HPV: What You Need to Know & How to Protect Yourself

Human Papilloma Virus (HPV) refers to a group of more than 200 related viruses, some of which are harmless, while others can lead to serious health conditions, including genital warts and certain cancers. It is the most common of the sexually transmitted infections. HPV is spread through bodily contact, commonly during sexual activity. The virus is highly contagious, and approximately 85% of sexually active people will contract at least one type of HPV in their lifetime. Most HPV infections do not cause symptoms and go away on their own. However, some types can persist and lead to complications, including cervical cancer, anal cancer, or cancers of the throat, vulva, and penis. HPV does not discriminate based on age, gender or economic status. I have seen it in teenagers who have had one sexual partner, 30 year olds who are pregnant for the first time and in 60 year olds who have been in a monogamous relationship for decades. I recently connected with Lillan Kreppel who started HPV Cancer Alliance after her successful battle against an HPV related cancer. Please check out her story in the link at then end of the blog. 

What does HPV look like and who gets it? Well for my patient “M” it looked like this: 

“M” first came to see me when she was in her mid thirties, it had been about 10 years since her last annual exam and pap smear. Her pap smear results showed abnormal cells on her cervix. I did a colposcopy (an exam using a fancy pair of binoculars on a stick) and biopsies of her cervix that showed that there were precancerous cells on her cervix. A small surgery to remove these cells (cone biopsy) showed that the cells were cancer and she was sent to an oncologist (a doctor who specializes in gynecologic cancers). She was unsure if she wanted to have children and the cancer was very early stage so she had a procedure that removed her cervix and stitched the bottom portion of her uterus closed. Her cancer was detected early because she came in for routine screening. Could it have been prevented by a vaccine? Maybe. 

Prevention of HPV: Key Strategies 

1. Vaccination 

The most effective way to prevent HPV-related diseases is through vaccination. The HPV vaccine is safe, well-tolerated, and effective at preventing infection with the strains of HPV that cause the majority of cancers and genital warts. 

The vaccine is recommended for all children starting at ages 11 to 12, but it can be given as early as age 9. Catch-up vaccinations are available for individuals up to age 26. For those who have not been vaccinated by this age, some people may still benefit from the vaccine through age 45, depending on individual circumstances. 

The vaccine works best when given before any exposure to HPV, but it still provides protection if given later in life. It is typically administered in a series of two or three shots over several months, depending on the recipient’s age at the time of vaccination.

2. Condom Use 

While condoms do not provide 100% protection against HPV, they can reduce the risk of transmission. This is because HPV can affect areas not covered by a condom, such as the scrotum, vulva, and thighs. Using condoms or latex underwear as a barrier consistently during sexual activity can still significantly lower the likelihood of transmission. 

3. Limiting Sexual Partners 

Reducing the number of sexual partners can also decrease the likelihood of being exposed to HPV. However, this method is not foolproof, as even individuals with one partner may be at risk if that partner has been previously exposed to the virus. 4.

4. Routine Screenings 

For individuals with a cervix, regular cervical cancer screenings (Pap tests and HPV tests) are essential in detecting abnormal cell changes early on. Early detection of these changes can prevent cervical cancer by allowing timely interventions. For individuals who have had or are having anal penetrative sex screening is critical to prevent anal and rectal cancers. This can be done with routine anal pap smears or anoscopy. 

HPV Vaccination: Why It Matters 

The HPV vaccine is a key component in the fight against HPV-related cancers. The vaccine targets 7 of the high-risk strains of the virus responsible for the majority of cervical cancers. It protects against strains that can cause cancers of the anus, penis, vulva, and throat. Finally it helps prevent the two most commoon types of HPV that lead to condyloma (external genital warts). 

Vaccinating at the recommended age of 11 or 12 before an individual makes their sexual debut will maximize the vaccine's ability to prevent HPV infection. While the vaccine is most effective when given early, it can still benefit individuals up to age 45, preventing future infections and associated health risks. 

HPV Screening: The Importance of Early Detection 

For individuals with a uterus/cervix, routine screenings for HPV and cervical cancer are essential. These screenings typically begin at age 21 and involves a Pap test, which looks for abnormal cell changes on the cervix. If there are abnormal cells on the cervix an HPV test is also performed to check for the presence of high-risk viral strains. If an HPV infection is detected, further testing or follow-up care may be recommended to monitor or treat any abnormal cell changes. 

● Cervical Pap Tests: Recommended every three years starting at 21 years old.

● Cervical HPV Testing: Recommended for individuals over age 25 or HPV testing may be combined with the Pap test every five years starting at age 30. 

● Anal Pap Tests: Recommended if there is anal penetration with individuals of any gender, or if there are precancerous changes on a cervical exam. For men or transgender women with HIV, screening should start at age 35. For other people with HIV and for men who have sex with men and transgender women who are not living with HIV, they recommend starting screening at age 45. 

● Digital Anal Rectal Exam: Recommended during annual exams to help detect growths and masses within the anal canal and rectum.

Most HPV related cancers are preventable with education, vaccination, adequate STI protection and early detection through screenings with pap smears and digital rectal exams. We have the tools, we just need to use them. 

Resources: 

Special thanks to HPV Cancers Alliance for their dedication to spreading awareness and advocating for HPV-related cancer prevention. To learn more about their mission and resources, visit hpvca.org or follow them on social media at @hpvcancersalliance.

References: 

Anal Cancer Advances Open Door to Screening and Prevention was originally published by the National Cancer Institute. 

Clinical overview of HPV was originally published by the National Cancer Institute 

Human papillomavirus vaccination. ACOG Committee Opinion No. 809. American College of Obstetricians and Gynecologists. Obstet Gynecol 2020;136:e15–21. 

Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. U.S. Preventive Services Task Force. JAMA 2018;320:674–86. Available at: href="https://jamanetwork.com/journals/jama/fullarticle/2697704. Retrieved April 12, 2021. 

Management of vulvar intraepithelial neoplasia. Committee Opinion No. 675. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;128:e178–82.