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HPV (Human Papillomavirus)

What is HPV?

HPV (Human Papillomavirus) is a family of over 200 viruses but only some are considered sexually transmitted. HPV often has no symptoms and transmits easily. Because people often pass the virus to their partners without realizing they have it, HPV has become one of the most common STDs worldwide.

It is important to realize that HPV not only causes Genital Warts but has other effects as well.

  • HPV is categorized into approximately 40 known low risk or high risk sub-types that affect the genitals and other body sites. 
  • The low risk types 6 and 11 are associated with Genital Warts.  
  • The high risk types are viruses that can lead to cancer, causing pre-cancerous changes in the cervix, vagina, anus or oropharynx (back of the throat).  
  • HPV 16 and 18 are particularly important to detect and are the cause of the majority of genital cancers and pre-cancers. Other types of high risk HPV are very dangerous.
  • 80% of humans will have been exposed to HPV at some time during their lives.
  • Roughly 3 million people are diagnosed with genital warts in the U.S. each year.
  • Data suggests that we never actually “clear” the virus – the viruses may just lay dormant.
  • While proper condom use can reduce the chances of spreading genital HPV, it does not eliminate the risk.
  • Individuals can be positive for more than one type of HPV, at the same time or in different anatomic body sites, including both low risk and high risk types.

Not all HPV viruses behave in the same way, so it is extremely important to realize that HPV-16 in women and HPV-16 in men is particularly aggressive, even in the very young. SelfCollect detects HPV-16, HPV-18 and other High-Risk HPV types.

HPV-16:

This virus is known to be one of the most aggressive types of HPV detected in humans.  It is capable of rapid oncogenic changes (pre-cancer changes) and can infect humans of any age. HPV-16 causes nearly 60% of the cervical cancer cases worldwide and is very prevalent in the U.S. Having HPV-16 in the sample provided to SelfCollect means that you more than likely are infected with this virus. It is important that you seek guidance from a physician or health care provider who specializes in changes associated with the infected body site (i.e. cervix, oropharynx, anus).  For example, if a vaginal sample contains HPV-16, then a health care provider who specializes in women’s health and understands the need for further examination of your cervix, possibly including a pap smear and colposcopy would be advised.

HPV-18

This virus is known to be one of the most aggressive types of HPV detected in humans and is responsible for a significant number of cancers of the cervix and adjacent organs (endocervix). Although very aggressive, HPV 18 is not quite as common in the U.S. as it is in other countries in the world.

Overall, HPV-18 is considered high risk and is the cause of about 10% of cervical cancer cases and a significant cause of pre-cancer in the female anogenital organs. HPV-18 also accounts for over 50% of a type of cervical cancer called adenocarcinoma. This type of cancer is harder to detect on a pap test. It is important that you seek guidance from a physician or health care provider who specializes in women’s health and understands the need for further examination of your cervix, possibly including a pap smear and colposcopy.

Other High Risk HPV Types

A positive result for “Other High Risk Types” means you have one or more of the following High Risk HPV types: 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 or 68. Even though HPV-16/18 are the most aggressive of these viruses, the other high risk viruses can cause pre-cancerous changes but do so less efficiently. 

Many individuals are infected with more than one virus at a time. Consequently, these additional viruses may be detected in other body sites, such as the oral cavity or anus, and may lead to increased risk of pre-cancerous changes in these body sites.

What should a woman know about a cervical/vaginal HPV Infection?

The Pap smear was introduced in the 1950s as a way of screening for abnormalities of the cervix. Prior to that, cervical cancer was the leading cause of death for women of childbearing age in the US. In the 1990s, High Risk HPV was identified as the cause of cervical cancer.

We are now able to detect the presence of High Risk HPV, the cause of cervical and other cancers, using simple collection techniques and available laboratory methods. It is important to understand that the presence of the virus always precedes any cancer-causing changes in the cervix. HPV testing has dramatically helped identify those individuals with High Risk HPV, and who are truly at risk for the pre-cancerous changes that lead to cervical cancer. 

Because of this greater understanding of the importance of HPV testing, the FDA has approved the Cobas® HPV test to be used as the primary screening tool for women 25 and older to identify those who are at greatest risk for cervical pre-cancer and cancer. In the past, a woman would have a pap test on a regular basis but not always receive an HPV test. Although the pap test still has many benefits, HPV testing is the more sensitive way to know if these cancer-causing viruses are present.

To learn more about the current cervical cancer screening guidelines, click here.

 

What should a man know about a penile HPV Infection?

Although genital HPV infections have been extensively studied in women, the natural history of the infection is not fully understood. Even less is known about the natural history of HPV in men.  Nonetheless, it is widely accepted that both women and men can carry HPV on their genitalia. 

The presence of HPV on a man’s penis does not have the same cancer-causing risk as it does in the anus, oropharynx or a woman’s cervix/vagina. However, if HPV is detected on the penis, it is a potential risk for penile cancer and for passing the virus to a partner, even if protection is used properly. The SelfCollect Penile HPV test identifies a “carrier” of HPV by sampling the cells that host the HPV virus.

Although very few healthcare professionals are aware there is a test for penile HPV, SelfCollect has chosen a medical laboratory that adheres to strict regulatory guidelines, and with advanced testing methodology, detects the presence of HPV on the penis. The collection method, obtained from a medical study researching HPV in young men entering the Danish Army, entails an exterior brushing of the shaft of the penis, corona and glans. Unlike many other STDs carried by men (chlamydia, gonorrhea, trichomonas), HPV does not “live” in a man’s urethra (the tube carrying urine from the bladder). Therefore, a urine specimen obtained by a man is not a credible sample for detection of HPV and can lead to a “false negative” test result.

Medical studies performed on the detection and prevalence of penile HPV are available in the "Further Reading" section below.

What should a person know about an anal HPV Infection?

The anus, rectum and colon are 3 separate organs. The anus, which allows you to control your bowel movements, has a similar anatomy and environment to the cervix. This is an ideal environment for HPV to live and grow and may potentially cause pre-cancer or cancer of the anus.

What should a woman know about an anal HPV Infection?

It’s a common misconception that only gay men, HIV-positive individuals or those who engage in anal intercourse are at risk for anal cancer. However, in the U.S., there are nearly double the reported cases of anal cancer in heterosexual women than in men.

Although engaging in anal intercourse allows for direct exposure to acquiring HPV or other STDs, it is not the only way for a woman to contract HPV in the anus. The presence of HPV in the anus seems to be highly linked to having the virus in a woman’s cervix/vagina due to close proximity between the two sites. Women who have had a history of cervical pre-cancer or cervical or vulvar cancer caused by HPV are at increased risk of having an anal HPV infection as well. 

Fortunately, an anal HPV test can now easily and painlessly detect the presence of the virus. Knowing your anal HPV status is an important step in taking control of your health.

What should a man know about an anal HPV Infection?

Overall, there are more anal cancer cases diagnosed annually in women than men, but there are some sexual practices and health factors that still put a man at risk. 

  • Most anal cancers (80%) are diagnosed in people who are over age 60. However, the incidence of anal cancer prior to age 35 is more common in men, especially in men who have sex with men (MSM). After age 50, anal cancer is more common in women.
  • The incidence of anal cancer is six times higher in single men as compared to married men.
  • Receptive anal intercourse is strongly related to the development of anal cancer.
  • Immunocompromised patients, such as those with HIV or on immunosuppressive medications, are at a higher risk of developing anal cancer. In this subgroup, the prognosis is worse than for non-immunocompromised patients.

Fortunately, much like a woman receiving cervical/vaginal HPV testing, an anal HPV test can now easily and painlessly detect the presence of the virus. Knowing your anal HPV status is an important step in taking control of your health.

What should a person know about an oral HPV Infection?

Oral infection with high risk HPV is associated with pre-cancerous changes or cancer in the back of the throat, in an area known as the oropharynx (base of the tongue, nasopharynx and tonsils). These cancers are called oropharyngeal cancers. Nearly 7% of individuals in the US have oral HPV, but only about 1% of those individuals have the most aggressive type of high risk virus, HPV 16, which is linked to nearly all oropharyngeal cancers. Additionally, oral cancers caused by HPV are four times more common in men than in women.

It is unclear why men have an increased incidence of oropharyngeal cancer compared to women.  But there does seem to be a direct relationship with sexual activity rather than sexual practices and preferences. The incidence of oropharyngeal HPV infection is relatively low in those who are not sexually active.

There is still much to be learned in the medical community about oral HPV and the cancers caused by oral HPV. Unfortunately, the number of HPV-related oral and oropharyngeal cancers is continuing to rise.

Further research still needs to be done on the exact ways an individual acquires oral HPV.  Some studies suggest that oral HPV can be passed during oral sex or from deep kissing; however, other studies do not reflect those same results. The research does indicate that monogamous partners that have been together for an extended period of time tend to share the same HPV viruses. 

The first step in understanding HPV-related oral cancers is to know your oral HPV status. The technology to detect oral HPV is available and being used by very select clinicians and laboratories. SelfCollect has chosen a medical laboratory that has the advanced testing methodology, adhering to strict regulatory guidelines, to detect the presence of HPV in the oral cavity. Knowing your oral HPV status will allow you to know your risk of cancer, and possibly that of your partner.

Can you still get HPV or cancer due to HPV if you’ve received the HPV Vaccine (Gardasil or Cervarix)?

Unfortunately, yes. The current vaccine is only effective against HPV types 16 and 18 (the major cancer causing viruses) and types 6 and 11 (the genital wart viruses). The new Gardasil-9 vaccine now additionally protects against viruses 31, 33, 45, 52 and 58.

Previous exposure to an infection by any of the high risk viruses lessens the protective effect of the vaccine.  Consequently, the vaccine is not a cure for a pre-existing HPV infection and it is recommended those vaccinated follow the same screening guidelines as those that are unvaccinated.

In the US, the vaccine continues to be strongly encouraged for females age 9 - 26 years old and males 9 - 21 years old.

I’ve received the HPV Vaccine (Gardasil or Cervarix), can I still get Genital Warts caused by HPV 6 or 11?

Unfortunately, yes. While the Gardasil vaccine does protect you against HPV types 6 and 11, Cervarix does not. 

You must receive all of the doses of the vaccine to be fully protected and to develop a robust immune response to the viruses. If you received the vaccine after already having been exposed to one of these viruses, studies have suggested that protection is either lessened or non-existent. Consequently, the vaccine is not a cure for a pre-existing HPV infection and it is recommended those vaccinated follow the same screening guidelines as those that are unvaccinated.

In the US, the vaccine continues to be strongly encouraged for females age 9 - 26 years old and males 9 - 21 years old.

Would you still like more information?

To speak with a trained STD counselor, contact the CDC National Hotline at:

  • Phone: (800) 232-4636 (24 hours - English & Spanish)
  • Email: cdcinfo@cdc.gov
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Further reading