What is HPV (Human Papillomavirus)?
HPV (Human Papillomavirus) is a common virus transmitted through skin-to-skin contact, particularly in the genital, anal, oral, or throat areas. It affects both women and men and is one of the most prevalent causes of sexually transmitted diseases (STDs) globally.
There are over 200 different types of HPV, which can be broadly classified into two main categories:
- Low-risk types: Such as HPV 6 and 11, commonly linked to genital warts and other benign skin growths.
- High-risk types: Including HPV 16 and HPV 18, which are strongly associated with cancers such as cervical, anal, and oropharyngeal cancers.
Most HPV infections are asymptomatic and are naturally cleared by the immune system within 1–2 years. However, persistent infections with high-risk HPV types can cause abnormal cell changes that may progress to cancer over time.
In Thailand, cervical cancer remains one of the most common cancers among women, and HPV is the leading cause.
Types of HPV: Low-risk and High-risk Strains
HPV consists of over 200 viral types, with approximately 40 types transmitted sexually. These are grouped into two major categories:
Low‑risk types
- Include HPV 6 and 11, which commonly cause genital warts and other benign skin lesions, but are not directly linked to cancer.
- Other low-risk types, such as 40, 42, 43, 44, and 54, typically cause non-cancerous warts on genital or skin surfaces.
High‑risk types
- Include types 16, 18, 31, 33, 45, 52, 58, among at least 12 identified strains, which can cause cellular abnormalities and cancer.
- Particularly, HPV 16 and HPV 18 account for approximately 70% of cervical cancers and are also linked to cancers of the oropharynx, anus, and penis.
Summary Table
| Category |
Common Types |
Related Conditions |
|---|
| Low‑risk |
6, 11, 40, 42, 43, 54 |
Genital warts, benign skin lesions |
| High‑risk |
16, 18, 31, 33, 45, 52, 58 |
Cervical, oropharyngeal, anal, penile cancers |
Why This Matters
- Understanding HPV types improves awareness of health risks
- Guides vaccine selection, such as 4‑ or 9-valent vaccines covering high-risk types
- Aids decision-making for screening strategies, like Pap or HPV DNA testing
HPV Transmission: How It Spreads and Risk Factors
HPV is mainly transmitted through direct skin-to-skin contact in the genital area during penetrative sex, as well as through oral or anal sex. Hands can also transfer the virus to genital areas, and in rare cases, a mother may pass HPV to her baby during birth.
Transmission Routes
- Skin-to-skin contact: The virus lives on the surface of genital skin. If contact occurs without a condom or in areas not covered, transmission can happen.
- Oral and anal sex: These activities can transmit HPV to the mouth, throat, or anal regions.
- Hands or shared objects: Though less common, HPV can be transmitted via fingering or shared sex toys.
- Mother-to-child at birth: Rarely, mothers can pass HPV to their newborns during childbirth.
Condom Effectiveness
- Condoms reduce the risk of many STIs but don’t fully prevent HPV, as they don’t cover all genital skin.
- Consistent and correct condom use can reduce HPV transmission by approximately 70%.
- For optimal protection, condoms should be used alongside HPV vaccination and limiting sexual partners.
Why Understanding Transmission Matters
- Increased awareness of how HPV spreads through skin contact in various body areas.
- Better prevention strategies: using condoms properly, reducing the number of partners, and vaccinating before sexual activity begins.
- Reducing stigma: recognizing that HPV can spread even in non-penetrative sex and that many carriers may not know they are infected.
Warning Signs: Symptoms of HPV Infection You Shouldn’t Ignore
General HPV Symptoms: Often Unnoticed
- Most HPV infections are asymptomatic, and the virus may clear on its own within 2 years.
- Silent infections can still spread or cause cellular abnormalities before any symptoms appear.
Genital Warts
- Caused by low‑risk types (e.g., HPV 6 and 11), these appear as flesh-colored or cauliflower-like bumps, often painless.
- Can occur on the penis, scrotum, vulva, cervix, anus, or mouth (in cases of oral sex).
- Common symptoms include small bumps, itching, mild discomfort, or slight bleeding during sexual activity.
Location-Based Symptoms
- Common warts/plantar warts: Not sexually transmitted; these appear on hands or feet and are generally harmless.
- Oral or throat warts: From oral sex, usually asymptomatic but may cause growths or irritation.
- Precancerous lesions: Persistent infection from high‑risk types can lead to abnormal cells, detectable via Pap smear or HPV DNA testing.
Symptoms by Sex
- Women: May experience unusual vaginal discharge, odor, or spotting if warts affect internal areas.
- Men: May develop warts on the penis or around the anus, often with mild discomfort or itchiness.
When to See a Doctor
- New warts, bumps, red or white patches, or sores after sexual contact.
- Unusual vaginal discharge, bleeding, or odor.
- Lesions in the mouth, throat, or anal region.
- Abnormal Pap smear or HPV DNA test results.
Pap smears and HPV DNA tests are crucial because HPV often remains silent, yet testing may reveal early-stage cellular changes.
Diagnosis and HPV Testing: Early Detection Matters
Should Men Be Tested for HPV? How?
While HPV testing is commonly focused on women, men—especially those with high-risk behaviors (e.g., MSM) or suspicious lesions—should consider testing:
- Sampling from penile or anal region, similar to women’s cervical tests
- Clinical examination if warts or suspicious lesions are present
- No broad guidelines exist, but high-risk men with lesions should consult a specialist
Pap Smear vs. HPV DNA Test: What’s the Difference?
- Pap Smear (Cytology): Collects cervical cells to detect abnormalities like dysplasia or cancer.
- HPV DNA Test: Detects DNA of high-risk HPV types (e.g., 16, 18) even before cellular changes occur.
Quick Comparison:
| Test |
Pap Smear |
HPV DNA Test |
|---|
| Detects |
Abnormal cells (dysplasia/cancer) |
High-risk HPV DNA |
| Sensitivity |
~55% |
~90–97% |
| Recommended Age |
Women 21–65 |
Women ≥30 (or with co-testing) |
| Frequency |
Every 3 years |
Every 5 years or co-test every 5 |
Colposcopy: When Is It Needed?
Colposcopy is recommended if:
- Pap results show HSIL or ASC-US with high-risk HPV
- HPV DNA Test detects types 16 or 18—linked to highest cancer risk.
During the procedure, a biopsy may be performed to check for precancerous changes (CIN 2/3).
Colposcopy Process Overview:
- Insert speculum for cervical visualization.
- Use colposcope to examine the cervix.
- Apply acetic acid or iodine for clarity.
- Biopsy any suspicious areas.
- Mild cramping or discharge post-procedure—follow doctor’s care instructions
HPV Testing at Safe Clinic: Convenience & Privacy
Located on the 3rd floor of Times Square Building, Sukhumvit (near BTS Asok and MRT Sukhumvit), Safe Clinic offers both walk-in and scheduled appointments for HPV screening.
Testing Process
- Appointment or Walk‑in
- Book online via phone, HDmall, or GoWabi anytime
- Clinic open daily from 12:00 to 20:00
- HPV Screening
- HPV DNA Test (Urine PCR for 14 strains): THB 2,500.
- Results & Follow-up
- Report available in 3–5 days; doctor will explain results and recommend next steps if abnormalities are found.
Pricing
- HPV DNA Test (Urine PCR 14-strain): THB 2,500
Why Choose Bangkok Safe Clinic?
- Central location in Asok, easy access via BTS/MRT
- Strict privacy: results shared directly only with the patient
- Specialist doctors in STDs and viral infections provide comprehensive care
- On‑site lab ensures fast, accurate results within 3–5 days
HPV Treatment Options: Managing Symptoms and Controlling Progression
Treating Genital Warts: Methods and Effectiveness
Although no medication can eliminate HPV itself, genital warts caused by the virus (mainly by types 6 and 11) can be treated through several approaches:
Topical Treatments (Patient-applied)
- Podofilox (podophyllotoxin): Applied twice daily for 3 days, followed by 4 rest days, repeatable for up to 4 cycles. Should not be used on large areas (>10 cm²) or during pregnancy.
- Imiquimod 5% cream: Applied three times per week at night. Stimulates the immune response. May cause redness, swelling, or itching.
- Sinecatechins 15% ointment: A green tea extract used three times daily for up to 16 weeks.
Provider-administered Treatments
- Cryotherapy: Freezing warts with liquid nitrogen; around 50% clear within 3 sessions. Effective (~94%) but may recur in 10% of cases.
- Trichloroacetic Acid (TCA) 60–90%: Safe for use in pregnancy; applied weekly by healthcare providers.
- Surgical removal / laser therapy: For large or resistant warts; effective in a single session but may leave scarring.
Summary Table:
| Treatment |
Highlights |
Cautions |
|---|
| Podofilox |
Convenient self-use |
Not for pregnant women |
| Imiquimod |
Boosts immune response |
May irritate skin |
| Sinecatechins |
Natural extract |
Requires long-term use (≤16 weeks) |
| Cryotherapy |
Fast, in-clinic solution |
May require multiple sessions |
| TCA |
Safe during pregnancy |
Can cause stinging or burning |
| Surgery/Laser |
Immediate wart removal |
Requires medical professional |
Managing Precancerous Lesions: Options and Outcomes
When precancerous lesions such as CIN 2–3, HSIL, or AIS are detected, treatment options include:
- Cryocautery or laser cautery: To destroy abnormal cervical tissue.
- LEEP or Cold Knife Conization: To excise a cone-shaped section of tissue from the cervix.
Key Considerations:
- These procedures can significantly reduce cancer risk.
- However, they may increase the risk of infertility or preterm delivery, particularly if large amounts of cervical tissue are removed.
- Long-term follow-up (at least 25 years) with Pap smear or HPV DNA tests is recommended.
Can HPV Be Cured? What You Need to Know
- The immune system can clear HPV naturally in over 90% of cases within 1–2 years.
- However, there is no medication that eliminates the virus directly. Current treatments focus on managing symptoms or lesions. Re-infection or recurrence remains possible.
- Enhancing immunity—e.g., with Imiquimod, adequate rest, quitting smoking—can help the body eliminate the virus faster.
HPV Vaccine: A Cancer Prevention Shield for Everyone
Types of HPV Vaccines: 2-, 4-, and 9-valent
- Three main HPV vaccines exist:
- Bivalent (2-valent): e.g., Cervarix protecting against high-risk types 16 and 18.
- Quadrivalent (4-valent): original Gardasil covering types 6, 11, 16, and 18.
- Nonavalent (9-valent): Gardasil 9 includes protection against 16, 18, 6, 11, 31, 33, 45, 52 & 58.
- All have excellent safety profiles and significantly reduce cervical cancer risk:
- 2-valent protects against ~70% of cervical cancers.
- 9-valent vaccine offers ~93–100% protection against multiple high-risk strains.
Who Should Get the HPV Vaccine? Age & Importance
- Primary target: ages 9–14, with a 2-dose schedule 6–12 months apart.
- Ages 15–45 or immunocompromised: recommended 3-dose schedule (0, 1–2, 6 months).
- Best to vaccinate before sexual debut to achieve robust immune protection.
Benefits and Side Effects of HPV Vaccination
- Key benefits:
- Prevents high-risk HPV infection and genital warts
- Significantly lowers risk of cervical, anal, penile, and oropharyngeal cancers.
- Common mild side effects:
- Injection site pain, redness, swelling, fever, headache, nausea, and possible fainting—recommended to rest for 15 minutes post-vaccination.
- Severe allergic reactions (anaphylaxis) are extremely rare (~1.7 cases per million).
- No evidence links HPV vaccines to autoimmune diseases or infertility.
Scheduling HPV Vaccines at Safe Clinic
Safe Clinic administers Gardasil 9 as follows:
- Ages 9–14: 2 doses, spaced 6–12 months apart
- Ages 15–45 or immunocompromised: 3 doses at 0, 1–2, and 6 months.
Ideal for those unvaccinated or seeking professional consultation—appointments with specialist doctors are available.
Preventing HPV Beyond Vaccination: Reducing Your Risk
Safe Sex Practices: Practical Guidelines
- Use condoms (male or female) consistently and correctly during all sexual activities—including vaginal, oral, and anal sex. While they can reduce the risk of HPV transmission by 70–80%, condoms do not fully cover all genital skin, so transmission is still possible.
- Dental dams for oral sex can help reduce STI risk but still do not guarantee full protection against skin-to-skin transmission.
- Limit sexual partners and delay sexual debut: Fewer partners and initiating sexual activity at an older age significantly lowers the risk of HPV infection.
Regular Screening: Long-Term Health Strategy
- Pap smears and HPV DNA tests can detect early cellular changes or high-risk HPV strains before they progress to cancer.
- Recommended every 3–5 years: Women aged 21–65 should have a Pap smear every 3 years or co-testing every 5 years (Pap + HPV DNA test).
- Such screening programs—called “secondary prevention”—have reduced cervical cancer mortality by up to 80%.
Supporting Immunity with Healthy Habits
- Avoid smoking and reduce alcohol intake: Chemicals in tobacco and alcohol impair the immune system’s ability to fight HPV infections.
- Maintain overall wellness: A balanced diet rich in vitamins A, C, and E, regular exercise, and adequate sleep enhance your immune response and help clear HPV more effectively.
Summary of HPV Prevention Measures
- Get the HPV vaccine (primary prevention)
- Use condoms or dental dams properly and limit number of partners
- Undergo regular screening (Pap/HPV tests)
- Adopt healthy lifestyle changes (quit smoking, balanced diet, rest)
HPV and Cancer Risk: Understanding Strains, Specific Sites, and High-Risk Groups
Not All HPV Types Cause Cancer: Focus on the High-Risk Strains
- Out of over 150 known types of HPV, only around 14 are classified as high-risk, with strong associations to cancer
- HPV 16 and 18 are the most prominent, accounting for more than 70% of cervical cancer cases globally
- Other cancer-linked types include 31, 33, 45, 52, and 58, associated with anal, vaginal, vulvar, and oropharyngeal cancers
Cancer Types and Their HPV Linkage
| Cancer Type |
HPV-Attributable Rate |
Key HPV Types |
|---|
| Cervical cancer |
>90% |
16, 18 |
| Anal cancer |
~90% |
16, 18 |
| Oropharyngeal cancer |
~70% |
16 |
| Penile/Vaginal/Vulvar |
40–70% |
16, 18, 31 |
- Men—especially MSM—are more likely to develop anal or oropharyngeal cancers linked to HPV
- Persistent high-risk HPV infection for over 2 years significantly increases the chance of cancer development
Early Detection Prevents Progression
- It takes up to a decade or more for precancerous lesions to develop into invasive cancer
- If abnormalities such as CIN or HSIL are found early, treatment is highly effective and can prevent cancer entirely
- A positive HPV test is not a cancer diagnosis. Regular monitoring and follow-ups are key to staying safe
HPV in Pregnant Women: Impact and Management
- Pregnancy does not increase HPV transmission to the fetus in most cases. However, if genital warts are present, especially near the cervix or vaginal area, there is a small risk of neonatal infection (e.g., laryngeal papillomatosis) during delivery .
- Obstetricians may recommend close monitoring of wart size and possibly elect C-section if warts obstruct the birth canal.
- Postpartum, treatment is advised to remove persistent warts to prevent potential HPV persistence and transmission risks in the future.
HPV in Immunocompromised Individuals (e.g., HIV-positive): Elevated Risks and Care
- Immunocompromised individuals have a higher likelihood of persistent or recurrent HPV infections, increasing the risk of developing precancerous lesions such as CIN or anal intraepithelial neoplasia (AIN).
- Recommended management includes:
- More frequent screenings, such as every 6 months instead of every 3–5 years.
- Considering vaccination even after age 45, due to possible immune responses despite the age group.
- Collaborating with clinicians on immunostimulatory treatments or adjuvant strategies to bolster immune defense against HPV.
Post-Treatment Care After HPV Lesion Removal
- Rest and avoid strenuous activity for faster recovery after wart removal or biopsy.
- Avoid soaking or prolonged water exposure (e.g., baths or swimming pools) for 1–2 weeks to prevent infection at the treatment site.
- Monitor for unusual symptoms, such as excessive bleeding, discharge, or persistent pain, and consult a doctor immediately.
- Follow-up screening (e.g., Pap smear or HPV DNA test) is recommended within 6–12 months to detect any new changes early .
Post-Vaccination Care After HPV Dose
- Rest for 15–30 minutes after vaccination at the clinic to monitor for fainting or dizziness.
- Avoid heavy physical activity in the injection arm or leg for 24 hours.
- Apply a cool compress to reduce inflammation if area becomes sore or swollen; symptoms typically resolve in 48–72 hours.
- Watch for systemic reactions, such as mild fever or muscle aches—these are self-limiting; consult a doctor if symptoms persist beyond 2–3 days.
- Keep vaccination records updated, including vaccine type, dose number, and dates, to ensure completion of the 2–3 dose schedule.
Frequently Asked Questions about HPV
How is HPV transmitted?
- HPV spreads through skin-to-skin contact involving the genitals, anus, or mouth—via vaginal, oral, or anal sex—without needing penetration.
- Transmission can still occur even with condom or dental dam use because the virus can infect uncovered areas .
If infected with HPV, can I have children?
- HPV does not directly affect fertility, and most people infected can conceive normally.
- However, severe lesions (e.g., CIN 2–3) or treatments involving removal of cervical tissue may slightly increase risks of preterm birth or fertility issues.
- Consult a doctor for personalized reproductive planning.
Should men receive the HPV vaccine?
- Absolutely. HPV vaccination in males helps prevent anal, oral, and penile cancers, particularly among men who have sex with men (MSM).
- It is recommended for both men and women aged 9–45, following age-appropriate dosing protocols .
I tested positive for HPV. What should I do?
- Don’t panic—positive result only means the virus is detected.
- Follow-up with Pap smear or colposcopy to check for abnormal cells.
- Treat any lesions or monitor in regular intervals.
- Consider vaccination (if not yet done) and follow your doctor’s advice.
Do I still need screening after HPV vaccination?
- Yes. Regular screening remains necessary post-vaccination because the vaccine does not cover all HPV types.
- Women aged 21–65 should continue with Pap smears or co-testing (Pap + HPV DNA) as per medical guidelines.
Conclusion
Human papillomavirus (HPV) is a leading cause of sexually transmitted infections, with strong links to cervical cancer and other cancers affecting mucosal surfaces and reproductive organs. Many individuals infected with HPV show no symptoms, making regular screening essential for early detection and prevention of cancer progression.
Prevention strategies include vaccination, Pap smears, HPV DNA testing, and maintaining a strong immune system. Practicing safe sex and regular checkups are particularly important for high-risk groups such as pregnant women, immunocompromised individuals, and men who have sex with men.
By staying informed and following appropriate preventive care, you can significantly reduce the risk of infection and protect your long-term health effectively.
