HPV infection

HPV infection is a viral infection. There are more than 100 types of human papillomavirus (HPV). Some types of HPV infection cause skin growths called warts and some types of HPV infection can cause cancer.

Most HPV infections don't lead to cancer. But some types of genital HPV can cause cancer of the lower part of the uterus that connects to the vagina, called the cervix. Other types of cancers have been linked to HPV infection. These include cancers of the anus, penis, vagina, vulva and back of the throat. Cancer at the back of the throat is called oropharyngeal cancer.

These infections are often passed through sex or through other skin-to-skin contact. Vaccines can help protect against the strains of HPV most likely to cause genital warts or cervical cancer.

Usually, the body's immune system defeats an HPV infection before it creates warts. Different types of HPV produce different warts, including:

• Genital warts. Some appear flat. Others look like small cauliflower-like bumps or tiny stemlike bumps. In women, genital warts appear mostly on the vulva. But they also can occur near the anus, on the cervix or in the vagina.

  In men, genital warts appear on the penis and scrotum or around the anus. Genital warts rarely cause discomfort or pain. But they might itch or feel tender.

• Common warts. Common warts appear as rough, raised bumps. They usually occur on the hands and fingers. Most common warts are simply not attractive. But they also can be painful. And it's easy for them to get injured or bleed.
• Plantar warts. Plantar warts are hard, grainy growths that usually appear on the heels or balls of the feet. These warts might cause discomfort.
• Flat warts. Flat warts are flat-topped, slightly raised sores called lesions. They can appear anywhere on the body. But children usually get them on the face, men tend to get them in the beard area, and women tend to get them on the legs.

Cervical cancer

HPV infections cause almost all cervical cancers. But cervical cancer may take 20 years or longer to develop after an HPV infection. The HPV infection and early cervical cancer typically don't cause symptoms. Getting vaccinated against HPV infection is the best way to protect against cervical cancer.

Because early cervical cancer doesn't cause symptoms, it's vital that women have regular screening tests. These tests can find changes in the cervix that might lead to cancer. Current guidelines recommend that women ages 21 to 29 have a test that checks cervical cells for cancer, called a Pap test, every three years.

Women ages 30 to 65 are advised to keep having Pap tests every three years. Or the Pap test can be every five years for women who also get an HPV DNA test at the same time. Women over 65 can stop testing if they've had three regular Pap tests in a row, or two HPV DNA and Pap tests with no irregular results.

If you or your child has any warts that cause embarrassment, discomfort or pain, seek advice from your healthcare professional.

HPV infection occurs when the virus enters the body, usually through a cut or other damage to skin. The virus spreads mainly by skin-to-skin contact.

Genital HPV infections are contracted through having sex, anal sex and other skin-to-skin contact of the genitals. Some HPV infections spread through oral sex.

People who are pregnant and have an HPV infection with genital warts can give the infection to the baby. Rarely, the infection may cause a noncancerous growth in the baby's voice box, called the larynx.

Warts spread easily. This means that warts are contagious and can spread through direct contact with a wart. Warts also can spread by touching something that has touched a wart.

HPV infections are common. Risk factors for HPV infection include:

• Number of sex partners. The more sex partners, the higher the risk of getting a genital HPV infection. Having sex with a partner who has had multiple sex partners also increases the risk.
• Age. Common warts occur mostly in children. Genital warts occur most often in adolescents and young adults.
• Weakened immune system. HIV/AIDS or certain medicines used after organ transplants can weaken immune systems. People who have weakened immune systems are at greater risk of HPV infections.
• Damaged skin. Areas of skin that have been injured are more likely to develop common warts.
• Personal contact. Touching someone's warts might increase the risk of HPV infection. So can touching surfaces that have been infected with HPV, such as public showers or swimming pools.

• Oral and upper respiratory sores, called lesions. Some HPV infections cause lesions on the tongue, tonsils or soft palate, or within the larynx and nose.
• Cancer. Certain strains of HPV can cause cervical cancer. These strains also might play a part in cancers of the genitals, anus, mouth and upper respiratory tract.

Common warts

It's hard to prevent HPV infections that cause common warts. If you have a common wart, you can prevent the spread of the infection and keep new warts from forming by not picking at a wart and not biting your nails.

Plantar warts

To lower the risk of contracting HPV infections that cause plantar warts, wear flip-flops or other shoes on public pool decks and in locker rooms.

Genital warts

Lower the risk of getting genital warts and other HPV-related genital sores by:

• Having only one sex partner who's not having sex with anyone else. This is a monogamous relationship.
• Using a latex condom during sex, which might lower the risk of HPV.

HPV vaccines

Gardasil 9 is an HPV vaccine approved by the U.S. Food and Drug Administration and can be used for males and females to protect against cervical cancer and genital warts.

The vaccine works best if a person gets it before having the first sexual contact. Once someone has HPV, the vaccine might not work as well or at all. Also, younger people respond better to the vaccine than older people do. If given before someone has HPV infection, the vaccine can prevent most cervical cancers.

Two doses of the HPV vaccine are recommended for children age 11 and 12, but this vaccines can be given as young as 9 years of age. The two-dose series is given until age 14. The doses are given at least five months apart. Teens and young adults who begin the vaccine series at ages 15 through 26 should get three doses of the vaccine.

A healthcare professional might be able to diagnose HPV infection by looking at the warts.

If genital warts don't show, one or more of the following tests can find them:

• Vinegar, called acetic acid, solution test. A vinegar solution applied to HPV-infected genital areas turns them white. This may help flat lesions show up.
• Pap smear. A sample of cells from the cervix or vagina go to a lab to look for changes that can lead to cancer.
• DNA test. Testing cells from the cervix can identify the DNA of the types of HPV that are linked to genital cancers. It's recommended that women 30 and older have this test with a Pap test.

Warts often go away without treatment, particularly in children. But there's no cure for the virus. So the warts can come back in the same place or other places.

Medications

Medicines to get rid of warts usually go directly on the warts. These medicines might need to be used many times before the warts go away. Examples include:

• Salicylic acid. Treatments without a prescription that contain salicylic acid work by removing layers of a wart a little at a time. For use on common warts, salicylic acid can irritate skin. Salicylic acid isn't for use on the face.)
• Imiquimod (Zyclara). This prescription cream might help the immune system fight HPV. Common side effects include swelling where the cream is applied.
• Podofilox (Condylox). Another prescription applied to the skin, podofilox works by killing genital wart tissue. Podofilox may cause burning and itching where it's applied.
• Trichloroacetic acid. This chemical treatment burns off warts on the palms, soles and genitals. It might cause irritation where it's applied.

Surgical and other procedures

If medicines don't work, one of these methods can remove warts:

• Freezing with liquid nitrogen, called cryotherapy.
• Burning with an electrical current, called electrocautery.
• Surgical removal.
• Laser surgery.

Treatment for HPV in the cervix

A procedure called a colposcopy can remove HPV from the cervix. A healthcare professional uses a tool, called a coloscope, to see the cervix and take tissue samples, called a biopsy, of areas that look atypical.

Precancerous lesions need to be removed. Options include freezing, called cryosurgery, and laser surgical removal. Another method called loop electrosurgical excision procedure (LEEP) uses a thin looped wire charged with an electric current to remove a thin layer of a section of the cervix. And cold knife conization is a surgical procedure that removes a cone-shaped piece of the cervix.

You'll likely start by seeing your main healthcare professional. Depending on where your warts are, you may be referred to a specific healthcare professional. For example, you may be referred to a specialist who treats skin, called a dermatologist; a specialist who treats feet, called a podiatrist; or a reproductive organs specialist, either a gynecologist or urologist.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, make a list of:

• Your symptoms, including any that seem unrelated to the reason for your appointment, and when they began.
• Key personal information, including major stresses, recent life changes and your sexual history.
• All medicines, vitamins or other supplements you take, including the doses.
• Questions to ask your healthcare professional.

For HPV infection, questions to ask include:

• What's the most likely cause of my symptoms?
• Are there other possible causes?
• Do I need to have any tests?
• How can I prevent HPV infection in the future?
• Are there brochures or other printed materials that I can have? What websites do you recommend?

Don't hesitate to ask all the questions you have about HPV infection.

What to expect from your doctor

Your healthcare professional is likely to ask you questions, such as:

• Do you have sex with more than one person? Does your partner?
• Where have you found warts?
• Are they painful or itchy?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?