Human Papillomavirus (HPV)

What is human papillomavirus (HPV)?

Human papillomavirus (HPV) is a group of viruses that spread through skin-to-skin contact. Some types of HPV cause common warts on the skin. Other types of HPV can cause genital warts, recurrent respiratory papillomatosis (tumors around the vocal cords), or lead to certain cancers. 

HPV is very common, and most people will get some type of HPV during their lifetime. Many infections do not cause symptoms and clear up on their own. 

HPV vaccination can protect against the common types of HPV that cause cancer and genital warts.

Symptoms of HPV

Most people with HPV do not have signs or symptoms and do not know they have it. But some types of HPV can cause health problems, including some cancers.

Low-risk HPV

Some types of low-risk HPV can cause warts on the skin or mucous membranes. These may appear as small skin growths or bumps. Common warts often appear on hands or feet. Genital warts appear on or around the genitals and anus. Rarely, HPV can cause warts in the mouth or throat or wart-like tumors around the vocal cords.

Warts can be uncomfortable or embarrassing and may need treatment. Low-risk HPV types do not cause cancer. 

High-risk HPV

Most cases of high-risk HPV do not cause visible symptoms. If the infection lasts for many years, it can lead to changes in cells that may develop into cancer. 

HPV can cause several types of cancer, including:

• Oropharyngeal cancer (cancer in the back of the throat, base of the tongue, or tonsils)
• Cervical cancer 
• Anal cancer
• Vaginal cancer
• Vulvar cancer
• Penile cancer

HPV causes more than 40,000 cancers in the United States each year. Worldwide, HPV causes almost 5% of all cases of cancer.

Diagnosis of HPV

There is no single test that can check for all types of HPV.   

A health care provider can diagnose health problems caused by HPV. Warts on the skin or genitals can be a sign of HPV infection.  

Pap tests  

In women, HPV testing can be done along with routine Pap tests (cervical cytology) or alone. During a Pap test (also called a Pap smear), a health care provider uses a soft brush to collect a small sample of cells from the cervix, the lower part of the uterus that connects to the vagina.  The sample is then sent to a lab to look for abnormal or precancerous cells.  

Regular Pap tests are important for catching problems early. Screening recommendations for Pap tests and HPV testing are based on age and risk factors. 

If results of a Pap test or HIV test are abnormal, further tests such as colposcopy or biopsy may be needed to check for abnormal cells.   

Recurrent respiratory papillomatosis (RRP) 

In rare cases, HPV can cause recurrent respiratory papillomatosis (RRP), a condition in which clusters of wart-like tumors grow on the vocal cords. To diagnose RRP, a health care provider may use an endoscope (a thin tube with a light and camera) to look at the back of the throat. They may also take a small sample of tissue to check for HPV or abnormal cells. 

Treatment of HPV

There is no treatment that can cure HPV infection. But health care providers can treat certain problems caused by HPV. 

Warts: For warts on the skin or genitals, treatments include medicines, freezing (cryotherapy), laser treatments, or surgical removal.   

Abnormal cells: If there are abnormal cells in the cervix or nearby areas, your health care provider may recommend additional tests. Treatments such as cryotherapy (freezing), laser therapy, or surgical procedures may be used to remove or destroy abnormal cells. Treating abnormal or precancerous cells can help keep them from developing into cancer. 

Cervical, throat, or other cancer: If HPV leads to cancer, treatments may include surgery, radiation, and chemotherapy. Treatments will depend on the type and stage of cancer. 

Recurrent respiratory papillomatosis: Surgery is used to remove RPP tumors. This may include laser surgery or freezing to remove growths.

Treatments can remove warts or abnormal cells, but they may not cure HPV. The virus can remain in the body, and warts may return. HPV infections often go away within 1-2 years without treatment. However, some high-risk types can persist and lead to health problems.   

HPV vaccine (Gardasil 9)

The HPV vaccine, like Gardasil 9, protects against the types of HPV that cause most cancers and genital warts. HPV vaccination is recommended for everyone aged 9 to 26 years and for some people aged 27 to 45 years. 

The HPV vaccine works best when it is given before someone is exposed to the virus. That is why your child needs the vaccine before they become sexually active. 

The vaccine only protects against HPV. It does not prevent other sexually transmitted infections (STIs).

Doctors generally recommend that children get the HPV vaccine at age 11 or 12, but it can be given starting at age 9.  

• Children ages 9–14 need 2 doses (shots) of the HPV vaccine. 
• People aged 15 and older need 3 doses of the HPV vaccine. 
• Childhood cancer survivors or people who have weakened immune systems need 3 doses of the HPV vaccine.

HPV vaccination is recommended for both boys and girls.

How HPV spreads

HPV spreads mostly through skin-to-skin contact during sexual activity. This includes vaginal, anal, and oral sex. HPV does not spread through things like clothes or toilet seats. Although it may be possible for HPV to spread through blood transfusions, it is unlikely to cause infection.  

Many people with HPV do not have any symptoms and do not know they are infected. But they can still pass HPV on to others. High-risk types of HPV can stay in the body for years. A person can have more than one type at a time. 

How to prevent HPV

To help prevent the spread of genital or high-risk HPV:

• Get the HPV vaccine as recommended.
• Wear condoms during sexual activity.
• Limit the number of sexual partners.  
• Get regular screenings, such as Pap tests and HPV tests.

Questions to ask your care team

• What is HPV, and how does it spread?
• Can my child get HPV if they are not sexually active?
• What health problems are caused by HPV?
• When should my child get the HPV vaccine?
• How many doses of the HPV vaccine does my child need?
• Is HPV vaccination recommended for boys and girls?
• What should I do if my child gets warts or other problems caused by HPV?

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