Infection with HPV (human papillomavirus) is very common. About 80 million people in the U.S. are affected. About 40 of the 100 HPV types are transmitted sexually. This HPV transmission can cause genital warts or abnormal cell changes in the cervix and other genital areas that can lead to cancer.
While there is no cure for HPV, the good news is the infection often clears on its own. If it does not, and treatment is needed, there are many HPV treatment options. Plus, as more males and females are vaccinated against HPV, the rates of infection may be greatly reduced. There are currently three vaccines currently available: Cervarix, Gardasil, and Gardasil-9.
For now, HPV treatment focuses on the symptoms of the infection. Symptoms include genital warts associated with low-risk HPV types (which don't generally lead to cancers) and the precancerous changes sometimes associated with the high-risk types of HPV.
HPV Positive, No Symptoms
Simply testing positive for HPV may not mean you will need treatment, at least not immediately. After a positive HPV test, your doctor may suggest close monitoring.
For women, doctors may swab cells from the cervix, just as they are collected for a Pap test, and have them analyzed in a laboratory. This analysis looks for genetic material, or DNA, of HPV within the body's cells. It can detect the high-risk HPV types. No specific test for the strains of HPV that cause cancer is available at this time for men.
If a woman is infected with a type of HPV that can lead to cancer, the doctor may suggest frequent Pap tests to watch for signs of abnormal cell changes in the genital area. Abnormal cell changes in the cervix are a warning sign of possible cervical cancer. The doctor may also do a test called a colposcopy, in which a special magnifying device is used to look closely at the cervix, vagina, and vulva.
The HPV virus itself cannot be treated, but often the body will clear HPV infection on its own. In most women, cervical HPV infection clears on its own within two years of detection.
Note: Pregnant women, or women trying to conceive, should consult closely with their doctor before starting treatment. HPV treatments can affect pregnancy, so doctors may want to delay treatment until after childbirth.
HPV Treatments for Tissue Changes
If the HPV infection has caused abnormal cell changes that could lead to cervical cancer, there are four main treatment options:
- Watch and wait. Sometimes the cell changes -- called cervical dysplasia, precancerous cell changes, or cervical intraepithelial neoplasia -- will heal on their own.
- Cryotherapy. This involves freezing the abnormal cells with liquid nitrogen.
- Conization. This procedure, also known as a cone biopsy, removes the abnormal areas.
- Laser therapy uses light to burn away abnormal cells.
- Loop electrosurgical excision procedure (LEEP). The abnormal cells are removed with an electrical current.
The goal is to remove all the abnormal cells and thus remove most or all of the cells with HPV.
HPV Treatments for Genital Warts
The genital warts associated with HPV infection can be raised or flat. They can be small or large. Colors vary, including pink or flesh-colored. Genital warts can appear on the cervix, scrotum, groin, thigh, anus, or penis.
Treating the warts aggressively immediately after they appear is discouraged. They could still be emerging. Repeat treatment would be needed later.
HPV types 6 and 11, those associated with genital warts, tend to grow for about six months, then stabilize. Sometimes, visible genital warts go away without treatment.
When treatment is indicated, patients can get a prescription cream from their doctor to apply at home. There are two options:
- Podofilox, or Condylox
- Imiquimod, or Aldara
A doctor can show you how to apply these treatments. Podofilox is used for about four weeks. It works by destroying the wart tissue. Research shows that about 45% to 90% of warts are cleared, but in 30% to 60% of cases, the warts can come back.
Imiquimod boosts the immune system so it fights off the virus. Clearance rates range from 70% to 85%, but in 5% to 20% of cases the warts come back.
In addition, a doctor can provide other types of wart-removal treatments. Among the options:
- Cryotherapy, the freezing off of the wart with liquid nitrogen
- Trichloracetic acid, a chemical applied to the surface of the wart
- Surgical removal, cutting the cells out with a scalpel
- Electrocautery, burning off warts using an electric current
- Laser vaporization or excision of the warts
Surgical removal may cure the problem in a single visit. Success rates for the other techniques range from about 80% to 90%.
Generally, smaller warts respond better to treatment than larger ones. Warts on moist surfaces respond more favorably to topical treatments than do warts on drier surfaces. If a specific treatment does not work after three treatments by a doctor, or if the warts don't go away after six doctor-provided treatments, the problem should be re-evaluated, according to the American College of Obstetricians and Gynecologists.