It seems like everybody’s talking about human papillomavirus (HPV) these days. From flyers in your health care provider’s office to ads in subway cars, information about HPV is everywhere. And that’s a good thing because HPV is one of the most common sexually transmitted infections (STIs) out there. In fact, the CDC reports that almost everyone who is sexually active will get HPV in their lifetime unless they are vaccinated.
So what exactly do you need to know if you find out you’re one of the many people who have been diagnosed with HPV? Here are some of the most common questions I hear in my practice as well as their answers:
The answer is yes and no. There are more than 150 strains of HPV. Some strains are commonly called “high-risk” because they increase your risk of certain types of cancers, including cancer of the cervix, vagina, and vulva; cancer of the penis; cancer of the anus; and cancer of the throat. Other strains are referred to as “low-risk” because they don’t increase your risk of cancer. However, some of these “low-risk” types of HPV can cause warts. (Though keep in mind that many low-risk strains cause no symptoms at all.) High-risk HPV infections don’t have symptoms, so the only way to know if you have HPV is to get tested by a health care provider.
If you test positive for a high-risk HPV strain on your cervix, especially if you have several positive tests over a few years, you have an increased chance of developing cervical cancer. However, just being HPV positive does not mean that you will get cervical cancer. Most types of cervical cancer take years to go from pre-cancerous cells to cancer, so the key to preventing cervical cancer is to catch HPV infections and treat any pre-cancerous cells that show up on the cervix before they become cancerous. So testing positive for HPV or having pre-cancerous cells means that you will need more frequent follow up tests to help prevent cancer.
Testing positive for HPV on your cervix means you’ll need more frequent visits to your provider to monitor your cervix (usually with a Pap smear and/or an HPV test), but it does not affect your chances of getting pregnant, and it doesn’t cause pelvic pain, bleeding, or vaginal discharge.
Currently the only tests to check for HPV that are done routinely are tests that check for HPV on the cervix. Pap smears of the anus are also recommended for people who are at higher risk, like those who have receptive penetrative anal sex with people who have penises, and those with HIV infections. But if you test positive for an HPV infection, your sexual partner(s) have most likely been exposed to the virus as well. If your partner has a cervix, they should be tested for HPV as well. And while not having a cervix means you can’t get cervical cancer, HPV infections increase the chances of other types of cancer as well. Anyone who has the HPV virus can spread it to other people.
There is no medication for high-risk types of HPV infections* but the good news is that HPV usually goes away on its own, especially if you are under 30. Smoking cigarettes and vaping as well as certain medical conditions like HIV can make it harder for your body to fight an HPV infection. When HPV hangs around longer, there’s a greater chance that it will cause pre-cancerous changes to your cells .
While eating a healthy diet and getting regular exercise are great for your overall health, they will not make HPV go away faster. That means that other than making sure you keep your appointments for follow up and do everything you can to break up with smoking, there isn’t much you need to do right now.
*NOTE: If you have genital warts caused by HPV, your health care provider may recommend a prescription cream or gel you can use at home. There are also certain medications that can be applied to the warts in the office, as well as procedures to remove them.
Based on the results of your HPV test and/or Pap smear, your provider may recommend you have a procedure called a colposcopy. A colposcopy uses a microscope to look at the tissues that make up the cervix more closely (FYI it has nothing to do with a colonoscopy). A colposcopy is the best way for your provider to tell how HPV is affecting your cervix.
During a colposcopy you will be in the same position as you would be for a Pap smear, lying on the exam table on your back, with your feet in stirrups. Your provider may take small samples of tissue from your cervix. These tissue samples are called biopsies. Taking over-the-counter ibuprofen, like Motrin or Advil, before your procedure may help with cramping if they need to take biopsies. Your provider may also use a numbing medicine on your cervix before taking biopsies. It’s normal to have some bleeding and cramping after having biopsies is normal, including dark brown or black discharge.
Based on the results of your colposcopy, you and your provider will discuss next steps. If the results are normal, you may only need another Pap smear and HPV test in a year, but if your biopsy results show pre-cancerous changes to your cervix, you may need an additional procedure and follow up to help prevent cervical cancer. Either way, to prevent cervical cancer, it’s important to stick with the follow up plan your provider recommends.
You may want to know who you got an HPV infection from, but the truth is that you may never know unless you have only ever had one sexual partner in your lifetime. Because HPV is a very common virus, infections develop slowly, and current testing options are limited to the cervix and anus, it’s difficult to determine who passed an HPV infection to you. You definitely don’t need to assume that your current partner has been unfaithful—you may both have both been exposed to HPV by different people at different points in your life.
Yes! You can prevent HPV by getting the HPV vaccine. Getting an HPV vaccine before you are sexually active is the best prevention since an HPV vaccine won’t protect you from an HPV strain you have already been exposed to. But even if you have already been diagnosed with HPV, getting an HPV vaccine now will protect you from other strains. And even if you started the vaccines a while ago and didn’t finish the series, you can complete the series now. Anyone up to age 45 who is at risk for HPV should talk to their provider about getting an HPV vaccine.
Since HPV is passed from skin-to-skin contact, using condoms, internal condoms, and dental dams can decrease (but not eliminate) your chances of getting a high-risk HPV infection in the first place or passing an HPV infection to your partner.
Overall, HPV is super common and cervical cancer doesn’t develop overnight, so don’t lose sleep tonight over testing positive for HPV. Most people who have an HPV infection find that their bodies get rid of it without it ever causing further problems, but keeping on top of your screenings and follow-ups can help you prevent cervical cancer.