Human papillomavirus (HPV) is a very common sexually transmitted infection that can cause serious health problems. There are over 150 different types of HPV, with around 40 types that specifically affect the genital area. HPV is so widespread that nearly all sexually active individuals will get it at some point in their lives. Thankfully, most HPV infections go away on their own without causing any symptoms. However, some high-risk HPV strains can lead to genital warts or cancer if left untreated. Knowing the signs and symptoms of an HPV infection is important for getting proper screening and treatment.
Most HPV infections are asymptomatic
One of the tricky aspects of HPV is that the majority of new infections cause no symptoms at all. According to the Centers for Disease Control and Prevention (CDC), around 70% of new HPV infections go undetected. When symptoms do occur, they often don’t develop until weeks, months, or even years after the initial infection. The lack of symptoms with initial HPV infection helps explain how easily the virus spreads between sexual partners. While condoms may lower transmission risk, HPV can still be passed through skin-to-skin genital contact not covered by a condom.
Even in cases when HPV symptoms manifest, they are often vague and nonspecific. Some symptoms that might indicate an HPV infection include:
- Itching, burning, or tenderness in the genital area
- Abnormal vaginal discharge
- Genital warts
- Recurrent urinary tract infections
However, these symptoms can also occur with other STDs or genital infections. The only way to confirm an active HPV infection is through HPV testing.
HPV testing
There are two main types of HPV tests used for screening:
- HPV DNA test – Detects the genetic material of high-risk HPV strains like HPV 16 and HPV 18 that can lead to cell changes. The test can identify an active infection.
- HPV/Pap cotest – Checks for abnormal cervical cells while also testing for high-risk HPV types. An abnormal Pap result coupled with a positive HPV test indicates precancerous cervical changes that require further evaluation.
HPV testing is not routinely performed on its own unless abnormal results show up on a Pap smear. Current guidelines recommend HPV screening for women ages 30-65 every 5 years. Testing can start at age 25 for high-risk women, such as those with compromised immune systems. HPV tests are performed on samples collected from the cervix. The sampling is minimally invasive and takes only a minute or two to collect.
Genital warts
Genital warts represent the most visible sign of an HPV infection. They are caused by low-risk HPV types, most commonly HPV 6 and HPV 11. Around 1% of sexually active adults in the U.S. have visible genital warts at any given time. Warts may take weeks or months to appear after initial HPV infection. In women, the warts usually form on the vulva but can also develop inside the vagina or on the cervix.
Genital warts start out small but can grow and spread into large, cauliflower-shaped clusters if left untreated. The warts are usually flesh-colored, pink, or white. They tend to be soft, smooth, and sometimes clustered into groups resembling cauliflower. In addition to their appearance, genital warts sometimes cause discomfort and itching. But they are not normally painful.
While genital warts are not cancerous, they can cause considerable emotional stress and interfere with sexual intimacy. They also tend to recur after treatment. For these reasons, removing genital warts as soon as possible is recommended.
Cervical cell changes
Certain high-risk HPV types like HPV 16 and 18 can cause abnormal changes in cervical cells. If these cervical cell irregularities are not treated, they may progress to cervical cancer over time. Precancerous changes most often arise at the transformation zone on the cervix where the outer squamous cells meet the inner glandular cells.
Detecting abnormal cervical cells in early stages allows for treatment before invasive cervical cancer develops. Routine Pap tests and HPV cotests can identify cervical abnormalities before they become cancerous. Pap test samples also allow doctors to determine the severity of any cervical changes present:
- ASC-US – Atypical squamous cells of undetermined significance. Mild cell changes.
- LSIL – Low-grade squamous intraepithelial lesion. Moderate cell changes.
- HSIL – High-grade squamous intraepithelial lesion. Severe cell changes and potential precursor to cervical cancer if not treated.
Women with abnormal cervical cell changes usually don’t experience any outward symptoms. That’s why getting regular screening as recommended is so important for detecting issues at an early stage when treatment is most effective.
HPV and cervical cancer
Over a period of 10-20 years, untreated high-grade cervical cell abnormalities can progress to invasive cervical cancer. HPV genotypes 16 and 18 are responsible for roughly 70% of all cervical cancers globally. As the cervical cancer advances, women may notice these key signs and symptoms:
- Abnormal vaginal bleeding between periods, after intercourse, or after menopause
- Watery or bloody vaginal discharge that may be heavy and have a foul odor
- Pelvic pain during intercourse
- Painful urination
- Low back pain
- Unexplained weight loss
Once cervical cancer becomes advanced or spreads to other tissues and organs, it is difficult to treat and can be fatal. The good news is cervical cancer is highly preventable through HPV vaccination, proper safer sex practices, and routine Pap/HPV testing to find precancerous changes early.
Other HPV-related cancers
While less common than cervical cancer, HPV can also lead to cancers in other parts of the female reproductive system:
- Vulvar cancer – Linked to HPV infection in about 40% of cases. Signs include itching, pain, or bleeding from an abnormal lesion on the external genitals.
- Vaginal cancer – HPV plays a role in around 70% of vaginal cancer cases. Symptoms include abnormal vaginal bleeding and discharge.
- Anal cancer – Around 90% of anal cancers are associated with HPV infection. Symptoms include anal bleeding, pain, itching, or discharge.
Routine HPV testing is not yet recommended for these other cancer types. But women should discuss any unusual symptoms or abnormalities of the lower genital tract with their doctor.
Who is most at risk for HPV?
HPV transmission is very common, but certain women face higher chances of persistent infection and HPV-related health problems:
- Women under 30 years old. Risk declines with older age as the immune system better clears HPV.
- Those with multiple sex partners or a partner who has had multiple partners.
- Women with weakened immune systems, such as those living with HIV.
- Smokers.
- Long-term oral contraceptive users.
Women in these higher risk categories should take steps to ensure they undergo regular Pap and HPV screening according to guidelines. Getting vaccinated against HPV can also help prevent persistent infections and HPV-related cancers.
How can HPV be prevented?
The two best ways for women to avoid getting infected with HPV or developing complications are:
- HPV vaccination – The CDC recommends all preteens get the HPV vaccine series starting at age 11-12. Catch-up vaccination is also recommended for women up to age 26 who did not complete the series earlier. The vaccine protects against cancer-causing HPV genotypes 16 and 18.
- Routine screening – Women ages 21-29 should have a Pap test every 3 years to check for abnormal cervical cells. Women 30-65 should get both a Pap test and HPV test every 5 years. Testing can end after 65 for low-risk women with a history of normal results.
Using barrier protection like condoms during intercourse may offer some protection against HPV but does not fully eliminate transmission risk. Limiting sexual partners is also advised.
Conclusion
HPV is extremely common but the vast majority of infections will not cause any symptoms or health issues. Some strains can lead to problems like genital warts or cancer, which is why getting vaccinated and undergoing regular screening is so important. Catching cervical cell changes early allows for quick treatment before cancer develops. While HPV has no cure, precancerous lesions and early-stage cervical cancer are highly treatable. Taking preventive measures gives women the best chance at avoiding major complications from HPV down the road.