I have HPV. What should I do?

Sunday, 18 June 2023 (16:49 IST)
Got an HPV diagnosis? Don't panic. Here's everything you need to know about the extremely common virus.
What is HPV?
HPV stands for human papillomavirus. There are over 100 different types of HPV. The majority are harmless, but around 14 strains can cause cancer, which is why so much focus has been placed on eradicating the virus over the past three decades.
Estimates say around 11.3% of women and 21% of men have HPV globally. Around 604,000 people were diagnosed with cervical cancer linked to HPV in 2020 and 342,000 people died, according to the World Health Organization.
90% of these cases and deaths occurred in low-income countries, where screening capacity and vaccine supply is low.
According to the US government's Centers for Disease Control and Prevention, nearly everyone will get HPV at some point in their lives, so you can rest assured that you are not alone.
What are the symptoms of HPV?
The vast majority of people with HPV won't experience any symptoms, but a minority will notice genital warts — small growths in the genital region or the mouth.
It's important to know that genital warts are the only clinical manifestation of HPV, and the strain that causes these warts is not the type that causes cancer, says Diane Harper, a professor of medicine at the University of Michigan who specializes in HPV and served as an investigator in the clinical trials of the HPV vaccines Gardasil and Cervavix.
"The high risk types that go into cancer really don't have any signs or symptoms at all," says Harper. "You have absolutely no idea that you're infected with it…That's what makes it really disturbing when you get the piece of information from your doctor that you tested positive because you're like, where did this come from?"
How do you get HPV?
You can get HPV through skin-to-skin contact, generally during sex — even non penetrative. Although a condom helps prevent it, it doesn't fully protect you, because it doesn't cover all skin around the genitals.
With that said, the notion that you can only get HPV from sex is a misconception, Harper says, adding that between 10 and 15% of children are born with the virus. This happens when the mother carries the infection during pregnancy.
"If you've never had sex, it's highly likely you probably won't have had exposure, but it's not impossible," she says.
That's part of the reason people can never truly know the origin of their HPV infection. The other reason is the fact that HPV may not make itself visible immediately after a sexual encounter with an infected person. It is possible that a HPV infection only presents on a test years after exposure.
"For women to develop cervical cancer, they have to be exposed to HPV, but that exposure isn't just from the partner they were with," Harper says. "The partner's partners bring a lot to the bedroom. Men often have a lot of partners, especially early on as they're maturing and going through adolescence…every single one of those partners that they have they bring to the woman that they're now with."
What happens when I have HPV?
In the vast majority of cases, HPV won't turn into anything.
"When a woman is infected with HPV, and it's the first time that she's been found to have HPV, I will tell my patients that 90% of women will clear it on their own, which is why we're not testing really young girls anymore," says Harper.
The older a woman gets, the more worrisome HPV can become, but the risk is still small. If you have genital warts, you will be prescribed medication or a cream to heal them, or you can get them removed using different types of therapies, like electrocautery, freezing or laser treatment.
Even when the warts go away, you will remain a carrier of the strain that caused them, which means you can still spread them and they can still come back in the future. Like other strains, warts can come shortly after exposure or months to years after. Or you can carry the strain without ever developing them at all.
But what about cancer?
In a minority of cases, HPV can turn into cancer. Only a handful of HPV strains are cancerous.
If you have one of these strains, Harper says you will need to stay in screening to ensure it doesn't develop into cancer. In the rare case it does, it will take years to develop after the initial exposure, which is why screening is so important.
The most common type of cancer caused by HPV is cervical cancer, which occurs in the cells of the cervix, the lower part of the womb that connects the uterus to the vagina. The trademark sign of cervical cancer is abnormal vaginal bleeding, Harper says. But it's essential to get into screening before these symptoms develop, because by then, there's little doctors can do.
HPV is also thought to cause 70% of oropharyngeal cancers in the United States, according to the US Centers for Disease Control and Prevention, likely due to strains spread through oral sex. This number has been rising over the course of the past decades. However it's still unclear whether HPV is the only cause or if it's a mixture of HPV and something else, like smoking.
It can also cause other types of genital cancers in men, although this is very rare. The presence of these cancers is why men need to pay close attention when their female partners get an HPV diagnosis and get screened themselves.
Do I need to tell my partner? My past partners?
Harper says she only advises people to tell their current partners about an HPV diagnosis, partly for the sake of supporting the woman as she goes through follow-up exams and partly because partners can choose to use condoms to prevent spreading the virus back and forth between each other.
Although condoms can stop the spread of some HPV, Harper says they are not necessary for monogamous couples in which both partners are already infected, and leaves it up to her patients to decide for themselves.
"Condoms will prevent about 60% of HPV transmission. So it's like, is that good enough for you? I think that's a personal decision," she says.
She doesn't advise patients to tell their past sex partners because "unlike something like syphilis or gonorrhea or chlamydia, we have no treatment for it."
If there was a treatment, she says, it would make sense to tell past partners, because they could tell their female partners, who could get tested and treated. But since that doesn't exist, she says it's not necessary.
What about the HPV vaccine?
The best way to prevent HPV is by getting the vaccine, but the vaccine doesn't offer 100% protection against the virus, which Harper says is sometimes forgotten.
The HPV vaccine Gardasil 9 is only protective against seven — around half — of the cancer-causing types of HPV. These seven include the strains most likely to cause cancer, 16 and 18, as well as many of the strains that cause genital warts.
"[Patients] need to know that because HPV vaccination is a wonderful bridge to screening but we can't forget about screening because the vaccination isn't 100% coverage," she says, adding that if people think the vaccine they may think they don't need to screen, which is a problem.
With that said, Harper says that she always suggests that people get the vaccine if it's available to them.
I'm old. Should I get the vaccine?
Harper says that although mass vaccination of women over 25 will do little to eliminate cervical cancer at a population level, she still suggests it on a personal level if a woman wants to invest in it.
"The way the vaccine works is it grabs onto that little HPV particle and won't let it go into the cell," Harper says. "And so it makes it so it doesn't fit into the receptors and so that part of it becomes very clear that it works to prevent that [spread]."
How do I know if the HPV is gone?
By continuing screening, you can keep track of your HPV.
Does an STI test detect HPV?
Traditional STI tests don't catch HPV, and although pap smears may detect it, they aren't nearly as accurate as actual HPV tests themselves. These tests are the most sensitive and will detect HPV if you have it.
Will the HPV live in me forever?
In the vast majority of cases, the HPV is no longer detectable after a few years. This is when doctors say it has been "cleared". But there are rare situations in which the HPV reoccurs. Harper stresses these situations are seldom but do happen, which means it's impossible to say HPV goes away completely.

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