Human Papillomavirus or HPV is a Sexually transmitted disease that can cause cancerous changes and genital warts in BOTH men and women. HPV is not HIV (Human Immunodeficiency Virus) and not HSV (Herpes Simplex Virus). While all the above are sexually transmitted diseases, HPV is one that is often overlooked and misunderstood.
What are the common misunderstandings surrounding HPV?
Common points of confusion include:
- Is it really an STD?
- Does it cause warts or cancer?
- Is it only a women’s disease?
- Is HPV Screening for men necessary?
- Do I need to get vaccinated against it?
Is it really an STD?
Yes it is an STD.
HPV is a DNA Virus with over 200 subtypes. The virus is passed from 1 person to another through physical contact and is considered a Sexually Transmitted Disease as sexual intercourse is the primary source of exposure to the virus. That said, any kind of sexual contact including Oral Sex can transmit HPV. Studies have shown that men or women with a higher number of sexual partners, regardless of sexual orientation, are at higher risk of HPV infection. That said, because HPV is so common and so contagious, even people who have only had one sexual partner are considered to be at risk. And therefore will benefit from screening and vaccination.
Does it cause warts or cancer?
It causes both warts and cancer.
The large number of subtypes of the virus means different subtypes of the virus affect the body differently:
- Warts – Can occur on any skin surface that came into contact with wart causing subtypes. The resulting warts can either be flat or raised bumps (papules) that cluster together and grow larger as the HPV replicates within the tissue. Warts are commonly described as looking like “cauliflowers”. They commonly grow on or around the genitals and anus. Conditions that weaken the immune system can cause more warts to grow and to grow faster and larger. These include Diabetes, Smoking and HIV.
- Cancers – HPV infection has been linked to a variety of cancers including:
- Cervical Cancer
- Anal Cancer
- Penile Cancer
- Vulvar and Vaginal Cancer
How do I know I have HPV Warts?
The diagnosis of a wart is a clinical one meaning the doctor determines it is a wart if it has a characteristic features (commonly described as looking like a cauliflower). Some skin lesions can look very much like warts. If there is doubt if it is a wart, doctors do sometimes send the tissue for testing after removing it. People most commonly confuse moles (benign growths) with warts. A few features that are useful in differentiating the 2 are
- How long has it been there? – moles seldom spontaneously appear but warts do
- Has it been getting larger faster recently? – moles often do not grow quickly but warts do
- Are there more growths appearing? – warts tend to “expand” into other areas but moles are usually solitary
Apart from being unsightly and contagious, warts can appear on areas such as the foreskin and affect urination. In situations like these, we do recommend circumcision to remove the foreskin and the warts in a single procedure.
What are the treatments for HPV warts?
Warts are easily removed with either creams, freezing or laser. The idea is to destroy any tissue that contains the virus. Warts can be very stubborn and sometimes multiple treatment sessions are necessary.
Getting rid of warts is only the first step. Preventing them from recurring and avoiding getting re-infected is probably more important. This is why getting the HPV vaccine is so crucial even if you have already developed HPV warts.
How does HPV Cause Cancer?
Once the virus has infected an area of tissue such as the cervix or anus, it starts to use the cells in the area to replicate. As the virus replicates it causes damage to the cells and makes the body’s repair of the area inefficient. The result is the original healthy and well organised tissue loses its ability to produce normal cells. This is known as dysplasia and is regarded as a precancerous change. Given enough time, the HPV drives more dysplasia in the area and eventually the area becomes so damaged the cells become cancerous.
The 2 most common areas in which HPV causes cancerous change are the Cervix and the Anus. International figures estimate that HPV Subtypes 16/ 18 cause 70% of Cervical Cancer and 90% of Anal Cancer. Penile cancer due to HPV is on the other hand uncommon globally and while there is a small proportion of penile cancers that are infected with HPV, the link is not as strong as that of the Cervical and Anal Cancers.
Fortunately, HPV infection is transient in most cases and even the cancer causing subtypes can be cleared by the body over 12 months. However, having a HPV infection that lasts longer than 12 months increases the chances of cancer developing. Certain risk factors increase the chances of you having a persistent HPV infection and an increased risk of cancer:
- Multiple sexual partners – Regardless of orientation, individuals with more sexual partners are found to have higher risk of having persistent HPV infection. The thinking behind this is that the body is not given enough time to recover from a HPV infection because each sexual partner can potentially add on more HPV to the original infection.
- No condom use
- Not Circumcised – Circumcised men naturally clear HPV more efficiently from their systems compared to men who are not circumcised
Regular screening combined with vaccination reduces the risks of HPV infection and consequently HPV warts and cancer. Regular screening allows Doctors to detect pre-cancerous changes at an early stage. Very often, Doctors will just keep a close eye on this while the body fixes itself. If the pre-cancerous lesion is found at a late stage or progresses onto a more advnaced stage, the pre-cancerous cells can be removed thus preventing the development of cancer altogether.
Vaccination creates antibodies against several subtypes of HPV thus reducing the chances of HPV remaining in the body. And protects the patient against infection by other HPV strains.
Vaccination can also reduce the risk of warts recurring.
HPV screening is done by doing a swab in the affected area. In women, this involves a cervical smear. In Men who have sex with Men (MSM), this is done with an anal swabs. Penile swabs can be done for heterosexual men.
Is it only a women’s disease?
No it is not. HPV affects men too.
HPV is most well-known for causing Cervical Cancer. That is why many people believe it is only a disease that affects women.
However, HPV infection is just as common among men. It causes genital warts. And also causes penile and anal cancer. HPV infection is a common risk among men of all sexual orientations.
Is HPV Screening for men necessary?
Routine HPV Screening is not recommend for men (correct as at the date this article was written)
HPV screening for women has been well established to detect pre-cancer and prevent cervical cancer. However, no such guideline or protocol currently exists for heterosexual men.
The jury is still out on this matter. As opposed to regular screening advised for women below 65 and MSM, there is no strict guideline about HPV screening in heterosexual men. Whether you really need to depends on your exposure risk. As mentioned above, having multiple sexual partners and unprotected sexual intercourse increases the risk of HPV infection.
An important thing to note about HPV screening is that the current tests we have only tests for cancer causing strains. It does NOT test for wart causing strains. So when a Doctor tells you that your HPV test is “clear”, what he is saying is that the test did not detect any cancer causing strains. If you do develop warts this does not mean the test was inaccurate. Another way of putting it – a “clear” HPV test does NOT mean that you are clear of every single strain of HPV.
Do I need to get vaccinated against HPV?
Yes! You absolutely do!
Current HPV vaccines are recommended for men from age 9 to 45 years old. The latest vaccine is called Gardasil 9. It directly protects against 9 strains of HPV. It also gives cross protection against many other strains.
Getting vaccinated against HPV will reduce your risk of developing genital warts as well as penile and anal cancer.
It also protects your partners against a HPV infection.
A famous example from history is Juan Peron, the Argentinian President and husband of Evita Peron. All 3 of President Peron’s wives died of cervical cancer. Although never established because there was no test at that time to screen for HPV, medical historians believe that he most likely caused cervical cancer in all 3 partners by being a carrier of the virus.
In conclusion
HPV is a sexually transmitted disease that can have a varied range of manifestations for both men and women from cancer to warts. Getting screened regularly and being vaccinated reduces the risk of contracting or transmitting HPV.
Have a question on HPV infection or vaccines? Put it in the comments section below.