Introduction

HPV is a virus with more than 200 subtypes which spreads from person to person, commonly via skin-to-skin contact of any kind.^1-3 

Getting infected with HPV is extremely common around the world and as long as you have engaged in unprotected sexual activity, there is always a risk that you may have been exposed to one subtype of HPV or another without knowing.² 

HPV infects your body through your skin, specifically the skin on your hands and feet or mucus-producing cells around the body such as the mouth, or anogenital (the genitals and anus) area.^3,4 

Not all HPV subtypes cause symptoms or problems for you however, there are a group of HPV subtypes that can lead to serious diseases, often in the specific areas where the virus infects.

HPV subtypes that cause health conditions can be classed into two groups depending on the likelihood that they will increase your risk of developing cancer:^1-3

• Low-risk HPVs

Low-risk HPVs are rarely linked to cancer but are known to lead to warts that can appear on the skin often on the hands and feet or on the anogenital area.^4,5

To list a few low-risk HPV subtypes: 6, 11, 42, 43, 44.^1,4,5

• High-risk HPVs

High-risk HPVs such as 16, 18, 31, 33, and 45 are linked to different types of cancers.^1,5

Risk factors

A list of some of the risk factors that can increase the likelihood of you being infected with HPV is presented below:^1,3,4

• Engaging in sexual activity
• Multiple sexual partners
• Lack of use of protective contraceptives e.g. condoms against sexually transmitted infections (STI)
• If you have a weakened immune system e.g. if you are infected with HIV
• If you have had other STIs in the past
• Coming into contact with surfaces or objects which are infected with HPV

One of the conditions you can experience caused by HPV infections is warts located in the genital area (genital warts) which will be explored further below.

Overview of genital warts

Genital warts, also known as anogenital warts are growths or bumps on the skin or the mucus lining of the anogenital area.⁶ 

Genital warts have been mainly caused by HPV 6 and 11 though HPV 30, 42, 43, 45, 51, 54, 55, 70 have also been linked to these warts.^1,3,4,7 

The HPV virus is mainly spread through any kind of sexual activity and in some cases through non-sexual skin contact in the genital area such as a mother giving birth to a baby vaginally.⁶ 

Once you have been exposed to genital warts, it can take 3 weeks to 8 months for them to appear and even if you do not see them, you can still be infected and spread the virus to others.^6,7

Appearance and symptoms

Genital warts are usually raised on the skin so you should be able to feel them but can vary in shape, colour, and size though usually small (less than 5mm) or present in a cluster or separately.^6,7 

Genital warts can be located in these areas of the body:

• Genital
• Perineal
• Anal
• Perianal

The main symptoms of genital warts are the warts. However, you may also experience some itchiness, redness, bleeding, or discharge in the infected areas.^6,7

Diagnosis

A healthcare professional can usually diagnose genital warts by examining the area they are located in but it can also be confirmed by taking a sample of the wart from your body and testing it in the laboratory for the virus.^1,7

Other HPV-related conditions

As mentioned previously, there are a few other health conditions that can be linked to HPV infection in individuals. There are other types of warts you may experience such as:⁴

• Plantar warts: usually located on the sole of your feet and linked to HPVs such as 1,2, 4, and 63
• Flat warts: Linked to many HPV subtypes such as 3,10, 26 and located usually on the hands and face
• Common warts: Linked to many HPV subtypes such as 1, 2, and 7 which can be located on any part of your body but usually on the hands and feet

HPV infections can also lead to other skin bumps or growth such as cysts and rare conditions where there is non-cancerous growth or tumours in the mouth or respiratory tract (Recurrent respiratory papillomatosis).⁴ 

HPV-related cancers

It is important to recognise that extensive research has established links between some strains of HPV and various cancers which highlights the need for awareness of HPV and for continuous practice of preventative measures.^1-5,7,9  

HPV 16 and HPV 18 are high-risk HPV subtypes commonly linked with the development of abnormal cells or growth in your body that have the potential to turn into cancer.^1,9,10 

The known cancers which are said to be linked to HPV infections are stated below:^1-5,7,9 

• Cervical cancer
• Anal cancer
• Oropharyngeal Cancer
• Penile Cancer 
• Vaginal Cancer
• Vulvar Cancer

However, it is important to understand that being infected with these HPV subtypes does not automatically mean you will develop cancer. Instead, these subtypes increase your risk and additional factors are needed for the abnormal cells to develop into cancer such as:^1,10 

• Smoking
• Exposure to UV light
• If you have a weakened immune system
• Pregnancy
• Using oral birth control for a long period of time

Early detection of the abnormal cells or growth in your body and treatment of the symptoms before the development of cancer can help to improve your prognosis following infection with HPV.⁹

Treatment

Your body immune system may be able to get rid of the virus and/or genital warts in time although this may not be the case for everyone.^1,3,6-8 

Treatment is available for those with genital warts or abnormal growth following HPV infection but they do not target the HPV virus itself.⁷ It is important to consider treatment if it is recommended as there is a concern that your symptoms can progress to serious conditions.¹ The treatment options recommended by health guidelines are stated below but they can take a few months to work and you may need repeated treatment as the symptoms can recur.^1,6,7 Also, you may or may not be eligible for some of the treatments as it depends on the nature of the genital warts.^3,8

Some treatments for genital warts can be applied at home. However, these should not be used if you are pregnant or breastfeeding:^6-9

• Podofilox/podophyllotoxin, a solution or cream
• Imiquimod cream
• Sinecatechins ointment

Other treatments which can be used if you are pregnant:^6-9

• Trichloroacetic acid solution
• Nitrizinc complex topical solution
• Cryotherapy
• Surgical removal
• Laser treatment

You can discuss these treatment options with a healthcare professional, and additional information on the use of the treatment can be found on the product label.

If you have been diagnosed with cancer, the standard cancer treatment or management can be offered to you such as:⁹

• Surgery to remove cancerous growth or tissue
• Chemotherapy
• Radiotherapy
• Targeted therapy

Prevention of HPV and related conditions

Beyond treatments for HPV-related conditions, the most effective approach that can be taken against HPV is to take preventative measures to reduce the risk of infection in the first place. The steps you can take to help protect yourself are as follows:⁹

• HPV vaccination

There are vaccines available that can protect you against the most common high-risk HPV types such as HPV 16 and 18 but they are most effective if you have not been exposed to the virus before.⁹ Therefore, HPV vaccines are offered before individuals become sexually active and two doses are said to be effective.^1-3,9 However, individuals who have a weakened immune system are advised to have three doses.¹¹

• Safe sex and sexual protection

When you become sexually active, using condoms and dental dams can reduce the risk of infection and prevent the spread of the virus to others.³ It would also be good to refrain from having multiple sexual partners to reduce the risk of HPV exposure as more partners increase the chance of infection.¹ 

• Screening

It is also important to ensure you and your partner undergo regular checks for STIs as screening allows for early detection and treatment before the progression of the disease.¹

If you are infected with HPV, there is emotional support and advice available through trusts and support groups which can be found online or by speaking to healthcare professionals. Naturally, the news of HPV infection can have an emotional impact on you however, you are not alone in this as others are going through similar experiences but remember there is a clear healthcare pathway available to guide you.

Summary

HPV is a virus with multiple subtypes that many people will come into contact with in their lifetime. There are risk factors that can increase your chances of contracting HPV such as having multiple sexual partners or lack of use of contraceptives. It is mainly spread through skin-to-skin contact and for many people, it does not cause any problems and can clear from the body over time. However, some subtypes of HPV can cause health conditions such as genital warts. Genital warts commonly result from specific HPV infections and although it can take weeks to present on your body, you can still infect others with the virus. Other HPV-related conditions such as noncancerous tumours and various cancers can also be linked to HPV infection. Although your immune system may be able to clear the virus and symptoms from your body over time, there is treatment and support available. However, taking preventative measures is the most effective approach to protecting yourself from HPV.