HPV can also cause genital warts, which are caused by different types of the virus than those that can lead to cancer. Still other types of HPV can cause common skin warts or plantar warts, which grow on the bottoms of your feet. HPV is actually a group of more than 150 related viruses. Each virus in the group has an assigned number, which is known as its HPV type (or serotype). While both skin warts and genital warts may be distressing or even painful — and can be transmitted from one person to another, or even from one area of the body to another — the most concerning types of HPV are those that can cause precancerous changes in the cells they infect. These precancerous changes, known as dysplasia, can occur in the cervix, vagina, vulva, anus, penis, or oropharynx (the area at the back of your mouth and throat that includes the base of your tongue and your tonsils). Virtually all sexually active individuals are infected with one or more types of HPV in their lifetime. But many people never know they have HPV because they never develop any symptoms or experience other consequences of the infection. While the body often clears an HPV infection within months to years, the infection may persist in some people. There is no treatment available that can rid the body of HPV, but some of the symptoms and consequences of HPV can be treated.
Skin Warts
In healthy people, the immune system can usually fight off the viruses that cause skin warts — limiting the number of warts people typically develop and making them eventually go away. But this is often not the case in people whose immune systems are compromised, such as by human immunodeficiency virus (HIV), drugs to prevent organ rejection or to treat autoimmune diseases, or simply older age. In these people, HPV infection of the skin may cause more extensive warts that persist.
Genital Warts (Mucosal Warts)
Vulva (outside the vagina)Shaft or under the foreskin of the penis
Warts from the same HPV types may also occur in the following areas:
Vagina or cervixUrethra (tube through which urine exits the body)ScrotumPerineum (area between the genitals and anus)Area around the anusInside the anus (most common in people who have receptive anal sex)Inner nose, mouth, and throatInner eyelids
Low-Risk Mucosal HPV
Mucosal HPV types are categorized as either low risk or high risk. Low-risk HPV types can cause genital warts, which may occur around the genitals and anus, as well as in the mouth and throat. But most low-risk HPV types don’t cause any symptoms and are generally not a reason for anyone to be concerned.
High-Risk Mucosal HPV
High-risk HPV types can cause changes in mucosal cells that lead to cancer. The HPV vaccine protects against HPV types 16 and 18, as well as several other cancer-causing types of the virus and the two main HPV types that cause genital warts. Skin warts — which can vary in size, shape, and appearance — are growths on the skin surface that may range from fairly flat to protruding. It’s not always possible to know if a skin growth is a wart. Precancerous cell changes in the cervix cause no symptoms but can be detected with the Pap test, in which a sample of cells is collected and examined under a microscope. Early vaginal, vulvar, and cervical cancers related to HPV may cause no symptoms, but advanced-stage cancer can lead to abnormal vaginal bleeding or discharge and pain during intercourse. Signs and symptoms of oropharyngeal cancer may include persistent sore throat, a lump in the neck, and persistent ear pain. Vocal cord cancers typically cause hoarseness or a change in the voice. Early penile cancer may cause changes in skin color and thickening of the skin. You should see your doctor if you have any signs or symptoms of HPV-related cancers. Learn More About HPV Symptoms and Diagnosis You’re at higher risk for genital or oral HPV if you:
Haven’t been vaccinated against HPVHave many sexual partnersHave a sexual partner with HPVHave a sexual partner who has had many sexual partners or whose sexual history you don’t knowDon’t use a condom every time you have sexStart having sex at a young age, especially under 18Have had other STDs, especially chlamydiaHave a weakened immune system, such as from HIV or taking a drug that suppresses your immune response
Symptoms from HPV may develop years after you become infected, so it’s often impossible to know who transmitted the virus to you. Even with no symptoms, you can pass HPV on to other people, and you can get HPV from someone who doesn’t show any symptoms. To help diagnose genital warts, your doctor may apply an acetic acid solution to the area to lighten the warts, making them more visible. If you’re a woman with detectable genital warts, your doctor may also perform a colposcopy (a procedure that uses a light and a low-power microscope) to find genital warts on your cervix that are too small to see with the naked eye. Women can be screened for HPV infection of the cervix with the HPV test, which is done by removing some cervical cells with a swab and testing them for the presence of HPV. The test can detect HPV types 16 and 18, and can provide broad results for other high-risk (cancer-causing) HPV types in cervical tissue. In other cases, the immune system does not prevent the virus from infecting the cells, but the infection doesn’t immediately cause symptoms. In fact, it may never cause symptoms, but the virus can be transmitted to another person through skin-to-skin or sexual contact. And in still other cases, an HPV infection causes abnormal changes in the infected cells that can eventually develop into cancer. The time between an infection and the development of precancerous changes or cancer may be years or even decades. The earlier HPV-related symptoms are found, the more likely they can be treated successfully. If you have a skin wart, you may choose to leave it until it goes away on its own, treat it with an over-the-counter product, or see your doctor for treatment. For genital warts, your doctor can prescribe several topical medicines to apply to external warts at home. Genital warts may also be treated in a doctor’s office with topical medication, cryotherapy (freezing the warts), or surgical removal. Topical medication may need to be applied repeatedly for weeks or even months to fully treat genital warts. Cryotherapy may need to be repeated multiple times. And cancers caused by HPV are treated with standard cancer therapies, including chemotherapy, radiation therapy, and surgery. Learn More About How HPV Is Treated The HPV vaccine currently used in the United States, Gardasil 9, protects against HPV types 6 and 11, which cause most cases of genital warts; 16 and 18, which cause most cases of HPV-related cancer; as well as five other types that can cause cancer (31, 33, 45, 52, and 58). In the United States, the HPV vaccine is approved for children and adults ages 9 to 45. Routine vaccination is recommended at age 11 or 12, and through age 26 if you didn’t receive the full vaccine schedule before that. An analysis published in June 2019 in the journal The Lancet examined the impact of HPV vaccination, using data from 60 million people in 14 countries that had set up HPV vaccine programs in the previous 10 years. It showed that high-risk HPV infections dropped by 83 percent among girls and women ages 13 to 19, and by 66 percent among women ages 20 to 24. For genital warts, the incidence dropped by 67 percent among girls and women ages 15 to 19, by 54 percent among women ages 20 to 24, and by 31 percent among women ages 25 to 29. Precancerous cervical lesions also dropped, by 51 percent among girls and women ages 15 to 19, and by 31 percent among women ages 20 to 24. Learn More About the HPV Vaccine
HPV is believed to cause over 90 percent of cases of cervical and anal cancer, about 70 percent of cases of vaginal and vulvar cancer, and about 60 percent of cases of penile cancer, according to the Centers for Disease Control and Prevention (CDC).
Cervical Cancer
More recently, the HPV test was developed to directly test for HPV infection in the cervix, even before any precancerous changes take place. Both the Pap test and HPV test maybe used for cervical cancer screening. Even though cervical cancer is now almost entirely preventable, the American Cancer Society estimates that in 2022, about 14,100 new cases of invasive cervical cancer will be diagnosed, and about 4,280 women will die from cervical cancer. Learn More About HPV in Women
Oral Cancer
Oropharyngeal cancer develops on the back and sides of the throat, tonsils, and base of the tongue. It’s believed that people get oral HPV from oral sex, although why men develop HPV-associated oropharyngeal cancer so much more than women is not known. For most people, the first sign of a mucosal HPV infection is the appearance of genital warts or the signs and symptoms of some form of HPV-related cancer — the most serious consequence of HPV infection. The incidence of oropharyngeal cancer increased by about 0.8 percent each year from 2009 to 2018, according to the American Cancer Society. This increase can be explained almost entirely by HPV-related forms of the cancer in non-Hispanic white people. Such variability may reflect differences in prevailing community behavior, biology, or unequal access to screening tests and medical care. The CDC publishes estimates of HPV infections by race and ethnicity, based on data from the National Health and Nutrition Examination Survey, a survey designed to monitor the health and nutritional status of the overall U.S. population. The most recent estimates were published in April 2017 and are based on data from 2011 to 2014 for genital HPV and from 2013 and 2014 for oral HPV among adults ages 18 to 69. The CDC found the following:
The prevalence of any genital HPV and of high-risk genital HPV was lowest among Asian men and women and highest among non-Hispanic Black men and women, with both non-Hispanic white and Hispanic men and women in between.The prevalence of any oral HPV and of high-risk oral HPV was lowest among Asian adults, while the rate of any oral HPV was highest among non-Hispanic Black adults.
While rates of HPV vaccination have been on the rise, there are differences in this rate by race and ethnicity, according to CDC data from 2013 to 2018, including adults ages 18 to 26:
Non-Hispanic white men and women were most likely to have received at least one dose of the HPV vaccine (42.1 percent), followed by non-Hispanic Black adults (36.7 percent) and Hispanic adults (36.1 percent).Among women, the HPV vaccination rate was highest for non-Hispanic white adults (57.9 percent), followed by Hispanic adults (48.8) and non-Hispanic Black adults (44.7).Among men, the HPV vaccination rate was highest for non-Hispanic Black adults (29.4 percent), followed by non-Hispanic white adults (26.6) and Hispanic adults (24.7).
Using data from cancer registries, the CDC also published estimates of new cases of HPV-associated cancers among Americans of different races and ethnicities based on data from 2014 to 2018:
Among both men and women, white adults had the highest incidence of HPV-associated cancers, while Asian and Pacific Islander adults had the lowest incidence.For women of all races and ethnicities, cervical cancer was the most common HPV-associated cancer.For men of all races and ethnicities, oropharyngeal cancer was the most common HPV-associated cancer.
Unlike HPV, which is a viral infection, chlamydia, gonorrhea, and syphilis are caused by bacteria. All three bacterial STIs can be cured by antibiotics, although some strains of the bacteria that cause gonorrhea have become resistant to most antibiotics. Like HPV, genital herpes and HIV/AIDS are caused by viruses and cannot be cured, although they can be treated — both to reduce symptoms in the person who is infected and to reduce the likelihood of spreading the virus to others. American Academy of Dermatology Get the lowdown on skin warts — their symptoms, treatment, and prevention — from experts on skin and skin care. American Sexual Health Association Learn the basics on sexually transmitted forms of HPV, including common myths and facts, and information on the connection between HPV and cervical cancer. Centers for Disease Control and Prevention The CDC offers information for parents on having their children vaccinated against HPV, as well as HPV fact sheets written specifically for men and for young women. Cleveland Clinic Check out Cleveland Clinic’s Health Library for information on oropharyngeal cancer caused by HPV. Mayo Clinic Plantar warts — those that occur on the bottom of the feet — can make walking painful. The Mayo Clinic explains how to identify them and how they can be treated. MedlinePlus This government website provides links to numerous resources on warts, including how to identify and treat them. National Cancer Institute The National Cancer Institute provides an in-depth discussion of the HPV vaccine, which protects against seven types of HPV that can cause cancer, as well as two that cause most genital warts. National Cervical Cancer Coalition This program of the American Sexual Health Association focuses on cervical cancer information and prevention, and offers an online support platform for people dealing with this form of cancer. Office of Women’s Health Get the information you need on genital warts, including what they are, how you get them, and what effect, if any, they could have on a pregnancy. Planned Parenthood For information on sexually transmitted types of HPV or for help getting tested, Planned Parenthood is the place to turn. Call 800-230-PLAN (7526). Sex, Etc. This is a website for teens, by teens. Sex, Etc. offers frank talk on sexually transmitted infections including HPV, as well as on relationships and communicating about sex with parents and peers. Learn More About Sexual Health Resources Additional reporting by Quinn Phillips.
