What is HPV?
HPV (Human Papilloma Virus) is a virus that can cause wart infection and certain cancers. There are many types of HPV that affect different parts of the body and some of them can infect the genital area. Genital warts is usually a sexually transmitted infection (STI).
Anyone who has ever had any form of sexual contact can have HPV – it’s so common that four out of five people will have had HPV at some time in their lives.
How do I know if I have HPV?
Most people will not know they have HPV because it can stay inactive inside the body or it can produce an infection that is invisible.
Warts are a visible HPV infection, which appear as solid lumps and may be itchy. They can appear on the penis, vulva, anus or other area of genital contact.
HPV can also be detected with the cervical screening test even if no symptoms are present. The types of HPV detected by this test are not the same as the types of HPV that cause visible genital warts.
It can take some time for HPV to become active. In most cases the HPV infection is cleared by the body’s immune system in around one to two years, but for some people it may remain active longer. Smoking can reduce the body’s ability to clear HPV infection.
How do I get HPV?
HPV is spread through skin-to-skin contact. This can include direct genital contact, finger penetration, oral sex, cuts and tears, and through sharing sex toys. The virus passes through tiny breaks in the skin.
The virus may be present without visible warts for years. A new episode of warts may represent reactivation of the virus rather than recent exposure. Use of steroid creams on the genitals can cause an episode of warts if HPV is present. HPV may also reactivate in the cervix and appear on a cervical screening test even if previous tests have been negative.
Using condoms with a new sexual partner helps to protect against STIs and may help to decrease the risk of getting HPV. They do not provide total protection because they do not cover all of the genital skin and the HPV infection is often invisible. If a person has visible warts then wart-to-skin contact should be avoided to decrease the risk of spreading the infection.
Who can get HPV?
Anyone who has had any form of sexual contact can get HPV, regardless of sexual orientation or gender identity.
What are the treatment options for genital warts?
In many people the warts will disappear by themselves within one to two years. However, some people prefer to have them treated. There is a variety of methods available. If the method you are using is not working it’s important to discuss this with a health professional. Treatments include:
- Wart paint (Podophyllotoxin): This can be applied by the person with the warts or by a health professional. It can be bought over-the-counter at pharmacies but is best discussed with a health professional before using. If warts remain after 4–5 weeks of treatment, you should also be reviewed. Do not use during pregnancy/breastfeeding.
- Wart cream (Imiquimod – e.g. Aldara): This cream is available on prescription. It is expensive, but there is a low chance of the warts reappearing after use. Treatment can take 8–12 weeks. Do not use during pregnancy/breastfeeding.
- Freezing (Cryotherapy): This uses frozen gas or dry ice applied by a health worker. It may cause some discomfort. You may need several treatments. It is quite effective and available at SHINE SA clinics.
- Laser therapy, or electrosurgery: These treatments require referral and admission to hospital for anaesthesia and surgery.
HPV and cancer
In a small number of people, a type of HPV can stay in the cells of the cervix. If the infection is not cleared, the virus can cause cell changes that may lead to cervical cancer. This will usually take a long time – often more than 10 years. Most people who have HPV clear the virus naturally and DO NOT develop cervical cancer.
Only a few of the many genital HPV types increase someone’s chance of having cancer.
A cervical screening test can detect the HPV that causes cervical cancer. This test will be due when a person’s next Pap test is due then every 5 years if it is negative. Cervical screening begins at age 25 and ends between the age of 69 to 74. If higher risk HPV is detected, more frequent testing may be recommended.
The types of HPV that can cause cervical cancer can also cause cancers of the mouth, throat, vulva, penis and anus. These are different to the HPV that causes genital warts, and having warts does not increase your risk of cancer.
Anal cancer is more common in people who participate in receptive anal sex (is the receiving partner). People living with HIV are at higher risk of HPV related cancer.
Smoking is a major risk factor in developing cancer with HPV exposure.
Can HPV infection be prevented?
Three vaccines are currently available that can prevent infection from certain types of HPV. The vaccines are given as a series of 2–3 injections within a 6-month period.
- Gardasil 4 prevents 2 types of HPV that are linked to the majority of cervical and anal cancers and a further 2 types that are linked to visible external genital warts.
- Gardasil 9 is available as a school-based immunisation program and protects against a further 5 strains of HPV; however, people who have previously had Gardasil 4 have no real increased benefit from having Gardasil 9.
- Cervarix prevents the same 2 types of HPV that are linked to cervical cancer as Gardasil 4.
Who should be vaccinated?
The best time to have the vaccination is before a person is exposed to HPV, which means before their first sexual contact (suggested age 10–15 years).
People who have already had sex can still have the vaccine, and if they have not yet been exposed to the types of HPV covered by the vaccine then the vaccine will be fully effective. Even if they have been exposed to one or more of the strains in the vaccine they will still receive protection against the remaining strains. The vaccine does not help clear or cure pre-existing HPV infection.
People living with HIV are at increased risk of developing cancer with HPV exposure and should consider vaccination.
How can I be vaccinated against HPV?
Currently, Gardasil vaccine is provided free through school-based programs, and to gay men and men who have sex with other men who are 20–26 years old. A catch up program is also available to people aged 15–19 who have missed out on the school-based program.
Outside of these programs, Gardasil and Cervarix are available on private prescription but at a significant cost.
Do I need cervical screening if I’ve had the HPV vaccination?
Yes. Although vaccinations will protect against the HPV infection that causes over 90% of cervical cancers, you are still at risk of infection from other HPV types.
Regular cervical screening are still a very important protection against developing cervical cancer.
Adelaide Sexual Health Centre
Tel: 7117 2800
Address: 275 North Terrace, Adelaide
SA Dept of Health: Immunisation Section
Tel: 1300 232 272
SA Cervix Screening Program
Tel: 13 15 56