Who gets HPV infections?
Anyone who has ever been sexually active (that is, engaged in skin-to-skin sexual conduct, including vaginal, anal, or oral sex) can get HPV. HPV is easily passed between partners through sexual contact. HPV infections are more likely in those who have many sex partners or have sex with someone who has had many partners. Because the infection is so common, most people get HPV infections shortly after becoming sexually active for the first time.13,14 A person who has had only one partner can get HPV.
Someone can have an HPV infection even if they have no symptoms and their only sexual contact with an HPV-infected person happened many years ago.
Can HPV infections be prevented?
People who are not sexually active almost never develop genital HPV infections. In addition, HPV vaccination before sexual activity can reduce the risk of infection by the HPV types targeted by the vaccine.
The Food and Drug Administration (FDA) has approved three vaccines to prevent HPV infection: Gardasil®, Gardasil® 9, and Cervarix®. These vaccines provide strong protection against new HPV infections, but they are not effective at treating established HPV infections or disease caused by HPV.15,16
Correct and consistent condom use is associated with reduced HPV transmission between sexual partners, but less frequent condom use is not.8 However, because areas not covered by a condom can be infected by the virus,7 condoms are unlikely to provide complete protection against the infection.
Can HPV infections be detected?
HPV infections can be detected by testing a sample of cells to see if they contain viral DNA or RNA.
Several HPV tests are currently approved by the FDA for three cervical screening indications: for follow-up testing of women who seem to have abnormal Pap test results, for cervical cancer screening in combination with a Pap test among women over age 30, and for use alone as a first-line primary cervical cancer screening test for women ages 25 and older.
The most common HPV test detects DNA from several high-risk HPV types in a group, but it cannot identify the specific type(s) that are present. Other tests do tell in addition whether there is DNA or RNA from HPV types 16 and 18, the two types that cause most HPV-associated cancers. These tests can detect HPV infections before abnormal cell changes are evident, and before any treatment for cell changes is needed.
There are no FDA-approved tests to detect HPV infections in men. There are also no currently recommended screening methods similar to a Pap test for detecting cell changes caused by HPV infection in anal, vulvar, vaginal, penile, or oropharyngeal tissues. However, this is an area of ongoing research.
What are treatment options for HPV-infected individuals?
There is currently no medical treatment for persistent HPV infections that are not associated with abnormal cell changes. However, the genital warts, benign respiratory tract tumors, precancerous changes at the cervix, and cancers resulting from HPV infections can be treated.
Methods commonly used to treat precancerous cervical changes include cryosurgery (freezing that destroys tissue), LEEP (loop electrosurgical excision procedure, or the removal of cervical tissue using a hot wire loop), surgical conization (surgery with a scalpel, a laser, or both to remove a cone-shaped piece of tissue from the cervix and cervical canal), and laser vaporization conization (use of a laser to destroy cervical tissue).
Treatments for other types of benign respiratory tract tumors and precancerous changes caused by HPV (vaginal, vulvar, penile, and anal lesions) and genital warts include topical chemicals or drugs, excisional surgery, cryosurgery, electrosurgery, and laser surgery. Treatment approaches are being tested in clinical trials, including a randomized controlled trial that will determine whether treating anal precancerous lesions will reduce the risk of anal cancer in people who are infected with HIV. More information about the treatment of genital warts can be found in the Centers for Disease Control and Prevention (CDC) Sexually Transmitted Diseases Treatment Guidelines, 2010.
HPV-infected individuals who develop cancer generally receive the same treatment as patients whose tumors do not harbor HPV infections, according to the type and stage of their tumors. However, people who are diagnosed with HPV-positive oropharyngeal cancer may be treated differently than people with oropharyngeal cancers that are HPV-negative. Recent research has shown that patients with HPV-positive oropharyngeal tumors have a better prognosis and may do just as well on less intense treatment. Ongoing clinical trials are investigating this question.17,18