What is Genital HPV Infection?

How do people get HPV?

HPV is passed on through genital contact, most often during vaginal and anal sex. HPV may also be passed on during oral sex and genital-to-genital contact. HPV can be passed on between straight and same-sex partners—even when the infected partner has no signs or symptoms. A person can have HPV even if years have passed since he or she had sexual contact with an infected person. Most infected persons do not realize they are infected or that they are passing the virus on to a sex partner. It is also possible to get more than one type of HPV. Very rarely, a pregnant woman with genital HPV can pass HPV to her baby during delivery. In these cases, the child can develop Juvenile-Onset Recurrent Respiratory Papillomatosis (JORRP). What are the signs, symptoms and potential health consequences of HPV? Most people with HPV do not develop symptoms or health problems from it. In 90% of cases, the body’s immune system clears HPV naturally within two years. But there is no way to know which people who get HPV will go on to develop cancer or other health problems.

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• Sometimes, certain types of HPV can cause genital warts in males and females. Rarely, these types can also cause warts in the throat -- a condition called recurrent respiratory papillomatosis or RRP.

• Other HPV types can cause normal cells in the body to turn abnormal, and might lead to cancer over time. These HPV types can cause cervical cancer and other, less common cancers, including cancers of the vulva, vagina, penis, anus, and head and neck (tongue, tonsils and throat).

The types of HPV that can cause genital warts are not the same as the types that can cause cancer.

What are the potential health problems of HPV?

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Genital warts usually appear as a small bump or groups of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. Health care providers can diagnose warts by looking at the genital area during an office visit. Warts can appear within weeks or months after sexual contact with an infected partner—even if the infected partner has no signs of genital warts. If left untreated, genital warts might go away, remain unchanged, or increase in size or number. Warts will not turn into cancer.

Cervical cancer usually does not have symptoms until it is quite advanced, very serious and hard to treat. For this reason, it is important for women to get regular screening for cervical cancer. Screening tests can find early signs of disease so that problems can be treated early, before they ever turn into cancer.

Other HPV-related cancers might not have signs or symptoms until they are advanced and hard to treat. These include cancers of the vulva, vagina, penis, anus, and head and neck. Human papillomavirus (HPV) has been found to be associated with several types of cancer: cervical, vulvar, vaginal, penile, anal, and some head and neck cancers. Each year, more than 17,300 HPV-associated cancers occur in women; cervical cancer is the most common. Almost 7,600 HPV-associated cancers occur each year in men; head and neck cancers are the most common.

RRP causes warts to grow in the throat. It can sometimes block the airway, causing a hoarse voice or troubled breathing. Although rare, RRP can occur among adults and children.

How can people prevent HPV?

There are several ways that people can lower their chances of getting HPV:

• Vaccines can protect males and females against some of the most common types of HPV. HPV vaccines are given in three doses over six months. It is important to get all three doses to get the best protection. The vaccines are most effective when given before a person's first sexual contact, when he or she could be exposed to HPV.
  • Girls and women: Two vaccines (Cervarix and Gardasil) are available to protect females against the types of HPV that cause most cervical cancers. One of these vaccines (Gardasil) also protects against most genital warts. Both vaccines are recommended for 11 and 12 year-old girls, and for females 13 through 26 years of age, who did not get any or all of the doses when they were younger. These vaccines can also be given to girls beginning at age 9. It is recommended that females get the same vaccine brand for all three doses, whenever possible.
  • Boys and men: One available vaccine (Gardasil) protects males against most genital warts. This vaccine is available for boys and men, 9 through 26 years of age.
• For those who choose to be sexually active, condoms may lower the risk of HPV infection. To be most effective, they should be used with every sex act, from start to finish. Condoms may also lower the risk of developing HPV-related diseases, such as genital warts and cervical cancer. But HPV can infect areas that are not covered by a condom - so condoms may not fully protect against HPV.
• People can also lower their chances of getting HPV by being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has had no or few prior sex partners. But even people with only one lifetime sex partner can get HPV. And it may not be possible to determine if a partner who has been sexually active in the past is currently infected. That's why the only sure way to prevent HPV is to avoid all sexual activity.

How can people prevent HPV-related diseases?

There are ways to prevent the possible health effects of HPV, including the two most common problems: genital warts and cervical cancer.

• Preventing Genital Warts: A vaccine (Gardasil) is available to protect against most genital warts in males and females (see above).

• Preventing Cervical Cancer: There are two vaccines (Cervarix and Gardasil) that can protect women against most cervical cancers (see above). Cervical cancer can also be prevented with routine cervical cancer screening (Pap test) and follow-up of abnormal results. The Pap test can find abnormal cells on the cervix so that they can be removed before cancer develops. Abnormal cells often become normal over time, but can sometimes turn into cancer. These cells can usually be treated, depending on their severity and on the woman’s age, past medical history, and other test results. An HPV DNA test, which can find HPV on a woman's cervix, may also be used with a Pap test in certain cases. Even women were vaccinated when they were younger need regular cervical cancer screening because the vaccines do not protect against all cervical cancers.

• Preventing Anal and Penile Cancers: There is no approved or recommended screening test for anal or penile cancer because more information is still needed to find out if such tests can be effective.

• Preventing Head and Neck Cancers: There is no approved test to find early signs of head and neck cancer because more information is still needed to find out if such tests can be effective.

• Preventing Recurrent Respiratory Papillomatosis (RRP): Cesarean ("C-section") delivery is not recommended for women with genital warts to prevent juvenile-onset RRP in their babies. This is because it is not clear that cesarean delivery prevents RRP in infants and children.

Screening

The Pap test (or Pap smear) helps find precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately. The HPV test checks for the virus that can cause these cell changes on the cervix. It may be used to screen for cervical cancer, with the Pap test, in women aged 30 years and older. It also may be used to provide more information when a Pap test has unclear results. Currently, there is no routine screening test recommended for other HPV-related health effects, such as genital warts or other HPV-associated cancers (vulvar, vaginal, anal, and head and neck cancers). The Pap test does not screen for cancers other than cervical cancer. Although there is no routine screening test for other HPV-associated diseases, you should visit your doctor regularly for checkups.

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The Pap test is recommended for all women, and can be done in a doctor's office or clinic. During the Pap test, the doctor will use a plastic or metal instrument, called a speculum, to widen your vagina. This helps the doctor examine the vagina and the cervix, and collect a few cells and mucus from the cervix and the area around it. The cells are then placed on a slide or in a bottle of liquid and sent to a laboratory. The laboratory will check to be sure that the cells are normal.

If you are getting the HPV test in addition to the Pap test, the cells collected during the Pap test will be tested for HPV at the laboratory. Talk with your doctor, nurse, or other health care professional about whether the HPV test is right for you.

When you have a Pap test, the doctor may also perform a pelvic exam, checking your uterus, ovaries, and other organs to make sure there are no problems. There are times when your doctor may perform a pelvic exam without giving you a Pap test. Ask your doctor which tests you are having, if you are unsure.

If you have a low income or do not have health insurance, you may be able to get a free or low-cost Pap test through the National Breast and Cervical Cancer Early Detection Program. To find out if you qualify, call your local program or 1-800-CDC-INFO.

When to Get Screened

You should start getting regular Pap tests at age 21, or within three years of the first time you have sex—whichever happens first. The Pap test, which screens for cervical cancer, is one of the most reliable and effective cancer screening tests available.

The only cancer for which the Pap test screens is cervical cancer. It does not screen for ovarian, uterine, vaginal, or vulvar cancers. So even if you have a Pap test regularly, if you notice any signs or symptoms that are unusual for you, see a doctor to find out why you're having them.

In addition to the Pap test—the main test for cervical cancer—the HPV test may also be used to screen women aged 30 years and older, or women of any age who have unclear Pap test results.

If you are 30 years old or older and your screening tests are normal, your chance of getting cervical cancer in the next few years is very low. For that reason, your doctor may tell you that you will not need another screening test for up to three years. But you should still go to the doctor regularly for a check-up that may include a pelvic exam.

It is important for you to continue getting a Pap test regularly—even if you think you are too old to have a child, or are not having sex anymore. If you are older than 65 and have had normal Pap test results for several years, or if you have had your cervix removed (during an operation called a hysterectomy), your doctor may tell you it is okay to stop getting regular Pap tests.

For more information, please read the U.S. Preventive Services Task Force overview of cervical cancer screening recommendations.

How to Prepare for Your Pap Test

If you are going to have a Pap test in the next two days, you should not—

• Douche, which means rinsing the vagina with water or another fluid.
• Use a tampon.
• Have sex.
• Use a birth control foam, cream, or jelly.
• Use a medicine or cream in your vagina.
• Schedule your Pap test for a time when you are having your period.

Pap Test Results

It can take up to three weeks to receive your Pap test results. If your test shows that something might not be normal, your doctor will contact you and figure out how best to follow up. There are many reasons why Pap test results might not be normal. It usually does not mean you have cancer.

If your Pap test results show cells that are not normal and may become cancer, your doctor will let you know if you need to be treated. In most cases, treatment prevents cervical cancer from developing. It is important to follow up with your doctor right away to learn more about your test results and receive any treatment that may be needed.

Is there a treatment for HPV or related problems?

There is no treatment for the virus itself, but there are treatments for the problems that HPV can cause:

• Visible genital warts can be removed by the patient him or herself with medications. They can also be treated by a health care provider. Some people choose not to treat warts, but to see if they disappear on their own. No one treatment is better than another.

• Abnormal cervical cells (found on a Pap test) often become normal over time, but they can sometimes turn into cancer. If they remain abnormal, these cells can usually be treated to prevent cervical cancer from developing. This may depend on the severity of the cell changes, the woman’s age and past medical history, and other test results. It is critical to follow up with testing and treatment, as recommended by a doctor.

• Cervical cancer is most treatable when it is diagnosed and treated early. Problems found can usually be treated, depending on their severity and on the woman’s age, past medical history, and other test results. Most women who get routine cervical cancer screening and follow up as told by their provider can find problems before cancer even develops. Prevention is always better than treatment.

• Other HPV-related cancers are also more treatable when diagnosed and treated early.

• Recurrent Respiratory Papillomatosis (RRP) can be treated with surgery or medicines. It can sometimes take many treatments or surgeries over a period of years.

HPV Vaccines

HPV vaccines ("shots") are available for males and females to protect against the types of HPV that most commonly cause health problems.

What HPV vaccines are available in the United States?

Two HPV vaccines are licensed by the FDA and recommended by CDC. These vaccines are Cervarix (made by GlaxoSmithKline) and Gardasil (made by Merck).

How are the two HPV vaccines similar?

• Both vaccines are very effective against HPV types 16 and 18, which cause most cervical cancers. So both vaccines prevent cervical cancer and precancer in women.

• Both vaccines are very safe.

• Both vaccines are made with very small parts of the human papillomavirus (HPV) that cannot cause infection with HPV, so neither of the vaccines can cause HPV infection.

• Both vaccines are given as shots and require 3 doses.

>How are the two HPV vaccines different?

• Only one of the vaccines (Gardasil) also protects against HPV types 6 and 11. These HPV types cause most genital warts in females and males.

• The vaccines have different adjuvants—a vaccine adjuvant is a substance that is added to the vaccine to increase the body's immune response.

Who should get HPV vaccine?

Cervarix and Gardasil are licensed, safe, and effective for females ages 9 through 26 years. CDC recommends that all girls who are 11 or 12 years old get the 3 doses (shots) of either brand of HPV vaccine to protect against cervical cancer and precancer. Gardasil also protects against most genital warts. Girls and young women ages 13 through 26 should get all 3 doses of an HPV vaccine if they have not received all doses yet. Gardasil is also licensed, safe, and effective for males ages 9 through 26 years. Boys and young men may choose to get this vaccine to prevent genital warts.

People who have already had sexual contact before getting all 3 doses of an HPV vaccine might still benefit if they were not infected before vaccination with the HPV types included in the vaccine they received. The best way to be sure that a person gets the most benefit from HPV vaccination is to complete all three doses before sexual activity begins.

Why is Gardasil not on the immunization schedule for boys and men?

CDC did not add this vaccine to the recommended immunization schedules for males in these age groups because studies suggest that the best way to prevent the most disease due to HPV is to vaccinate as many girls and women as possible. Parents of boys can decide if Gardasil is right for their sons by talking with their sons’ health care providers. Young men can also discuss this vaccine with their doctors.

Why is HPV vaccine recommended at ages 11 or 12 years?

For the HPV vaccine to work best, it is very important to get all 3 doses (shots) before being exposed to HPV. Someone can be infected with HPV the very first time they have sexual contact with another person. It is also possible to get HPV even if sexual contact only happens one time.

How does getting HPV vaccine at ages 11 or 12 fit with other health recommendations?

Doctors recommend health check-ups for preteens. The first dose of an HPV vaccine should be given to girls aged 11 or 12 years during a pre-teen health check-up. The first dose of Gardasil can also be given to boys during their pre-teen check-ups. Two other vaccines are recommended for pre-teens. During one visit, either HPV vaccine can be given safely with these other pre-teen vaccines. A check-up in the pre-teen years is also a time when pre-teens and their parents can talk to their providers about other ways to stay healthy and safe.

What is the recommended schedule (or timing) of the 3 HPV doses (shots)?

For both females and males, 3 doses (shots) are needed. CDC recommends that the second dose be given one to two months after the first, and the third dose be given six months after the first dose.

Will someone be protected against HPV-related diseases if they do not get all 3 doses?

No studies so far have shown whether or not 1 or 2 doses protect as well as getting 3 doses, so it is very important to get all 3 doses.

Are the HPV vaccines safe and effective?

FDA has licensed the vaccines as safe and effective. Both vaccines were tested in thousands of people around the world. These studies showed no serious side effects. Common, mild side effects included pain where the shot was given, fever, headache, and nausea. As with all vaccines, CDC and FDA continue to monitor the safety of these vaccines very carefully.

Do people faint after getting HPV vaccines?

People faint for many reasons. Some people may faint after getting any vaccine, including HPV vaccines. Falls and injuries can occur after fainting. Sitting or lying down for about 15 minutes after a vaccination can help prevent fainting and injuries.

Can HPV vaccines treat HPV infections, cancers, or warts?

HPV vaccines will not treat or get rid of existing HPV infections. Also, HPV vaccines do not treat or cure health problems (like cancer or warts) caused by an HPV infection that occurred before vaccination.

Are there other HPV diseases that the two vaccines may prevent?

Studies have shown that Gardasil prevents cancers of the vagina and vulva, which like cervical cancer, can be caused by HPV types 16 and 18. Studies of Cervarix have not specifically looked at protection against vaginal and vulvar cancers.

Published studies have not looked at other health problems that might be prevented by HPV vaccines. It is possible that HPV vaccines will also prevent cancers of the head and neck, penis, and anus due to HPV 16 or 18. Gardasil might prevent recurrent respiratory papillomatosis (RRP), a rare condition caused by HPV 6 or 11 in which warts grow in the throat.

Are kids getting too many vaccines?

Vaccines strengthen the body’s immune system—they do not overload it. No reputable science shows that getting recommended vaccines hurts the immune systems of healthy kids. The HPV vaccines are important tools to prevent cervical cancer and genital warts. As with all vaccines, the benefits outweigh potential risks.

Why aren’t HPV vaccines recommended for people older than 26?

Both vaccines were studied in thousands of people from 9 through 26 years old and found to be safe and effective for these ages. The FDA will consider licensing HPV vaccines for other ages if new studies show that this would also be safe and effective.

Should pregnant women be vaccinated?

Pregnant women are not included in the recommendations for HPV vaccines. Studies show neither vaccine caused problems for babies born to women who got the HPV vaccine while they were pregnant. Getting the HPV vaccine when pregnant is not a reason to consider ending a pregnancy. But, to be on the safe side until even more is known, a pregnant woman should not get any doses of either HPV vaccine until her pregnancy is completed.

What should a woman do if she realizes she received HPV vaccination while pregnant?

If a woman realizes that she got any shots of an HPV vaccine while pregnant, she should do two things:

• Wait until after her pregnancy to finish the remaining HPV vaccine doses.
• Report the vaccination to the appropriate pregnancy registry. There are pregnancy registries to help us learn more about how pregnant women respond to each of the vaccines. So, if a woman realizes that she got any shots of either HPV vaccine while pregnant, she should work with her health care provider to report it to the appropriate pregnancy registry:
  • The toll-free number for Gardasil is 800-986-8999
  • The toll-free number for Cervarix is 888-452-9622

Will HPV vaccination be covered by health insurance?

Most health insurance plans cover recommended vaccines. But there may be a lag time after a vaccine is recommended before it gets added to insurance plans. Some insurance plans may not cover any or all vaccines. Check with your insurance provider to see if the cost of the vaccine is covered before going to the doctor.

How can my child get an HPV vaccine if I don’t have insurance?

The Vaccines for Children (VFC) program helps families of eligible children who might not otherwise have access to vaccines. The program provides vaccines at no cost to doctors who serve eligible children. Children younger than 19 years of age are eligible for VFC vaccines if they are Medicaid-eligible, American Indian, or Alaska Native or have no health insurance. "Underinsured" children who have health insurance that does not cover vaccination can receive VFC vaccines through Federally Qualified Health Centers or Rural Health Centers. Parents of uninsured or underinsured children who receive vaccines at no cost through the VFC Program should check with their health care providers about possible administration fees that might apply. These fees help providers cover the costs that result from important services like storing the vaccines and paying staff members to give vaccines to patients. For more information visit VFC program.

HPV and Cancer

• Cervical cancer: The most common HPV-associated cancer. Almost all cervical cancer is caused by HPV.
• Vulvar cancer: About 40% are linked to HPV.
• Vaginal cancer: About 70% are linked to HPV.
• Penile cancer: About 40% are linked to HPV.
• Anal cancer: About 85% are linked to HPV.
• Cancers of the head and neck are mostly caused by tobacco and alcohol, but recent studies show that about 25% of mouth and 35% of throat cancers may be linked to HPV.

Most of the time, HPV goes away by itself within two years and does not cause health problems. It is thought that the immune system fights off HPV naturally. It is only when HPV stays in the body for many years that it can cause these cancers. It is not known why HPV goes away in most, but not all cases. There is no way to know which people will go on to develop cancer or other health problems.