Signs and Symptoms of Human Papillomavirus (HPV) Infection

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States. It is caused by a group of related viruses. Certain low-risk HPV types cause genital warts, while a small handful of high-risk types can cause changes in cells that lead to cancer. Others still cause no symptoms at all.

This article looks at the various signs and symptoms of HPV infection, including the different types of cancer associated with high-risk HPV strains.

Frequent Symptoms

The most frequent symptom of HPV infection is no symptoms at all. This is what healthcare providers refer to as an asymptomatic infection.

In fact, most sexually active people will get HPV at some point in their lives and not even know it. If an infection does occur, most will clear the virus spontaneously with no long-term consequences. Moreover, they will be immune to that particular HPV type.

With that said, there are over 150 different HPV types, and it is possible to be infected again by another type that may not clear and may end up causing symptoms and complications.

Less Frequent Symptoms

Studies suggest that around 1% of people who get HPV will get a low-risk type that causes genital warts.

HPV is ultimately the cause of all common warts. Some HPV types only cause warts on the hands or feet and can be spread by casual contact. Genital warts, by contrast, are caused by a handful of low-risk types that are spread by intimate sexual contact.

While there are several different low-risk types that cause genital warts, around 90% are the result of two specific types:

• HPV type 6
• HPV type 11

As per their name, genital warts can occur on or around the genitals, including those of the female reproductive tract (including the labia, vulva, vagina, clitoris, and cervix) and male reproductive tract (penis and scrotum).

If you engage in anal sex, warts may also appear in or around the anus as well as inside the rectum. If you engage in oral sex, you can even get warts inside the mouth and throat or even on the lips.

Genital warts are typically painless, fleshy overgrowths of skin that closely resemble pieces of cauliflower. There may just be one wart or a cluster of them, and they can either be big or small.

Genital warts can disappear on their own without treatment, typically within the first two years. Others may need to be removed by a healthcare provider with liquid nitrogen, laser therapy, or surgery.

Complications

The larger concern about HPV is that you can get certain high-risk types that significantly increase your risk of certain cancers. There are roughly 14 strains that can cause changes to cells that can lead to cancer, including cancers of the cervix, penis, rectum, vagina, vulva, mouth, and throat.

Those linked to the highest risk of cancer include:

• HPV type 16
• HPV type 18
• HPV type 31
• HPV type 45

HPV is thought to cause precancerous changes to tissues—referred to as neoplasia—by integrating its genetic material into that of infected cells. The genes from high-risk HPV types appear to function as oncogenes, meaning genes that can give rise to cancer by causing cells to grow abnormally and out of control.

There are six types of cancer linked to HPV infection:

• Cervical cancer: Nearly all cases of cervical cancer are associated with HPV infection, with HPV type 16 and HPV type 18 accounting for 70% of cases.
• Anal cancer: Around 90% of anal cancers are linked to HPV. People coinfected with HIV and high-risk HPV are at up to 70 times greater risk of anal cancer than the general population.
• Vaginal cancer: Around 77% of cancers of the vagina are linked to HPV, mostly HPV type 16 but also HPV type 18.
• Vulvar cancer: Around 70% of cancers of the vulva are linked to HPV, mostly HPV type 16 but also HPV type 18.
• Penile cancer: HPV is associated with approximately 60% of cancers of the penis, with the majority caused by HPV type 16.
• Mouth and throat cancer: Also known as oropharyngeal cancer, around 70% of cases in the United States are linked to HPV type 16.

Overall, HPV type 16 is the strain most likely to cause cancer.

When to See a Healthcare Provider

You should see your healthcare provider if you notice any changes in the appearance of your genitals, mouth, throat, or anus. If cancer is suspected, a biopsy and other tests can be performed to check for cancer or precancerous cells.

With that said, most cases of cervical cancer are found during a routine pelvic exam.

This is why thy the American Cancer Society recommends cervical cancer screening—which involves a Pap smear to check for abnormal changes in cells and an HPV test to check for high-risk HPV types—every five years for everyone with a cervix from ages 25 to 65. If HPV testing is not available, people can get a Pap test every three years.

While there are anal Pap smears available to check for anal cancer, routine screening is currently not recommended. With that said, if you find an anal wart (or something that looks or feels like it), you can ask your healthcare provider for the test, especially if you are at increased risk. This includes men who have sex with men (MSM) who have HIV.

HPV Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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Summary

The majority of people with human papillomavirus (HPV) will not experience any symptoms and may clear the virus without even realizing they were infected.

However, a small portion may get a low-risk HPV type that can cause genital warts, while others may get a high-risk HPV type that can cause changes in cells that could lead to cervical cancer, penile cancer, oral cancer, anal cancer, vaginal cancer, or vulvar cancer.

A Word From Verywell

As scary as the thought of HPV-related cancers may be, there are ways to reduce your risk. Chief among them is HPV vaccination with Gardasil-9. This is a vaccine given by injection that protects against nine high-risk HPV strains, including HPV types 16 and 18.

HPV vaccination is recommended for children ages 11 to 12 as well as teens and adults up to the age of 26. Gardasil-9 can also be used in adults over 26 based on a discussion of the potential benefits with their healthcare provider.