HPV Info!

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Frequently Asked Questions About Human Papilloma Virus (HPV) Vaccines

An HPV vaccine is now available. Below is general information about HPV as well as information about this new vaccine.

What are viruses?

Viruses are very small organisms -- most cannot even be seen with an ordinary microscope. They cannot reproduce on their own; they must enter a living cell, which becomes the host cell, and "hijack" the cell’s machinery to make more viruses.

Viruses can enter the body through the nose, mouth, or breaks in the skin. Once inside, they find their specific type of host cell to infect. For example, cold and flu viruses specifically attack cells that line the respiratory or digestive tracts. The human immunodeficiency virus (HIV) infects the T-cells and macrophages of the immune system. HPV infects squamous epithelial cells in the body.

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What is HPV?

HPV is short for human papilloma (pap-ah-LO-mah) virus. HPVs are a group of over 100 related viruses. Each HPV virus in the group is given a number, which is called an HPV type. HPVs are called papilloma viruses because some of the HPV types cause warts, or papillomas, which are non-cancerous tumors. The papilloma viruses are attracted to and are able to live only in squamous epithelial cells in the body. Squamous epithelial cells are thin, flat cells that are found on the surface of the skin, cervix, vagina, anus, vulva, head of the penis, mouth, and throat. HPVs will not grow in other parts of the body.

Of the more than 100 strains of HPV, about 60 HPV types cause warts on non-genital skin, such as on the hands and feet. These are the common warts.

The other 40 HPV types are mucosal types of HPV. "Mucosal" refers to the body’s mucous membranes, or the moist skin-like layers that line organs and cavities of the body that open to the outside. For example, the vagina and anus have a moist skin-like layer. The mucosal HPV types are also called the genital (or anogenital) type HPVs because they typically affect the anal and genital area. The mucosal HPVs prefer the moist squamous cells found in this area. They do not prefer the skin of the hands and feet.

Some types of genital HPVs can cause cauliflower-shaped warts to appear on or around the genitals and anus of both men and women. In women, visible warts may also appear on the cervix and vagina. This type of "genital wart" is known technically as condyloma acuminatum and is most often caused by HPV-6 or HPV-11. Because these genital warts rarely develop into cancer, HPV-6 and HPV-11 are called "low-risk" viruses. These low-risk types can also cause low-grade cervix cell changes that do not develop into cancer.

Other genital type HPVs have been linked with genital or anal cancers in both men and women. They also cause low and high-grade cervix cell changes and pre-cancers. These are called "high-risk" HPV types and include HPV-16, HPV-18, HPV-31, HPV -35, HPV-39, HPV-45, HPV-51, HPV-52, and HPV-58, as well as some others.

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How do you get HPV?

Genital HPV is transmitted mainly by direct genital contact during vaginal or anal intercourse. It is not spread through bodily fluids, nor does it live in blood, or any organs.

Infection is very common soon after a woman becomes sexually active. In one recent study, more than 50% of college age women were found to have acquired an HPV infection within 4 years of first having sex.

Transmission by genital contact without intercourse is not common, but infection has been reported in women who did not have a history of intercourse. Oral-genital and hand-genital transmission of some genital HPV types is possible and has been reported. Transmission from mother to newborn during delivery is rare. When it occurs it can lead to development of warts in the infant’s throat called respiratory papillomatosis.

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How common is HPV? Who gets it?

HPV is a very common virus. Some doctors think it is almost as common as the common cold virus. In the United States, over 6 million people get an HPV infection every year. Almost half of the infections are in those between 15 and 25 years of age. About half to three-fourths of the people who have ever had sex will have HPV at some time in their life.

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What are the symptoms of HPV?

HPV usually has no symptoms, unless it is a type that causes genital warts. Genital warts may occur within weeks or months after contact with a partner who has HPV. More rarely, genital warts may occur years after exposure.

Most people will never know if they have HPV because no significant disease develops and the immune system suppresses the virus. A small percent of people with HPV will have the virus for a longer time and will develop cell changes that may lead over many years to cervical or other anogenital cancer.

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How is HPV related to cervical cancer?

Almost all (>99 percent) cervical cancers are related to HPV. Of these, about 70 percent are caused by HPV types 16 or 18. About 500,000 pre-cancerous cell changes of the cervix, vagina, and vulva are diagnosed each year in the US, and over half are related to HPV 16 and 18. Low-grade cervix cell changes are caused by a variety of HPV types, including 16, 18, 6, or 11.

Although nearly all cervical cancers are related to HPV, most genital HPV infections do not cause cervical cancer. Most people who test positive for genital HPV DNA in research studies eventually test negative, often within 6 to 12 months. Scientists are still not sure whether this means that a person’s immune system has completely destroyed all of the HPV or has only suppressed the infection to an extremely low level (too low to be detected by available tests). If even a few cells of the cervix still contain HPV, it’s possible that the virus may start to become active again if your immune system becomes very weakened.

It is possible that some low-grade cervix cell changes and some high-grade cervix cell changes may suddenly occur many years after first HPV exposure. This could help explain how a woman could get such changes after many years of normal Pap tests and no history of a partner change.

If the HPV infection isn’t eliminated or suppressed, the virus may cause cervix cells to change and become pre-cancer cells. True pre-cancer cell changes are called high-grade SIL (squamous intraepithelial lesions), sometimes abbreviated as HSIL. Another term for HSIL is CIN 2 and CIN3. CIN is an abbreviation for cervical intraepithelial neoplasia.

Pre-cancer cells are not cancer. Although some pre-cancer changes may return to normal on their own, most cases of CIN 3 are likely to progress to cervical cancer over a period of time that probably takes about 10 years if not detected and treated. But very few HPV infections lead to cervical cancer. Pre-cancer cells are found by having regular Pap tests.

For more information on cervical cancer, please see the American Cancer Society document, “Cervical Cancer.”

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What about other cancers and HPV?

About 80 percent of squamous cell anal cancers are caused by either HPV 16 or 18. At least 40 percent of cancers of the vulva are HPV-related. Several other anogenital cancers (penile, vaginal, urethral) and some head and neck cancers (specifically tongue and tonsils) have been found to contain high-risk HPV types. A high percentage of non-melanoma skin cancers in people with weakened immune systems contain HPV types.

What about other HPV-related diseases?

Over 500,000 new cases of anogenital warts are diagnosed yearly in the United States, and over 90% are caused by HPV types 6 or 11. Juvenile respiratory papillomatosis occurs in about 1 in 200,000 infants and children and may lead to respiratory problems or rarely progress to cancer of the larynx. HPV types 6 and 11 are most frequently found with this condition.

d clinics, and will become more widely available in 2007.

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Do men have HPV-associated cancers?

Men and women share this virus. Therefore, HPV is likely to be as common in men as in women. But HPV is not as easily diagnosed in men as in women, so the infection rate of HPV in men is always more of an estimate than it is in women. Genital HPV is passed to men through vaginal and anal sex -- the same way as in women. Certain types of HPV have been linked to penile and anal cancer in men. While penile cancer is rare, anal cancer is now almost as common in men and women who have anal sex as cervical cancer was in women before the Pap test was introduced.

Men do not have symptoms with HPV unless it is the type that causes genital warts. In men, genital warts can appear around the anus, or on the penis, scrotum, groin or thighs.

There is no test approved to detect HPV in men. But genital warts can be detected and treated. There are no tests approved to detect early HPV-related cancers in men, as there is in women with the Pap test. In gay, bisexual, and HIV-positive men, some doctors use anal Pap tests to detect and treat precancerous changes of the anus. Since the use of anal testing is in the early stages of development, the impact on anal cancer rates will not be seen for many years in the future. For more information on sexually transmitted illnesses in men, please contact ASHA at http://www.ashastd.org, or http://www.iwannaknow.org (Teen sexual health education services), or http://www.quierosaber.org (Spanish teen sexual health education services).

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Can HPV be treated?

Treatments cannot cure HPV. However, most genital HPV infections go away with the help of the body’s immune system. Seventy percent (70%) of HPV infections are typically gone within one year and 90% are gone within 2 years. Treatments are available for genital warts, for the pre-cancer cell changes that HPV can cause, and for cervical and other HPV-associated anogenital cancers.

Can HPV be prevented?

The only sure way to prevent HPV is to abstain from all sexual activity. Limiting the number of sexual partners and avoiding sex with people who have had many other sexual partners decreases risk of exposure to HPV. It is usually not possible to know who has HPV, and HPV infection is so very common that even these measures do not guarantee that a person will not get HPV. These measures are likely, however, to reduce the number of HPV exposures over one’s life.

Condoms provide some (but not total) protection against HPV. They also are very helpful in protecting from other infections that can be spread through sexual activity.

What are the risk factors for genital HPV?

Having many sexual partners is a risk factor for HPV infection. The risk increases with the number of partners. Also, being younger than 25 years of age, starting to have sexual intercourse at age 16 or younger, and having a male partner who has had several different sex partners increase the risk.

Source: cancer.org