Human Papilloma Virus Hpv

Overview

HPV stands for human papillomavirus. It is a large family of viruses — more than 100 types — that infect skin and the moist linings of the body, such as the genitals, mouth and throat. Most HPV infections do no harm and go away on their own within a year or two. A few types cause genital warts. A small number of 'high-risk' types can, over many years, cause changes in cells that may lead to cancer if the body does not clear the virus. Having HPV does not mean you will get cancer — it means you should keep up with the checks your doctor recommends.

Very common. Around 8 in 10 people will have HPV at some point in their lives. It is so common that doctors think of it as a normal part of being sexually active rather than something unusual.

Anyone who is or has been sexually active can get HPV, at any age. It is most often picked up in the late teens and twenties. It affects men and women equally, though the health checks that look for it — cervical screening — are usually offered to women and people with a cervix.

Symptoms

Common symptoms

• Usually no symptoms at all — most people never know they have it
• Small, flesh-coloured bumps or cauliflower-shaped growths around the genitals or anus (genital warts), which may itch but are often painless
• Common warts on the hands, fingers or feet, caused by other types of HPV
• Occasional discomfort, bleeding or discharge if warts are in a sensitive place

Symptoms in children

• Most HPV in children shows up as ordinary warts on the hands, feet or face — these are harmless and very common
• Genital warts in a young child are uncommon. If they appear, a doctor will gently look into how they might have happened. This does not automatically mean anything worrying occurred, but it does need a careful, kind assessment
• Children often have no symptoms at all, and their body usually clears the virus without any treatment

Symptoms in older adults

• HPV can still be picked up at any age, and in older adults the body may take longer to clear it
• Cervical screening is usually offered up to age 64 in the UK and similar ages elsewhere — keep attending if you are invited
• New lumps, bumps, bleeding between periods or after sex should always be checked, whatever your age
• A weakened immune system, which is more common with age or some long-term conditions, can make it harder to clear the virus

Causes

Main causes

• HPV spreads through direct skin-to-skin contact with an infected area, most often during vaginal, anal or oral sex
• It can pass even when there are no warts or visible signs, because most infections are silent
• It can also pass through close non-sexual contact with warts on hands or feet, from the common skin wart types

Risk factors

• Being sexually active with one or more partners, especially without condoms
• Starting sexual activity at a younger age, which simply means more years of possible exposure
• Smoking, which makes it harder for the body to clear HPV
• A weakened immune system, for example from some medicines or long-term conditions
• Not having had the HPV vaccine, or not keeping up with screening invitations

When to see a doctor

See a doctor urgently if:

• Heavy or unusual bleeding that worries you
• A new lump, sore or growth on the genitals or around the anus that is painful, bleeding or changing quickly
• Pelvic pain with a high temperature
• Any bleeding after the menopause

Book a routine appointment if:

• You notice small bumps or warts and want them checked
• You have been invited for cervical screening — it is worth going even if you feel well
• A partner has told you they have HPV or genital warts
• You have questions about the HPV vaccine, at any age
• You feel anxious about HPV and want to talk it through

Diagnosis

HPV is most often found through a routine cervical screening test, where a small sample of cells is taken from the cervix and checked for the virus and for cell changes. Genital warts are usually diagnosed just by looking — no swab or blood test is needed. There is no routine HPV test for men, and no test that tells you who gave you the virus or when you got it.

Tests that may be done

• Cervical screening (often called a smear test) with an HPV test on the sample
• A closer look at the cervix using a magnifier called a colposcopy, if screening finds changes
• A visual examination of the skin for warts
• A small tissue sample (biopsy) if an area looks unusual
• Sometimes an examination of the anus, if warts or changes are suspected there

What to expect at your appointment

These checks are usually quick and can be done at your GP surgery or a sexual health clinic. Screening may feel a little uncomfortable but should not be painful, and you can ask to stop at any time. Results often take a few weeks. If something is found, you will be told what it means and what happens next, and you will have time to ask questions.

Treatment

There is no medicine that kills HPV itself. In most people the body's immune system clears the virus on its own. Treatment focuses on the problems HPV can cause — the warts, or changes in cells found on screening — and on keeping a close eye so that any changes are dealt with early.

Self-care at home

• Do not pick, cut or scrape at warts — this can spread them or cause infection
• Keep the skin clean and dry, and wash your hands after touching warts
• Use condoms to lower the chance of passing HPV on, though they do not fully protect against it
• If you smoke, stopping is one of the best things you can do to help your body clear the virus
• Go to your screening appointments when invited, even if you feel completely well
• Tell current or recent partners if you have genital warts, so they can be checked too

Medical treatments

Doctors treat the visible effects of HPV, not the virus itself. Genital warts can be treated with creams or liquids that you apply at home over several weeks, or with treatments done at a clinic such as freezing, heat, or removal with a small instrument. Some people choose to wait and see, as warts can clear on their own. If cervical screening finds cell changes, you may be offered a colposcopy and, if needed, a short procedure to remove the changed cells. These procedures are usually done with a local anaesthetic and you can go home the same day. Your healthcare team will explain the options, the pros and cons, and what to expect.

When is surgery considered?

Surgery is not usually needed for HPV itself. It may be offered if warts are large, in a hard-to-treat place, or keep coming back, or as part of treating abnormal cells found on the cervix. These are usually minor procedures done under local anaesthetic, and your doctor will discuss the details with you beforehand.

Living with this condition

For most people, living with HPV means very little changes. You carry on with work, relationships and daily life. You may have a follow-up screening appointment booked, and it helps to note the date. If you have warts, you may need to apply treatment regularly for a few weeks. It is normal to feel self-conscious at first, but HPV is so common that most people you know will have had it too.

Lifestyle tips

• Stop smoking if you can — it makes a real difference to how well your body clears HPV
• Keep up with screening and follow-up appointments, even when you feel fine
• Use condoms to reduce passing HPV to partners
• Get plenty of sleep and manage stress, which supports your immune system
• Talk to partners openly — HPV is normal and nothing to be ashamed of

Diet and exercise

There is no special diet that clears HPV, but looking after your general health helps your immune system do its job. Aim for a balanced diet with plenty of fruit and vegetables, move your body in a way you enjoy most days, keep alcohol within sensible limits, and try to get enough sleep. Small, steady changes are worth more than a strict plan you cannot keep up.

Mental health and emotional wellbeing

Being told you have HPV can bring up worry, shame or anger — especially because it is spread through sex and often has no symptoms. These feelings are very common and they do settle. HPV does not mean you or your partner did anything wrong, and it does not mean you will get cancer. If the worry is affecting your sleep, mood or relationships, please tell your doctor. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis support line straight away — you deserve help right away.

Prevention

You can lower your risk, though no method is perfect. The HPV vaccine is the most effective protection. Condoms reduce the chance of passing HPV but do not cover all skin, so they do not remove the risk entirely. Regular screening is the other key step, because it finds cell changes early when they are easy to treat.

Vaccines

HPV vaccines protect against the types most likely to cause genital warts and cancer. In the UK and many other countries, the vaccine is offered to children around age 12 to 13, and it is given as a series of injections. It works best before any exposure to the virus, but it can still be useful for some adults — ask your GP or pharmacist whether it is right for you. The vaccine cannot treat HPV you already have, but it can protect you from types you have not yet caught.

Screening programmes

Cervical screening checks the cervix for HPV and for early cell changes. In the UK it is usually offered to women and people with a cervix aged 25 to 64, with tests every few years depending on your results and where you live. Screening is not a test for cancer — it is a way of catching small changes long before they would cause a problem. If you have missed a screening appointment, you can usually book one at any time.

Complications

If left untreated

• Genital warts may grow, spread or become uncomfortable, though they are not dangerous in themselves
• High-risk HPV can cause cell changes on the cervix, which over many years may develop into cervical cancer if not found and treated
• Less commonly, HPV is linked to cancers of the anus, mouth, throat, vulva, vagina and penis
• Rarely, warts can make passing urine difficult or, in pregnancy, affect delivery plans

Long-term outlook

The outlook is good. Around 9 in 10 HPV infections clear on their own, and when cell changes are found through screening they are usually simple to treat and fully resolved. Cervical cancer rates have fallen a great deal in countries with good screening and vaccination programmes. If you have HPV, the most useful things you can do are keep your appointments, look after your health, and raise any worries with your doctor early.

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