Human papillomavirus (HPV) is a very common virus that can lead to a variety of health problems. There are over 100 different strains of HPV, with around 40 strains that specifically affect the genital area. HPV is primarily spread through sexual contact. Most sexually active adults will contract HPV at some point in their lives, though many never show any symptoms.
When HPV does cause symptoms, pain is one of the most common. The degree and type of pain can vary considerably depending on the strain of HPV and area of the body affected. Genital warts are a particularly painful manifestation of HPV.
What is HPV?
HPV stands for human papillomavirus. It is a group of related viruses, rather than a single virus. There are over 100 known strains of HPV. Different strains are given numbers to identify them. Some noteworthy strains include:
– HPV 6 and 11: These strains most commonly cause genital warts. They do not cause cancer.
– HPV 16 and 18: These high risk strains are responsible for around 70% of cervical cancer cases, as well as cancers of the anus, penis, vagina, vulva, and back of the throat.
– HPV 31, 33, 45, 52 and 58: These high risk strains are responsible for many other cervical cancer cases. They may also cause anal and penile cancers.
HPV is primarily spread through sexual contact with an infected partner. It can be passed through vaginal, oral, and anal sex. Using condoms reduces, but does not eliminate, the risk of transmission. The virus infects the skin and mucous membranes.
Most people contract HPV soon after becoming sexually active. Around 79 million Americans currently have HPV, with about 14 million becoming newly infected each year. Most strains of HPV cause no symptoms and resolve spontaneously within 1-2 years. However, sometimes HPV persists in the body and leads to health problems.
What health problems can HPV cause?
While HPV often causes no symptoms at all and goes away on its own, it sometimes leads to notable health issues. The most common problems caused by HPV include:
– Genital warts – soft, skin-colored growths in the genital area caused by low risk HPV strains 6 and 11.
– Cervical cell changes (abnormal Pap test results) – HPV infection, especially with high risk strains like 16 and 18, can cause abnormal precancerous changes to cervical cells. These changes are detected by Pap tests. If not treated, they may eventually progress to cervical cancer.
– Cervical cancer – Nearly all cases of cervical cancer are attributable to high risk HPV infection. Cervical cancer arises from precancerous cell changes that were not treated.
– Other cancers – HPV is linked to cancers of the vulva, vagina, penis, anus, and throat. High risk strains are responsible.
– Recurrent respiratory papillomatosis – A rare condition where warts form inside the airways, caused by HPV 6 and 11.
What kinds of pain can HPV cause?
HPV can cause several types of pain depending on the particular health problem it triggers:
Genital warts
Genital warts usually form painless, soft growths. However, they can sometimes be painful due to:
– Irritation – Warts may itch, burn, or feel tender. Tight clothing can rub against warts.
– Inflammation – The area around warts may become red, swollen, and painful.
– Bleeding – Warts may bleed if irritated or scratched.
– Location – Warts on the opening of the vagina or anus can be especially painful during intercourse.
– Size and number – Larger warts or clusters of warts are more prone to pain and irritation.
Treatment of genital warts can also be painful:
– Burning off warts with electrical currents, lasers, chemicals, or freezing causes a burning sensation.
– Medicated creams promote peeling and inflammation as the warts die off. This can sting.
– Surgical removal requires a local anesthetic injection to numb the area. This injection causes a pinprick pain.
Cervical cell changes
Abnormal cervical cell changes do not usually cause pain themselves. However, some women experience pelvic pain or discomfort during a Pap test to collect cells. This brief pain is due to:
– Speculum insertion – The metal or plastic speculum holding the vagina open can cause pressure.
– Cervical motion tenderness – Moving the cervix during sample collection may cause a pinching pain.
– Cramping – Some women have cramping during or after a Pap test, similar to menstrual cramps. Taking ibuprofen an hour before the procedure can help.
Cervical cancer
In its early stages, cervical cancer normally does not cause pain. As it progresses, women may experience:
– Pelvic pain – A persistent dull ache or feeling of heaviness in the pelvis. It may worsen over time.
– Pain during intercourse – Women may feel pelvic pain during deep penetration.
– Back pain – Advanced cancer pressing on pelvic nerves can cause lower back pain.
– Leg pain – Compression or invasion of pelvic nerves can cause sciatica-like pain down the legs.
– Painful urination – Cancerous lesions on the bladder or urethra can cause burning with urination. There may also be blood in the urine.
– Abdominal pain – If the cancer spreads to the liver, abdomen, or elsewhere, it can cause pain in these areas.
Other HPV-related cancers
Anal, penile, vulvar, and throat cancers caused by HPV can also become painful as they enlarge and spread. Common symptoms include:
– A lump, growth, or ulcer on the penis, vulva, or anus that progressively enlarges and becomes painful.
– Anal or pelvic pain during intercourse.
– Burning pain with bowel movements or urination with anal cancer.
– Pain in the neck, throat, or lymph nodes with throat cancer. Difficult, painful swallowing may occur as the cancer enlarges.
– Severe pain if the cancer spreads to bones, the spine, or other areas.
When should someone see a doctor about possible HPV pain?
Anyone experiencing the following symptoms should see a doctor to check for possible HPV infection:
– Genital warts or wart-like bumps in the genital region
– Unusual growths, sores, or ulcers on the genitals
– Pelvic or cervical pain
– Pain during intercourse
– Pain during a Pap test
– Blood in the urine or abnormal discharge
While brief, mild pain from irritation or inflammation of genital warts may not require urgent care, new, worsening, or severe pain should be evaluated promptly to rule out progression to cancer. Back, leg, or abdominal pain could also indicate possible cancer spread.
Anal or throat pain should also be assessed quickly to check for cancers in these areas, especially in those at high risk due to HPV exposure or other factors. Any difficulty or pain swallowing requires immediate medical attention to evaluate for possible throat cancer.
How is HPV-related pain treated?
Treatment for HPV-related pain depends on the underlying cause:
Genital warts
– Use warm baths and avoid irritating the area to ease discomfort from inflammation.
– Take OTC analgesics like acetaminophen or ibuprofen to relieve pain.
– Apply numbing creams, gels, or sprays to the genital area for temporary pain relief.
– Have warts removed to permanently eliminate the source of pain. Methods include burning, freezing, surgical excision, laser therapy, and applying topical chemicals.
Cervical cell changes
– Take OTC anti-inflammatories like ibuprofen before a Pap test to minimize cramping.
– Arrange for smaller speculum use if insertion causes substantial pain or pressure.
– Have any precancerous lesions removed to prevent progression to cancer. Methods include LEEP (loop electrosurgical excision procedure) and cone biopsy.
Cervical cancer
– Use analgesics and complementary therapies like massage or acupuncture to help manage chronic pelvic and back pain.
– Try nerve blocks, opioids, and other prescription medications for severe pain.
– Undergo radiation, chemotherapy, or surgery to treat the cancer and eliminate the source of pain. This may successfully reduce pain in early stage cancers.
Other cancers
– Take OTC or prescription pain medications to manage pain from anal, penile, vulvar, or throat cancers. More severe pain may require opioid drugs.
– Use radiation therapy to shrink tumors pressing on nerves or bones causing pain. Targeted radiation provides localized pain relief.
– Consider surgical removal of cancerous growths. This can relieve pain from large tumors obstructing organs.
– If cancer has spread extensively, palliative pain management is important to improve quality of life. A combination of medications, nerve blocks, and complementary methods is often used.
What is the outlook for HPV-related pain?
The prognosis for HPV-related pain depends greatly on the specific condition causing it:
– Discomfort from genital warts or Pap tests is temporary and usually manageable with minimal intervention.
– Precancerous cell changes can be cured by removing the abnormal cells, providing lasting pain relief.
– For early stage cervical cancer, treatment is usually very effective at eliminating pain along with the cancer.
– Advanced cervical cancer that has spread may cause chronic pain that is difficult to fully control, especially at the end of life. Quality of life often decreases.
– Anal, penile, vulvar, and throat cancers have good cure rates when detected early. Pain often resolves with successful treatment. Advanced or recurrent cancers have poorer outlooks for pain resolution.
– Even if the cancer cannot be cured in late stages, palliative pain management can still significantly improve comfort levels and let those with HPV-related cancers have a better quality of life.
Conclusion
HPV can cause several types of pain ranging from mild discomfort to severe, chronic pain at advanced cancer stages. Low risk HPV strains commonly lead to temporary irritation from genital warts. High risk HPV strains can cause cervical and other cancers that progressively become painful if not treated early. Anyone experiencing unexplained pain in the genitals, pelvis, throat, or elsewhere should be evaluated for possible HPV infection and related cancers. Catching cell changes and cancers early greatly improves the prognosis for eliminating HPV-associated pain. Palliative pain relief is also important for advanced stage patients to improve their quality of life.