HPV is more common—and misunderstood—than you think. Here’s what doctors want you to know.
This sexually transmitted infection is almost entirely preventable. Here's what experts say you really need to know to protect yourself.
Nearly every American will contract the human papillomavirus (HPV) in their lifetime, and over 40 million Americans currently have HPV. Globally, hundreds of thousands of cancer cases annually are attributed to the virus. With over 200 strains, “HPV infection is just so common and so ubiquitous,” says June Hou, a gynecologic oncologist at Columbia University Irving Medical Center.
Here’s what HPV is, how it spreads, and what the science says about the misinformation around the illness.
What is HPV?
HPV is the most common sexually transmitted infection in the United States. Low-risk strains can cause genital warts, while high-risk strains can cause cancer. The vast majority of HPV strains are low-risk, and many people who contract HPV never even know they are infected—the infection can quickly clear up on its own with no symptoms. But when the high-risk strains of the virus persist, they can cause cervical cancer and other HPV-related cancers.
Many high-risk HPV strains are preventable through vaccines; however, not enough Americans are getting vaccinated to slow the infection’s spread.
By comparison, Australia has had high success eliminating certain strains of HPV through vaccination programs. “They've completely eliminated genital warts, which is due to the vaccine,” says Megan Huchko, a gynecologist at the Duke Global Health Institute. “They've almost reached the WHO thresholds for cervical cancer elimination because they so comprehensively vaccinated both boys and girls.”
HPV vaccines, usually administered between ages 11 and 12 across two doses, significantly reduce the risk of HPV-related cancers, although a recent study suggests that a single-dose vaccine could have similar efficacy. “It's a vaccine that prevents cancer, and that's pretty amazing,” says Lisa Rahangdale, a gynecologist at UNC Health. But last year in the United States, just over 62 percent of adolescents were considered up-to-date on their HPV vaccine series.
The HPV vaccine, Gardasil-9, protects against nine of the highest-risk strains of HPV and reduces HPV-related cancer risk by more than 90 percent. Nearly all cases of cervical cancer come from HPV, so much of the public attention is on women getting vaccinated, but cases of HPV-related throat cancer in men may actually be more numerous overall, according to estimates from the Centers for Disease Control and Prevention.
So when it comes to vaccination, “don't forget your boys,” Hou says. “They are basically half of the population, and they are at equal risk to not only harbor the HPV virus infection [but they may also] pass it on to other people that they care about.”
A major reason parents may not get their children vaccinated against HPV is because of the virus’s association with sexual activity. Yet “there is no evidence that vaccinating [in] early adolescence will increase their propensity towards early sexual activity or change their sexual behavior at all,” Huchko says.
In fact, people from ages 9-26 are recommended to get the vaccine in part because it produces a better immune response in younger ages, although some older patients may get “catch-up” vaccines, Hou says. “I've seen so many cases of cervical cancer that technically could have been all prevented if all of them had the chance to have this vaccination,” she says.
Although most people will contract at least one strain of HPV in their lifetimes, misconceptions about the vaccine and virus persist. Here are the most common myths about the most common sexually transmitted infection.
Myth #1: All strains of HPV cause cancer
Most strains of HPV will never cause cancer. While low-risk strains can cause genital warts, “it’s really the high-risk strains we’re worried about,” Hou says. A much smaller subset of strains is considered high-risk, and HPV tests screen for the presence of 14 cancer-causing strains. “We don't test for the kinds that don't lead to pre-cancerous or cancerous changes,” Huchko says.
Myth #2: HPV only causes cervical cancer
While cervical cancer is the most common HPV-caused cancer in women and perhaps the most well-known HPV-related cancer, the virus can also cause anal, vaginal, vulvar, penile, and oral and throat cancers. This means both men and women can get cancer from HPV.
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Myth #3: HPV can only be transmitted through intercourse
HPV is most commonly transmitted through sexual skin-to-skin contact, however that’s not the only way the illness spreads. In rare cases, nonsexual contact, like birth, can also spread HPV. But whether sexual or nonsexual, HPV is spread through contact with genitals.
Myth #4: Condoms can always protect you from HPV infections
HPV spreads through skin-to-skin contact, not bodily fluids, so it’s still possible to contract the virus while using condoms. “It does reduce the risk, we think, by about 70 percent,” Huchko says. “But because HPV can affect the vulva, the vagina, and the perianal area, it's really a regional disease.” Experts say using condoms does not eliminate the risk or reduce it as much as the vaccine and screening, although condoms should still be used in tandem with these practices.
Myth #5: Men are the only people who can spread HPV
“Anybody who's infected with HPV can spread it to a sexual partner,” Rahangdale says. The virus is often spread through penetrative vaginal intercourse and anal intercourse but can be spread by any party who is infected with HPV, regardless of sex. “It's about any skin or mucosal contact,” says Huchko. “It can be spread through same sex relationships as well, and we do see oropharyngeal cancer, so there's some oral-genital transmission.”
Myth #6: There are no signs a man has HPV
While men don’t get routinely checked for HPV like women often do alongside Pap smears or in self-testing kits, there are visual cues that can tell doctors a man might have HPV. However, there is no direct or routine HPV testing for men, including for HPV in the throat. Still, men can be checked for HPV-related warts and unusual growths. Anal pap smears also can’t directly identify HPV, but these tests can find cancers caused by the virus. But, without visual cues, HPV may go undetected. “Warts are not associated with cancer,” Huchko says. “Those are a different type of HPV. If they have genital warts, they're most likely related to one of the lower-risk types of HPV. But if they have skin changes or growths on their penis, they should have them looked at, because some are not warts, and some could be cancerous lesions.”
Myth #7: HPV is a lifelong virus
“Most women who have HPV infection will clear it within six months to a year,” Huchko says. The same is true for men. The body’s immune system can even clear high-risk strains of HPV entirely on its own, although “it is hard to precisely outline a pathway as to what you need to do to clear the HPV infection aside from just kind of boosting our own endogenous immune system,” Hou says. It’s the persistent, cancerous, high-risk strains that are of most concern.
