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Human Papilloma Virus (HPV)

What it is?

HPV is a large family of viruses that can caseu warts and certain cancers. Specific strains of HPV infect the genital area (in contrast to strains that cause plantar warts, for example.).  It is one of the most common sexually transmitted viruses. While it causes few symptoms on its own, it is linked to several forms of cancer. In fact, the National Cancer Institute reports that essentially all cervical cancers are the result of HPV infection. Cancers of the mouth, throat, penis and anus are also linked to HPV infection. Protecting yourself is extremely important.

There are over a hundred different HPV strains that infect the genital area. They are broken down into “low risk” strains that can cause genital warts, and “high risk” strains that are associated with cancers.

HPV Symptoms and Detection:

Approximately 75-80 % of all sexually active people will be infected with HPV at some point in their lives. Most people show no symptoms at all. Others experience:

  • Genital warts: Raised, dry, usually soft and painless bumps around the genital or anal area. These are usually caused by low risk strains 6 or 11.
  • Cervical changes:  detected by Pap test, a specific high risk HPV test that detects a group of strains associated with cervical cancer, or colposcopy (examination of the cervix using a magnifying scope). HPV infection of the cervix might not cause any problem, or could result in a precancerous change or even cervical cancer.  High risk strains 16 and 18 are most likely to be found in cervical cancers.

There is no screening test that detects HPV in men. However, if your sexual partner is diagnosed with HPV, it is likely that you are infected too.

Luckily, most of the time our immune system is able to clear an HPV infection, even if it is a high risk strain. Studies suggest this process takes, on average, 18 months. Thus, for most people, an HPV infection is transient. Smoking specifically impairs the immune response to HPV, so it is particularly important for smokers to quit.

HPV Prevention:

Abstinence: The only way to avoid all forms of HPV infection is to abstain from intimate genital contact, including oral sex.

Vaccines: There are 3 HPV vaccines currently available:

  • Cervarix: protects against high risk strains 16 and 18
  • Gardisil: protects against high risk strains 16 and 18, and low risk strains 6 and 11
  • Gardisil 9: protects against high risk strains 16, 18, and five others, as well as low risk strains 6 and 11

All vaccines are designed to prevent cervical cancer, and are recommended for both women and men. The benefit to men is to protect them from HPV related head and neck  and anal cancers, as well as protecting their female partners from cervical cancer.

Cervarix and Gardisil are FDA approved for females and males ages 9-26. Gardisil 9 is approved for females 9-26 and males 13-21. All vaccines may be appropriate for people older than these designated ages. Talk to a provider at the IU Health Center Medical Clinic (http://healthcenter.indiana.edu/services/medical-clinic.shtml)

You can get the vaccine at the IU Health Center Immunization Clinic (http://healthcenter.indiana.edu/services/shots.shtml). The HPV vaccine is expensive, costing $170 per injection for any student who has paid the IU Health Fee. A series of 3 shots is required for full immunization. Please note that prices are subject to change. Merck, the manufacturer of one of the vaccines, offers their vaccine at no cost to low income and uninsured patients. To apply, download the Merck Vaccine Patient Assistance Form (http://healthcenter.indiana.edu/docs/mvpap_app.pdf).

"Safer Sex ":  Condoms or other latex barriers can reduce your risk of contracting HPV; however, they are not 100% effective since they do not cover all potentially exposed skin. Limiting your number of lifetime sexual partners can also reduce your risk of becoming infected. A long term, mutually monogamous relationship is the safest.

HPV Treatment:

There are many treatments for genital warts, including freezing or applying chemicals to the warts. There are some prescription topical treatments that are self-applied.  Repeated treatments usually are required, and can sometimes take several months. Warts in the anal or rectal area may require surgical treatment. Genital warts cannot be treated with over-the-counter medications. Even after the visible warts are gone, you may still be infected with the HPV virus, and warts may return. You also may still be able to transmit the virus to your sexual partners.

Cervical HPV infections can be monitored through regular Pap smears, colposcopy, and biopsy when necessary. If there are associated precancerous changes, office treatments are available that prevent progression to cervical cancer. After these treatments, women need careful follow up.

Even if you had the HPV vaccine, you should visit the IU Health Center Women's Clinic (http://healthcenter.indiana.edu/services/womens-health.shtml) for recommended cervical cancer screenings. If you have paid the IU Health Fee (http://healthcenter.indiana.edu/about/fees-payments.shtml), the cost of your visit is reduced if you make an appointment in advance.