Human Papillomavirus (HPV) is a part of a very common set of viruses. In some people, HPV can lead to genital warts or cancer. There are more than 130 strains of HPV.
These strains are split into high risk and low risk depending on their ability to produce abnormal cells.
Low-Risk HPV – strains of HPV not associated with cancers
Such strains of HPV are more likely to cause skin warts and genital warts. Genital warts are most commonly associated with HPV types 6 and 11.
High-Risk HPV – strains of HPV associated with cancers
Such strains of HPV may cause abnormal cell changes (cell dysplasia) associated with the development of certain cancers. This can include cervical, vulval, vaginal, penile and anal cancers, as well as some types of head and neck cancers. Types 16 and 18 cause 70% of cervical cancers and pre-cancerous lesions.
Contrary to popular belief, HPV can affect both men and women and is most commonly sexually transmitted. It can also be transmitted via close genital skin-to-skin touch.
Symptoms
The symptoms of HPV depend on the type of HPV you have.
It is important to note that some patients can have both Low and High Risk HPV types. It is not entirely clear why some patients develop symptoms whilst others do not. Those with underlying medical conditions with a suppressed immune system are more likely to have symptoms and experience a recurrence of symptoms after successful treatment.
What are the symptoms of Low Risk HPV?
Low Risk HPV can cause warty lesions on the skin or mucosa - the lining of various cavities in the body, for example, your lips.
Certain HPV types can produce lesions on your hands and feet, whilst other types mainly affect the ano-genital area.
What are the symptoms of High Risk HPV?
High Risk HPV does not produce genital warts, and therefore, may go unnoticed by most people who have the virus.
Some people will present with patches, plaques, ulcers and non-specific lesions on the affected area. These may progress with the passage of time to become precancerous and eventually cancerous lesions. Generally, this process is a slow one taking many years to develop from an early lesion to a cancerous one but can have a rapid course in some people especially if they have an immunosuppressive medical condition or are on immunosuppressants.
It’s possible that someone who has genital warts (presumably due to Low Risk HPV) can also have High Risk HPV at the same time. This is why your clinician may recommend a High Risk HPV test for those presenting with genital warts.
Sometimes, innocuous looking changes in the skin or mucosa on the penis, vulva, around the back passage or in the mouth can often be misinterpreted as a non-specific cause whilst in reality it may be due to an underlying High Risk HPV infection.
In those who don’t clear the virus naturally, HPV can change the structure of the cells (cell dysplasia) which may lead to further complications.
Sometimes patients with underlying skin conditions such as Lichens Sclerosis, Eczema, Psoriasis of the ano-genital area can have associated High Risk HPV infection thus substantially increasing the risk of cancer.
Can I have HPV with no symptoms?
Yes. In fact, most people with HPV have mild, unnoticeable or no symptoms and are unaware that they have the virus.
A key characteristic of HPV (both low and High Risk types) is the ability to be in the host body without producing any symptoms.
The virus may take weeks to years to produce symptoms after first acquiring it. Even if you have no symptoms, the virus can still be shed from the genital area and transmitted to new partners.
What complications can HPV lead to, if untreated?
Low Risk HPV does not lead to many complications, however, it may produce genital warts which can be psychologically distressing.
The main complication of High Risk HPV infection is the risk of developing cervical, vulval, anal, penile and mouth or throat cancers. Not all High Risk HPV infections lead to cancer, but it’s crucial to attend cervical screening and colposcopy appointments as per the medical advice.
You can read more detailed information about the complications of HPV here.
Causes
What causes HPV?
A HPV infection can be caused by:
- Vaginal, oral and anal sex
- Close genital contact, including hand-to-genital contact
- Sharing sex toys
- Skin to skin contact of the genital area, especially if there are warts present
HPV cannot be caused by:
- Sharing towels or toilet seats
- Hugging
- Breastfeeding
- Sharing plates, cutlery, cups
What factors can increase the likelihood of getting HPV?
- Being sexually active: sexually active individuals are likely to get at least one strain of HPV. You can still get HPV even if you have only had sex with one person, and even if you use a condom. Those who have unprotected sex, have a higher number of partners, or were sexually active from an early stage are at an increased risk.
- Previous genital conditions: previous history of other sexually transmitted infections, genital warts, abnormal smear tests, or cervical or penile cancer increases the risk of contracting HPV.
- Diabetes: poorly controlled diabetes, especially type 1 diabetes mellitus, is associated with more severe cases of genital warts, poor response to treatment and higher chances of recurrence.
- Infected partner(s): If your partner(s) has had a high number of partners, a history of HPV, genital warts, other sexually transmitted infections, cervical or penile cancer, then the risk of getting HPV is increased.
- Smoking: smokers are more likely to get HPV.
- Weaker immune system: a weakened immune system, such as those with HIV, or those who are taking immunosuppressant medication have a higher risk of developing HPV due to increased susceptibility to infection.
Can I get HPV even if I wear a condom?
Condom and femidom use only offers partial protection. HPV is shed from a much wider genital and anal tissue area than the condom can cover (i.e. the labia, scrotum or anus). Furthermore, HPV may be present on absolutely normal looking skin.
Can you tell who gave me HPV?
Unfortunately, we are unable to tell you who gave you HPV.
You may be able to work this out based on your sexual history, but we are not able to provide you with a definitive answer.
How can I prevent getting HPV?
- HPV vaccines can protect against 9 different strains of HPV. However, protection is limited to the type of strains present in the vaccine.
- Whilst condoms or femidoms may reduce the risk of transmitting or getting HPV, it does not completely eradicate the risk.
- Stop smoking
- Have a HPV test before sexual intercourse with any new partners.
- Recommend your partner gets treatment for genital warts. Although treating and removing the warts will not get rid of the underlying HPV infection, it may have an effect on how much virus is present in the warts and how transmittable it is.
Want to protected against HPV?
Think you might have HPV?
Tested positive for HPV?
Prognosis
Once treated, am I immune from getting HPV again?
No. You can become reinfected with HPV, both with the same type, or with another type. Reinfection is often associated with sexual activity and new partners. HPV does not have associations with natural immunity.
How can HPV affect me during pregnancy?
There has been an extensive amount of research focused on finding a link between HPV and pregnancy, and although there are often mixed findings it seems like a common theme, according to the British Journal of Midwifery, is that it is advisable to test for a HPV infection before you try to conceive as certain types of HPV may affect your ability to conceive. Once the infection has cleared, fertility should return to normal.
In women that are pregnant and have HPV, doctors may wish to monitor their health more closely due to the rapid cell changes that are associated with pregnancy. If cell changes occur then treatment will be delayed until after birth. The same advice runs true for pregnant women who have warts in that treatment will be delayed until after birth. However, if the warts are growing too big they may obstruct the vagina and will need to be removed before birth.
Furthermore, it is unlikely that HPV will be passed on to the baby when giving birth. If transmission does occur, the baby will be able to clear the virus naturally. It is important to note that babies born to mothers with genital warts may develop warts in their throats, however, there is only a small chance of this happening. If this does occur, the baby will need to be treated using laser surgery to allow them to breathe properly.
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Reviewed by: Dr. Manoj Malu (Clinical Director)
Written By: Shannon Abraham
Last reviewed date: 1 September 2022
Next review due: 1 September 2025
Whilst this content is written and reviewed by sexual health specialists, it is for general guidance only. It is not intended to replace the advice of your clinician.
References & Further Reading
- IARC Monographs on the Evaluation of Carcinogenic Risks to Humans Volume 90: Human Papillomaviruses
- World Health Organisation: Human papillomavirus (HPV) and cervical cancer
- Anal Cancer Foundation: What Is HPV?
- University of Oxford Vaccine Knowledge Project: HPV (Human Papillomavirus)
- American Society for Microbiology: Human Papillomavirus and Cervical Cancer
- The Journal of the American Osteopathic Association: Metastatic Penile Squamous Cell Carcinoma to the Retroperitoneum in a Man With Human Papillomavirus Type 45
- Translational Andrology and Urology: Relationship between human papillomavirus and penile cancer—implications for prevention and treatment
- Jo’s Cervical Cancer Trust: How people get HPV
- The Journal of Obstetrics and Gynaecology Research: Possible non‐sexual modes of transmission of human papilloma virus – Sabeena
- Virology Journal: Rate of vertical transmission of human papillomavirus from mothers to infants: Relationship between infection rate and mode of delivery
- Cancer Epidemiol Biomarkers Prev: Relationship between cigarette smoking and human papillomavirus type 16 and 18 DNA load
- Journal of Virology: How Does Tobacco Smoke Contribute to Cervical Carcinogenesis?
- Clinical Microbiology Review: Human Papillomavirus and Cervical Cancer
- BMJ: Epidemiology of genital warts in the British population: implications for HPV vaccination programmes
- American journal of epidemiology: Risk factors for cervical intraepithelial neoplasia: differences between low- and high-grade lesions
- NHS England: Primary High Risk HPV Testing with Cytology Triage
- Gov UK: Cervical Screening – Helping you decide
- The British Society for Colposcopy and Cervical Pathology: About Cervical Screening.
- NHS: Overview – Colposcopy
- CDC: STD Facts – HPV in Men
- International Journal of Environmental Research and Public Health: Prevalence and Risk Factors of Human Papillomavirus in Male Patients: A Systematic Review and Meta-Analysis.
- Sexually Transmitted Infections – British Medical Journal: Human papillomavirus in men: comparison of different genital sites
- Cancer Epidemiology, Biomarkers and Prevention: The Human Papillomavirus Infection in Men Study: Human Papillomavirus Prevalence and Type Distribution among Men Residing in Brazil, Mexico, and the United States
- HHS Public Access: HPV infection and re-infection in adult women: the role of sexual activity and natural immunity
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3882063/
- British journal of midwifery: HPV during pregnancy