- HPV Symptoms and Diagnosis
- Types of Common Skin Warts (Nongenital)
- Genital Warts Not Confined to the Genitals
- Potential Complications of HPV Infection
- Diagnosis: Exam, Biopsy, Colposcopy, and HPV Test
- What Happens If HPV Is Left Untreated?
- High Risk HPV
- Non-High-Risk strains
- Is There a Cure for HPV?
- Human papillomavirus (HPV) and cervical cancer
- What is HPV?
- How HPV infection leads to cervical cancer
- Risk factors for HPV persistence and development of cervical cancer
- Global burden of cervical cancer
- Cervical cancer control: A comprehensive approach
- HPV vaccination
- Screening and treatment of pre-cancer lesions
- Management of invasive cervical cancer
- WHO response
- Genital HPV Infection – Fact Sheet
- How is HPV spread?
- Does HPV cause health problems?
- Does HPV cause cancer?
- How can I avoid HPV and the health problems it can cause?
- Who should get vaccinated?
- How do I know if I have HPV?
- How common is HPV and the health problems caused by HPV?
- I’m pregnant. Will having HPV affect my pregnancy?
- Can I be treated for HPV or health problems caused by HPV?
- Where can I get more information?
- Want to get tested for HPV?
- High-risk HPV doesn’t have symptoms
- If I have high-risk HPV, will I get cancer?
- What’s the difference between HPV and genital warts?
- Nasal and paranasal sinus cancer
- How common nasal and sinus cancer is
- Factors that increase your risk
- Factors that may increase your risk
- – REFERENCES –
HPV Symptoms and Diagnosis
Different types of HPV can cause common skin warts, genital warts, or cancer.
Many types of HPV cause common skin warts, which may be annoying but are generally harmless. Getty Images
Whether they know it or not, most people will be infected with one or more types of the human papillomavirus — or HPV —at some point in their lives. HPV is a group of more than 150 related viruses, and the symptoms that result from an HPV infection depend in part on which type of the virus a person has.
About three-fourths of HPV types can cause common skin warts (noncancerous growths). Common warts often appear on the hands or feet, but they can appear anywhere on the body. (1)
The other 25 percent of types of HPV infect the mucosal surfaces of the body — such as the vagina, anus, and inner nose, mouth, and throat. Some of these types of HPV can cause genital warts, and some can cause cellular changes, called dysplasia, that may progress to cancer.
Still, just because a type of HPV can cause warts or dysplasia doesn’t mean it will. In many cases, infection with HPV causes no symptoms and goes unnoticed.
In fact, most genital HPV infections are temporary and go away on their own. (2)
Here’s what to look for — or what screening tests to consider — to know if you’ve been infected with HPV.
Types of Common Skin Warts (Nongenital)
HPV enters the top layer of the skin through tiny cuts or abrasions, and when it does, a wart may grow as a result.
There are a few different varieties of skin warts:
Common Warts Common warts most often appear on the fingers, around the fingernails, and on the backs of the hands. The growths may feel like rough bumps and may have tiny black dots in them.
The black dots are tiny blood vessels that have been “smothered” by the dead skin that builds up on the wart.
Plantar Warts Warts that grow on the soles of the feet are called plantar warts. They sometimes grow in clusters, in which case they’re known as mosaic warts.
Typically hard and grainy, plantar warts may be flat or may grow inward. They can be painful to walk on.
Flat Warts As the name implies, flat warts are typically flat-topped and are usually smaller and smoother than other warts. They often grow in large numbers (20 to 100 at a time) and can occur anywhere but frequently occur on the face in children, the beard area in men, and the legs in women.
Filiform Warts These warts resemble finger-like projections or long threads. They often appear on the face and often grow quickly.
Periungual Warts Periungual warts form in clusters around fingernails or toenails and may extend under the nails as well. They appear as cauliflower-like thickened skin and may be fissured, inflamed, or tender. Periungual warts are most common in nail biters and those who pick at their cuticles. They are difficult to treat and have a high recurrence rate.
Genital Warts Not Confined to the Genitals
Warts that develop in the genital and anal regions are caused by a different group of HPV types than those that cause skin warts.
So-called genital warts can also form inside the nose, mouth, and throat; in the trachea and bronchi (the windpipe and smaller air passages leading to the lungs); and on the inner eyelids.
HPV types that cause genital warts are usually, but not always, transmitted during intimate sexual contact.
About 90 percent of genital warts are caused by HPV types 6 and 11, according to the Centers for Disease Control and Prevention (CDC). (3)
These warts, which are sometimes too small to see, may be:
- Flat or raised
- Grouped in clusters, resembling cauliflower
- Pink or flesh-colored
- Soft to the touch
- Painful or itchy
They typically grow:
- Inside or around the anus
- On the upper thighs
- In the groin area
- On the scrotum and penis, including under the foreskin and in the urethral opening
- Inside the vagina, on the cervix (lower end of the uterus), or around the vulva (opening of the vagina)
Potential Complications of HPV Infection
Genital warts that go untreated may eventually cause abnormal urine flow in men (if warts are present in the urethra); bleeding from the urethra, vagina, or anus; or vaginal discharge.
The HPV types that cause genital warts are not linked to cancer, but some other types of HPV that also infect the mucous membranes are.
While most of those HPV infections never cause any symptoms, some cause changes in the cells that eventually can lead to cancer.
High-risk types of HPV can cause:
- Cervical cancer
- Vulvar cancer
- Vaginal cancer
- Penile cancer
- Anal cancer
- Cancer of the back of the throat
The Pap test and HPV test can detect cervical changes at an early stage, so that cervical cancer can be avoided, in most cases.
There are no screening tests for the other types of cancer caused by HPV, so it’s important to notice any changes in appearance, lumps, skin changes, pain, abnormal bleeding, or any other abnormalities in the areas potentially infected with HPV.
Diagnosis: Exam, Biopsy, Colposcopy, and HPV Test
Skin warts and genital warts can usually be diagnosed on sight during a physical examination, but your doctor may also refer you to a dermatologist for a biopsy (removal of tissue for examination under a microscope) to be sure your skin condition is a wart.
If you’re a woman with detectable genital warts, your doctor may also perform a colposcopy — a procedure that uses a light and a low-power microscope — to find genital warts on your cervix that are too small to see with the naked eye.
The HPV test can detect HPV types 16 and 18 and provide broad results for 12 other high-risk (cancer-causing) HPV types in cervical tissue.
Women who have an abnormal Pap test or positive HPV test should seek advice from a doctor on how best to follow up to prevent cervical cancer.
A positive HPV test will generally be followed up with a colposcopy if HPV types 16 or 18 are found, a Pap test if one wasn’t done at the same time as the HPV test, or repeat testing in 12 months if types of HPV other than 16 or 18 are found but the results of a Pap test are normal. (4)
Cancers in areas other than the cervix are diagnosed by taking a biopsy of abnormal-appearing areas and examining the tissue under a microscope.
Additional reporting by Ingrid Strauch.
What Happens If HPV Is Left Untreated?
HPV affects millions of Americans and has become the most prevalent STD in the United States. Although there is a vaccine available now, millions of unvaccinated Americans have already been infected or become newly infected every year.
There are more than 100 different strains of HPV, some of which never show symptoms and can not be detected without the presence of symptoms.
High Risk HPV
There are 14 strains of “High risk” HPV that cause cancer. Cancer caused by HPV can affect the vulva, penis, anus, or throat. Cervical Cancer is the 2nd most common of all the cancers among women and is almost only caused by HPV.
High risk strains of HPV do not have any symptoms until it they have caused enough damage to begin developing cancer. Without HPV testing, women won’t find out they have it until they have an abnormal pap smear or cancer has been detected though the presence of abnormal cell formations.
Symptoms of high-risk HPV cancer:
- Change in the color or texture of the skin on the penis
- Itching, burning, discharge or bleeding from the anus
- Itching, pain, or irregular bleeding from the vagina
- Trouble swallowing or breathing, persistent ear pain, constant cough or mass or lump in your throat.
Read more about the signs of HPV here.
If high risk HPV is left untreated after cancer symptoms present it can become very serious and spread to other areas of the body, ultimately resulting in death.
Other forms of HPV show symptoms but do not have the cancerous effects of high risk strains. If these are left untreated it is unlikely that anything will happen other than experiencing annoying or irritating symptoms. Some of the symptoms associated with the non-cancer-causing HPV include:
- Genital warts- Soft fleshy growths that can resemble cauliflower.
- Itching in the presence of genital warts
Is There a Cure for HPV?
Currently there is not a cure for any strain of HPV. There are vaccines available to prevent HPV, but if you were sexually active prior to the development of the vaccine or were sexually active prior to receiving the vaccine you may be infected. There is such a high population for people that have been infected that it is important to get tested periodically just to be safe.
Testing is the first step in taking control. Getting tested and diagnosed is the only way to catch a high-risk HPV infection before it becomes cancerous. HPV is treatable if treatment begins early. Convenient testing now can be done in the privacy of your own home with our at home testing kits.
HSA may cover your testing costs. Read more here.
MyLab Box offers an HPV test for women ages 30+.
Human papillomavirus (HPV) and cervical cancer
What is HPV?
Human papillomavirus (HPV) is the most common viral infection of the reproductive tract. Most sexually active women and men will be infected at some point in their lives and some may be repeatedly infected.
The peak time for acquiring infection for both women and men is shortly after becoming sexually active. HPV is sexually transmitted, but penetrative sex is not required for transmission. Skin-to-skin genital contact is a well-recognized mode of transmission.
There are many types of HPV, and many do not cause problems. HPV infections usually clear up without any intervention within a few months after acquisition, and about 90% clear within 2 years. A small proportion of infections with certain types of HPV can persist and progress to cervical cancer.
Cervical cancer is by far the most common HPV-related disease. Nearly all cases of cervical cancer can be attributable to HPV infection.
The infection with certain HPV types also causes a proportion of cancers of the anus, vulva, vagina, penis and oropharynx, which are preventable using similar primary prevention strategies as those for cervical cancer.
Non-cancer causing types of HPV (especially types 6 and 11) can cause genital warts and respiratory papillomatosis (a disease in which tumours grow in the air passages leading from the nose and mouth into the lungs). Although these conditions very rarely result in death, they may cause significant occurrence of disease. Genital warts are very common, highly infectious and affect sexual life.
How HPV infection leads to cervical cancer
Although most HPV infections clear up on their own and most pre-cancerous lesions resolve spontaneously, there is a risk for all women that HPV infection may become chronic and pre-cancerous lesions progress to invasive cervical cancer.
It takes 15 to 20 years for cervical cancer to develop in women with normal immune systems. It can take only 5 to 10 years in women with weakened immune systems, such as those with untreated HIV infection.
Risk factors for HPV persistence and development of cervical cancer
- HPV type – its oncogenicity or cancer-causing strength;
- immune status – people who are immunocompromised, such as those living with HIV, are more likely to have persistent HPV infections and a more rapid progression to pre-cancer and cancer;
- coinfection with other sexually transmitted agents, such as those that cause herpes simplex, chlamydia and gonorrhoea;
- parity (number of babies born) and young age at first birth;
- tobacco smoking
Global burden of cervical cancer
Worldwide, cervical cancer is the fourth most frequent cancer in women with an estimated 570 000 new cases in 2018 representing 7.5% of all female cancer deaths. Of the estimated more than 311 000 deaths from cervical cancer every year, more than 85% of these occur in less developed regions.
In developed countries, programmes are in place which enable girls to be vaccinated against HPV and women to get screened regularly. Screening allows pre-cancerous lesions to be identified at stages when they can easily be treated. Early treatment prevents up to 80% of cervical cancers in these countries.
In developing countries, there is limited access to these preventative measures and cervical cancer is often not identified until it has further advanced and symptoms develop. In addition, access to treatment of such late-stage disease (for example, cancer surgery, radiotherapy and chemotherapy) may be very limited, resulting in a higher rate of death from cervical cancer in these countries.
The high mortality rate from cervical cancer globally (Age Standardized Rate: 6.9/100,000 in 2018) could be reduced by effective interventions.
Cervical cancer control: A comprehensive approach
WHO recommends a comprehensive approach to cervical cancer prevention and control. The recommended set of actions includes interventions across the life course. It should be multidisciplinary, including components from community education, social mobilization, vaccination, screening, treatment and palliative care.
| Girls 9-14 years
||Women 30 years old or older||All women as needed|
| Girls and boys, as appropriate
|| “Screen and treat” – single visit approach
|| Treatment of invasive cancer at any age and palliative care
Primary prevention begins with HPV vaccination of girls aged 9-14 years, before they become sexually active.
Other recommended preventive interventions for boys and girls as appropriate are:
- education about safe sexual practices, including delayed start of sexual activity;
- promotion and provision of condoms for those already engaged in sexual activity;
- warnings about tobacco use, which often starts during adolescence, and which is an important risk factor for cervical and other cancers; and
- male circumcision.
Women who are sexually active should be screened for abnormal cervical cells and pre-cancerous lesions, starting from 30 years of age.
If treatment of pre-cancer is needed to excise abnormal cells or lesions, cryotherapy (destroying abnormal tissue on the cervix by freezing it) is recommended.
If signs of cervical cancer are present, treatment options for invasive cancer include surgery, radiotherapy and chemotherapy.
There are currently 3 vaccines protecting against both HPV 16 and 18, which are known to cause at least 70% of cervical cancers. The third vaccine protects against three additional oncogentic HPV types, which cause a further 20% of cervical cancers. Given that the vaccines which are only protecting against HPV 16 and 18 also have some cross-protection against other less common HPV types which cause cervical cancer, WHO considers the three vaccines equally protective against cervical cancer. Two of the vaccines also protect against HPV types 6 and 11, which cause anogenital warts.
Clinical trials and post-marketing surveillance have shown that HPV vaccines are very safe and very effective in preventing infections with HPV infections.
HPV vaccines work best if administered prior to exposure to HPV. Therefore, WHO recommends to vaccinate girls, aged between 9 and 14 years, when most have not started sexual activity.
The vaccines cannot treat HPV infection or HPV-associated disease, such as cancer.
Some countries have started to vaccinate boys as the vaccination prevents genital cancers in males as well as females, and two available vaccines also prevent genital warts in males and females. WHO recommends vaccination for girls aged between 9 and 14 years, as this is the most cost-effective public health measure against cervical cancer.
HPV vaccination does not replace cervical cancer screening. In countries where HPV vaccine is introduced, screening programmes may still need to be developed or strengthened.
Screening and treatment of pre-cancer lesions
Cervical cancer screening involves testing for pre-cancer and cancer among women who have no symptoms and may feel perfectly healthy. When screening detects pre-cancerous lesions, these can easily be treated, and cancer can be avoided. Screening can also detect cancer at an early stage and treatment has a high potential for cure.
Because pre-cancerous lesions take many years to develop, screening is recommended for every woman from aged 30 and regularly afterwards (frequency depends on the screening test used). For women living with HIV who are sexually active, screening should be done earlier, as soon as they know their HIV status.
Screening has to be linked to access to treatment and management of positive screening tests. Screening without proper management is not ethical.
There are 3 different types of screening tests that are currently recommended by WHO:
- HPV testing for high-risk HPV types.
- visual inspection with Acetic Acid (VIA)
- conventional (Pap) test and liquid-based cytology (LBC)
For treatment of pre-cancer lesions, WHO recommends the use of cryotherapy and Loop Electrosurgical Excision Procedure (LEEP). For advanced lesions, women should be referred for further investigations and adequate management.
Management of invasive cervical cancer
When a woman presents symptoms of suspicion for cervical cancer, she must be referred to an appropriate facility for further evaluation, diagnosis and treatment.
Symptoms of early stage cervical cancer may include:
- Irregular blood spotting or light bleeding between periods in women of reproductive age;
- Postmenopausal spotting or bleeding;
- Bleeding after sexual intercourse; and
- Increased vaginal discharge, sometimes foul smelling.
As cervical cancer advances, more severe symptoms may appear including:
- Persistent back, leg and/or pelvic pain;
- Weight loss, fatigue, loss of appetite;
- Foul-smell discharge and vaginal discomfort; and
- Swelling of a leg or both lower extremities.
Other severe symptoms may arise at advanced stages depending on which organs cancer has spread.
Diagnosis of cervical cancer must be made by histopathologic examination. Staging is done based on tumor size and spread of the disease within the pelvis and to distant organs. Treatment depends on the stage of the disease and options include surgery, radiotherapy and chemotherapy. Palliative care is also an essential element of cancer management to relive unnecessary pain and suffering due the disease.
WHO has developed guidance on how to prevent and control cervical cancer through vaccination, screening and management of invasive cancer. WHO works with countries and partners to develop and implement comprehensive programmes.
In May 2018 the WHO Director-General made a call to action towards the elimination of cervical cancer and engage partners and countries to increase access to and coverage of these 3 essential interventions to prevent cervical cancer: HPV vaccination, screening and treatment of pre-cancer lesions, and management of cervical cancer.
Genital HPV Infection – Fact Sheet
Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Some health effects caused by HPV can be prevented by the HPV vaccines.
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HPV is the most common sexually transmitted infection (STI). HPV is a different virus than HIV and HSV (herpes). 79 million Americans, most in their late teens and early 20s, are infected with HPV. There are many different types of HPV. Some types can cause health problems including genital warts and cancers. But there are vaccines that can stop these health problems from happening.
How is HPV spread?
You can get HPV by having vaginal, anal, or oral sex with someone who has the virus. It is most commonly spread during vaginal or anal sex. HPV can be passed even when an infected person has no signs or symptoms.
Anyone who is sexually active can get HPV, even if you have had sex with only one person. You also can develop symptoms years after you have sex with someone who is infected. This makes it hard to know when you first became infected.
Does HPV cause health problems?
In most cases, HPV goes away on its own and does not cause any health problems. But when HPV does not go away, it can cause health problems like genital warts and cancer.
Genital warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. A healthcare provider can usually diagnose warts by looking at the genital area.
Does HPV cause cancer?
HPV can cause cervical and other cancers including cancer of the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils (called oropharyngeal cancer).
Cancer often takes years, even decades, to develop after a person gets HPV. The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers.
There is no way to know which people who have HPV will develop cancer or other health problems. People with weak immune systems (including those with HIV/AIDS) may be less able to fight off HPV. They may also be more likely to develop health problems from HPV.
How can I avoid HPV and the health problems it can cause?
You can do several things to lower your chances of getting HPV.
Get vaccinated. The HPV vaccine is safe and effective. It can protect against diseases (including cancers) caused by HPV when given in the recommended age groups. (See “Who should get vaccinated?” below) CDC recommends HPV vaccination at age 11 or 12 years (or can start at age 9 years) and for everyone through age 26 years, if not vaccinated already. For more information on the recommendations, please see: https://www.cdc.gov/vaccines/vpd/hpv/public/index.html
Get screened for cervical cancer. Routine screening for women aged 21 to 65 years old can prevent cervical cancer.
If you are sexually active
- Use latex condoms the right way every time you have sex. This can lower your chances of getting HPV. But HPV can infect areas not covered by a condom – so condoms may not fully protect against getting HPV;
- Be in a mutually monogamous relationship – or have sex only with someone who only has sex with you.
Who should get vaccinated?
HPV vaccination is recommended at age 11 or 12 years (or can start at age 9 years) and for everyone through age 26 years, if not vaccinated already.
Vaccination is not recommended for everyone older than age 26 years. However, some adults age 27 through 45 years who are not already vaccinated may decide to get the HPV vaccine after speaking with their healthcare provider about their risk for new HPV infections and the possible benefits of vaccination. HPV vaccination in this age range provides less benefit. Most sexually active adults have already been exposed to HPV, although not necessarily all of the HPV types targeted by vaccination.
At any age, having a new sex partner is a risk factor for getting a new HPV infection. People who are already in a long-term, mutually monogamous relationship are not likely to get a new HPV infection.
How do I know if I have HPV?
There is no test to find out a person’s “HPV status.” Also, there is no approved HPV test to find HPV in the mouth or throat.
There are HPV tests that can be used to screen for cervical cancer. These tests are only recommended for screening in women aged 30 years and older. HPV tests are not recommended to screen men, adolescents, or women under the age of 30 years.
Most people with HPV do not know they are infected and never develop symptoms or health problems from it. Some people find out they have HPV when they get genital warts. Women may find out they have HPV when they get an abnormal Pap test result (during cervical cancer screening). Others may only find out once they’ve developed more serious problems from HPV, such as cancers.
How common is HPV and the health problems caused by HPV?
HPV (the virus): About 79 million Americans are currently infected with HPV. About 14 million people become newly infected each year. HPV is so common that almost every person who is sexually-active will get HPV at some time in their life if they don’t get the HPV vaccine.
Health problems related to HPV include genital warts and cervical cancer.
Genital warts: Before HPV vaccines were introduced, roughly 340,000 to 360,000 women and men were affected by genital warts caused by HPV every year.* Also, about one in 100 sexually active adults in the U.S. has genital warts at any given time.
Cervical cancer: Every year, nearly 12,000 women living in the U.S. will be diagnosed with cervical cancer, and more than 4,000 women die from cervical cancer—even with screening and treatment.
There are other conditions and cancers caused by HPV that occur in people living in the United States. Every year, approximately 19,400 women and 12,100 men are affected by cancers caused by HPV.
*These figures only look at the number of people who sought care for genital warts. This could be an underestimate of the actual number of people who get genital warts.
I’m pregnant. Will having HPV affect my pregnancy?
If you are pregnant and have HPV, you can get genital warts or develop abnormal cell changes on your cervix. Abnormal cell changes can be found with routine cervical cancer screening. You should get routine cervical cancer screening even when you are pregnant.
Can I be treated for HPV or health problems caused by HPV?
There is no treatment for the virus itself. However, there are treatments for the health problems that HPV can cause:
- Genital warts can be treated by your healthcare provider or with prescription medication. If left untreated, genital warts may go away, stay the same, or grow in size or number.
- Cervical precancer can be treated. Women who get routine Pap tests and follow up as needed can identify problems before cancer develops. Prevention is always better than treatment. For more information visit www.cancer.orgexternal icon.
- Other HPV-related cancers are also more treatable when diagnosed and treated early. For more information visit www.cancer.orgexternal icon.
Where can I get more information?
Cervical Cancer Screening
CDC’s National Breast and Cervical Cancer Early Detection Program
STD information and referrals to STD Clinics
In English, en Español
CDC National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
E-mail: [email protected]
National HPV and Cervical Cancer Prevention Resource Center American Sexual Health Association (ASHA)external icon
P. O. Box 13827
Research Triangle Park, NC
E-mail: [email protected]
- STDs during Pregnancy
In This Section
- Human Papillomavirus (HPV)
- What are the symptoms of HPV?
- Should I get tested for HPV?
- How is HPV treated?
- How can I make sure I don’t get or spread HPV?
- Should I get the HPV vaccine?
Most people with HPV don’t have any symptoms or health problems. Sometimes HPV can cause genital warts. Some types of HPV can cause cancer.
X in a circle
Want to get tested for HPV?
Find a Health Center A right arrow in a circle
High-risk HPV doesn’t have symptoms
Unfortunately, most people who have a high-risk type of HPV will never show any signs of the infection until it’s already caused serious health problems. That’s why regular checkups are so important. In many cases, cervical cancer can be prevented by finding abnormal cell changes that, if left untreated, could develop into cancer.
A Pap test can detect these abnormal cells in your cervix. A Pap test doesn’t directly test for cancer, or even HPV, but it can discover abnormal cell changes that are likely caused by HPV. These problem areas can be monitored by your nurse or doctor and treated before turning into something more serious.
There isn’t a test for high-risk HPV in the vulva, penis, anus, or throat, and the HPV itself doesn’t have any symptoms. If it becomes cancer, then there may be some symptoms.
Penile cancer — cancer of the penis — might show symptoms like changes in color or thickness of the skin of your penis, or a painful sore might show up on your penis.
Anal cancer might cause anal bleeding, pain, itching, or discharge, or changes in bowel habits.
Vulvar cancer — cancer of the vulva — might show symptoms like changes in color/thickness of the skin of your vulva. There may be chronic pain, itching, or there may be a lump.
Throat cancer might cause a sore throat, ear pain that doesn’t go away, constant coughing, pain or trouble swallowing or breathing, weight loss, or a lump or mass in your neck.
If you develop any of these symptoms, see a doctor right away.
If I have high-risk HPV, will I get cancer?
High-risk HPV can cause normal cells to become abnormal. These abnormal cells can lead to cancer over time. High-risk HPV most often affects cells in the cervix, but it can also cause cancer in the vagina, vulva, anus, penis, mouth, and throat.
The good news is most people recover from HPV infections with no health problems at all. We don’t know why some people develop long-term HPV infections, precancerous cell changes, or cancer. But we do know that having another disease that makes it difficult for you to fight infections makes it more likely HPV will cause cervical cancer. Smoking cigarettes also makes HPV more likely to cause cervical cancer.
There’s no cure for HPV, but it usually takes several years for cancer to develop, and abnormal cells in the cervix can be detected and treated before they turn into cancer. And the vast majority of HPV infections are temporary and not serious, so don’t spend a ton of energy worrying about whether you have HPV. Just make sure you’re not skipping your regular checkups, including Pap and/or HPV tests.
What’s the difference between HPV and genital warts?
Genital warts are harmless growths on the skin of your vulva, vagina, cervix, penis, scrotum, or anus. Most genital warts are caused by two types of HPV — types 6 and 11. Genital warts look like fleshy, soft bumps that sometimes resemble miniature cauliflower. They’re usually painless and can be treated and removed just like the warts you might get on your hands or feet.
Because genital warts can look like other common bumpy skin issues, only your nurse or doctor can diagnose and treat your genital warts. Fortunately, warts aren’t dangerous and they don’t lead to cancer — that’s why the types of HPV that cause genital warts are called “low-risk.” However, they may cause irritation and discomfort, and you can pass the HPV that caused them to other people. If you think you have genital warts, it’s important to get checked out right away.
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Nasal and paranasal sinus cancer
Find out about the possible risks and causes of nasal cavity and paranasal sinus cancers.
How common nasal and sinus cancer is
Cancer of the nasal cavity and sinuses is rare. Only around 400 cases are diagnosed in the UK each year. Compared with around 41,300 cases of bowel cancer diagnosed each year, you can see how rare it is.
Factors that increase your risk
We do know that a few things can increase your risk, including the following:
Smoking increases your risk of nasal cavity cancer. If you smoke you are at a higher than average risk of developing this type of cancer.
Cigarettes contain nitrosamines and other chemicals that cause cancer. When you smoke, the smoke may pass through your nasal cavity on its way to your lungs.
Your risk increases the longer you smoke. If you smoke a lot, you increase your risk even more. Stopping smoking is the best thing you can do for your health and will reduce the risk of developing cancer.
Exposure to some substances at work
Research suggests that working in some jobs increases your risk of developing cancers in the nasal cavity and paranasal sinuses. This is because they can expose you to certain chemicals.
The Health and Safety Executive produced a report in 2012 that looked at whether there were particular occupations that increase the risk of nasal and paranasal cancers. They state that around a third of nasal and paranasal sinus cancers are linked to occupation.
The following may increase your risk:
- Wood dust – people who work in carpentry, including furniture and cabinet makers, wooden floors and any other wood related industry
- Leather dust – shoe makers may be exposed to leather dust
- Chromium – is a chemical used in stainless steel, textiles, plastics, leather. The use of chromium is now restricted in Europe.
- Nickel – is a metal used to make stainless steel
- Formaldehyde – an industrial chemical used to make other chemicals, building materials, and household products
- Cloth fibres – people who work in the textile manufacturing may be exposed to these fibres
Human papilloma virus (HPV)
HPV is a common virus that can cause small growths or warts. There are lots of different strains of HPV and some are high risk for other types of cancer, such as cervical cancer.
More than 1 in 5 cases of nasal and paranasal sinus cancers are linked to HPV. Of the different types of HPV, type 16 is the most common with nasal and sinus cancers.
Radiotherapy for hereditary retinoblastoma
A long term follow up study has shown an increased risk of nasal cancer in people treated with radiotherapy for hereditary retinoblastoma compared to the general population.
Factors that may increase your risk
There are also possible risk factors. This means some researchers suspect they may be risk factors, but there isn’t enough evidence to be sure.
Previous non Hodgkin lymphoma
A study has shown that people who have had non Hodgkin lymphoma may have a higher risk of nasal cavity cancer compared to the general population.
Human Papilloma Virus (HPV) causes a number of diseases and is most commonly discussed in reference to sexually transmitted diseases. HPV infection has a substantial impact in ENT. It has multiple subtypes that are associated with diseases extending from completely benign to invasive carcinoma.
There are more than 150 subtypes of HPV. Seventy-five percent of HPV types are associated with the common wart, and 25% are associated with diseases in the mucosa of the nose, sinuses, oropharynx, larynx, and ano-genital region. HPV types are categorized as low risk and high risk. The most common types seen in ENT are 6, 11, 16 and 18. Types 6 and 11 are low risk for malignancy. Types 16 and 18 are high risk. High risk is associated with cytologic changes of dysplasia, pre-cancer and malignancy. Infection of types 6, 11, 16 and 18 are largely contracted by sexual contact. There are reports of HPV infection in monogamous relationships, and in individuals with no sexual activity. HPV infections are very common. Seventy-five percent of sexually active people ages 15 – 49 years have been infected at sometime. Most HPV infections are temporary and resolve with no long term consequences. Five – ten percent of cases with HPV infection persist with significant impact on quality of life.
Adult laryngeal squamous papillomas.
Photos courtesy of Ashli O’Rourke, M.D.
Recurrent respiratory papillomas (RRP) have been associated with genital condyloma since the 1950’s. RRP is second to nodules as benign laryngeal lesions in children. There are approximately 20,000 cases of RRP in the US. RRP types 6 and 11 are also the most common subtypes associated with ano-genital condyloma. Pediatric RRP is most commonly diagnosed between ages 2 – 4 years. Adult RRP is most commonly diagnosed between ages 20 – 30 years. RRP in children is a more persistant and aggressive disease than the adult form.
About twenty-five percent of RRP are type 6, 66% are type 11, and 14% percent type 6 and 11. Types 16 and 18 are rare in RRP. Cases with type 11 alone and in combination with type 6 have more severe disease,,longer illness, and require more surgical procedures than cases with type 6 alone. Malignant transformation to squamous cell carcinoma is more common in type 11.
Pediatric RRP has a 200 – 400% increased risk of occurrence if the mother has active HPV disease at the time of delivery. Exposure at delivery may not be the only factor, as HPV has been found in amniotic fluid. The American College of OB-GYN does not have a C-section indication based on the mother’s HPV status.
Within the nasal fossa, papillary lesions occur commonly on the vestibular skin. These squamous papillomas are benign, usually HPV types 2, 4 and 6. Types 2 and 4 are associated with the common wart. Treatments for these include excision, cautery and cryotherapy with recurrence being common. Inverting papillomas are a distinct pathologic sino-nasal entity. HPV types seen with inverting papilloma are 6, 11, 16 and 18. Fungiform papilloma are exophytic in growth usually occurring on the septum. Schneiderian and Inverting papillomas are located on the lateral nasal wall and sinus mucosa. These are locally invasive with ability to destroy bone, extend intraorbital and intracranial. Inverting and Schneiderian papillomas have potential for squamous cell malignancy. HPV types 6 and 11 are noted to have less frequent recurrence. Types 16 and 18 are more likely to recur and have malignant transformation. Tissue typing may be of value as to prognosis and recurrence.
Tobacco and alcohol. For years these two substances alone or together were felt to be the primary risk factors for head and neck cancers. From 1965 to 2009 there was a 50% decrease in the percent of smoking adults. The number of smokers changed little, but with population increase the percentage dropped substantially. Alcohol consumption shows a less dramatic but significant decrease in percentage of people drinking alcohol, and a decrease in the amount of alcohol consumed. With these risk factors decreasing the rates of oral cancers have decreased over the last 30 years, but there is an increase in tonsil and base of tongue cancer. HPV was first observed in Oro-pharyngeal squamous cell cancer in the 1980’s. Since that time, the research into HPV + Oro-pharyngeal cancer has exploded. Typing of HPV in oro-pharyngeal cancer is necessary as treatment plans have changed dramatically over time based on these results. Most of the tumors that are HPV positive contain HPV type 16 with oncogenes E6 and E7. The increase in HPV + cancers is felt to represent the increase in HPV Genital infection rates over the last 30 years.
HPV DNA has been detected in cholesteatomas in rates from 3 – 36 %. There is no substantial evidence for HPV as a factor for cholesteatoma formation.
Because of the extent of disease that may occur in ENT from HPV, immunization information is very important. Current CDC recommendation is for a series of three vaccinations over a six month period for males and females ages 11 – 12 years, and for males and females who have not completed this series ages 13 – 21 years. Vaccination may be given as early as age 9 years and as late as age 26 years.
Two vaccines are FDA approved. Gardisil is for males and females and immunizes for types 6, 11, 16 and 18. Ceravix is for females only and immunizes for HPV 16 and 18. The HPV vaccine is not a preventative of other sexually transmitted diseases. The HPV vaccine is not a treatment for existing HPV disease. Additional boosters may be needed in the future, as length of protection is not known. Vaccinations are 99% effective for prevention of disease from the specific subtypes.
Robert C. Waters, M.D.
Medical University of South Carolina