HPV stands for Human Papilloma Virus. These viruses are the most common sexually transmitted diseases. There are more than 14 million new cases of HPV in the U.S. each year. It is estimated that every sexually active man or woman will acquire or be exposed to a genital HPV infection at some point in their lives. Most infected people have no idea they are infected. It is possible to have more than 1 type or strain of HPV. Just because you get infected with 1 strain, you are not immune to infections with other strains. There are more than 100 types or strains of HPV. More than 40 types can infect the genital area. This can happen with normal intercourse, genital to genital contact, mouth to genital contact, anal intercourse or sharing infected sex toys. Transmission of HPV by an environmental surface (toilet, tanning bed, hot tub etc.) has never been documented. If you have been with your partner for a while, your partner likely has HPV too.
The majority of HPV infections are asymptomatic, unrecognized or sub clinical. Genital HPV infection is common and usually self limited. Some strains ( types 6 or 11) cause visible genital warts, but the majority of infections are silent. HPV types 16,18, 31, 33, and 35 are strongly associated with pre cancerous cells of the cervix . “High risk types” like 16 and 18 cause cancer of the cervix, vulva, vagina, anus, penis, throat, tongue and tonsils. HPV types 16 & 18 account for 70% of the high risk types and require close surveillance. “Low risk types” like 6 & 11 cause genital warts and mild abnormalities of the cervix or vagina.
There is no treatment for HPV. We can only treat the abnormal cells it causes. These are usually called “dysplastic” or “neoplastic” cells. These terms mean “pre cancer.” Your immune system will take care of most (>90%) of infections within 2 years. A persistent infection with a “High risk type” is a risk factor for development of pre cancer or cancer of the cervix. The incubation period for genital warts is 3 weeks to several months. The incubation for cervical problems can take months to years. A person can have HPV for years before it is found.
There is no treatment for HPV. We can only treat the abnormal cells it causes.
Condoms may reduce the risk of HPV transmission but HPV infection can occur in areas that are not covered or protected by a condom (the scrotum, vulva, around the anus). To be effective, condoms must be used FOR EVERY SEX ACT FROM START TO FINISH! Just like pregnancy it only takes 1 slip up.
One way to protect yourself against HPV is through vaccination. There are two vaccines for HPV.
- The GARDASIL vaccine- protects against HPV types that cause genital warts and cervical, vaginal, vulvar, penile and anal cancer. It is recommended for men and women ages 13 to 26. Insurance will not cover it once you turn 27. The younger you are when you get vaccinated, the better your immunity will be. That’s why it is recommend for teens before they are even having sex. It is a series of 3 shots over 6 months (first shot then 2 months later then 6 months later). The shots go in the arm.
- The Cervarix vaccine- only protects against HPV types 16 & 18 and is given to women only. It is given the same way as Gardasil. In my opinion Gardasil is a better vaccine.
Another way for women to protect themselves is to get a yearly pap smear. This checks for the presence of precancerous cells. If you over 30 or <65, it will also check for the presence of high risk types of HPV. If High risk types are detected it will be further tested for types 16 or 18. If one or both of these are detected, it is recommended that a colposcopy (procedure to look at your cervix under a microscope) and anal pap smear be done. The CDC and American College of OB/GYN only recommend routine pap smears for women ages 21-65.
There is NO TEST FOR HPV IN A MAN. If your male partner swears he tested negative “for all STDs” by his doctor – great, but he DID NOT GET TESTED FOR HPV. Currently the only test for HPV is off the pap/anal pap smear. The only way you would know if your man had HPV would be if you had it and have unprotected sex with him, or he has had genital warts, or one of his prior girlfriends had abnormal paps or cervical or vaginal dysplasia or cancer. A person can have HPV even if it has been years since they had sexual contact with the infected person. I have an 80 year old patient who hasn’t had sex in 30 years. Guess what? She got infected 30 years ago!
Another way to protect yourself is by NOT SMOKING !!! Smoking increases your chance of cervical cancer. Smokers have a hard time clearing HPV from their bodies. If you smoke – STOP SMOKING. This is for men and women. HPV and smoking are most likely responsible for most cases of throat, tongue and tonsil cancer (and probably many more we don’t know about yet).
Frequently asked Questions
- Does HPV affect pregnancy? Having HPV or precancer cells on your cervix doe not affect getting or staying pregnant. Hopefully you have a vaginal delivery and shed all those abnormal cells off your cervix when you dilate to 10! Genital warts can be contracted by the baby as it comes through the vagina at delivery. This can cause warts on the babies vocal cords which have to be surgically removed. If you have a lot of genital warts at the time of delivery, your doctor may recommend a C-section. Treatment (LEEP or LLETZ) of cervical dysplasia theoretically shorten your cervix. Let your doctor know at your first OB visit.
- What happens if I got the first Gardasil but never got the second? Get the second one any time and two months later get the third one.
- Why should I get the Gardasil shots if I am married/ am only going to have sex with my husband? Chances are your future husband/wife has had sex or genital contact of some form with someone else. Remember when you have sex with someone you are basically getting exposed to anything he/she has been exposed to in the last 5 years. Not to rain on anyone’s parade – more than 50% of all marriages end in divorce. You will be left unprotected (too late for that HPV vaccine) as your immune system declines with age. I like to say hope for the best, prepare for the worst.
- What are the best condoms/lubricants to protect against HPV? LATEX condoms are the only type of condoms that have been shown to consistently protect against HPV and STDs. (Pick your partner carefully if you are latex sensitive). There are polyurethane (plastic condoms) for men and women. They are more expensive than latex, and break easier. It is better to use a male condom than a female condom if you are trying to prevent pregnancy or STDs. There are “extra strength” condoms available for rectal or aggressive sex. Spermicides in the condom are probably a no go. Latest thinking is that they may actually increase spread of STDs by irritating the vagina or penis. In case you didn’t know – there are flavored condoms available for oral sex. DON’T USE VASELINE, MASSAGE OIL, BABY OIL, BODY LOTION, VEGETABLE OIL (really?) or VAGINAL YEAST/BACTERIAL MEDICATIONS for lubrication. These all weaken the latex and can cause the condom to break. ;( Use water based lubricants like KY. Remember CONDOMS have EXPIRATION DATES.
- Should I tell my future partners I have HPV ? Yes- but also tell them they probably have it currently or have had it in the past. No test for a man. And remember – even though your last boyfriend gave you HPV, this new guy can give you a different strain and a new infection! In fact, you can get repeatedly infected with new strains for the rest of your life! Reason enough to get the GARDASIL vaccine shots.