Frequently Asked Questions at hpvinfo.ca

If you've got questions about HPV (and who doesn't?) then we've got answers.

How do you get HPV? What do you mean by skin-to-skin contact?

HPV is usually transmitted through intimate sexual contact between partners. This may happen with rubbing the penis on the entrance of the vagina or the anus, or kissing the genitals or anus of a partner. You do not need penetration to transmit the infection. Some people wrongly think that not ejaculating in the vagina protects them from acquiring an STI. It is not the case. There are sufficient viruses for HPV transmission even when minimal skin-to-skin contact occurs. Condoms need to be worn for protection from the start of intercourse until the end. See the section on condoms for more information.

HPV can also be transmitted during delivery from the infected mother to the baby. Most of the time, mothers do not even know they are infected.

HPV can also be transmitted by sharing contaminated sex toys. Sex toys are to be used by one partner at a time. Sharing sex toys without properly disinfecting them carries a risk of transmission for all STIs. If sex toys are to be shared they can be used with condoms, as long as the condom is changed each time a different partner uses the toy.

HPV cannot be passed by sitting on toilet seats or touching door knobs.

Can you get HPV through oral sex?

Yes, HPV spreads through oral sex. We do not have all the facts about what happens if someone gets HPV through oral sex. It is also not clear if HPV spreads more easily when it goes from an infected person’s mouth to a partner’s genitals, or from an infected person’s genitals to a partner’s mouth. We know that HPV is linked to diseases in the mouth, the lungs, and the digestive tract.

One type of HPV, known as HPV 16, is found in cancers of the tonsils, vocal cords, the base of the tongue, the lungs and even the oesophagus. This is a high risk HPV because it may cause these kinds of cancer.

Low risk HPV, which causes genital warts, may be found in rare cases of cancer of the vocal cords, and in growths in the mouth or the vocal cords. This type of HPV needs to be destroyed by cold, heat, or laser.

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Should you tell your sexual partner(s) if you have HPV?

If you have a sexually transmitted infection (STI) such as HPV, you should inform your past and present sexual partner(s) of the infection and they should be evaluated, tested and treated for infections.  

By telling your partner that you have HPV, you are helping to prevent it from spreading. You are also letting them know that you value and respect them.

Your partner may decide to act in ways that will protect their health. These actions could be abstinence, consistent condom use and vaccination against the types of HPV that cuase 90% of warts and 70% of all cervical cancers. But, not even condoms provide full protection from HPV.

Is there a test to detect HPV?

There is no screening test to detect HPV. Even when you go to get screened for STIs, you are not tested for the two most common STIs: HPV and herpes simplex virus. And since most HPV infections have no symptoms, you may not be able to tell if you (or your partner) is infected. It is still very important to get tested for STIs before engaging in any unprotected sexual activity.

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I don’t understand. If there’s not an HPV test, how do we know we’re infected?

There are certain tests to detect some strains of HPV, but these tests are not publicly available. One test is used to detect high-risk HPV among women with abnormal smear results to screen for cervical cancer, but even in those cases the test is not easily accessible in Canada.

Most of these tests are designed to detect the virus’ nucleic acids, the tiny DNA molecules that contain genetic information. The most available test in Canada is called Hybrid Capture II. There are two different types of Hybrid Capture II tests. One of these is only used for research purposes to detect low-risk HPV, those types not related to cervical cancer. The other test is for high-risk HPV, those types related to cervical cancer. When it is positive, it means that you are a carrier of at least one of 15 high-risk types of HPV that are detected by the test. It does not tell us which one or the number of different strains that are present.

What can you do to protect yourself from HPV?

Anyone who is sexually active is at risk for HPV. Since not all HPV infections have symptoms, you may not be able to tell if you (or your partner) is infected. Condoms are a good way to protect yourself from many kinds of sexually transmitted infections. Use them consistently. But when it comes to HPV, a condom can reduce the risk of transmitting the virus, but doesn’t provide full protection. You can still get HPV from skin not covered by the condom.

Vaccination against HPV is 98% effective in preventing the effects of four kinds of HPV infection. These four types of HPV can cause:

  • cancer of the cervix, vulva and vagina (types 16 and 18), as well as
  • genital and anal warts (types 6 and 11).

These four types of HPV cause 70% of all cervical cancers, 90% of genital warts and other diseases such as cancer of the vagina and the vulva.

Two vaccines are now available in Canada; one protects against types 16 and 18 and the other against all four types.

Vaccination won’t cure an existing HPV infection but it will prevent other types of HPV covered by the vaccines. It may even protect partially against strains not in the vaccines.

The best defence against cancer of the cervix is regular Pap testing. Even if you have been vaccinated against HPV, you should still have a Pap test within three years of becoming sexually active. Then, you should have regular Pap tests as often as your doctor suggests.

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If the condom doesn’t protect entirely against HPV, what’s the point of using it?

Condoms will reduce but not completely eliminate your risk of STIs. It is quite good for protection against HIV, herpes and Chlamydia, which are infections that can lead to developing cervical cancer in women if they have high risk HPV.

After you get HPV, will it go away? Or will you have it forever?

The immune system will eventually develop protection against the virus, preventing HPV from leaving the cell and creating lesions, or transmitting the infection to babies or partners. Most people that get an HPV infection will have it for life, but their immune system protects them from recurrences. Even after years of successful treatment, a wart or a precancer or a cancer may reappear because of a waning immune response such as what happens in pregnancy (immune tolerance), in treatment of cancers or after a graft or in the case of AIDS or HIV infection (immune deficiency) or when we get old (immunosenescence).

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Can men get HPV too?

Of course they can. And they are they are responsible for the major part of infection to women and vice-versa. Men can develop external genital warts, precancer or cancer of the penis and anus. Also they can develop cancers or warts in the mouth or respiratory and digestive tracts, as is the case with women.

Can HPV be treated?

HPV cannot be treated. Doctors can remove visible genital lesions and warts caused by HPV, but are not able to kill the virus. Unlike bacterial STIs such as gonorrhoea, Chlamydia or syphilis, there are no antibiotics to cure HPV. We can boost the local immune system to control the lesions or some precancers of the anal or vulvar areas. But the lesions can always recur. The average time from acquisition of low-risk HPV, the ones causing the warts, to disappearance of these warts is 6-8 months. So most people even without treatment will have their warts clear spontaneously, some with only one treatment others still have them after 24 months of treatment. Most patients will likely prefer that a treatment be applied to the warts to have them disappear understanding that they may recur or that they may continue being contagious even without visible lesions.

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What are genital warts and why should I worry about them? Won’t they just go away by themselves?

The viruses causing warts are usually types 6 and 11. They are associated with chronic warty lesions of the anus and genital area. They are not dangerous usually. But they may lead to lesions in the respiratory tract of the baby when infected mothers deliver their baby through the vagina. Also they are a common lesion on the vocal cords of adults probably acquired by oral sex. In some women, these lesions are associated with abnormal Pap smears and precancerous lesions of the outer portion of the genitalia. In both sexes, they are associated with precancerous lesions of the anal area. Their treatments are painful and may lead to scarring and pain with sex, even many years after the treatment. The warts are associated with anxiety, fear of cancer, depression, guilt, shame and loss of sexual interest.

How are genital warts treated?

In general, treatment for genital warts caused by HPV is aimed at making the immune system stronger so it can fight the HPV virus, or destroying the sores or warts that HPV may cause.

The good news is that the type of HPV that causes genital warts is a type that is not likely to cause cancer. The bad news is that there is no treatment to prevent the warts.

Some treatments for genital warts can be applied at home while others can only be offered at a clinic. And because HPV is a virus, antibiotics will not work to cure or treat genital warts caused by HPV. Antibiotics are only used in infections caused by bacteria.

Two kinds of treatments are applied at home*:

  • Imiquimod is a compound that makes the immune system stronger so it can fight HPV. It is taken three times a week for as long as four months.
  • Podophyllotoxin is an extract of a plant. It is applied on the skin twice a day for three days. Then, after waiting four days, you apply it again for three days.

The goal of the treatments that are applied at a clinic is to destroy the warts or growths. This can be done by:

  • heat (cauthery or laser)
  • surgery (scalpel or scissors)
  • cold (cryotherapy that uses liquid nitrogen or CO2), or
  • caustic application (tri or bi chloro acetic acid).

Please note:

  • Pregnant women should not use these treatments.
  • These treatments can make your skin red and tender. This can be treated. Talk to you your health-care provider about your options.
  • On average, it takes 6 to 8 months to control the HPV that causes genital warts. It is normal to still have warts  8 months after the first treatment.
  • Only one of out 10 patients still have HPV warts two years after being infected. Smoking can increase the time it takes for warts to heal. It would be a good idea to quit smoking.
  • When the HPV warts disappear, this does not guarantee that HPV will not spread to your sexual partners because the virus can still be present.   

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What causes cancer of the cervix?

High risk HPV can cause cervical cancer. But most women who have high risk HPV will not get cervical cancer.

There are two kinds of cervical cancer:

  • One kind affects the skin surface of the cervix (squamous cell carcinoma)
  • The second kind affects the glands inside the cervix (adenocarcinoma).

Cancer of the cervix occurs because you have been affected by a virus (such as HPV), or because of other factors (known as human factors).
Viral Factors

  • High risk HPV: HPV types 16 and 18 are known as high risk HPV. As well, 11 other types of HPV put women at high risk for cervical cancer.
  • Length of time: The high risk HPV needs to be in your body for a long time before abnormal cells will increase.
  • Integration: The high risk HPV needs to become part of the human genetic code. When this happens, our body cannot protect us from developing cancer.

Human Factors

  • Genetics: some women are more likely to get cancer than others (family history).
  • Pregnancy: women who have had many babies are more at risk of developing cervical cancer.
  • Nutrition: not enough vitamin A can enhance the virus’ ability to create cancer.
  • Smoking: tobacco is a factor in causing many types of cancer, including cervical cancer.
  • Other STIs: HIV infection, genital herpes and chlamydia enhance the risk that HPV may create cancer.
  • Age at first intercourse: when a woman has sexual intercourse at a young age, she is more likely to develop cervical cancer.
  • Having Pap tests: Some women may not like Pap tests, but these tests save lives. Not having regular Pap tests increases a woman’s risk for cervical cancer.
  • Hormone therapy: Taking birth control pills or hormone replacement therapy may increase the risk slightly. For women who take birth control pills, the risk of cervical cancer is deemed equal to that of unwanted pregnancy. Women should not stop taking  the pill to prevent cervical cancer.

Are there other causes of cervical cancer besides HPV?

Yes, but they are very rare. Most cancers of the cervix are caused by HPV.

Rare cancers of the cervix are types of cancer that screening tests cannot find early or prevent. They include cancer of the skin (melanoma) that has spread to the cervix and cancers of the muscles, nerves, and connective tissues of the cervix. The other factors are listed in the previous question.

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How long does it take for cervical cancer to develop?

It is difficult to know how long it takes to develop cervical cancer. Women with normal Pap smears can already be infected by HPV. If they are already infected and the immune system is not checking the virus, women are then at risk of developing precancerous lesions such as high grade lesion of the cervix then cancer. We know that most but not all women with high grade lesions will develop cervical cancer if they are not treated. But there is a long interval between being infected, the development of high grade lesion and eventually cancer giving many opportunities before full development of cancer. In USA the estimated peaks of age for different stages of the disease are:

  • 21 years for HPV infection
  • 28 years for low grade lesion (LSIL) of the cervix
  • 42 years for high grade lesion (HSIL) of the cervix and
  • 48 years for infiltrative cancer.

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