Human Papillomavirus (HPV): What Is It, Causes, Symptoms, and Prevention 

Introduction

Human papillomavirus (HPV) is one of the most common sexually transmitted infections (STIs) prevalent globally. This virus primarily affects the skin and mucous membranes of the genital area, mouth, and throat, causing asymptomatic infections or growths called as warts. While most HPV infections resolve on their own without medical intervention, persistent infection with certain high-risk strains can lead to serious health issues, including certain cancers such as cervical, oropharyngeal (tonsils, base of tongue), anal, and penile cancers^1,2. 

In India, HPV-related cancers pose a significant public health challenge. Projections for 2025 estimate approximately 121,302 new HPV-related cancer cases, accounting for 7.7% of the total cancer burden in the country (3.3% among males and 12.0% among females).³ Therefore, understanding the causes, symptoms, and prevention methods for HPV infections is crucial for reducing the risk of diseases caused by this virus and promoting public health. In this article, we will discuss what is HPV, and why is it something we should all be aware of!  

What is Human Papillomavirus (HPV)?

HPV belongs to a group of small, non-enveloped, double-stranded DNA viruses known as papillomaviruses. It mainly infects the basal cells of the skin or mucous membranes, usually entering through tiny cuts or tears on the surface³.  

Once inside the basal layer of the skin (stratified squamous epithelium), the virus begins its life cycle. As the infected skin cells mature and move toward the surface, HPV replicates along with them.  

In some cases (especially with high-risk types like HPV 16 and 18) the virus can interfere with normal cell functions. These high-risk types may integrate with the  DNA of host cells, leading to the continuous production of proteins that block the body’s natural control over cell growth. Over time, this uncontrolled cell growth can lead to cancer, such as cervical cancer. 

On the other hand, low-risk HPV types (like types 6 and 11) are not linked to cancer occurrence, though they can cause conditions like genital warts³.  

Scientists have made major progress in understanding HPV, especially through genetic research, but there is still more to learn about how the virus behaves and changes over time⁴. 

Types of HPV

There are over 200 types of HPV viruses, and they are classified based on where they infect and the level of risk they pose. These types are broadly divided into: 

Non-mucosal Infection Site 

These infect the skin rather than the mucosal (tissue lining of organs) areas^5,6,7: 

• Skin warts (HPV types 1, 2, 3, 4, 7, 10, 27, and 57) 

Mucosal Infection Site 

These infect the mucosal (tissue lining of organs) areas and are classified into two types: 

Low-risk HPV types: These conditions are non-cancerous but can be recurrent or obstructive and may require ongoing medical treatment:^5,6,7 

• Genital warts and respiratory papillomatosis (e.g., HPV types 6 and 11) 
• Other low-risk HPV types include 40, 42, 44, 54, 55, 61, 62, 71, 74, 81, 84, 89, and 90. 

High-risk HPV types: These types can cause pre-cancerous changes and cancers, especially^5,6,7: 

• Cervical cancer (mostly caused by HPV types 16 and 18). These types are also linked to anal, vaginal, vulvar, penile, and throat cancers 
• Other high-risk HPV types include HPV 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 73, and 82. 

Causes of HPV

The HPV virus is mainly spread when a healthy person comes in direct contact with an infected person. Common human papillomavirus causes/modes of transmission include: 

• Sex (vaginal, anal, oral)⁸ 
• Skin-to-skin contact (especially genital-to-genital contact, even without intercourse or ejaculation). It is important to note that HPV can spread through contact with infected genital, anal, or oral areas, even if there is no penetrative sex. 
• Having multiple sexual partners (which increases the exposure risk)⁵ 
• Early age of sexual activity (linked to longer lifetime exposure)⁵ 
• Weakened immune system (makes the body more susceptible to infection)⁸ 
• Transmission from mother to baby during childbirth (rare)⁵. This is known as vertical transmission, and in some cases, it can lead to a condition called juvenile-onset recurrent respiratory papillomatosis (JORRP) in the newborn, where non-cancerous growths develop in the airways. 

Symptoms of HPV

In most cases, human papillomavirus infection causes no symptoms and goes unnoticed, especially in the early stages. However, in some cases, HPV symptoms may appear due to warts or long-term complications of persistent infection: 

• Small, rough, lump-like growths (called genital warts) on or around the genitals, anus, groin, or thighs.^1,8 
• Itching or irritation in the genital or anal area may occur if warts are present, however, this is not specific to HPV and could be caused by other skin problems or STIs¹.

Note: Vaginal or anal bleeding may occur in advanced cervical/anal disease; however, this is not an early or direct symptom of HPV itself.  

Complications of HPV

HPV can lead to several serious health complications, particularly when caused by high-risk strains of the virus. While many human papillomavirus infections are asymptomatic and clear on their own, persistent infections can result in the following complications: 

• Genital Warts: These growths are non-cancerous, but they can recur due to persistence or reactivation of the virus¹.
• Recurrent Respiratory Papillomatosis (RRP): A rare condition where warts grow in the respiratory tract, particularly the larynx (voice box), leading to breathing difficulties⁹. 
• Cervical Cancer: Almost all cervical cancer cases (over 99%) are linked to persistent infection with high-risk HPV types¹⁰. 
• Other Cancers: Oropharyngeal cancers (including tonsil and base of tongue), anal cancer, vaginal and vulvar cancers (in women), penile cancer (in men)^7,8. 

Diagnosis and Testing for HPV

Since human papillomavirus infections are often asymptomatic, routine screening and specific diagnostic tests are essential, especially for women. While there is no general screening test for HPV in men, several tests can help identify HPV-related complications in both sexes. Common methods of HPV diagnosis include: 

• Visual Inspection: Doctors may examine visible warts during a physical exam. In some cases, acetic acid (vinegar) may be applied to highlight mucosal lesions, such as cervical or anal abnormalities to detect areas that may require further evaluation². 
• Biopsy and Histopathological Examination: Cells of warts may be examined under a microscope to confirm HPV involvement and rule out any other cause².
• Pap Test (Pap Smear): This test checks for abnormal changes in cells that may develop into cancer. It includes Pap smears for the cervix and anus and can be done in both men and women^2,8.
• HPV DNA Test: This test detects the presence of high-risk HPV types in cervical cells and is commonly used alongside the Pap test to assess the risk of cervical cancer. While HPV DNA testing can also be done on anal cells, it is not part of routine screening and is typically used in research settings or high risks groups^2,4. 
• Colposcopy: A follow-up diagnostic procedure using a colposcope to closely examine the cervix, vagina, or anus for abnormal areas after an abnormal Pap or HPV test result². 

Treatment and Management for HPV

There is currently no cure for human papillomavirus infection itself, but various treatment options are available for HPV-related conditions, including genital warts and HPV-associated cancers. 

Warts 

Warts caused by HPV can be managed using various methods, depending on their location, size, and the patient’s immune response. However, it’s important to note that there is no antiviral cure to eliminate the HPV virus itself. Most HPV infections are cleared naturally by the immune system within 1 to 2 years. Treatment focuses on removing visible warts and relieving symptoms, not eradicating the virus. Common treatment options include^2,4: 

• Cryotherapy: Freezing the wart tissue using liquid nitrogen. 
• Topical agents: Including imiquimod (an immune response modifier) and chemical treatments such as trichloroacetic acid (TCA), which is widely used for genital warts. 
• Laser therapy: Using focused light to destroy wart tissue. 
• Surgical removal: Physically excising the warts, typically in cases where other treatments are ineffective. 

HPV-Related Cancers

If HPV infection progresses to cancer (such as cervical, anal, vulvar, penile, or mouth cancer), management involves²: 

• Surgical removal of the tumour 
• Radiotherapy 
• Chemotherapy therapy 

Note: HPV-positive cancers, especially oropharyngeal cancers, generally have a better prognosis and may respond differently to therapy, which can influence treatment planning. 

Prevention Steps

While HPV is a quite common virus, several steps can significantly reduce the risk of infection and its complications. These measures include: 

1. Getting Vaccinated 

The HPV vaccine is the most effective way to avoid infection from the most harmful types of HPV virus, including those that cause genital warts and cancer. It is ideally given before the onset of sexual activity, typically recommended for children aged 9 to 14, with a 2-dose schedule. Older individuals (aged 27 to 45) may also benefit from vaccination based on risk factors and in consultation with their doctor¹¹. 

2. Practicing Safe Sex 

Using condoms and protection during vaginal, anal, and oral sex also helps to reduce the risk of HPV transmission¹. Additionally, limiting the number of sexual partners can also decrease the risk of exposure.  

3. Getting Regular Health Screenings 

Routine cervical cancer screening is recommended for women aged 21 to 65 years. This includes a Pap test every 3 years, or for women aged 30 and above, a combination of Pap test plus HPV co-testing every 5 years¹². These screenings help detect early abnormal cell changes caused by HPV, allowing for timely intervention and prevention of cervical cancer. 

4. Educating Yourself and Others 

Increasing awareness about HPV transmission, symptoms, and prevention methods helps reduce stigma and encourages initiative-taking healthcare. Parents should also be informed about the benefits of HPV vaccination for their children. 

When to See a Doctor

Although many HPV infections clear on their own without causing symptoms, it’s important to seek medical attention if you: 

• Notice new genital warts, oral warts, or skin growths in the genital, anal, or throat region¹. 
• Have persistent symptoms like itching, burning, or discomfort in the genital region^1,8. 
• Experience abnormal vaginal bleeding, unusual discharge, or pain during intercourse^1,2. 
• Have abnormal Pap smear or HPV test results. 
• Are concerned about possible exposure to HPV or want advice on vaccination and screening. 
• Are taking medications for any autoimmune disease or have had an organ transplant⁸. 

Conclusion

Human papillomavirus causes an cause warts and serious cancers, but most infections have no symptoms and clear on their own. Therefore, understanding what HPV is, what are the common HPV symptoms, and how to protect yourself through vaccination, testing, and awareness, are key to preserving long-term health and reducing the risk of serious complications.  

Vaccines protect against the high-risk cancer-causing types (like HPV 16 and 18) and some low-risk types that cause warts (like 6 and 11), but they do not treat existing infections. Additionally, regular testing helps detect early changes caused by HPV for timely treatment. Together, vaccination, testing, and awareness are key to reducing HPV-related health problems and protecting public health.

Also Read: HPV Vaccine: What is It, When to Be Taken, Importance & Side Effects 

Frequently Asked Questions (FAQs)

References

1. World Health Organization. Human papillomavirus and cancer [Internet]. World Health Organization. 2024 Mar 5; [cited 2025 May 26]. Available from: https://www.who.int/news-room/fact-sheets/detail/human-papilloma-virus-and-cancer 

2. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Human Papillomaviruses. Lyon (FR): International Agency for Research on Cancer; 2007. (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, No. 90.) 1, Human Papillomavirus (HPV) Infection. Available from: https://www.ncbi.nlm.nih.gov/books/NBK321770/ 

3. Ramamoorthy T, Sathishkumar K, Das P, Sudarshan KL, Mathur P. Epidemiology of human papillomavirus related cancers in India: findings from the National Cancer Registry Programme. Ecancermedicalscience. 2022 Sep 7;16:1444. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9666279/  

4. Luria L, Cardoza-Favarato G. Human Papillomavirus [Internet]. StatPearls Publishing. 2025 Jan; [Cited May 26]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448132/ 

5. Meites E, Gee J, Unger E, Markowitz L. Chapter 11: Human Papillomavirus. In: Epidemiology and Prevention of Vaccine-Preventable Diseases [Internet]. Centers for Disease Control and Prevention; [cited 2025 May 26]. Available from: https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-11-human-papillomavirus.html 

6. Mlynarczyk-Bonikowska B, Rudnicka L. HPV Infections-Classification, Pathogenesis, and Potential New Therapies. Int J Mol Sci. 2024 Jul 11;25(14):7616. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11277246/ 

7. Mlynarczyk-Bonikowska B, Rudnicka L. HPV Infections-Classification, Pathogenesis, and Potential New Therapies. Int J Mol Sci. 2024 Jul 11;25(14):7616. Available from: https://pmc.ncbi.nlm.nih.gov/articles/pmid/39062859/ 

8. National Cancer Institute. HPV and cancer [Internet]. National Cancer Institute; [cited 2025 May 26]. Available from: https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer 

9. Dunne EF, Park IU. HPV and HPV-associated diseases. Infect Dis Clin North Am. 2013 Dec;27(4):765-78. Available from: https://pubmed.ncbi.nlm.nih.gov/24275269/ 

10. Okunade KS. Human papillomavirus and cervical cancer. J Obstet Gynaecol. 2020 Jul;40(5):602-608. doi: 10.1080/01443615.2019.1634030. Epub 2019 Sep 10. Erratum in: J Obstet Gynaecol. 2020 May;40(4):590. Available from: https://pubmed.ncbi.nlm.nih.gov/31500479/ 

11. Centers for Disease Control and Prevention. HPV vaccination recommendations [Internet]. Centers for Disease Control and Prevention; [cited 2025 May 26]. Available from: https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html 

12. National Cancer Institute. Cervical Cancer Screening [Internet]. National Cancer Institute; [cited 2025 May 29]. Available from: https://www.cancer.gov/types/cervical/screening 

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