoms. Therefore, it is vital to have regular screening exams for cervix owners. Screening exams are essential in detecting any precancerous changes in the cervix which may lead to cancer. Guidelines often shift, but the most current recommendation is that those ages 21-29 have a pap test every three years. Cervix owners aged 30-65 are advised to have a pap test every three years, or every five years if they get HPV DNA testing at the same time. Those over 65 can stop testing if they’ve had three normal Pap tests in a row, or two HPV DNA and Pap tests with no abnormal results. 

Can I prevent getting infected? 

While it’s hard to necessarily prevent HPV infections as they are relatively common, there are certain risk factors that can put us at a higher risk of developing an infection with HPV. 

First and foremost is the number of sexual partners. The more sexual partners one has, the increase in the likelihood of contracting a genital HPV infection. In addition, we can take this a step further and say if your partner has had multiple sexual partners that your risk increases. Using condoms can also help to prevent transmission. 

Personal contact. As we mentioned before, direct contact with someone with warts can increase the risk of contracting HPV. Indirect contact can also increase the risk–for example, contact with surfaces like swimming pools or public restrooms. Take that a step farther, and areas with damaged skin are also at higher risk for transmission. 

Age. While age ain’t nothing but a number, it is a risk factor for certain HPV infections. For example, genital warts are more commonly found in adolescents and young adults. 

Those with weakened immune systems and those who are immunocompromised can also be more at risk of transmission. 

So how do we protect ourselves? 

Vaccination. Vaccination. Vaccination. Gardasil 9 is an HPV vaccine approved by the U.S. Food and Drug Administration and can be used, regardless of gender, to protect against cervical cancer and genital warts in both men and women. Gardasil 9 is highly effective yet in certain communities, highly underutilized. The Centers for Disease Control and Prevention (CDC) recommends routine HPV vaccination for girls and boys ages 11 and 12, although it can be given as early as age 9. In a perfect world, one would receive the vaccine before they have sexual contact and are exposed to HPV to maximize the benefits. 

A common hesitation point for many parents is that somehow recommending or receiving the vaccine would promote kids having sex at an earlier age. This point has in fact been studied, and results show that receiving the vaccine at a young age is NOT linked to an earlier start of sexual activity. We want to protect our kids in all the ways that we can–and this vaccine does help to do so. 

It is important to remember that once someone is infected with HPV, the vaccine might not be as effective or might not work at all. Also, response to the vaccine is better at younger ages (as recommended above) than much older ones. Regardless, protection is protection, and if given before someone is infected, the vaccine can prevent most cases of cervical cancer. 

To receive full protection, the CDC recommends that all 11- and 12-year-olds receive two doses of HPV vaccine at least six months apart. Younger adolescents ages 9 and 10 and teens ages 13 and 14 can also receive a vaccination on the updated two-dose schedule. Research has shown that the two-dose schedule is effective for children under 15. 

What if I’m older and decide I want the vaccine? Well, teens and young adults who begin the vaccine series later, at ages 15 through 26, should receive three doses of the vaccine. 

The CDC also recommends “catch-up” HPV vaccinations for all people through age 26 who aren’t adequately vaccinated. 

Interestingly, recently the FDA has approved the use of Gardasil 9 for males and females ages 9 to 45. If you’re deciding if you want the vaccine, and are between the ages of 27 to 45, it would be important to discuss details of the vaccination with your doctor or healthcare provider. This is because the older you get, the more likely you are to have been exposed to HPV. And in this situation, the HPV vaccination may provide less benefit–hence, the importance of the discussion. 

There’s no better time than now to better understand and inform ourselves about HPV.  We have options and methods to protect ourselves and our children. In honor of HPV Awareness Day–let’s protect ourselves and our families by staying informed and staying vigilant. 

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Dr. Sonia

ASTROGLIDE’S SEXUAL HEALTH ADVISOR

Sonia Bahlani, MD, is a pelvic pain specialist who takes a holistic view of common women’s health issues. After completing her OB/GYN residency, she pursued a fellowship in urology, working with pioneers in the world of pelvic pain. Having trained in these two areas gives her a unique perspective in her approach to women's health. She takes a compassionate, patient-centric approach and listens to her patients to gain a deep understanding of their challenges.