Infection by genital HPV (human papillomavirus) is very common. At least half of people who are sexually active will contract the HPV virus at some point in their lives. Yet many will not know it and have no symptoms.
Whether symptoms occur or not can depend on the type of HPV virus involved in the infection. There are more than 100 types of HPV. Some HPV types are associated with genital warts, although the warts are not always visible.
Some types of HPV are associated with cervical and other cancers, and no warts occur, and no other symptoms may be noticed. Some HPV types also cause common warts that you can find on other areas of the body such as your hands or feet.
Many people who get genital HPV will clear it without treatment and no health problems will occur. The longer the virus is in the body, however, the higher your risk of developing health problems such as cervical or anal cancer.
Here's what you need to know about genital HPV infection, symptoms, and diagnosis:
The HPV virus lives in mucous membranes, such as those in the genital area, or on the skin. If genital warts show up, it's an indication of HPV infection. Genital warts take on many different appearances. They can be raised, flat, pink, or flesh-colored. They can even be shaped like cauliflower. Sometimes there is a single wart; other times multiple warts appear. They can be small or large. They can be on the anus, cervix, scrotum, groin, thigh, or penis.
Genital warts can show up weeks or even months after sexual contact with a person infected with an HPV virus. That person may not know he or she is infected and is responsible for HPV transmission.
Some types of genital HPV infection are associated with cancer, including cervical cancer and cancer of the vulva, anus, oropharynx (the middle part of the throat, behind the mouth), or penis. If infection occurs with one of these virus types, precancerous changes can occur in cells in the tissue without causing any symptoms.
How Is HPV Infection Diagnosed?
The appearance of genital warts is one way HPV infection is diagnosed. A doctor simply does a visual inspection. The HPV types associated with warts, however, are not generally the types associated with cancer.
Women infected with the type of HPV that can cause cancer may first be told their Pap test results are abnormal. Pap tests are the main way doctors find cervical cancer or precancerous changes in the cervix.
To find out for sure if the changes are related to HPV, a doctor may decide to perform a DNA test of the Pap sample to detect the virus in women who have an abnormal Pap smear. This tells the doctor whether the type of HPV virus you have can cause cancer. Only certain strains of HPV cause cancer. In fact, HPV types 16 and 18 account for 70% of all cervical cancers. This DNA test is often done on women who have Pap test abnormalities. It may also be done as part of a routine Pap test.
In the HPV test, a doctor takes a swab of cells from the cervix, just as for the Pap test. The cells are then analyzed in a laboratory. The test can identify 13 or 14 of the high-risk HPV types associated with cervical cancer.
This test is rarely given routinely to women under age 30, because so many younger women are exposed to HPV and their bodies typically clear the infection without treatment. The DNA test could cause unnecessary worry and concern. Some experts also believe that in younger women the cervix is more susceptible to the HPV virus and that as women get older the cervix may become less susceptible.
In men, as in women, genital warts reflect HPV infection. But no specific test for the strains of HPV that cause cancer is available at this time for men.
When Is the Best Time to Test?
Combining the Pap test with the HPV test is appropriate for women ages 30 and over, according to the American College of Obstetricians and Gynecologists.
This test -- which should be repeated every five years -- helps women and their doctors learn if a woman is at high risk or low risk for developing cervical cancer. If the HPV test is positive, the doctor can then decide if more testing is needed. One test that may be ordered next is a colposcopy, in which a special magnifying device is used to examine the cervix, vagina, and vulva.
If a woman is trying to get pregnant, there's no need to have the HPV test unless her doctor orders it based on an abnormal Pap test. During the first prenatal visit, a Pap smear is taken, and if the results are suspicious of HPV infection, the doctor can order the HPV test then.