HPV in Women: Causes, Symptoms, and Treatment Options
Introduction
It is estimated that around 80% of sexually active women will be exposed to at least one type of HPV during their lifetime1.HPV is a common viral infection that affects both men and women. However, it may go unnoticed as it usually does not present with symptoms2.
HPV is caused by a virus that is primarily transmitted through skin-to-skin sexual contact. While some types of HPV do not cause any harm, other types may lead to the development of cancer (especially cervical cancer) or genital warts. Understanding the causes, symptoms, and treatment options for HPV in women can help lower your chance of infection2.
What Is HPV?
Are you wondering what HPV is and what causes HPV in females? Human papillomavirus, or HPV, is a group of more than 200 types of HPV viruses. Certain mucosal or genital types of HPV viruses are transmitted through sexual contact. The other types can cause the formation of warts, which may not sexually transmitted3,4.
HPV primarily spreads through close skin contact, particularly during vaginal, anal, or oral sexual activity. Many individuals may have been exposed to HPV in our lives5. Most HPV infections disappear on their own within 1-2 years without needing any treatment, especially in healthy young individuals. However, sometimes, they may last longer and lead to the development of cancer5.
How HPV Affects Women
Based on their potential to cause cancer and their effects, HPV can be classified into 2 types,3,6,7:
Low-risk HPV: This can lead to the development of warts (skin growth) on the genitals, mouth, anus, or throat. These are not linked to cancer.
High-risk HPV (such as HPV 16 and HPV 18): This can lead to the development of precancerous lesions, which may progress to cancer over time.
In many cases, high-risk HPV infections remain at the cervix (lower portion of the uterus), without causing any symptoms. This persistent infection can cause cervical intraepithelial neoplasia (precancerous changes in the cervix). If these cell changes are not detected through regular screening (like a Pap smear or HPV test), they can eventually lead to the development of cervical cancer3.
Types of HPV Linked With Cervical Disease
Certain HPV types are classified as high-risk because of their association with cervical cancer3. A study6 has shown that there are 13 HPV types (HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68) that are linked with cervical disease in HPV female patients8. The two high-risk types of HPV (HPV 16 and HPV 18) are responsible for 70% of cervical cancers worldwide7.
Any sexually active woman may become infected with HPV. Usually, the body fights off this infection or the infection resolves on its own in 1-2 years, especially in young, healthy individuals. However, if the infection persists for a long period of time, it could lead to changes in the cervical cells, eventually leading to the development of cervical disease7,8.
Symptoms and Signs of HPV in Women
Generally, most HPV infections are asymptomatic and do not show any signs or symptoms (especially high-risk types). The infection often passes unnoticed in women. If symptoms occur, they include3,4:
Genital warts: Usually caused by low-risk HPV type, these are small elevations that may be present in the genital area. Genital warts can appear as raised or flat growths and may occur alone or in clusters. Symptoms will only arise if complications develop, such as cervical intraepithelial neoplasia or cancer. Low-risk HPV types (types 6 and 11) are responsible for 90% of genital warts.
Abnormal Pap smear test results: This is normally detected during cervical cancer screening. Abnormal results on the Pap smear test may indicate cytological changes due to the presence of any high-risk HPV and show changes in the cells of the cervix (cervical dysplasia)9.
Signs of cervical cancer noticed in HPV female patients: This includes bleeding from the vagina (after intercourse, between periods, or after menopause), watery vaginal discharge with a foul odour, pain during intercourse, or pelvic pain. It is important to note that vaginal bleeding (especially postcoital), foul-smelling discharge, and pelvic pain are late signs of invasive cervical cancer4,10.
Understanding the HPV symptoms women commonly experience is essential for early detection and prevention of complications3,4.
Types of HPV and Risk Levels
HPV is a common viral infection that includes a wide range of virus types. The virus types are classified as11:
Your body’s immune system cannot fight off this type of viral infection, which may cause damage to normal cells, resulting in cellular dysplasia, eventually leading to cancer.
In women, high-risk HPV strains have been linked to cancers of the cervix, oropharynx, vagina, anus, and vulva.
Low-risk HPV types are mainly associated with non-cancerous growths like warts, while high-risk types, especially HPV 16 and 18, are strongly associated with cervical cancer and other cancers7,11.
Testing and Diagnosis
Are you wondering how to test for HPV in females? As HPV is usually asymptomatic, regular screening is essential to detect early signs of infection and prevent complications. Your doctor may recommend the following tests for the detection of HPV12:
HPV Test: Checks for high-risk HPV types that cause cervical cancer.
Pap Test (or Pap Smear or cervical cytology): During this test, a few cells are collected from your cervix to check whether they are precancerous or cervical cancer cells. It may incidentally detect any cellular changes or inflammation, suggestive of infection.
HPV/Pap Co-test: Combines both the HPV and Pap tests to check for high-risk HPV types and cervical cell changes.
Colposcopy and Biopsy: This method uses a special instrument to visualise the cervix, vagina, and vulva closely and provide a magnified view. Biopsies are taken from the suspicious areas. A colposcopy may be recommended if your Pap test is abnormal or if high-risk HPV has been identified. This test can help in early detection and can help reduce the incidence of cervical cancer13.
There are many human papillomavirus subtypes, of which HPV 16 and 18 are the most common causes of cervical cancers in women, and most HPV detection methods look for these strains. Pap smear for HPV detection in women should be done every 3 years from age 21–65; while for 30–65, HPV DNA testing every 5 years (with or without Pap) is an alternative21.
HPV can have a wide range of effects on women’s health. Although most HPV infections clear up without treatment, some high-risk types may result in significant health issues. These include14:
Cervical cancer: This is usually caused by high-risk HPV types (HPV 16 and HPV 18). Persistent infection can lead to the development of precancerous lesions, which may progress to cancer (vaginal, vulvar, anal, and oropharyngeal cancer), if left untreated.
Genital warts: Low-risk HPV types can result in genital warts, which are non-cancerous.
Psychological stress: HPV can lead to psychological stress due to stigma or fear of cancer.
Pregnancy complications: A few studies have shown the association of HPV with spontaneous abortion and preterm birth. However, there is no clear evidence of HPV being a direct cause of miscarriage or preterm labour.
Early detection and timely treatment are vital in reducing the health risks associated with HPV14.
Treatment Options
There is no cure for HPV. However, treatment options are available for the removal of genital warts and HPV-related cancer. These include15:
Cryotherapy or cryosurgery: This is a procedure in which the tissue of the genital wart is frozen and destroyed. A colposcopy may be done before your treatment to visualise the wart and guide the biopsy.
Excision procedures: The commonly followed procedures include:
Loop electrosurgical excision procedure (LEEP): Uses a thin wire loop to remove abnormal tissue from your cervix.
Cold knife cone biopsy (Conization): Extensive type of cervical biopsy where a cone-shaped piece of cervical tissue is removed.
Laser therapy: Usually, a carbon dioxide laser is used in this technique, in which a focused beam of light helps to remove the abnormal tissue and simultaneously cauterise it, reducing bleeding and pain.
Electrosurgery: This method uses electric current to burn the pre-cancerous lesions or warts.
Hysterectomy: In this procedure, the uterus is removed. Based on your doctor’s advice and the surgical plan, it may or may not involve the removal of the ovaries or fallopian tubes.
Trichloracetic acid: This acid is directly applied by the doctor to the wart to burn it off. It is said to be effective in removing up to 50% of the lesion.
Topical ointments: Topical ointments (e.g., imiquimod and polyphenon) can be applied to treat the genital warts.
HPV Prevention and Vaccination
Many individuals (approximately 80% of women) will get HPV at some point in their lives. Simple methods to protect yourself from HPV include1,16:
Getting vaccinated to protect yourself from developing cervical, throat, vulva, vaginal, and anal cancers.
Using condoms is an effective method to reduce your risk of infection; however, this method does not eliminate the risk of HPV.
Avoiding direct contact (genital contact) with another person.
Quadrivalent HPV vaccine (Gardasil, 4vHPV): Helps provide protection against HPV types 16 and 18.
Bivalent HPV vaccine (Cervarix, 2vHPV): Helps provide protection against HPV types 16 and 18 that cause most HPV cancers.
Vaccination is most effective if given before exposure to the virus. HPV vaccination can be started at the age of 9 years5. Recommended HPV vaccination and the dose schedule are as mentioned below17,18:
Age Group
Vaccination Recommendation
Dose Schedule
9-10 years
HPV vaccination can be started at this age
2 doses (0 months, 6-12 months) – if started before age of 15 years
11-12 years
Routine vaccination recommended
2 doses (0 months, 6-12 months) – if started before age of 15 years
13-14 years
Vaccination recommended if not already vaccinated
2 doses (0 months, 6-12 months) – if started before the age of 15 years
15-26 years
Vaccination advised for those who have not completed the recommended vaccination schedule earlier.
3 doses (0, 1-2, and 6 months)
27–45 years
Not routinely recommended. Consider vaccination after consulting your doctor regarding the risk of developing HPV and the benefits of vaccination
3 doses (0, 1-2, and 6 months)
Immunocompromised individuals (including HIV), 9–26 years
Vaccination recommended if not already vaccinated
3 doses (0, 1–2, and 6 months).
Can HPV Be Cured?
No, there is no cure for HPV. In most cases, your body’s defence system will fight against the infection so that it resolves on its own3,5.
Moreover, there are effective treatments for the health problems it can cause (such as genital warts and cervical cancer). Early diagnosis and detection are key for reducing your risk of complications15.
Living with HPV
Being diagnosed with HPV can be challenging, but it is important to remember that in most cases, this infection resolves on its own19.
Regular medical tests, such as Pap smears or HPV tests, to monitor for any changes that might require treatment.
Maintaining a healthy lifestyle: A healthy lifestyle, which includes a nutritious diet, regular physical activity, avoiding tobacco use, and stress management, can support overall well-being.
Taking care of your mental health and talking to your doctor can help ease anxiety or fears.
Open communication with partners and staying informed about HPV can empower women to manage their health confidently19.
HPV is a widespread and often silent infection that can have serious health consequences for women, including cervical cancer and genital warts. While many infections resolve on their own, high-risk HPV types require close monitoring and early detection. Regular screening, timely vaccination, and healthy lifestyle practices play a crucial role in managing HPV successfully.
What are the factors that increase the risk of cervical cancer in a person suffering from HPV?
If you have a weak immune system, smoke (or if you are exposed to second-hand smoke), are obese, or use oral contraceptive pills (or birth control pills), you may have an increased risk of developing cervical cancer7.
When should I get screened for cervical cancer?
The updated guidelines recommend starting screening for cervical cancer at age 25 years with an HPV test every 5 years until 65 years of age. Alternatively, you can also choose to get a HPV or Pap co-test every 5 years or just a Pap test every 3 years13.
Can HPV be transmitted without having sexual intercourse?
Yes, HPV spreads through intimate skin-to-skin contact, including genital touching, but without penetration20.
Can I have a normal pregnancy if I have HPV?
If you have HPV, you are likely to face genital warts or abnormal cervical cell changes during your pregnancy. It is best to consult your doctor and get regular screenings for cervical cancer to ensure good overall health5.
References
Myers ER, McCrory DC, Nanda K, Bastian L, Matchar DB. Mathematical Model for the Natural History of Human Papillomavirus Infection and Cervical Carcinogenesis. American Journal of Epidemiology [Internet]. 2000 Jun 15;151(12):1158–71. Available from: https://pubmed.ncbi.nlm.nih.gov/10905528/
Qaderi K, Mirmolaei ST, Geranmayeh M, Farnam F, Sheikh Hasani S. “Does HPV affect my fertility?” Reproductive concerns of HPV-positive women: a qualitative study. Reproductive Health [Internet]. 2021 Apr 1;18(1). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8017806/
Galeshi M, Shirafkan H, Yazdani S, Motaghi Z. Challenges and Needs of HPV-Positive Women. INQUIRY: The Journal of Health Care Organization, Provision, and Financing [Internet]. 2023 Jan;60:004695802211500. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9893350/
Petca A, Borislavschi A, Zvanca M, Petca RC, Sandru F, Dumitrascu M. Non-sexual HPV transmission and role of vaccination for a better future (Review). Experimental and Therapeutic Medicine [Internet]. 2020 Oct 13;20(6):1–1. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579832/pdf/etm-20-06-09316.pdf
Elrefaey S, Massaro MA, Chiocca S, Chiesa F, Ansarin M. HPV in oropharyngeal cancer: the basics to know in clinical practice. Acta Otorhinolaryngol Ital. 2014 Oct;34(5):299–309. PMID:25709145; PMCID:PMC4299160. Available from: https://pubmed.ncbi.nlm.nih.gov/25709145/
Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.
Is Pneumonia Contagious? Causes, Transmission, Symptoms & Treatment
Introduction
Did you know that you have an increased risk of developing pneumonia if you are above 65 years of age or under 2 years of age1? Pneumonia is one of the leading causes of death worldwide2.
While pneumonia itself is not contagious, the causative agents (bacteria, virus) generally are. Understanding how pneumonia spreads, what causes it, how to recognise whether your infection is contagious and knowing about the right treatment are essential to protect yourself1.
What Is Pneumonia?
Pneumonia is a serious infection that can affect either one or both of your lungs, causing the air sacs of your lungs or alveoli to be filled with fluid or pus3,4.
Pneumonia is a clinical syndrome with multiple aetiologies and classifications, which include5:
Community-Acquired Pneumonia: Pneumonia acquired outside of hospital settings or in a community setting.
Hospital-Acquired Pneumonia: Pneumonia acquired 48 hours or more of admission in any hospital.
Ventilator-associated Pneumonia: Pneumonia acquired more than 48 hours after endotracheal intubation.
What Causes Pneumonia?
Pneumonia is the inflammation of alveoli in your lungs mostly caused by bacteria, viruses or fungi. These include6,7,8:
Bacterial Pneumonia: Bacteria are a common cause of pneumonia in adults. The most commonly noticed bacterium is Streptococcus pneumoniae while others like Haemophilus influenzae, Bordetella pertussis etc may also be the cause. Atypical bacteria such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, or Legionella are also causes of pneumonia, especially in younger individuals.
Viral Pneumonia: Viruses such as influenza virus, SARS-CoV-2, respiratory syncytial virus (RSV), and rhinovirus can also cause pneumonia.
Fungal Pneumonia: Not as common as bacterial and viral pneumonia, but fungi such as Pneumocystis jirovecii, cryptococcus, histoplasma and blastomyces may also lead to the development pneumonia, especially in individuals with weak immune systems.
Aspiration Pneumonia is one subtype of pneumonia, which occurs when food, liquids, or vomit are inhaled into the lungs, and is not caused by infectious organisms per se9.
Understanding the cause of pneumonia can help to identify whether it is contagious and prevent its spread.
Is Pneumonia Contagious?
This depends upon the underlying cause of pneumonia. Certain types can be contagious based on the causative organism, while others may not spread directly6.
Contagious pneumonia is generally caused by bacteria or viruses, which can be transmitted through respiratory droplets when an infected person coughs, sneezes, or talks6.
Non-contagious pneumonia does not spread from person-to-person. This type of pneumonia occurs due to inhalation of foreign substances (aspiration pneumonia) and is not caused by an infectious agent so cannot spread to others9.
Another type of pneumonia that is less likely to be contagious is that caused by fungal infections, which typically affect people with weakened immune systems. While these are not transmitted between individuals, they can occur in clusters due to shared environmental exposure10,11.
Let’s have a look at the contagious ones in detail.
Which Pneumonia Types are Contagious?
Are you wondering which pneumonia is contagious? Well, as mentioned, not all pneumonias are contagious. Some can spread from person to person, while others do not.
Bacterial pneumonia: Bacteria such as Streptococcus pneumoniae can cause infections that can spread through cough, sneezes, or close contact.
Atypical pneumonia: Some bacteria may cause pneumonia with different symptoms which are usually milder that those in typical pneumonia (referred to as walking pneumonia or atypical pneumonia). This is mostly caused by Mycoplasma pneumoniae, Chlamydia pneumoniae, or Legionella pneumophila and generally affects younger populations. This is contagious and spreads through inhalation of infected respiratory droplets or aerosolised contaminated water.
Viral pneumonia: Viruses such as influenza virus, RSV, or SARS-CoV-2 are also highly contagious and spread similarly via airborne droplets or contact with contaminated surfaces.
Fungal pneumonia: These are acquired from environmental exposure, and person-to-person transmission is exceedingly rare or non-existent, except sometimes in transplant settings (e.g., organ donation from infected donor)12.
One important point about pneumonia occurrence is that after alcoholic intoxication, chances of aspiration pneumonia are high. This is because of slowing of reflexes and epiglottis that lead to entry of stomach/oral bacteria into lungs causing a severe life threatening pneumonia.
Pneumonia can spread in several ways, which includes9,10:
Airborne Droplets: This occurs when an individual affected with pneumonia coughs, sneezes or talks. This causes the release of respiratory droplets (infectious as they may contain bacteria or viruses). When you inhale these droplets, you may develop pneumonia.
Contact with Contaminated Surfaces: When an individual touches a surface that is contaminated with bacteria and viruses, and then touches their nose or mouth, they may develop pneumonia.
Aerosols or water droplets: Some organisms which cause pneumonia (such as Histoplasma, Blastomyces, Legionella) are present in the aerosolised soil particles or contaminated water droplets. Hence, when an individual is exposed to these factors, they may inhale an infectious organism and develop pneumonia.
Aspiration: This is not actually a mode for person-to-person transmission, rather a mechanism of entry of oropharyngeal or gastric contents into the lungs. It is a non-infectious event, though it can lead to secondary infection.
Despite these, developing pneumonia depends on host factors, virulence, and exposure dose. Not everyone exposed develops pneumonia. Certain factors may increase risk of pneumonia such as a weakened immune system (this includes HIV, or any chronic diseases like asthma, diabetes, etc). It’s important to be especially vigilant of pneumonia symptoms if you have any preexisting conditions8.
How Long is Pneumonia Contagious?
The contagious period can vary based on the type of pneumonia you are suffering from. The table below lists when pneumonia is contagious6,9:
Type of Pneumonia
Contagious Period
Bacterial Pneumonia
Contagious for approximately 48 hours after starting antibiotics and until fever reduces
Walking Pneumonia
Contagious for several weeks (2-4 weeks before your first symptoms appear and until symptoms resolve)
Viral Pneumonia
Several days to over a week (until fever reduces and symptoms subside)
Fungal Pneumonia
Generally, not contagious
Aspiration Pneumonia
Not contagious
Is Pneumonia Contagious After Antibiotics?
An individual infected with bacterial pneumonia is said to be contagious for approximately 48 hours after starting effective antibiotics, while viral pneumonia may remain contagious longer (several weeks). You are likely to be contagious until your symptoms subside and fever resolves. It is always best to consult your doctor and follow instructions to reduce the spread of infection6.
Symptoms of Pneumonia
The signs and symptoms of pneumonia may include4,13,14:
Fever and chills
Headache
Chest pain (pleuritic pain, which is a sharp pain on breathing and coughing)
Muscle pain or myalgia
Productive cough (may be associated with greenish, yellow or even bloody mucus)
If you are facing any of these symptoms, consult your doctor and seek immediate medical care.
I have come across many stroke patients are also developing aspiration pnuemonia. Proper chest physiotherapy along with incentive spirometer exercises can help prevent the risk of aspiration pneumonias in them.
A cough can indicate any infection from a common cold, bronchitis, to pneumonia. The below table summarises the key differences in these 3 infections and helps you to understand if your cough might be pneumonia14,16,17.
Common Cold
Bronchitis
Pneumonia
Duration of Cough
Short duration
Short duration
Persistent Cough
Type of Cough
Productive / nonproductive cough
Productive cough (Clear or yellow-green mucous)
Productive cough (greenish, yellowish or blood stained mucous)
Symptoms
Sore throat, runny nose, sneezing, coughing and headache
Chest discomfort, productive cough, tiredness, low-grade fever, shortness of breath
Rest, fluids, and over-the-counter pain or cold or cough medicines
Rest, fluids, and over-the-counter pain or cold or cough medicines
Antibiotic treatment
Diagnosis
After a careful assessment of your symptoms, your doctor will be able to diagnose your condition with the help of18,19:
Chest X-ray: If you present with clinical symptoms, your chest X-ray may show infiltrates, consolidation, or opacities in your lungs which maybe a sign of pneumonia.
Blood Tests: Your doctor may recommend laboratory tests such as:
Complete blood count: To check for any infections, such as leucocytosis with neutrophilia (bacterial) or lymphocytosis (viral).
Arterial blood gases: Used only in severe cases. It can be used to help assess the oxygenation and acid-base balance in cases of hypoxia or when any other respiratory compromise is expected.
Pulse Oximetry: To measure your oxygen level in your blood. Pneumonia fills air spaces in lungs with fluids, impairing gas exchange, which leads to hypoxemia. If you are suffering from pneumonia, it can prevent your lungs from getting enough oxygen into your blood.
Sputum Test: To identify the organism causing your illness.
Blood Culture Test: To identify the causative agent and to check for bacterial infection in your blood which has prognostic implications in severe CAP or suspected sepsis.
Polymerase Chain Reaction (PCR) Test: To identify the DNA of the causative agent
Bronchoscopy: A tube is inserted into your airway and your doctor may collect samples of the tissue and fluid from your lungs to identify the cause of your pneumonia. This method is only done in complicated cases, cases of unresolved pneumonia or immunocompromised patients.
Chest Computed Tomography (CT) Scan: This tool can help to identify the extent to which your lungs are affected by pneumonia and can also identify abscesses and other lung disorders.
Based on these tests, your doctor will be able to accurately diagnose your condition and will suggest the appropriate treatment for your condition18.
Treatment for Pneumonia
Depending on the type of pneumonia you have, your doctor may suggest the following treatments20,21:
Bacterial pneumonia: Antibiotics may be prescribed. You should start to notice a reduction in your symptoms in 48-72 hours. However, complete recovery can take a much longer time in elderly patients (several weeks). Take your medications as prescribed by your doctor and do not discontinue your medication.
Viral pneumonia: While in most cases, viral pneumonias clear up by itself, Influenza, RSV and SARS-CoV-2 can cause severe disease, especially in children, elderly individuals and individuals who are immunocompromised. Oseltamivir may be prescribed for managing influenza, ribavirin may be prescribed for RSV, parainfluenza virus, adenovirus, and measles virus22.
Fungal pneumonia: Treatment prescribed is dependent on the causative organism. For example, if your infection is caused by Pneumocystis jirovecii, your doctor may prescribe a combination of trimethoprim-sulfamethoxazole, or if your infection is caused by Histoplasma, your doctor may prescribe itraconazole or amphotericin B for the management of your condition22.
Apart from these medications, it is important to get plenty of rest, drink plenty of fluids, and you may take over-the-counter medications for pain, cough, cold and fever.
In cases of severe pneumonia, you may have to be a hospitalised to receive medications (antibiotics and fluids) through an intravenous (IV) line. Your doctor may also recommend oxygen therapy to increase the amount of oxygen in your blood. If you are suffering from a serious infection, you may need ventilator support20,21.
Prevention Tips
Taking a few proactive steps and getting vaccinated, can reduce your chances of developing pneumonia. This includes23:
Apart from getting vaccinated, certain simple tips that you can follow to protect yourself against pneumonia include23,25:
Avoid close contact with infected and sick individuals.
If you are sick, stay at home to prevent the spread of infection.
When in a public place, cover your nose and mouth with a tissue while sneezing and coughing or cough or sneeze into your elbow followed by good hand hygiene.
Quit smoking and avoid alcohol consumption.
Make sure you wash your hands regularly with warm water and soap for at least 20 seconds.
It is important to clean and disinfect frequently contacted surfaces to reduce the risk of infection.
Consult your doctor for any medical issues such as heart disease, diabetes and take medications as directed. These conditions can lead to secondary pneumonia and managing them is essential for pneumonia prevention.
You should consult a doctor if you experience symptoms of pneumonia. If you face difficulty in breathing, high fever, difficulty breathing, chest pain, and a productive cough, seek immediate medical care26.
Moreover, it is important to get immediate medical care in high-risk individuals (adults over the age of 65, children below the age of 2 and adults with any underlying health condition such as diabetes, heart disease) or weakened immune system (immunocompromised individuals) as the disease can progress quickly in these individuals. Moreover, if you notice symptoms such as bluish lips or nails (cyanosis), confusion, and rapid breathing, it is best to seek prompt medical care26,27.
Talking about the main question – is pneumonia contagious in adults? Well, it may or may not be, depending on its underlying cause. It is important to recognise the type of pneumonia you have and how it may be transmitted. Taking appropriate precautions such as getting timely vaccinations and promoting good hygiene can help prevent its spread. Early diagnosis and treatment are essential for a quick recovery.
What are the complications of pneumonia, if left untreated?
The complications of untreated or incompletely treated pneumonia include respiratory failure, accumulation of pus in between the lung and the lining of the chest wall (empyema), lung abscess, sepsis and may also lead to multi organ failure5.
Is pneumonia more dangerous during pregnancy?
Yes, pregnant individuals are at higher risk of complications of pneumonia such as low weight at birth and increased risk of preterm birth due to weakened immunity28.
Can pets transmit pneumonia to humans?
Yes, this can occur, though rarely. Certain infections such as Q fever (caused by Coxiella burnetii) and Psittacosis (caused by Chlamydophila psittaci) may occur in individuals working closely with animals or livestock29,30.
What is the difference between bronchitis and pneumonia?
Bronchitis affects your bronchial tubes (airways), while pneumonia affects the air sacs (alveoli) in the lungs. The symptoms of pneumonia tend to be more severe and may involve high-grade fever, chest pain, and shortness of breath14,17.
Troeger C, Blacker B, Khalil IA, Rao PC, Cao J, Zimsen SRM, et al. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Infectious Diseases [Internet]. 2018 Nov;18(11):1191–210. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6202443/
Smith DJ, Williams SL, Benedict KM, Jackson BR, Toda M, Adame G, et al. Surveillance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis — United States, 2019. MMWR Surveillance Summaries [Internet]. 2022 Aug 19;71(7):1–14. Available from: https://www.cdc.gov/mmwr/volumes/71/ss/ss7107a1.htm
José RJ, Periselneris JN, Brown JS. Opportunistic bacterial, viral and fungal infections of the lung. Medicine [Internet]. 2020 Jun 1;48(6):366–72. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7206443/
Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.
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Bacterial Pneumonia: What Is It, Causes, Symptoms & Treatment
Introduction
Pneumonia is one of the leading causes of mortality in the world, making it a global health concern1. It is a serious infection that affects your lungs by causing inflammation and fluid or pus accumulation in the alveoli (air sacs) of your lungs2. Bacterial pneumonia, especially from Streptococcus pneumoniae or Haemophilus influenzae type b, is a common cause of pneumonia-related deaths. However, viral pneumonia, caused by viruses like respiratory syncytial virus (RSV) and influenza, also contributes significantly to pneumonia cases and fatalities1,3.
What Is Bacterial Pneumonia?
Bacterial pneumonia, as the name suggests, is caused by various bacteria that invade your lungs. Your body’s natural defence system tries to fight these bacteria as a part of the immune response, leading to inflammation of the air sacs of your lungs and the accumulation of fluid and pus in them4. Inflammation occurs as part of the immune response, but sometimes pathogenic bacterial factors also directly damage tissue, e.g., inflammation caused by the toxin pneumolysin from S. pneumoniae5. Bacterial pneumonia can be of different types, including3:
Community-acquired Pneumonia: Occurs in individuals who acquire the infection outside of hospital settings or within 48 hours of admission.
Hospital-acquired Pneumonia: This type of pneumonia occurs in individuals who develop the infection 48 hours after admission to any hospital.
Atypical Pneumonia: This type of pneumonia is generally caused by bacteria that are less commonly associated with pneumonia, e.g., Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella spp. These organisms are not generally identified by the traditional staining methods (Gram stain), but the pneumonia often presents with symptoms that occur outside the lungs. Though atypical bacterial pneumonia is mostly bacterial in origin, it may not be categorised as typical bacterial pneumonia6.
Ventilator-associated Pneumonia: This type of pneumonia occurs 48 hours or more after a person has been placed on a ventilator to help them breathe.
Community-acquired Pneumonia: The main organisms that cause this infection include S. pneumoniae, H. influenzae, M. pneumoniae, Legionella spp., Moraxella catarrhalis, and Staphylococcus aureus (especially methicillin-resistant S. aureus), which is commonly associated with severe cases or following a viral infection like influenza.
Hospital-acquired Pneumonia: The main organisms that cause this infection include S. aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii.
Atypical Pneumonia: The main organisms that cause this infection include M. pneumoniae, C. pneumoniae, or Legionella pneumophila.
Ventilator-associated Pneumonia: The main organisms that cause this infection include S. aureus, P. aeruginosa, enterobacter species (such as Klebsiella, E. coli) and gram-negative bacilli8.
In 50% of pneumonia cases, the etiological factor remains unknown. Identifying the causative organism is essential for appropriate treatment7.
How Does Bacterial Pneumonia Spread?
Bacterial pneumonia is contagious and can spread from person to person. This infection is transmitted through contact with infected surfaces. It can also spread when the droplets released when an infected person coughs or sneezes are inhaled by another person3,7.
It is always recommended to avoid close contact with infected individuals, wear a mask and practice proper hand hygiene to reduce your risk of infection9.
As per my experience, I have noticed that health care workers like doctors, nurses, ward boys etc are at the greatest risk of developing pneumonias. I feel consuming immunity boosting foods/supplements like Vitamin C can help in lowering the risk of getting these infections.
Productive cough with mucus that can be clear, yellow/green, or contain blood. Dry cough is more common with viral and atypical pneumonia6,11.
Systemic symptoms of bacterial pneumonia may include3,7:
Headache
Sweaty and clammy skin or chills
Altered mental status or confusion
Hypotension
Cyanosis due to low oxygen levels
Increased heart rate (tachycardia). Decreased heart rate (bradycardia) is uncommon and may be associated with pneumonia caused by Chlamydia sp, Legionnaire’s disease, and typhoid12.
In children under 5 years of age, the signs and symptoms of bacterial pneumonia may include rapid breathing, chest pain, abdominal pain, and pale colour of the face3,7.
Leptospirosis, a disease caused by urination of rodents mixed into stagnant water can cause life threatening pnuemonia. Thus, utmost care should be taken to avoid travel through stagnant waters. Calf and thigh pain with blood in sputum should raise suspicion of leptospirosis21.
After a careful assessment of your symptoms, your doctor will be able to diagnose your condition with the help of3,7:
Chest X-ray: If you present with symptoms of pneumonia, your chest X-ray serves as a first-line imaging tool for the diagnosis of bacterial pneumonia. Your chest X-ray may show pulmonary infiltrates and may suggest the type of pneumonia present (for example, lobar or interstitial pneumonia). However, it cannot accurately distinguish between bacterial and non-bacterial pneumonia (such as viral pneumonia).
Computed Tomography: Helpful in unclear cases or when other conditions may be present.
Blood Tests: Your doctor may recommend laboratory tests such as:
Complete blood count: Creatinine levels and complete white blood cell count (for the diagnosis and detection of severity of infection)
Liver function tests: Abnormalities on the liver function tests may be observed in cases of severe or complicated pneumonia or Legionella infections13.
Inflammatory biomarkers (e.g., erythrocyte sedimentation rate and C-reactive protein): Supportive markers for inflammation and severity. Elevated levels of C-reactive protein are suggestive of bacterial pneumonia. However, this result is not definitive, and these tests cannot distinguish between bacterial and viral pneumonia.
Arterial blood gases: Used in severe cases where hypoxia (low oxygen supply to tissues) and respiratory acidosis (acidic blood due to the presence of carbon dioxide) are present.
Sputum Culture: May be advised in severe cases or hospitalised cases to identify the bacteria causing your illness.
Gram Staining: To identify the bacteria and guide your treatment. For example, Gram-positive cocci, such as S. pneumoniae, and Gram-negative bacilli like H. influenzae.
Respiratory Viral Panel (including influenza): Done by collecting a sample from your respiratory tract (nasopharyngeal swab) to check for viral pathogens such as influenza, RSV or SARS-CoV-2. The results may indicate a secondary bacterial infection, which is common after a viral infection.
Based on these tests, your doctor will be able to diagnose your condition accurately and will suggest the appropriate treatment for your condition. A definitive diagnosis, especially in hospitalised cases or complicated cases will always require identification of the organism.
Bacterial vs. Viral Pneumonia
While bacterial and viral pneumonia are two common types of lung infections that share similar symptoms, the table below highlights the key differences between the two types of pneumonia3,7,11.
Bacterial Pneumonia
Viral Pneumonia
Aetiology
Bacterial (e.g., Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus)
Viral (for example, Respiratory syncytial virus or RSV, influenza virus, adenovirus and coronaviruses like SARS-CoV-2)
Onset
Sudden onset and more severe symptoms
Gradual onset and symptoms may not be severe initially
Nasal or throat swab (PCR), Chest X-ray, and patient’s history
Treatment
Antibiotics
Supportive care (rest, fluids, fever control); antivirals in some cases (e.g., influenza)
Complications
Abscess, empyema, and sepsis
Respiratory failure, liver failure, heart failure, and secondary bacterial infection
If you are suffering from any lung infection and are unsure whether it is a bacterial or viral infection, it is best to consult your doctor and get appropriate medical treatment.
The main treatment of bacterial pneumonia involves the use of antibiotics. If you are healthy and do not have any other chronic medical conditions, the treatment may include antibiotics like3,7:
If you have any chronic medical conditions such as diabetes or heart disease, the treatment may include combination treatments like3,7:
Amoxicillin/clavulanate or cephalosporins (such as cefpodoxime or cefuroxime) along with a macrolide (such as azithromycin or clarithromycin) or doxycycline.
Alternatively, your doctor may recommend a single stronger antibiotic like levofloxacin or moxifloxacin.
If you are admitted to the hospital but your pneumonia is not too severe, your doctors may recommend3,7:
A beta-lactam antibiotic (such as ceftriaxone) along with a macrolide (such as azithromycin or doxycycline).
Alternatively, a single respiratory fluoroquinolone (such as levofloxacin) may be used. However, it is important to note that overuse of these respiratory fluoroquinolones may lead to resistance to the antibiotic and an increased risk of Clostridium difficile infection14.
If you are admitted to the hospital and your pneumonia is severe, your treatment will be more aggressive and usually includes3,7:
A beta-lactam antibiotic plus a macrolide
Alternatively, your doctor may recommend a beta-lactam antibiotic along with a respiratory fluoroquinolone.
Prevention of Bacterial Pneumonia
Certain tips that you can follow to reduce your risk of pneumonia include3,7,9:
Ensure good hand hygiene by washing your hands regularly with warm water and soap.
Avoid smoking and alcohol consumption.
Maintain good oral hygiene, as poor oral hygiene is a risk factor for bacterial pneumonia.
Ensure prompt medical care if you have chronic conditions such as asthma.
Consult your doctor regarding the following vaccinations for infants and children to prevent pneumonia:
H. influenzae type b vaccination (Hib Vaccination): Recommended for infants and children under 5 years of age. The vaccination schedule can be a 3-dose series with doses taken at 2, 4, and 6 months plus a booster dose at 12-15 months or a 2-dose series with doses taken at 2 and 4 months plus a booster dose)15,16
Pertussis vaccination (DTaP / Tdap Vaccination): The DTaP vaccine is administered during childhood, while the Tdap booster is advised for adolescents and adults, especially for pregnant women. However, this vaccination does not directly prevent bacterial pneumonia17.
Pneumococcal vaccination (PCV 15/PCV20 and PPSV23): Helps protect against S. pneumoniae. This vaccination is recommended for all children under 5 years of age and for children and adults with chronic conditions like diabetes and chronic lung disease18.
By following these steps, you can reduce your risk of developing bacterial pneumonia and improve your overall health3,7.
If left untreated, bacterial pneumonia can lead to complications like7:
Fluid buildup around the lungs (pleural effusion)
Pus collection in the lung area (empyema)
Infection in the lung (lung abscess)
Breathing difficulty due to lung damage
Residual lung scarring after severe pneumonia or acute respiratory distress syndrome (ARDS)19
Widespread infection in the body (sepsis)
Bacteria in the bloodstream (bacteraemia)
Low oxygen levels in the blood (hypoxemia)
Early diagnosis and proper treatment of bacterial pneumonia can help prevent serious and potentially life-threatening complications7.
When to See a Doctor
You should consult a doctor for bacterial pneumonia if you experience symptoms like a persistent cough, chest pain, difficulty breathing, or a high fever3,7.
You should seek immediate medical attention if you are at an increased risk of developing bacterial pneumonia (if you are an adult over 65 years of age, a child under 5 years of age, or if you are facing any other chronic medical conditions)3,7.
Bacterial pneumonia is a serious infection that continues to pose a major global health challenge. Understanding its causes, risk factors, symptoms, and the importance of timely diagnosis and appropriate antibiotic treatment is key to improving outcomes. Preventive measures such as good hygiene, vaccination, and lifestyle modifications play a crucial role in reducing the risk of bacterial pneumonia. Most importantly, early medical attention, especially for high-risk individuals, can significantly lower the chances of complications and ensure better recovery.
Yes, bacterial pneumonia can recur after treatment. The chances of recurrence are increased in individuals with underlying health conditions, weakened immunity, or poor lung function. Recurrence may also happen if the initial infection wasn’t completely treated3,7.
When will my symptoms start to improve?
Most patients show improvement in 48 to 72 hours. If there is no improvement, an alternative cause should be suspected3.
Can bacterial pneumonia develop as a complication of viral pneumonia?
Yes, bacterial pneumonia can often develop as a secondary infection following viral illnesses like COVID-19 or influenza, often worsening the clinical outcome11.
What benefits does walking have for individuals with bacterial pneumonia?
Mild physical activity like walking can aid recovery; however, strenuous exercise should be avoided until your doctor confirms full recovery and lung function is stable. Consult your doctor to understand if exercises are suitable for your condition20.
References
Troeger C, Blacker B, Khalil IA, Rao PC, Cao J, Zimsen SRM, et al. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Infectious Diseases [Internet]. 2018 Nov;18(11):1191–210. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6202443/
Miyashita N. Atypical pneumonia: Pathophysiology, diagnosis, and treatment. Respiratory Investigation [Internet]. 2021 Nov;60(1). Available from: https://pubmed.ncbi.nlm.nih.gov/34750083/
Pahal P, Rajasurya V, Sharma S. Typical Bacterial Pneumonia [Internet]. National Library of Medicine. StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534295/
Kohbodi GA, Rajasurya V, Noor A. Ventilator-associated Pneumonia [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507711/
Ostergaard L, Huniche B, Andersen PL. Relative bradycardia in infectious diseases. The Journal of Infection [Internet]. 1996 Nov 1;33(3):185–91. Available from: https://pubmed.ncbi.nlm.nih.gov/8945708/
Patterson CM, Loebinger MR. Community acquired pneumonia: assessment and treatment. Clinical Medicine [Internet]. 2012 Jun;12(3):283–6. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4953496/
Shea KM, Hobbs ALV, Jaso TC, Bissett JD, Cruz CM, Douglass ET, et al. Effect of a Health Care System Respiratory Fluoroquinolone Restriction Program To Alter Utilization and Impact Rates of Clostridium difficile Infection. Antimicrobial Agents and Chemotherapy [Internet]. 2017 Jun;61(6). Available from: https://journals.asm.org/doi/10.1128/aac.00125-17
Gilsdorf JR. Hib Vaccines: Their Impact on Haemophilus influenzae Type b Disease. The Journal of Infectious Diseases [Internet]. 2021 Sep 30;224(Supplement_4):S321–30. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8482018/
Matthay MA, Zemans RL, Zimmerman GA, Arabi YM, Beitler JR, Mercat A, et al. Acute Respiratory Distress Syndrome. Nature Reviews Disease Primers [Internet]. 2019 Mar 14;5(1). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6709677/
Ikeda T, Inoue S, Konta T, Murakami M, Fujimoto S, Iseki K, et al. Can Daily Walking Alone Reduce Pneumonia-Related Mortality among Older People? Scientific Reports [Internet]. 2020 May 22;10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244731/
Wang S, Dunn N. Leptospirosis. [Updated 2024 Sep 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441858/
Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.
1
HPV in Men: What It Is, Causes, Symptoms & Treatment
Introduction
HPV (Human Papillomavirus) infection is a sexually transmitted infection commonly affecting both men and women. Some types of HPV are considered low-risk and may cause warts, while others are high-risk types and that can even lead to cancer.
HPV is more often discussed in women due to the risk of cervical cancer. However, there a 90% probability of men too being infected with HPV through their lifetime. Though not always serious, it can sometimes cause cancer of the penis, anus, or certain parts of the throat, such as the base of the tongue and tonsils1.
In this blog, we will focus on HPV in men, how to get tested and manage this infection.
What is HPV (Human Papillomavirus)?
HPV is a virus that infects the surface layers of the skin and mucus membranes (thin linings) of the body areas like the genitals, anus, and parts of the throat, commonly spread through sexual contact. It can cause infections in these areas of skin with minor or sometimes even no symptoms, especially in cases of genital infection. The rate of HPV in men is high throughout their lives, while in women, the infection rate reduces as they age.
There are over 200 HPV types and are mainly classified as: the low-risk type (like HPV-6, 11) the high-risk type (like HPV-16, 18) of HPV. Women are infected more often with the high-risk type, while in men, both the high- and low-risk types are equally common1,2.
In my practice, I have noticed that a lot of cases of oropharyngeal cancers in men occur due to HPV-16, after smoking. These men are at a life long risk of cancer, not just younger age groups.
HPV is easily spread from one person to another in different ways, such as:
Through vaginal, oral, and anal sex.
Through skin-to-skin contact.
By touching contaminated underwear or shared objects.
By hand contact, if the virus is present on the skin2.
The risk is higher in men who have sex with men, in those who are HIV-positive, or in those with infected partners. In rare cases, HPV can also pass to a unborn children through sperm or egg, leading to infection3.
Why HPV is a Concern for Men
HPV infections can be concerning for men because they often have no symptoms, and many are unaware that they have an infection which can easily pass to their partners.
In men, the low-risk type HPV can cause warts (growths on skin) on gentiles or mouth/throat, but the high-risk type can lead to more serious health issues like cancers affecting the skin around the penis and anus and some mouth/throat cancers. Some research studies also suggest that HPV may affect sperm quality in men, although a clear link has not been proven yet.
Moreover in men, the immune response to HPV is often less effective in clearing the virus completely, and it may remain in the body or come back later. This means the virus can stay for a long time in the body or become active again, causing reinfection and unintentional spread to their partner.
Unlike for women who have HPV related cervical cancer screening, there is no regular screening for the HPV test for men. However, the risk of HIV infections is higher in some categories of men such as those who have sex with other men or those with HIV3,4.
Therefore, though HPV is commonly spoken about in women, men may also have serious health issues when infected with HPV and need regular HPV-related cancer screening using anal smears or HPV DNA testing, especially in certain groups4,5.
Risks & Complications of HPV in Men
HPV is not always dangerous and often goes away without causing much trouble5. But in some cases, it can lead to various health issues like:
Condyloma acuminata: Small, flesh-coloured or grey, painless growths (warts) around the penis, anus, or nearby areas, usually caused by low-risk HPV types.
Adult-onset recurrent respiratory papillomatosis (AoRRP): A rare condition where HPV (mainly types 6 and 11) causes wart-like growths in the throat. It typically appears in men in their 30s–40s and presents with symptoms such as hoarseness. Seen in men who have oral sex.
Cancers: High-risk HPV types may cause cancers in the penis, anus, mouth, certain parts of the throat, tongue and tonsils1,2.
These risks show that it is important for men to be aware of HPV, identify the symptoms and take steps to manage it early.
Symptoms of HPV in Men
Usually, men with HPV do not show many symptoms. But when symptoms are present, they depend on the type of HPV and the location of the infection. Some possible symptoms include:
Warts: Small, painless, flat, or cauliflower-like growths on the penis, anus, or groin (usually caused by low-risk HPV).
Throat symptoms: Hoarse voice, breathing trouble, or airway blockage due to wart-like growths (seen in recurrent respiratory papillomatosis).
Cancer signs: High-risk HPV may cause penile or anal cancer. Penile cancer may show red or painful growths. Anal cancer may cause lumps, bleeding, discharge, pain, itching, or bowel changes1,6. HPV related cancer in the base of the tongue or tonsils often shows up as a neck lump or sore throat. It may also cause trouble swallowing, throat pain, or an earache. All these symptoms may not appear early, but later as the disease progresses7.
These symptoms may also occur in other conditions. While there is no standard test for HPV in men, a specific test like the anal pap smear test may be advised for those who have sex with men or HIV patients. So, it is better to consult a doctor who may advise you to get the HPV test male and accordingly manage the condition based on the results1,6.
Cancers Linked to HPV in Men
Several cancers in men are linked to the high-risk HPV type, especially HPV-16 and HPV-18. HPV is a major cause of certain throat cancers, especially those in the oropharynx (like the base of the tongue and tonsils), often seen in men with a history of oral sex. It also causes 40–50% of penile cancers and about 90% of anal cancers, particularly in men who have sex with men or in HIV-positive men. These cancers may start as small precancerous growths and progress to become cancerous1,2.
But how do men test for HPV to reduce the risk of getting these cancers? We will find it in the next section.
HPV Testing for Men
As of now, there are no standard HPV test for men that are approved for screening. In males without any symptoms, it is hard to test for HPV. However, HPV testing may be recommended in the following situations:
When the man’s partner is HPV positive or has an HPV-related disease.
When he shows HPV symptoms.
In high-risk categories such as men who have sex with men or men who have HIV2,4.
Most of the time, warts are checked by doctors just by looking at them and are diagnosed based on how they appear. Testing is usually done on warts or visible spots only if the doctor thinks it could be a serious type of HPV.
While not routinely done, anal cytology (Pap smear) can be advised for detecting HPV in men who may have weakened immune systems or those who engage in anal intercourse (high-risk categories). Here, a soft swab is used to collect cells from the anal region to check for early signs of cancer4.
Male HPV tests, particularly for high-risk categories, also include molecular tests like PCR, used to detect HPV DNA (genetic material of virus) and identify its type. Samples can be taken from areas like the penis, throat, mouth, or skin growths2.
For men who had cancer linked to HPV, their follow-up after treatment involves regular check-ups, scans, or cytology. HPV DNA test may be done only if the doctor recommends it2,6.
Treatment Options for HPV in Men
HPV infection cannot be cleared by any specific antiviral medicine, and there is no standard management plan. In most cases, the immune system clears the HPV virus on its own7,8,9. However, for HPV related growths and cancers, especially genital warts and early signs of cell changes that could turn into cancer, there are clear treatment options available10.
The focus is mainly on addressing visible growths and related health problems. For growths around the penis, topical creams like imiquimod may stimulate an immune response and clear the warts, though they do not remove the virus completely in that area.
Surgery, radiation, or cancer-related medicines may be suggested in cases where cancer has developed due to HPV8,9.
Immunotherapy medicines such as nivolumab, and pembrolizumab help the body’s immune system fight cancer and are used in some HPV-related cancers of certain areas of the throat11.
Managing HPV should include both partners to help reduce the chance of passing the virus back and forth8,9.
An important point to note here is that HPV doesn’t behave the same at all anatomical sites. In males, there is no particular test to detect early HPV like Pap smear in females. Clearance may be faster in men than in women, but men generate weaker long-lasting antibody responses, meaning reinfection is common.
HPV vaccines may help reduce the chances of getting HPV and may lower the risk of HPV-related cancers by up to 90%. Though vaccines are often focused more on women, men may also benefit, as they experience more than 90% of certain HPV-related cancers. HPV vaccines help protect against the many high-risk types of the virus (like types 16 and 18), which can cause cervical cancers and many other cancers in the genital and throat areas.
HPV vaccines have shown strong benefits with good efficacy and immune response. In India, in 2021, Gardasil 9, a vaccine that may be given to both men and women, was introduced8.
The HPV vaccine can be given to males aged 9 to 26 years. It may also be given up to age 45, based on a person’s health and risk factors, as advised by a doctor.
For boys aged 9 to 14 years, two doses are given. The second dose is given 6 to 12 months after the first. If the second dose is given too early (less than 5 months apart), a third dose is needed.
For males aged 15 to 45 years, three doses are given. The second dose is given after 2 months, and the third dose after 6 months from the first8,12.
Getting vaccinated is one way you may help reduce the risk of spreading HPV and avoid the health risks associated with HPV.
How to Prevent Spreading HPV
You can reduce the chances of getting HPV and its related complications by following these tips13,14:
Safe sex: If you are sexually active, using condoms may give you some protection against HPV, though the virus can still spread through skin contact in uncovered areas.
HPV vaccine: This vaccine may help you and your partner stay protected from certain types of HPV that are linked to cancer.
Screening: Routine screening is usually not done in men, but a Male HPV test, such as an anal Pap test for anal cancer or an HPV DNA test may be used in certain high-risk groups like men who have sex with men or those with HIV. If you have a female partner, she may need screening for cervical cancer, as HPV can be a cause in both.
Quit smoking: Avoiding smoking is advised, as it may make it harder for the body to clear HPV and increase the risk of HPV-related cancers.
By taking timely action and staying aware, you and your partner may be safeguarded from serious health risks related to HPV.
You need to see a doctor if you observe any changes in your body or any symptoms that are unusual. This could include a new growth or lump in the genital or anal area, sometimes with pain or bleeding. If you come to know that your partner has HPV, you may ask the doctor if you can get the HPV testing for men and, also get guidance on whether the vaccine can be taken to reduce the risk of exposure6,13.
HPV cannot be taken lightly in men, as it may lead to cancer in some cases. The symptoms may not always be visible, but being aware, taking necessary precautions, getting vaccinated, and seeking medical advice can help you and your partner stay healthy and safe.
How long does it take for symptoms to develop if I have HPV?
HPV symptoms do not appear immediately after getting infected with HPV. It may take weeks, months, or even years for signs to show up6.
If I have genital warts, will I have cancer?
Genital warts are usually non-cancerous. They are typically caused by low-risk HPV and resolve on their own. However, in case of persistent lesions, it’s best to consult your doctor. They will examine the lesion and advise HPV testing if needed1.
How can I protect my son from HPV?
HPV can cause genital warts and, in some cases, lead to cancers in the anus, penis, mouth, or throat, even in men. You may get your son vaccinated before the start of sexual activity. Consult your doctor to know more about the HPV vaccine and prevention strategies.
Can men be tested for HPV related cancer?
Yes, anal cancer screening through cytology may be advised for men at high risk, such as those who have sex with men or are HIV-positive. Regular checkups can help detect early signs6,8.
References
A. Garolla, Graziani A, Grande G, Ortolani C, Ferlin A. HPV-related diseases in male patients: an underestimated conundrum. Journal of endocrinological investigation. 2023 Sep 28;47(2):261–Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10859347/
Lenzi A, Mirone V, Gentile V, Bartoletti R, Ficarra V, Foresta C, et al. Rome consensus conference – statement; human papillomavirus diseases in males. BMC Public Health. 2013 Feb 7;13(1). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3642007/
Naidoo D, Govender K, Mantell JE. Breaking barriers: why including boys and men is key to HPV prevention. BMC Medicine. 2024 Nov 8;22(1). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11549739/
Giovannelli L, Migliore MC, Capra G, Caleca MP, Bellavia C, Perino A, et al. Penile, Urethral, and Seminal Sampling for Diagnosis of Human Papillomavirus Infection in Men. Journal of Clinical Microbiology. 2007 Jan;45(1):248–51. Available from: https://journals.asm.org/doi/10.1128/jcm.01576-06
Lechner M, Liu J, Masterson L, Fenton TR. HPV-associated oropharyngeal cancer: epidemiology, molecular biology and clinical management. Nature Reviews Clinical Oncology. 2022 Feb 1;19(19). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8805140/
Zou K, Huang Y, Li Z. Prevention and treatment of human papillomavirus in men benefits both men and women. Frontiers in Cellular and Infection Microbiology. 2022 Nov 24;12. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9729793/#s4
Kaur KN, Niazi F, Nandi D, Taneja N. Gender-Neutral HPV Vaccine in India; Requisite for a Healthy Community: A Review. Cancer Control. 2024 Jan 1;31. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11440547/
O’Mahony C, Gomberg M, Skerlev M, Alraddadi A, de las Heras‐Alonso ME, Majewski S, et al. Position statement for the diagnosis and management of anogenital warts. Journal of the European Academy of Dermatology and Venereology [Internet]. 2019 Jun 1 [cited 2021 Aug 9];33(6):1006–19. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6593709/
Huang Y, Lan Y, Zhang Z, Xiao X, Huang T. An Update on the Immunotherapy for Oropharyngeal Squamous Cell Carcinoma. Frontiers in Oncology [Internet]. 2022 Mar 15 [cited 2024 Jan 27];12. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8965058/
Gallego LS, Dominguez A, Parmar M. Human Papilloma Virus Vaccine [Internet]. Nih.gov. StatPearls Publishing; 2024 [cited 2025 Jul 21]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562186/
Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.
Typhoid Test: What is It, When To Be Taken & Side Effects
Introduction
The typhoid infection has been increasing in India over the past few years, affecting around 10 million people in 20211. The infection is caused by the Salmonella typhi bacteria that enters and spreads throughout your body when you consume contaminated food or water1,2. Some symptoms of typhoid, like fever, tiredness, and stomach pain, can resemble other diseases like malaria. Therefore, doing a typhoid test may help confirm the infection3,4.
In this blog, we will explain what typhoid is, which test is done for typhoid, and when to take it.
What is Typhoid Fever?
Typhoid fever is a serious infection that spreads throughout the body after the bacteria enter the body through contaminated food or water. After the bacteria pass through the intestinal walls, they reach the blood within 24 hours. The infection then spreads to other organs like the liver, spleen, bone marrow, gall bladder, and, sometimes, into the brain. Within 7 to 14 days of exposure, symptoms like high fever, body pain, abdominal pain, and weakness start to show. If not tested and treated early, typhoid can become more severe with complications like bleeding in the stomach, perforation of the intestines, and brain-related issues like delirium, confusion, and memory loss2,5.
Why Typhoid Testing is Important?
The typhoid test is important to confirm that you have a typhoid infection. It helps to differentiate typhoid from other illnesses like dengue and malaria, which may have similar symptoms6.
Testing in the early stage may help you take the right antibiotic and medicines, so the disease doesn’t become more severe and cause complications6,7,8. It also may help your doctor choose the most effective antibiotic, as some bacteria in India do not respond well to certain antibiotics like fluoroquinolones2.
Testing may help find who is having typhoid, and necessary precautions can be taken to not spread it to others. In places where typhoid is prevalent, it may help to find out how many people are affected and whether it is becoming an outbreak, so that action can be taken to prevent its spread9.
When Should You Get Tested for Typhoid?
Your doctor may advise you to get a typhoid test if you have2,10:
A high body temperature above 38°C that rises gradually (step-wise pattern) for three or more days without a clear reason2,10
Symptoms like headache, body pain, abdominal pain, constipation (seen in the early stage) and sometimes diarrhoea (occurs later). In severe cases, confusion or drowsiness may be seen2,11,12.
Recent travel to typhoid-affected area or close contact with a typhoid-affected individual in the last 28 days2,10
In such cases, a doctor may look into your symptoms, medical history and accordingly recommend an appropriate blood test for typhoid.
In my experience, I have noticed that unlike other fevers where pulse usually rises by 10 with every 1 degree increase in temperature, in typhoid fever, the heart beat may remain normal or slow down to less than 60 beats per minute. This relative bradycardia is classical sign seen in typhoid.
The risks of typhoid depend on an individual’s age, environment, and location and is higher in the following individuals2,3,13:
People living in areas with unclean water and poor sanitation
Travellers to places where typhoid is common (areas of Africa, Asia, or Latin America)
Those with a weak immunity, including those with HIV/AIDS, cancer, and those taking medicines that lower their immunity (steroids or cancer medicines) 2
Children under 15 years of age, especially between 5 and 15 years, and those in areas where typhoid is common 2,14
If these individuals experience symptoms of typhoid fever, it is best to consult a doctor who may advise a blood test for typhoid.
A with a fever lasting more than two weeks with decrease in white blood cell counts should raise the suspicion of typhoid fever. If you notice any rose coloured spots present over your chest and abdomen resembling mosquitoes/insects bites along with persistent fever, these could be signs of typhoid.
There is no single test that can confirm a typhoid infection. A blood culture test is considered the gold standard test for typhoid; however, different typhoid tests may help identify typhoid infection and provide more accurate results when done early. Let us see how to test for typhoid using different tests:
1. Culture Tests
This is considered the standard test for typhoid. In this test, a sample of your blood or bone marrow is checked to find the presence of bacteria causing typhoid. It may give more reliable results compared to other tests when done in the first week of illness. It has a sensitivity of 50-80%, which means it can correctly detect the infection 5 to 8 times out of 10. Stool and urine samples can also be helpful, but they may be less reliable early on.
2. Antibody Tests
The widal blood test for typhoid checks for antibodies which your body produces against the bacteria. It may be used commonly in areas where the disease is spreading fast. However, the results may be affected if there was any past infection or other Salmonella diseases2,6. It usually shows positive results only after 7 to 10 days of infection, and also may miss real cases or show false positives due to low sensitivity and low specificity2,15.
3. Molecular Tests
The Polymerase Chain Reaction (PCR) test may help identify the genetic material (DNA) of the typhoid bacteria and show which antibiotic may work and which may not (including fluoroquinolone antibiotics). It may be more reliable compared to other tests, but it is costly and not commonly used for routine typhoid testing2,16.
Along with these, the doctor may advise other tests to rule out conditions like malaria and brain fever. A blood count is taken to check for a low white cell count or anaemia, and liver function tests may also be done. Together, these tests may help the doctor get a clearer picture of your disease condition and decide on how to manage it2,6.
Treatment and Management
Treatment of typhoid primarily involves appropriate antibiotics, based on the resistance pattern of typhoid in that region.
Once typhoid is suspected, medication should be started as soon as possible to help prevent complications. Doing a blood culture test before starting antibiotics may help confirm the infection and guide the right choice of antibiotic for it16. However, antibiotics may also be started early based on the individual’s condition and the doctor’s judgement before test results are available, especially in areas with limited medical facilities2.
For mild cases
Oral antibiotic medicines may be given along with fever medicines like paracetamol to manage typhoid. Oral replacement fluids may help for symptoms like vomiting or diarrhoea2,17,18.
For severe cases
Hospital admission may be needed. Medicines like antibiotics and fluids may need to be given through the vein.
The following antibiotics may help manage typhoid:
Ciprofloxacin: Can be given orally in areas with low resistance. but it may not work well in regions like India and South Asia due to widespread resistance against this antibiotic.
Azithromycin: In mild cases where there is resistance to ciprofloxacin18,19.
Ceftriaxone: For severe cases, it is given as an injection.
Combination: In severe or extreme drug-resistant typhoid cases, combining antibiotics may help, for example, azithromycin with meropenem or ceftriaxone. However, this depends on the resistance pattern and blood culture results20.
Usually, the fever may reduce in 3 to 5 days after taking medicines. If not, antibiotics may need to be changed based on blood test results2,17.
It is important to consult a doctor to get the right plan for managing the disease based on your symptoms and clinical condition.
Complications
Complications may develop in some patients after 2 to 3 weeks of typhoid infection. These may vary based on age, gender, existing health conditions, and the region, as follows.
Digestive issues: Diarrhoea, dehydration, and liver problems, especially in children. Complications like perforation in the intestines are dangerous and may need surgery.
Brain and nerve problems: Seizures, severe confusion (delirium), brain infections (meningitis) and other brain-related problems like altered thinking/ behaviour, trouble walking, and muscle stiffness, may be seen in some children2,3.
Other health problems: Low blood count, lung infections (such as pneumonia) may occur, especially in children, people with lung diseases like cancer, or those taking medicines that lower the body’s immunity. In pregnant women, although complications are not very common, a severe infection can increase the risk of miscarriage, early delivery, or loss of the baby2,21.
Even after treatment, some people may carry the bacteria for weeks or months without feeling sick, but they can still spread the disease. In such cases, proper precautions should be taken to reduce the risk of spreading it to others2,3.
How to Prevent Typhoid?
As typhoid is mainly spread by contaminated food and water, following these practices may help reduce the risk of getting typhoid:
Wash your hands properly using soap and water, especially after you use the bathroom or before preparing or eating food. If soap is not available, use a hand sanitiser with at least 60% alcohol but, it may not be as effective as soap and water for typhoid prevention22,23,24.
Drink only boiled water or bottled water.
Avoid raw vegetables and fruits that you cannot peel.
Eat foods that are well-cooked, hot and steaming. Avoid eating foods cooked in unhygienic conditions, like food from roadside shops.
Drink pasteurised milk from sealed bottles.
Vaccination against typhoid may give you added protection, especially when you are going to areas where it is more common22,23.
Typhoid Vaccination
Typhoid vaccinationmay be advised for those who travel to typhoid-affected areas, laboratory workers handling typhoid bacteria, and those who are in close contact with a typhoid case. Two vaccines that may help in such cases are:
Inactivated (Vi polysaccharide) vaccine
This may help to develop antibodies that may fight against typhoid. It is given as an injection taken as per the doctor’s advice at least 2 weeks before travel (as protection usually starts within 7–14 days), and repeat doses every 2 years5,26.
Immunity is usually achieved within 7–14 days with theVi polysaccharide vaccine, but it’s ideal to take it at least 2 weeks before exposure.
Vi conjugate vaccine (TCV): This is a vaccine with Vi polysaccharide but joined to a special protein, which is why it is called a conjugate vaccine. It is WHO-prequalified and preferred in many countries where typhoid is common, even in India. It may give protection for up to 5 years, may work well in children under 2 years, and needs only one dose5,27,28.
Live attenuated (Ty21a) vaccine
It may help stimulate the immune system to act against typhoid bacteria. It can be given to people aged 6 years and older. One capsule is taken every other day (on day 1, 3, 5, and 7), for a total of 4 capsules. It should be taken at least 1 week before travel, and a booster dose may be given once in 5 years. This vaccine may not be suitable for people with weak immune systems or those taking antibiotics.
Vaccine is not a substitute for safe hygiene practices, as it may not be 100% effective5,25.
For quicker recovery from typhoid and to prevent spread of the disease, follow these things:
Take all the medicines as advised by the doctor.
Take adequate rest and drink plenty of water and fluids.
Eat easy-to-digest soft foods
Consult a doctor if your condition does not improve
Do not prepare or serve food to avoid spread of the infection
You may ask about vaccinating your child.
Once you have fully recovered, you also need to monitor closely for typhoid symptoms for at least 3 months, as there is a risk of relapse or developing complications of typhoid during this period29.
You need to see a doctor and may be advised to undergo a blood test for typhoid if you:
Have recently gone to a place where there are typhoid cases, and now have typhoid symptoms.
Have persistent fever for more than 3 days, severe abdominal pain, hard or swollen stomach, blood in stools/ vomiting in blood, severe weakness, confusion, or any other new symptoms.
Have typhoid symptoms after recovery.
Have been in close contact with a person with typhoid2,30.
Typhoid fever can become life-threatening if not identified early with a typhoid test, and treatment is delayed. If you have persistent fever, body pain, and tiredness, especially after recent travel or close contact with a typhoid patient, you need to consult a doctor and get tested. To reduce your chances of getting typhoid, always follow safe hygiene practices for food and water during your travel and even where you stay.
How long will it take for me to recover from typhoid?
You may feel better in 2 to 4 weeks once medicines are started. If treatment is started early, the chances of better recovery are higher, while complications may delay recovery31.
Can I spread typhoid even after I have recovered?
Yes, a few people may carry the bacteria for a long time, sometimes even for life, and can still spread it to others.
If I have typhoid, should I isolate myself from others?
Not everyone who has typhoid needs to be isolated. The bacteria usually spread through the faeces. Only children or those who cannot control diarrhoea may need isolation. Others should follow good hygiene after using the toilet and can return to normal activities once recovered30.
Which typhoid vaccine is safe during pregnancy?
The injectable Vi polysaccharide vaccine may be given to pregnant women as it does not contain live bacteria. The oral Ty21a vaccine is not recommended during pregnancy32.
References
Mehta K, Joshi M, Omar MA. Typhoid fever in India: A growing concern requiring immediate preventive efforts. Health science reports [Internet]. 2024 Feb 1;7(2). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10867790/
Wijedoru L, Mallett S, Parry CM. Rapid diagnostic tests for typhoid and paratyphoid (enteric) fever. Cochrane Database of Systematic Reviews. 2017 May 26;
Veronese P, Pappalardo M, Maffini V, Rubini M, Giacometti A, Ruozi MB, et al. Severe Typhoid Fever Complicated by Superior Mesenteric and Splenic Vein Thrombosis. Infectious Disease Reports [Internet]. 2023 Aug 1 [cited 2023 Dec 16];15(4):377–85. Available from: https://www.mdpi.com/2036-7449/15/4/38
CDC. About Typhoid Fever and Paratyphoid Fever [Internet]. Typhoid Fever and Paratyphoid Fever. 2024 [cited 2025 Jul 13]. Available from: http://cdc.gov/typhoid-fever/about/index.html
Ochiai RL. a study of typhoid fever in five Asian countries: disease burden and implications for controls. Bulletin of the World Health Organization. 2008 Apr 1;86(4):260–8. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2647431/
Bakr WM, El Attar LA, Ashour MS, El Toukhy AM. The dilemma of widal test – which brand to use? a study of four different widal brands: a cross sectional comparative study. Annals of Clinical Microbiology and Antimicrobials. 2011;10(1):7. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3050682
Khokhar F, Pickard D, Dyson Z, Iqbal J, Pragasam A, John JJ, et al. Multiplex PCR assay to detect high risk lineages of Salmonella Typhi and Paratyphi A. Hosuru Subramanya S, editor. PLOS ONE [Internet]. 2022 Jul 22;17(7):e0267805. Available from: https://doi.org/10.1371%2Fjournal.pone.0267805
Kalra S, Naithani N, Mehta S, Swamy A. Current Trends in the Management of Typhoid Fever. Medical Journal Armed Forces India [Internet]. 2003 Apr;59(2):130–5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4923770/
Kuehn R, Stoesser N, Eyre D, Darton TC, Basnyat B, Parry CM. Treatment of enteric fever (typhoid and paratyphoid fever) with cephalosporins. Cochrane Database of Systematic Reviews. 2022 Nov 24;2022(11). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9686137/#CD010452-sec-0158
Sulaiman K, Sarwari AR. Culture-confirmed typhoid fever and pregnancy. International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases [Internet]. 2007 Jul 1 [cited 2021 Oct 20];11(4):337–41. Available from: https://pubmed.ncbi.nlm.nih.gov/17321180/
FODDAI ACG, GRANT IR, DEAN M. Efficacy of Instant Hand Sanitizers against Foodborne Pathogens Compared with Hand Washing with Soap and Water in Food Preparation Settings: A Systematic Review. Journal of Food Protection. 2016 Jun;79(6):1040–54. Available from: https://www.sciencedirect.com/science/article/pii/S0362028X22080887
Zhu H, Chelysheva I, Cross DL, Blackwell L, Jin C, Gibani MM, et al. Molecular correlates of vaccine-induced protection against typhoid fever. Journal of Clinical Investigation. 2023 Aug 15;133(16). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10425215/
Syed KA, Saluja T, Cho H, Hsiao A, Shaikh H, Wartel TA, et al. Review on the Recent Advances on Typhoid Vaccine Development and Challenges Ahead. Clinical Infectious Diseases. 2020 Jul 29;71(Supplement_2):S141–50. Available from: https://academic.oup.com/cid/article/71/Supplement_2/S141/5877822
Typhoid Fever | Official Website of Department of Health & Family Welfare, Government of Puducherry, India. [Internet]. Py.gov.in. 2020. Available from: https://health.py.gov.in/typhoid-fever-
Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.
Links and product recommendations in the informationprovided here are advertisements of third-party products available on the website. PharmEasy does not make any representation on the accuracy or suitability of such products/services. Advertisements do not influence the editorial decisions or content. The information in this blog is subject to change without notice. The authors and administrators reserve the right to modify, add, or remove content without notification. It is your responsibility to review this disclaimer regularly for any changes.
1
Walking Pneumonia: What Is It, Causes, Symptoms, Diagnosis & Treatment
Introduction
Are you wondering what is walking pneumonia? Walking pneumonia or atypical pneumonia is an infection of the lower respiratory tract1. This condition is generally a milder form of pneumonia where the patient may be well enough to walk around, that’s why it’s called “walking pneumonia2”.
This type of pneumonia is usually acquired outside of hospital or healthcare settings and caused by pathogens that are not commonly associated with pneumonia and not easily detectable by common staining and culture methods1. The most common organisms associated with walking pneumonia include the bacteria Mycoplasma pneumoniae, Chlamydia pneumoniae, or Legionella pneumoniae3.
Bacterial atypical pneumonia comprises around 15% of the total pneumonia cases acquired outside of hospital and healthcare settings4.Although, usually these infections are not very severe, the mortality of walking pneumonia among the elderly is 8.0%, while in younger, healthy individuals, the mortality is 0.5-2.0%5.
What Is Walking Pneumonia?
Walking Pneumonia, scientifically referred to as atypical pneumonia, is a milder form of lung infection, often caused by Mycoplasma pneumoniae, that generally does not require hospitalisation.
As this pneumonia usually has a mild course , most affected individuals can still continue their routine without any interruption to your daily activities and hence, this condition is commonly referred to as walking pneumonia2. However, it is important to note that the severity of pneumonia can range from mild to life-threatening depending on factors such as age, the type of organism causing the infection, and when the walking pneumonia treatment is started1.
Causes of Walking Pneumonia
You may be wondering what causes walking pneumonia. Actually, walking or atypical pneumonia is caused by an invasion of bacteria (most commonly), and viruses or fungi (less commonly), that leads to inflammation of your air sacs or alveoli in your lungs1.
Bacteria: Bacteria such as Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella pneumoniae are the most common causative organisms of atypical pneumonia3.
Viruses: Viruses such as the severe acute respiratory syndrome coronavirus 2 may cause atypical pneumonia3.
Fungi: Rarely, pneumonia may be caused by fungi, especially in individuals with a weak immune system6.
Walking pneumonia is typically acquired from the community (outside a hospital setting), most often by inhalation of respiratory secretions that contain the causative organism.
Types of Atypical Pneumonia
Based on what causes walking pneumonia, the different types of atypical pneumonia include:
Mycoplasma pneumonia: This condition generally affects children, adolescents and young individuals (typically 5-15 years), but it can occur at any age7,8. In individuals, it can cause a range of symptoms, from mild respiratory tract infections to severe atypical pneumonia9.
Chlamydia pneumonia: This condition can cause upper and lower respiratory tract infections causing symptoms such as headaches, tiredness, hoarseness of voice, fever, sore throat and cough that becomes worse over time10.
Legionnaire’s disease: This condition generally affects middle age and older individuals. It is more often noticed in individuals with a weak immune system or chronic illness and in smokers7. This infection mainly spreads by inhalation or aspiration of contaminated water (For example: showers, hot tubs, etc) The symptoms noticed include fever, muscle pain, headaches, shortness of breath, diarrhoea and cough11.
Q Fever: This condition is caused by the bacteria Coxiella burnetii which may present with symptoms such as fever, tiredness, muscle aches and chills. Q fever is often zoonotic (infection transmitted from animals to humans) and it is commonly noticed in individuals who work closely with animals or livestock. Individuals may get infected by inhaling dust contaminated with animal products and excreta such as faeces, urine and milk3,12.
Psittacosis: Less commonly noticed, this condition generally affects individuals in close contact with pet birds and poultry and is caused by the bacteria, Chlamydophila psittaci (formerly Chlamydia psittaci) which is a zoonotic atypical pneumonia. Common symptoms of psittacosis include headaches, fever, chills, dry cough and muscle pain3,13.
An important difference between viral and atypical pneumonia is that viral pneumonia settles after a week but atypical takes more time and needs to be treated using antibiotics like macrolides, doxycycline, and fluroquinolones.
Though walking pneumonia is a mild infection, it does not always mean that you may be asymptomatic or fully functional. The walking pneumonia symptoms are generally mild and mainly include1,7:
Fever and chills
Shortness of breath
Dry cough that worsens at night
Sore throat
Headaches
Loss of appetite
Tiredness and low energy
Chest pain
Sweaty skin
Muscle pain and joint stiffness
Less common signs of walking pneumonia that may be noticed in the different types of walking pneumonia include7:
Mycoplasma pneumonia: Otitis media (Ear pain), cervical lymphadenopathy (lump in the neck), erythema multiforme (rashes), and conjunctivitis (eye pain and soreness)
Legionella pneumonia: Diarrhoea, vomiting, blood in mucous
Chronic medical conditions such as diabetes, heart or lung disease, chronic liver disease, etc.
Living in crowded settings
Smoking
Excessive alcohol consumption
You may pose an increased risk of developing specific types of atypical pneumonia if you are:
A child, teenager or an adult under 40 years of age (Risk factor for Mycoplasma pneumonia). Although it can occur in older adults, it is less common7.
Increased age, smoking, weak immune system, chronic lung disease and exposure to contaminated water (Risk factor for Legionella pneumonia)7 ,11.
In close contact with infected birds and poultry or exposure to bird droppings and secretions increase your risk of Psittacosis infection. (Risk factor for Psittacosis)13.
Is walking pneumonia contagious?
Yes, it is contagious and walking pneumonia symptoms can spread from person to person. However, infections caused by Legionella pneumonia and Coxiella burnetii (Q fever) are not spread from person-to-person1.
The most common type of walking pneumonia caused by Mycoplasma pneumonia is highly contagious and spreads through infected droplets of affected individuals especially when they cough and sneeze. The disease spreads when you inhale these infected droplets15.
Hence, close proximity with an infected individual over an extended period of time causes the spread of infection. The symptoms are generally noticed two to three weeks post exposure to the causative agent (Mycoplasma pneumonia). However, it is important to note that you may be contagious before any symptoms appear and generally, once infected, the contagious period is around 10 days and may be longer, if not treated15.
As per my experience, I suggest that if there’s long standing dry cough in almost every family member spreading from one to another without any allergies triggering it, along with other symptoms like headaches and low grade fever, you should think of atypical pneumonia and consult your doctor immediately.
Your doctor will be able to diagnose walking pneumonia with certain examinations and laboratory tests such as7:
Chest X-ray: Your Chest X-ray may show patchy infiltrates which is a feature of atypical pneumonia. However, it cannot accurately distinguish between walking pneumonia and other pneumonias or respiratory conditions like bronchitis4.
Blood Tests: Based on the severity of your condition, your doctor may recommend laboratory tests such as:
Measurement of arterial blood gases: To check oxygen and carbon dioxide levels in blood (Used in cases where ventilatory failure or hypoxia is suspected)16.
Other blood tests: To identify the specific bacteria causing your illness.
Bronchoscopy (Tube with a camera is passed to your lungs): Only used when diagnosis is unclear, atypical presentations, or failure to respond to treatment.
Swab of nose or throat: To identify any bacteria and viruses
Sputum Culture: To identify specific bacteria causing your illness.
Urine Test: To help in the diagnosis of Legionella pneumonia.
Based on these tests, your doctor will be able to accurately diagnose your condition and will suggest the appropriate walking pneumonia treatment.
Treatment
After a careful assessment of your condition, your doctor will be able to suggest the best walking pneumonia treatment suitable for you.
Macrolide antibiotics: This is generally the first line of treatment to manage walking pneumonia. Macrolide antibiotics prescribed may include azithromycin and clarithromycin1.
The macrolide antibiotics may be combined with broad-spectrum medications including ceftriaxone, cefotaxime depending on the severity of your condition (particularly when both typical and atypical pathogens are suspected)1. If your condition is severe, your doctor may recommend antibiotics intravenously7.
Over-the-counter medications: Non-Steroidal Anti-Inflammatory Drugs or NSAIDs (such as aspirin, ibuprofen, naproxen) and cough medication may be effective in managing symptoms such as fever and cough7. However, in children, aspirin is not recommended.
Drink lots of fluid. This will help to loosen your secretions and bring up the phlegm7.
Delayed treatment in individuals suffering from Legionella or weakened immune systems can worsen treatment outcomes. While delayed treatment may not always lead to severe disease in cases of Mycoplasma infections, early treatment is key for good recovery and prognosis1,11.
Prevention
To reduce your risk of infection, you can follow these steps2,7:
Wash your hands regularly with warm water and soap.
Avoid close contact with individuals who are sick and wear a mask to reduce your risk of infection.
Exercise regularly and eat timely meals with a well-balanced diet.
Ensure that you get a flu vaccination every year to reduce your chance of infection.
If you have a weak immunity, it is recommended to avoid crowds.
Consult your doctor about pneumonia vaccination. Your doctor may suggest that you get vaccinated for pneumococcal pneumonia as it can help protect against Streptococcus pneumoniae, which causes a type of pneumonia not associated with healthcare settings.
To ensure good respiratory health, consult your doctor about DTaP/ Tdap Vaccination (Diptheria, tetanus and pertussis vaccine) as it helpful for your respiratory health.
By following these simple methods, you can avoid catching pneumonia especially if you are at high risk and protect your overall health2.
While individuals with walking pneumonia may be able to carry on with routine activities, certain self-care and hygiene measures can aid in a faster recovery. These include2,7,17:
Get adequate rest and sleep well.
Pay attention to your diet; choose food that is healthy for your heart and stay hydrated.
Quit smoking and avoid alcohol.
Do light exercise. (You doctor can suggest the appropriate regimen)
Practise deep breathing.
Take medications as advised by your doctor.
Keep a watch of your symptoms. If there is no improvement or there is worsening of symptoms even after taking antibiotics, contact your doctor immediately.
Remember, if you are walking around with pneumonia, it’s your responsibility to prevent its spread to others. Avoid any unnecessary contact with other individuals. Avoid going to public places and always cover your mouth while sneezing and coughing or wear a protective mask. Wash your hands with soap and water regularly. Following these simple measures can have a huge public health impact.
You should consult your doctor if you develop signs of walking pneumonia such as fever, shortness of breath, or cough. Your doctor will thoroughly assess your condition and will advise you on the best method to manage your condition.
You should also consult your doctor if you have been diagnosed with pneumonia and if your walking pneumonia symptoms get worse after an initial improvement7.
Walking pneumonia, or atypical pneumonia, is generally a mild respiratory infection commonly caused by atypical bacteria such as Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumoniae. While walking pneumonia symptoms are not very severe, it still requires proper medical care. With timely diagnosis, appropriate walking pneumonia treatment, and good hygiene, you can recover smoothly and avoid complications. Tips like handwashing, vaccinations, and avoiding smoking play a key role in reducing your risk and promoting your overall health.
Although not very common, walking pneumonia can recur after treatment. The chances of recurrence are increased if the infection is not completely removed with antibiotics or if you face any antibiotic resistance1.
What are the complications of walking pneumonia?
If not diagnosed and treated properly, complications may arise and may include brain and nervous system infections (such as meningitis, encephalitis), severe lung damage, haemolytic anaemia (a condition in which the body destroys its own red blood cells) and respiratory failure7.
Can walking pneumonia be detected on a regular physical exam?
Walking pneumonia may not be detected on a routine physical exam alone and your doctor may require a chest X-ray or other laboratory tests to confirm the diagnosis7.
Can I exercise if I have pneumonia?
Exercise may be beneficial in pneumonia. A study18 has shown lower mortality rate in elderly individuals having pneumonia who walk daily compared to individuals who did not walk or exercise in any other form. However, you doctor will guide you best if exercising or walking is suitable for you if you have pneumonia.
References
Stamm DR, Stankewicz HA. Atypical Bacterial Pneumonia [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532239/
Miyashita N. Atypical pneumonia: Pathophysiology, diagnosis, and treatment. Respiratory Investigation [Internet]. 2021 Nov;60(1). Available from: https://pubmed.ncbi.nlm.nih.gov/34750083/
Dueck NP, Epstein S, Franquet T, Moore CC, Bueno J. Atypical Pneumonia: Definition, Causes, and Imaging Features. RadioGraphics [Internet]. 2021 Apr 9;41(3):200131. Available from: https://pubs.rsna.org/doi/full/10.1148/rg.2021200131
Bajantri B, Toolsie O, Venkatram S, Diaz-Fuentes G. Mycoplasma Pneumoniae Pneumonia: Walking Pneumonia Can Cripple the Susceptible. Journal of Clinical Medicine Research [Internet]. 2018 Dec 1;10(12):891–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6225856/
Meyer Sauteur PM, Unger WWJ, Nadal D, Berger C, Vink C, van Rossum AMC. Infection with and Carriage of Mycoplasma pneumoniae in Children. Frontiers in Microbiology [Internet]. 2016 Mar 23;7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803743/
Levin KP, Hanusa BH, Rotondi A, Singer DE, Coley CM, Marrie TJ, et al. Arterial blood gas and pulse oximetry in initial management of patients with community-acquired pneumonia. Journal of General Internal Medicine. 2001 Sep;16(9):590–8. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC1495269/
Ikeda T, Inoue S, Konta T, Murakami M, Fujimoto S, Iseki K, et al. Can Daily Walking Alone Reduce Pneumonia-Related Mortality among Older People? Scientific Reports [Internet]. 2020 May 22;10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244731/
Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.
Links and product recommendations in the informationprovided here are advertisements of third-party products available on the website. PharmEasy does not make any representation on the accuracy or suitability of such products/services. Advertisements do not influence the editorial decisions or content. The information in this blog is subject to change without notice. The authors and administrators reserve the right to modify, add, or remove content without notification. It is your responsibility to review this disclaimer regularly for any changes.
H1N1 (Swine Flu): Causes, Symptoms, Treatment, and Prevention
Introduction
H1N1, also known as swine flu, is a type of influenza A virus that was identified in humans in 2009. It emerged as a result of a mix of genes from flu viruses found in North American swine, North American birds, humans, and Eurasian swine1.
H1N1 causes respiratory illness by infecting the nose, throat, and sometimes the lungs. Its symptoms are similar to those of seasonal flu, which includes, fever, cough, sore throat, and body aches. In India, signidicant H1N1 outbreaks were recorded in 2009 and 2015, and the virus continues to circulate as a seasonal flu strain2.
The H1N1 infection can affect both the upper and lower respiratory tract. In severe cases, it may lead to complications such as viral pneumonia and acute respiratory distress syndrome (ARDS), particularly among vulnerable groups such as pregnant women, young children, the elderly, and individuals with compromised immune systems.
According to the National Centre for Disease Control (NCDC), India saw a significant surge in seasonal H1N1 cases recently, climbing from 1,3202 cases in 2022 to 8,125 cases in 202316. In subsequent years, influenza activity continued as seasonal regional surges, with Maharashtra and Kerala reporting among the highest case numbers. As of 30 September 2025, India had reported 3,320 H1N1 cases and 14 deaths. Influenza A (H1N1) is now monitored as a routine seasonal influenza virus alongside Influenza A (H3N2) and Influenza B through India’s surveillance programme16.
Vaccines that offer protection against the H1N1 virus are widely available and are included in the annual influenza vaccine recommended by global and national health authorities.
Understanding H1N1 causes, symptoms, treatment, and preventive measures is critical for managing future outbreaks and minimising health impacts. This article provides a comprehensive overview of H1N1 influenza to help increase awareness.
What Is Swine Flu (H1N1)?
Swine flu, or H1N1 influenza, is a contagious viral infection caused by a subtype of the influenza A virus, primarily affecting the respiratory tract. The H1N1 virus originated from a mix of swine, bird, and human flu viruses and gained global attention during the 2009 pandemic3.
It is important to note that, although it is called “swine flu,” the virus primarily spreads through inhaling contaminated air (either from an infected person or animal) and not through the consumption of properly cooked pork3,4.
Post-2009 Pandemic Status
Following the official end of the pandemic in August 2010, the H1N1 virus transitioned into a regular, seasonal influenza strain now scientifically designated as A(H1N1)pdm09. Today, it circulates globally alongside other seasonal influenza viruses and is monitored through routine influenza surveillance programmes17. Protection against this strain is included in the annual seasonal influenza vaccine, so a separate swine flu vaccine is not available or required.
Causes of Swine Flu (H1N1)
Swine flu (H1N1) is caused by the influenza A (H1N1) virus3.
Infection occurs when the virus enters the body through the nose, mouth, or eyes. The most common sources of infection include:
Inhalation of respiratory droplets released when an infected person coughs, sneezes, or talks3.
Touching contaminated surfaces or objects and then touching the face (especially nose, mouth, or eyes)3.
While the original H1N1 strain emerged from swine and was occasionally linked to close contact with infected pigs, the 2009 pandemic strain has since adapted to human transmission. In most incidences, it is not spread from pigs to humans. Instead, the virus primarily spreads through droplettransmission and fomite transmission, making person-to-person contact and surface hygiene key areas of prevention.
Symptoms of Swine Flu (H1N1)
Swine influenza (H1N1) presents symptoms similar to seasonal influenza, ranging from mild to severe. Common H1N1 symptoms include3:
Fever or chills
Sweating
Cough
Sore throat
Runny or stuffy nose
Appetite loss
Weight loss
Body aches or muscle pain
Headache
Fatigue or weakness
Shortness of breath (in some cases)
Gastrointestinal H1N1 symptoms such as nausea, vomiting, or diarrhoea are more commonly observed in children6.
H1N1 vs. COVID-19
While both H1N1 (seasonal swine flu) and COVID-19 are highly contagious viral respiratory infections that share foundational symptoms like fever, cough, body aches, and fatigue, they diverge significantly in their timing and clinical presentation18.
Feature
H1N1 (Seasonal Flu)
COVID-19
Symptom Onset
Abrupt and sudden
Gradual progression
Incubation Period
Short (1 to 4 days after exposure)
Long (2 to 14 days after exposure)
Unique Markers
Sudden high fever, cough, sore throat, and prominent body aches
Fever, cough, fatigue, and loss of taste or smell may occur, although this is less common with some newer variants
Complications
Secondary bacterial pneumonia can occur, particularly in high-risk individuals
Pneumonia, blood clots, and post-COVID conditions (Long COVID) may occur, especially after severe infection.
Risk Factors
While swine influenza (H1N1) can affect anyone, certain individuals are at a higher risk. These risk factors include7:
Children under 5 years of age
Adults over 65 years of age
Pregnant women
People with chronic health conditions, such as:
Asthma
Diabetes
Heart disease
Chronic lung diseases(such as COPD and interstitial lung disease)
Individuals with weakened immune systems (e.g., due to cancer, HIV/AIDS, or immunosuppressive therapy)
Obese individuals
Residents of nursing homes or long-term care facilities
Note: Due to natural changes in immune and lung function, pregnancy carries a significantly higher risk for severe H1N1 complications, making an annual flu shot safe and essential in any trimester. If flu symptoms occur, medical guidelines recommend starting antiviral treatment with oral oseltamivir (Tamiflu) immediately without waiting for lab results, ideally within the first 48 hours to protect both mother and baby19.
Swine flu is typically mild, and self-limiting. However, elderly, pregnant women and children may experience severe symptoms. Thus, vaccination in these groups is particularly important14.
Swine flu (H1N1) is diagnosed by detecting the presence of the H1N1 virus in respiratory specimens that are typically collected using nasopharyngeal swabs, nasal swabs, or nasal aspirates, depending on the type of diagnostic test being used. Throat swabs, while sometimes collected, are generally less sensitive and not preferred for molecular testing methods such as RT-PCR, which is commonly used for confirming H1N1 infection.Early and accurate diagnosis helps guide H1N1 treatment and prevent complications.
Rapid influenza diagnostic tests (RIDTs): Provide quick results by detecting viral antigens, but have limited sensitivity, often ranging from 50–70%, especially in adults and outside peak flu season. RIDTs usually cannot distinguish between influenza types or subtypes (e.g., H1N1 vs. H3N2).
Viral culture: Confirms the presence of the virus by growing it in a laboratory. While reliable, it is time-consuming and mainly used for research or confirmation purposes.
Complications of Swine Flu (H1N1)
While many cases of swine flu (H1N1) are mild, the infection can lead to serious complications, especially in high-risk individuals. These complications may require hospitalisation and can sometimes be life-threatening. Common complications include3,9:
Pneumonia (viral or secondary bacterial)
Acute Respiratory Distress Syndrome
Otitis media (ear infection)
Sinusitis
Worsening of chronic medical conditions such as asthma, diabetes, or heart disease
Neurological complications, including:
Seizures (rare)
Encephalopathy
Encephalitis
Guillain-Barré syndrome
Transverse myelitis
Sepsis (a life-threatening response to infection)
Multi-organ failure (in severe cases)
Treatment and Management
The H1N1 treatment focuses on reducing the severity of H1N1 symptoms, preventing complications, and stopping the spread of the H1N1 virus. Management strategies include:
Antiviral medications: Doctors commonly prescribe oseltamivir, zanamivir, and peramivir for symptom control3,10.
Oseltamivir: Administered orally as capsule or liquid suspension, oral oseltamivir is the most widely prescribed frontline systemic antiviral for treating and preventing H1N1 influenza
Zanamivir: Administered using an inhalation device zanamivir acts directly on the respiratory tract to halt viral replication, though it is not recommended for individuals with underlying airway diseases like asthma or COPD because of the risk of brohncospasm.
Peramivir: Administered as a single intravenous infusion, peramivir is generally reserved for hospitalised patients or for those who cannot take oral or inhaled antiviral medications.
Baloxavir Marboxil: Administered as a single oral dose, baloxavir is an antiviral that inhibits viral replication through a different mechanism than neuraminidase inhibitors. It may be considered in selected patients based on clinical judgement and current treatment recommendations
Supportive care: Adequate rest and hydration are necessary when recovering from swine flu.You may even use fever-reducing medications and other symptom-relieving H1N1 treatments, as needed under medical guidance3.
Monitoring for complications: Watch for signs of worsening symptoms such as difficulty breathing, persistent chest pain, or high fever.
Note: They are most effective when started within 48 hours of symptom onset3. Zanamivir is inhaled and not recommended for patients with asthma or COPD due to the risk of bronchospasm. Peramivir is administered intravenously and is usually reserved for hospitalised patients or those unable to take oral medications.
Prevention
Practicing essential H1N1 precautions, such as those mentioned below, can significantly reduce the risk of infection:
Annual flu vaccination: The seasonal flu vaccine includes protection against H1N1 and is recommended for everyone over 6 months of age3.
Frequent handwashing: Wash hands thoroughly with soap and water (for a minimum of 20 seconds) or use an alcohol-based hand sanitiser10.
Covering coughs and sneezes: Use a tissue (or elbow) to cover your mouth and nose when coughing or sneezing10.
Avoiding close contact with sick individuals/animals: Stay away from people or pigs showing flu-like symptoms5,10.
Staying home when sick: Helps prevent the spread of the virus to others10.
Disinfecting frequently touched surfaces: Clean surfaces like doorknobs, phones, and countertops regularly11.
Using a face mask (when necessary): Especially in crowded places or when taking care of someone with flu symptoms11.
Maintaining healthy habits: Support your immune system by getting enough sleep, staying physically active, managing stress, drinking plenty of fluids, and eating nutritious foods11.
Living with Swine Flu (H1N1)
If you are diagnosed with swine influenza (H1N1), it’s important to manage your symptoms at home while taking steps to prevent spreading the virus to others. Key guidelines for daily living while ill include:
Stay home and self-isolate when ill, preferably in a separate room, until at least 24 hours after the fever has resolved without the use of fever-reducing medications; immunocompromised individuals may require a longer isolation period as per health authority recommendations.
Monitor your symptoms daily and seek medical help if you experience worsening symptoms.
Get plenty of rest and drink fluids to stay hydrated and support recovery3.
Cover your mouth and nose when coughing or sneezing10.
Dispose of used tissues properly and wash hands frequently10.
Wear a mask when around people to reduce the risk of transmission11.
Return to work/school only after you have fully recovered for at least 24 hours without medication11.
Keeping up one’s lung immunity by practicing breathing exercises, can help keep such infections at bay and prevent them from becoming severe if contracted15.
Vaccination is one of the most effective ways to prevent H1N1.
Seasonal influenza vaccines, including quadrivalent vaccines (which also protect against both lineages of influenza B), are designed to provide immunity against the most common flu strains, including H1N1 and H3N2 (both subtypes of influenza A)12.
The vaccine is recommended annually for everyone aged 6 months and older3.
It is especially important for high-risk groups such as young children, the elderly, pregnant women, and individuals with chronic medical conditions3.
Vaccination helps reduce the risk of H1N1 infection, severe illness, hospitalisation, and complications; quadrivalent influenza vaccines protect against H1N1, H3N2 (influenza A subtypes), and two influenza B lineages, Victoria and Yamagata.
Most cases of swine flu (H1N1) are mild and can be managed at home. However, medical attention should be sought if you experience the following10:
Difficulty breathing or shortness of breath
Persistent chest pain or pressure
High fever (≥102°F or 39°C) lasting more than 3 days despite the use of antipyretics
Severe or worsening cough
Confusion or dizziness
Bluish lips or face
Symptoms that improve but return with worsening fever or cough
Note: In children, watch for signs like fast breathing, irritability, poor feeding, or lack of responsiveness10. Additionally, pregnant women, the elderly, and people with underlying health conditions should consult a doctorearly, even for mild symptoms.
Conclusion
Swine flu (H1N1) remains a significant public health concern, particularly for vulnerable populations. The H1N1 (pdm09) strain, which caused the 2009 pandemic, is now part of regular seasonal influenza circulation and no longer classified as a separate pandemic strain. Awareness of symptoms, early detection, and timely medical treatment are essential to reducing the severity and spread of the infection. Annual vaccination remains the most effective preventive measure.
In addition, following basic H1N1 precautions, such as maintaining hand hygiene, using masks, and avoiding close contact with those who are ill can reduce transmission. Public health campaigns also play a vital role in reinforcing these preventive measures, especially during flu season and among high-risk groups.
Yes, like other flu viruses, H1N1 can mutate over time6. Immunity from previous infection or vaccination may not provide full protection against new variants.
How long does it take to recover from swine flu?
Most individuas recover within 5 to 7 days, although fatigue and cough can persist for longer3. Recovery may take more time in severe cases or in individuals with underlying health conditions.
Are antibiotics effective against swine flu?
No, antibiotics are used to treat bacterial infections, not viral illnesses like H1N1. However, they may be prescribed by a doctor if a secondary bacterial infection, such as pneumonia develops.
Can I eat pork if there is a swine flu outbreak?
Swine flu is not spread by eating pork or pork products. The virus causes an infection in the respiratory tract and is not transmitted through meat. It is safe to eat properly cooked pork, as cooking meat to an internal temperature of at least 70°C (160°F) kills viruses and other pathogens13.
Kshatriya RM, Khara NV, Ganjiwale J, Lote SD, Patel SN, Paliwal RP. Lessons learnt from the Indian H1N1 (swine flu) epidemic: Predictors of outcome based on epidemiological and clinical profile. J Family Med Prim Care. 2018 Nov-Dec;7(6):1506-1509. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6293944/
Jilani TN, Jamil RT, Nguyen AD, Siddiqui AH. H1N1 Influenza [Internet]. StatPearls Publishing; [updated 2024 Mar 4; cited 2025 Jun 19]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513241/
Coleman BL, Fadel SA, Fitzpatrick T, Thomas SM. Risk factors for serious outcomes associated with influenza illness in high- versus low- and middle-income countries: Systematic literature review and meta-analysis. Influenza Other Respir Viruses. 2018 Jan;12(1):22-29. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5818335/
R R, Dalal A, Mohan H, Prasad M, Pundir CS. Detection methods for influenza A H1N1 virus with special reference to biosensors: a review. Biosci Rep. 2020 Feb 28;40(2):BSR20193852. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7000365/
Gutierrez C, Nazar GA, Torres JP. Otolaryngological complications in patients infected with the influenza A (H1N1) virus. Otolaryngol Head Neck Surg. 2012 Mar;146(3):478-82. Available from: https://pubmed.ncbi.nlm.nih.gov/21998086/
Department of Health & Family Welfare, Government of Puducherry. Swine Influenza (A H1N1) [Internet]. Puducherry: Government of Puducherry; [cited 2025 Jun 19]. Available from: https://health.py.gov.in/swine-influenzaa-h1n1
Trombetta CM, Kistner O, Montomoli E, Viviani S, Marchi S. Influenza Viruses and Vaccines: The Role of Vaccine Effectiveness Studies for Evaluation of the Benefits of Influenza Vaccines. Vaccines (Basel). 2022 May 1;10(5):714. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9143275/
Al-Muharrmi Z. Understanding the influenza A H1N1 2009 pandemic. Sultan Qaboos Univ Med J. 2010 Aug;10(2):187-95. Epub 2010 Jul 19. PMID: 21509228; PMCID: PMC3074714. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3074714/
Batta I, Kaur T, Agrawal DK. Distinguishing swine flu (H1N1) from COVID-19: Clinical, virological, and immunological perspectives. Arch Microbiol Immunol. 2023;7(4):271-280. doi:10.26502/ami.936500125. PMID: 37994372; PMCID: PMC10664801. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10664801/
Yudin MH. Risk management of seasonal influenza during pregnancy: current perspectives. Int J Womens Health. 2014;6:681-689. doi:10.2147/IJWH.S47235. PMID: 25114593; PMCID: PMC4122531. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4122531/
Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.
Links and product recommendations in the informationprovided here are advertisements of third-party products available on the website. PharmEasy does not make any representation on the accuracy or suitability of such products/services. Advertisements do not influence the editorial decisions or content. The information in this blog is subject to change without notice. The authors and administrators reserve the right to modify, add, or remove content without notification. It is your responsibility to review this disclaimer regularly for any changes.
0
Typhoid Vaccine: What is It, Types, When to Be Taken & Side Effects
Introduction
Typhoid fever is a serious (and potentially life-threatening) illness caused by the bacterium Salmonella Typhi that spreads primarily through contaminated food and water. Once inside the body, the bacteria rapidly multiply in the intestinal lymphoid tissue known as Peyer’s patches, and eventually enter the bloodstream, leading to infection (bacteraemia)1,2.
With increasing urbanisation, poor sanitation, and the growing threat of antibiotic-resistant strains, the global risk of typhoid is rising, especially in communities lacking clean water and proper hygiene1,2.
Given the public health threat posed by typhoid fever, vaccination plays a crucial role in prevention. This article explores the typhoid vaccine, what it is, the types available, when it should be administered, and its possible side effects, helping you make informed decisions about protection against this preventable disease.
What is the Typhoid Vaccine?
The typhoid vaccine is a preventive vaccine that provides immunity against the Salmonella Typhi bacterium, which is responsible for causing typhoid fever2,3.
The vaccine consists of either weakened live bacteria or inactive (killed) bacteria (alone or attached to a carrier protein). When the body is exposed to the bacteria or its antigens, it helps in developing long-lasting protection by stimulating the immune system to recognise and fight the bacteria if exposed in the future. While the vaccine does not treat active infection, it plays a critical role in preventing illness and reducing its spread3.
It is important to note that while the vaccine lowers the chances of getting sick, it doesn’t fully stop the bacteria from spreading (especially in people who carry it for a long time). So, while it helps reduce transmission, it doesn’t completely prevent it.
Not suitable for children <6years, people with compromised immune systems or certain medical conditions5.
Why Is the Typhoid Vaccine Important?
As of 2019, an estimated 9 million people contract typhoid each year, and approximately 110,000 die from the infection1. The disease disproportionately affects low- and middle-income countries, where access to clean water, proper sanitation, and healthcare may be limited2.
Vaccination plays a key role in reducing the risk of infection and preventing its transmission, which is especially crucial in areas with frequent outbreaks, improper sanitation, and rising antibiotic resistance. Moreover, by stimulating the body’s immune system to recognise and fight Salmonella Typhi, the vaccine lowers the chances of severe illness, complications, and death. It also helps protect vulnerable populations, making it an essential tool in the global fight against typhoid fever3.
Typhoid vaccine can help prevent typhoid infection, which is very common in a country like India. Outside food, contaminated and uncovered food, are all sources of typhoid, and eating street food is a common cause of infection. Thus, if one eats outside regularly, they should definitely take the typhoid vaccine.
The typhoid fever vaccine is recommended for individuals who are at a higher risk of exposure. These groups include:
Travelers to Endemic Areas: People visiting countries where typhoid fever is common (particularly parts of South Asia, Africa, and Latin America) should get vaccinated 1 to 2 weeks before travel2.
People Handling the Bacteria: Professionals who work in labs and may handle Salmonella Typhi bacteria as part of their research or diagnostic work are advised to receive the vaccine as a safety measure.
People Living in or Near Outbreak Zones: Individuals residing in communities where typhoid outbreaks have occurred, or where sanitation and water supply are poor, may also be advised to get vaccinated to help control the spread of the disease1,3.
Who Should Not Get the Vaccine?
While the typhoid fever vaccine is generally safe and effective, it may not be suitable for everyone. Individuals who should avoid or delay vaccination include:
People with Severe Allergic Reactions: Anyone who has had a severe allergic reaction (anaphylaxis) to a previous typhoid vaccine dose or any of its components should not receive it3.
Young Children: Age recommendations in young children may vary depending on the specific vaccine used. The oral typhoid vaccine is typically not recommended for children under 6 years of age, while the injectable vaccine is usually avoided in children under 2 years. The typhoid conjugate vaccine is however safe to be given from 6 months of age and is suitable for routine childhood immunization3.
Immunocompromised Individuals: People with weakened immune systems (such as those undergoing chemotherapy or taking immunosuppressive medications) should consult their doctor before taking the live oral vaccine. It is usually not recommended in these cases due to the risk of infection, especially the live oral typhoid vaccine3,4.
People with Certain Medical Conditions: Individuals with acute illness, gastrointestinal issues (for oral vaccine), or fever should postpone vaccination until they recover3,5.
Typhoid Vaccination During Pregnancy and in People with Weakened Immunity
Special consideration may be needed before receiving a typhoid vaccine during pregnancy or if you have a weakened immune system.
During Pregnancy
The typhoid vaccine is not routinely recommended during pregnancy but may be considered if the risk of exposure is high, such as when travelling to areas where typhoid is common.
If vaccination is considered necessary, injectable typhoid vaccines (Typhoid Conjugate Vaccine and Vi polysaccharide vaccine) are generally preferred after discussion with a healthcare professional16. The potential benefits and risks should be assessed on an individual basis.
The oral Ty21a vaccine is usually avoided during pregnancy because it contains a weakened form of the bacteria16.
People with Weakened Immunity
Individuals with weakened immunity due to medical conditions or treatments should consult their doctor before vaccination.
Injectable typhoid vaccines can generally be given safely, but the decision should be based on the person’s medical condition and treatment status17.
The oral Ty21a vaccine is usually not recommended because it contains live and weakened bacteria17.
Your doctor can help to determine the most suitable vaccine based on your health status and risk of exposure.
How is the Vaccine Given
The administration and preparation for all the typhoid fever vaccine types differ in certain aspects:
1. Typhoid Conjugate Vaccine
Method: Given as a single intramuscular injection3.
Currently typhoid vaccine is not part of NIS. The typhoid conjugate vaccine is available in India in the private sector and is being recommended to be included in India’s Universal immunization programme (UIP) in view of disease burden14.
Timing: Usually, a single typhoid vaccine dose; recommended to be taken at least 2 to 3 weeks before potential exposure (e.g., travel)5,6.
Booster: Currently, no routine booster is recommended, but guidelines may vary by country. However, for some types (like PedaTyph), a booster dose is recommended after 24 to 30 months6.
Approx. cost in India: ₹1,300 – ₹2,500 per dose
Where to get it: Available at hospitals and vaccination centres, including PharmEasy-partnered clinics
Timing: A 4-dose typhoid vaccine schedule, with one capsule taken on days 1, 3, 5, and 7. The last typhoid vaccine dose should be completed at least 1 week before exposure3,5.
Booster: Every 5 years for those at ongoing risk3.
Approx. cost in India: ₹2,000 – ₹3,500 for full course
Where to get it: Available at hospitals and vaccination centres, including PharmEasy-partnered clinics.
Note: Currently, IAP (ACVIP) immunisation guidance in India recommends Typhoid Conjugate Vaccines as the preferred option for routine prevention of typhoid fever15.
Effectiveness and Safety of the Typhoid Vaccine
Typhoid vaccines are generally effective and safe in preventing typhoid fever. They offer moderate protection, with an efficacy ranging from 50% to 85%, depending on the type of vaccine used7.
While they are not 100% protective, they significantly reduce the risk of infection, especially when combined with good hygiene and safe food and water practices.
Typhoid Conjugate Vaccine: Around 81 to 84% efficacy8
Vi Polysaccharide Vaccine: Around 55 to 65% efficacy9,10
Oral Ty21a Vaccine: Around 53 to 67% efficacy11,12
Vaccine protection may decline over time, particularly for the Vi polysaccharide and Ty21a vaccines, which may require booster doses for continued protection.
Possible Side Effects of Typhoid Vaccines
Most side effects of typhoid fever vaccines are mild and temporary. Common side effects include5:
For injectable vaccines:
Pain, redness, or swelling at the injection site
Low-grade fever
For oral vaccines:
Headache or tiredness
Diarrhoea
Nausea
Vomiting
Abdominal discomfort
Note: Allergic reactions like rash, itching, and swelling may rarely occur in all types of vaccines.
It’s important to seek medical advice at certain points related to typhoid vaccination and potential infection:
Before Travel: Consult a doctor at least 3 to 4 weeks (depending on the vaccine type as discussed above) before travelling to regions where typhoid is common5. This allows enough time to receive the appropriate vaccine and ensure protection. Along with vaccination, follow safe food and water practices while travelling. Prefer freshly cooked hot meals, avoid raw or cut fruits from outside, drink sealed bottled or boiled water, and maintain good hand hygiene.
After Vaccination: While side effects from typhoid vaccines are usually mild, you should see a doctor if you experience5:
Severe allergic reaction (difficulty breathing, swelling, rash)
High fever
Persistent gastrointestinal issues (especially after oral vaccine)
If Symptoms Appear Despite Vaccination: No vaccine offers 100% protection. If you develop symptoms like prolonged high fever, abdominal pain, fatigue, headache, constipation or diarrhoea, especially after travel to an endemic area, consult a doctor immediately2.
Note: Antibiotic-resistant typhoid is a growing concern, especially in South Asia, so prompt diagnosis and blood culture testing are crucial to ensure the right treatment13.
Typhoid vaccination is a simple yet powerful tool in preventing a potentially serious and life-threatening illness. It offers protection against Salmonella Typhi, the bacterium responsible for typhoid fever, which continues to affect millions of people globally each year.
Vaccines are especially important for travellers to high-risk regions, individuals living in or near outbreak areas, and those working in environments where exposure is more likely. While no vaccine provides complete immunity, typhoid vaccines significantly reduce the risk of infection and severe complications.
By getting vaccinated, you not only protect yourself but also help limit the spread of disease within communities, making typhoid prevention a shared responsibility and a vital part of public health.
What typhoid conjugate vaccines are available in India?
India currently offers two WHO-prequalified typhoid conjugate vaccines3: -Typbar-TCV® by Bharat Biotech -TyphiBev™ by Biological E Ltd
Can pregnant or breastfeeding women receive the typhoid vaccine?
Safety data is limited, but Vi polysaccharide vaccines and typhoid conjugate vaccines are considered to pose minimal risk and can be given if needed. However, the live oral Ty21a vaccine is not recommended during pregnancy due to potential risks3.
Besides vaccination, what other measures help prevent typhoid fever?
In addition to vaccination, safe food and water practices are crucial, such as eating thoroughly cooked food, peeling fruits before eating, and drinking only boiled, disinfected, or sealed bottled water. Handwashing before meals is also essential. In prevention of typhoid, WASH (Water, Sanitation, and Hygiene) interventions remain equally important to vaccination, especially in high-risk areas3.
Can the typhoid vaccine be given with other vaccines?
Yes, the typhoid vaccine can be safely administered alongside other routine vaccines3.
Should I inform my doctor about any medications before getting the typhoid vaccine?
Yes, it’s important to tell your vaccine provider if you are currently taking or have recently taken antibiotics or anti-malarial medications5.
What if I get typhoid symptoms even after vaccination?
While the vaccine greatly reduces the risk, no vaccine offers 100% protection. If you develop symptoms of typhoid fever after vaccination, it’s important to seek medical care immediately.
Bhandari J, Thada PK, Hashmi MF, et al. Typhoid Fever [Internet]. StatPearls Publishing; 2025 Jan; [updated 2024 Apr 19; cited 2025 Jun 17]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557513/
Van Camp RO, Shorman M. Typhoid Vaccine [Internet]. StatPearls Publishing; 2025 Jan; [updated 2024 Jul 1; cited 2025 Jun 17]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470571/
Tanrıöver MD, Akar S, Türkçapar N, Karadağ Ö, Ertenli İ, Kiraz S. Vaccination recommendations for adult patients with rheumatic diseases. Eur J Rheumatol. 2016 Mar;3(1):29-35. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5042271/
Patel PD, Patel P, Liang Y, Meiring JE, Misiri T, Mwakiseghile F, Tracy JK, Masesa C, Msuku H, Banda D, Mbewe M, Henrion M, Adetunji F, Simiyu K, Rotrosen E, Birkhold M, Nampota N, Nyirenda OM, Kotloff K, Gmeiner M, Dube Q, Kawalazira G, Laurens MB, Heyderman RS, Gordon MA, Neuzil KM; TyVAC Malawi Team. Safety and Efficacy of a Typhoid Conjugate Vaccine in Malawian Children. N Engl J Med. 2021 Sep 16;385(12):1104-1115. Available from: https://pubmed.ncbi.nlm.nih.gov/34525285/
Klugman KP, Koornhof HJ, Robbins JB, Le Cam NN. Immunogenicity, efficacy and serological correlate of protection of Salmonella typhi Vi capsular polysaccharide vaccine three years after immunization. Vaccine. 1996 Apr;14(5):435-8. Available from: https://pubmed.ncbi.nlm.nih.gov/8735556/
Klugman KP, Gilbertson IT, Koornhof HJ, Robbins JB, Schneerson R, Schulz D, Cadoz M, Armand J. Protective activity of Vi capsular polysaccharide vaccine against typhoid fever. Lancet. 1987 Nov 21;2(8569):1165-9. Available from: https://pubmed.ncbi.nlm.nih.gov/2890805/
Simanjuntak CH, Paleologo FP, Punjabi NH, Darmowigoto R, Soeprawoto, Totosudirjo H, Haryanto P, Suprijanto E, Witham ND, Hoffman SL. Oral immunisation against typhoid fever in Indonesia with Ty21a vaccine. Lancet. 1991 Oct 26;338(8774):1055-9. Available from: https://pubmed.ncbi.nlm.nih.gov/1681365/
Levine MM, Ferreccio C, Black RE, Germanier R. Large-scale field trial of Ty21a live oral typhoid vaccine in enteric-coated capsule formulation. Lancet. 1987 May 9;1(8541):1049-52. Available from: https://pubmed.ncbi.nlm.nih.gov/2883393/
Parry CM, Ribeiro I, Walia K, Rupali P, Baker S, Basnyat B. Multidrug resistant enteric fever in South Asia: unmet medical needs and opportunities. BMJ. 2019 Jan 22;364:k5322. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6340381/
Mogasale VV, Sinha A, John J, Farooqui HH, Ray A, Chantler T, Mogasale V, Dhoubhadel BG, Edmunds WJ, Clark A, Abbas K. Typhoid conjugate vaccine implementation in India: A review of supportive evidence. Vaccine X. 2024;17:100568. doi:10.1016/j.jvacx.2024.100568. Available from: https://www.sciencedirect.com/science/article/pii/S2590136224001414#:~:text=Abstract,Results
IAP Advisory Committee on Vaccines & Immunisation Practices. Typhoid fever [Internet]. Navi Mumbai (India): Indian Academy of Paediatrics; updated 2020 Jan 10 [cited 2026 Jun 18]. Available from: https://acvip.org/parents/columns/typhoid.php
Touchan F, Hall JD, Lee RV. Typhoid fever during pregnancy: case report and review. Obstet Med. 2009;2(4):161-163. doi:10.1258/om.2009.090020. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4989662/
Sztein MB, Salerno-Goncalves R, McArthur MA. Complex adaptive immunity to enteric fevers in humans: lessons learned and the path forward. Front Immunol. 2014;5:516. doi:10.3389/fimmu.2014.00516. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4209864/
Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.
Links and product recommendations in the informationprovided here are advertisements of third-party products available on the website. PharmEasy does not make any representation on the accuracy or suitability of such products/services. Advertisements do not influence the editorial decisions or content. The information in this blog is subject to change without notice. The authors and administrators reserve the right to modify, add, or remove content without notification. It is your responsibility to review this disclaimer regularly for any changes.
1
How HPV Can Lead to Cancers
Introduction
Human Papillomavirus (HPV) is the most common sexually transmitted infection (STI) worldwide, with nearly 80% of the global population exposed by the age of 501. While the immune system clears most HPV infections (within 1 to 2 years), persistent infection can be hazardous to health2,3.
There are over 200 known subtypes of HPV that are broadly categorised into low-risk and high-risk types, with around 40 subtypes affecting the genital tract2,4. Low-risk types, such as HPV 6 and 11, typically cause benign (non-cancerous) conditions like genital warts. In contrast, persistent infection with high-risk types (most notably HPV 16 and 18) can lead to precancerous lesions and malignancies. High-risk HPV types are associated with various cancers, including cervical, anal, oropharyngeal (back of the throat), and penile cancers3.
Vaccines are available and effective in preventing infection with the most common low and high-risk HPV types. However, global vaccination coverage still remains suboptimal1,3. Therefore, understanding the link between persistent HPV infection and cancer is critical for prevention, early detection, and treatment strategies.
How Is HPV Transmitted
HPV is mainly spread through skin-to-skin contact, especially during sexual activity. Here’s how transmission can happen:
Sexual contact: HPV is most often passed through mucocutaneous contact during sexual activity (vaginal, anal, or oral) with an HPV infected person. It is important to note that even without visible symptoms, the virus can still spread5.
Genital skin contact: HPV can be transmitted through close genital contact, even without penetration. Using shared sex toys (insertive types) can also carry risks5.
Oral and anal sex: The virus can spread to the mouth and throat or the anus, especially with unprotected oral or anal sex5.
Self-inoculation: A person may transfer the virus from one part of their body to another, such as from the genitals to the mouth, by touch5.
Mother-to-child transmission (rare): An infected mother may pass HPV to her baby during childbirth, which can sometimes lead to throat warts in the baby5.
Symptoms of HPV
Most people infected with HPV may not experience any symptoms. They may not even be aware that they have the virus. When symptoms do appear, they depend on the type of HPV involved. Common signs and symptoms include:
Low-risk HPV types: These may lead to genital warts (small, rough, skin-coloured growths) that can appear on the vagina, penis, or anus and also cause symptoms such as itching, discomfort, or bleeding in the affected area. Rarely, they may also cause lumps on the throat (known as respiratory papillomatosis)2,3.
High-risk HPV types: These strains can cause cellular changes that may slowly and gradually develop into cancer (over many years). These changes (early lesions) may not produce noticeable symptoms in the beginning. However, if the infection persists and progresses to advanced-stage HPV, it can eventually cause symptoms such as pain, bleeding, or noticeable lumps, depending on the location of the cancer (e.g., cervix, anus, or throat)6.
During regular health check-ups, many people who feel completely normal end up testing positive for HPV. I explain to them that this is very common because HPV usually causes no symptoms at all; it stays silent in the body but can still cause complications and be transmitted to your partner.
HPV can cause cancer when high-risk types of the virus stay in the body for a long time and interfere with how normal cells grow and divide.
In the early stages of an HPV infection, the virus multiplies in the skin or mucosal cells without immediately causing harm. Over time, when high-risk HPV types insert their genetic material into the human DNA, it leads to the constant production of oncoproteins. These are proteins produced by the virus that promote cancer growth by interfering with the growth and division of normal cells, which can eventually lead to abnormal or precancerous changes, and, if not treated, possibly cancer.
These proteins produced by the virus disrupt the functioning of tumour-suppressor proteins, which are proteins present in the body cells that help with DNA repair, control the cell cycle, and prevent uncontrolled cell growth. The oncoproteins produced by HPV in the body are3:
E6, which promotes the degradation of p53
E7, which promotes the degradation of pRb (retinoblastoma protein)
The inactivation of tumour-suppressor proteins p53 and pRb leads to impaired DNA repair mechanisms and loss of cell cycle control, creating conditions that cause uncontrolled cell growth and eventually cancer development.
Note: It’s important to note that wart-like lesions are usually caused by low-risk HPV types and do not typically progress to cancer. In contrast, high-risk HPV types can cause abnormal cell changes (like cervical intraepithelial neoplasia or CIN), which may become cancerous if not detected and treated early3.
Different Types of Cancer Caused by HPV
Did you know that HPV is estimated to cause around 690,000 cancers worldwide each year6?
Let us take a look at the types of cancers that are linked to HPV:
1. Cervical Cancer
HPV and cervical cancer are very closely linked. This is because almost all cervical cancer cases are caused by HPV6.
2. Anal Cancer
More than 90% of anal cancer cases are caused by HPV6.
3. Oropharyngeal Cancer
About 70% of oropharyngeal cancers, which occur in the middle part of the throat behind the mouth, are linked to HPV6.
Note: People often confuse oropharyngeal cancer with mouth and throat cancer, but they are not the same; each affects different areas within the head and neck region.
4. Vaginal Cancer
Approximately 75% of vaginal cancer cases are linked to HPV6.
5. Vulvar Cancer
HPV is responsible for around 69% of vulvar cancer cases. This cancer affects the outer part of the female genitalia6.
6. Penile Cancer
Around 63% of penile cancer cases are attributed to HPV. This rare cancer usually develops on or under the foreskin of the penis6.
Many people still wrongly believe that HPV affects only girls, and some even think HPV vaccination is a treatment, but actually, HPV affects both men and women, and the vaccine is for prevention, not for treatment.
Different types of HPV-related cancers have different diagnostic approaches. While some have well-established screening tests, others are detected only after symptoms appear or through targeted exams in high-risk individuals.
1. Cervical Cancer
Pap test (Pap smear): Detects abnormal cervical cell changes.
HPV test: Identifies high-risk HPV strains.
Co-testing: Combines Pap and HPV tests for more accurate screening.
Colposcopy: Follow-up procedure if screening tests are abnormal3.
Note: Women should begin regular cervical cancer screening at age 30, with tests typically recommended every 5 to 10 years, depending on the type of test used and individual risk factors2.
2. Anal Cancer
Anal Pap test: Used primarily for high-risk groups (e.g., people with HIV, men who have sex with men)3.
High-resolution anoscopy (HRA): Examines the anal canal more closely if abnormal cells are found7.
3. Oropharyngeal (Throat) Cancer
Physical examination: Checks for lumps or lesions in the throat and neck3.
Imaging (CT, MRI, or PET scans): Used to assess the extent of disease7,8.
While most HPV infections go away on their own without causing symptoms, some can lead to serious health issues if left untreated. Knowing when to seek medical advice is key to early detection and prevention. You should see a doctor if you experience:
Visible genital warts (often caused by low-risk HPV types)
Unusual bleeding, especially between periods or after sex (can be a sign of cervical changes associated with high-risk HPV infection)2
Persistent pelvic, anal, or throat pain (may likely to occur in advanced stages of HPV-related disease)3
Unusual vaginal discharge or foul odour (Although these may not be specific to HPV and are commonly linked to other infections like bacterial vaginosis, still these warrant medical evaluation)2
Note: It’s important to follow regular screening schedules based on your age and risk factors to detect any HPV-related changes early.
HPV vaccination offers safe, effective, and long-lasting protection against the most cancer-causing HPV infections, especially when given before exposure. Three types of HPV vaccines have been developed, each protecting against different numbers of HPV types12,13:
Bivalent (Cervarix): Protects against HPV types 16 and 18, the most common high-risk types linked to cervical cancer.
Quadrivalent (Gardasil): Covers types 6, 11, 16, and 18, protecting against both cancer-causing and wart-causing types.
9-valent (Gardasil 9): The most comprehensive, covering HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58, offering broader protection against cancers and genital warts.
Despite being a common viral infection, the majority of HPV-related cancers are preventable through regular screenings and timely vaccination. Therefore, it is important to raise awareness about HPV, its risks, and the need for early detection and vaccination in reducing the incidence of these cancers. Routine screening helps detect abnormal cell changes early, allowing for prompt treatment and improved outcomes. At the same time, HPV vaccination offers strong protection against high-risk strains, particularly when administered before exposure. These measures can help contribute to reducing the global burden of HPV as well as ensure better long-term health for individuals and communities alike.
Frequently Asked Questions (FAQs)
How can I prevent HPV-related cancers?
Routine HPV vaccination, regular screening (like Pap and HPV tests), and practising safe sex are key strategies for prevention2.
Who should get the HPV vaccine?
The HPV vaccine is recommended for all children aged 9 to 12 years. Catch-up vaccination is available for males and females up to age 26. In some cases, vaccination may be considered up to age 453,12. Talk to your doctor if you have doubts or are unsure.
Do condoms fully protect against HPV?
Condoms greatly reduce the risk, but do not offer 100% protection because HPV can infect areas not covered by condoms2.
Is HPV only a concern for women?
No. HPV affects all genders. It can cause cancers of the penis, anus, and oropharynx in men, and genital warts in anyone. Therefore, vaccination and awareness are important for everyone2.
Is there a cure for HPV?
There is no cure for the virus itself, but most infections clear on their own. Treatments are available for symptoms (like warts) and for precancerous or cancerous lesions3.
Luria L, Cardoza-Favarato G. Human Papillomavirus [Internet]. StatPearls Publishing. 2025 Jan; [updated 2023 Jan 16; cited 2025 Jun 10]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448132/
Gong P, Shi B, Cong X, Yang L, Gong C, Zhou Y, Li X, Wang J. Multiple infections containing the top five prevalent HPV genotypes and their impact on cervical lesions in Changzhou, China. Hum Vaccin Immunother. 2023 Aug 1;19(2):2245723. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10435003/
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 [Internet]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK321770/
Wells J, Flowers L, Mehta CC, Chandler R, Knott R, McDonnell Holstad M, Watkins Bruner D. Follow-Up to High-Resolution Anoscopy After Abnormal Anal Cytology in People Living with HIV. AIDS Patient Care STDS. 2022 Jul;36(7):263-271. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9464048/
Capria A, Tahir N, Fatehi M. Vulvar cancer [Internet]. StatPearls Publishing. 2025 Jan; [updated 2023 Jan 9; cited 2025 Jun 10]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK567798/
Engelsgjerd JS, Leslie SW, LaGrange CA. Penile cancer and penile intraepithelial neoplasia [Internet]. StatPearls Publishing. 2025 Jan; [updated 2024 Sep 2; cited 2025 Jun 10]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499930/
Centers for Disease Control and Prevention. HPV Vaccination [Internet]. Centers for Disease Control and Prevention; [updated 2024 Aug 20; cited 2025 Jun 10]. Available from: https://www.cdc.gov/hpv/vaccines/index.html
Bergman H, Buckley BS, Villanueva G, et al. Comparison of different human papillomavirus (HPV) vaccine types and dose schedules for prevention of HPV-related disease in females and males. Cochrane Database Syst Rev. 2019 Nov 22;2019(11):CD013479. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6873216/
Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.
Links and product recommendations in the informationprovided here are advertisements of third-party products available on the website. PharmEasy does not make any representation on the accuracy or suitability of such products/services. Advertisements do not influence the editorial decisions or content. The information in this blog is subject to change without notice. The authors and administrators reserve the right to modify, add, or remove content without notification. It is your responsibility to review this disclaimer regularly for any changes.
Influenza B: What is It, Causes, Symptoms, Treatment & Prevention
Introduction
Influenza B is one of the primary types of influenza viruses responsible for seasonal flu outbreaks across the globe1. Among the estimated 1 billion cases of influenza that occur annually, influenza B contributes significantly, more commonly in children and adolescents, however, it can affect all age groups1,2.
Although less prevalent than influenza A, influenza B virus can co-circulate with it and have varying global impact based on season and region3. Therefore, understanding what influenza B is, its symptoms and its management strategies is essential for effective prevention and treatment, especially during peak flu seasons.
What Causes Influenza B?
Influenza B is caused by the influenza B virus, a member of the Orthomyxoviridae family4. This virus is divided into two genetically and antigenically distinct lineages4:
B/Yamagata/16/88-like or the Yamagata lineage (this lineage has not been detected since March 2020 and is expected to go extinct)4,5
The influenza B virus spreads easily from person to person through respiratory droplets released when an infected individual coughs or sneezes, making close contact a key factor in transmission. It can also spread by touching contaminated surfaces and then touching your face without washing your hands2.
While influenza B typically leads to mild to moderate respiratory illness, particularly in otherwise healthy children, it can sometimes result in more severe disease. This is especially true for individuals with underlying chronic medical conditions, weakened immune systems, or other health vulnerabilities. In rare cases, it can even be fatal4.
Victoria vs Yamagata Lineage
The Victoria Lineage
The B/Victoria lineage is one of the two major lineages of Influenza B that have historically circulated in humans. It causes seasonal outbreaks that often impact younger demographics, particularly school-aged children.
Post-COVID: Following the pandemic, B/Victoria is currently the only Influenza B lineage known to be circulating widely in humans. Because it continues to spread actively across both hemispheres, international health agencies like the WHO and CDC have designated it as the exclusive Influenza B component included in the updated trivalent flu shots.
The Yamagata Lineage
The B/Yamagata lineage historically evolved at a slower rate and tended to strike older populations. Compared to other seasonal strains, it was naturally less transmissible, making its long-term survival highly dependent on steady, uninterrupted human-to-human chains of transmission19.
Post-COVID: The widespread pandemic has effectively broken those chains, and global health networks have not detected a single confirmed case of B/Yamagata since March 2020. Classified by experts as probably extinct or no longer circulating in humans, regulatory bodies have recommended removing the B/Yamagata component from current trivalent influenza vaccines because the lineage has not been detected in sustained circulation since 202019.
Influenza B Symptoms
Influenza B symptoms usually begin within 1 to 4 days after infection and can include2,6:
Sudden onset of high fever
Dry, persistent cough (may last 2 weeks or more)
Headache
Muscle and joint pain
Severe fatigue or general feeling of unwellness (malaise)
Sore throat
Runny or congested nose
Note: Children (especially those under 5 years of age) may experience vomiting, abdominal pain and diarrhoea. However, these symptoms are not prevalent in adults7.
Is It a Cold or Influenza B?
Since influenza B and the common cold are both respiratory viruses, their early signs can look incredibly similar. However, their intensity, how fast they develop, and their overall recovery timeline look very different.
The breakdown below highlights how to spot the difference between the two.
Feature
Common Cold
Influenza B
Onset Speed
Symptoms usually develop gradually
Symptoms often develop suddenly within a
Fever
below 100°F (except in toddlers)
100°F–102°F+, lasting 3 to 4 days.
Body Aches
Mild
Severe
Fatigue & Weakness
Mild
Moderate to severe
Cough Type
Often produces mucus or phlegm as it develops.
A persistent, hacking cough that can feel painful.
Headache
Rare
Prominent
Congestion & Sneezing
Very common
May occur but are usually less prominent.
Recovery Timeline
7 to 10 Days
1 to 2 Weeks
How Influenza B Differs from Types A and C
Influenza B differs from types A and C in several important ways, including its virus structure, who it primarily affects, and the severity of the illness it causes:
Virus Strains:
Influenza A has many subtypes (e.g., H1N1, H3N2).
Influenza B has two main lineages (B/Victoria and B/Yamagata)
BIO-FIRE Pneumonia Panel, the BF-PP has reliable analytical performance and provides a high rate and rapid detection of microorganisms in respiratory specimens, offering advantages over cultures for detection of Influenza18.
While influenza B can affect anybody, certain groups are at a greater risk of complications. These include:
Young children (especially under 5 years): Their immune systems are still developing, making them more susceptible9.
Older adults (65 years and above): Aging weakens the immune system, reducing the body’s ability to fight off infections2.
People with chronic conditions: Individuals with asthma, diabetes, heart disease, kidney problems, or lung disorders may face more severe illness2,9.
Those with weakened immune systems: People undergoing treatments like chemotherapy or those living with conditions like HIV/AIDS are at greater risk9.
Pregnant women: Changes in the immune system during pregnancy increase the risk of flu-related complications2,9.
Healthcare workers and caregivers: Due to frequent contact with infected individuals, they have a higher chance of exposure and transmission, although not a higher risk of complications as such2.
Note: While Influenza A often gets the most attention, Influenza B is actually a primary driver of flu illness in children, making early protection vital. Because kids’ immune systems are still learning how to fight off bugs, this strain can sometimes hit them harder, leading to faster complications like severe croup or pneumonia.
Diagnosis of Influenza B
Diagnosing influenza B typically starts with a clinical evaluation, where doctors review the patient’s symptoms and medical history10. To confirm the infection, several diagnostic tests may be used but the common ones are:
Rapid influenza diagnostic tests (RIDTs): These detect flu virus antigens (proteins) from a nose or throat swab. They can easily be done using test kits and give quick results but are less accurate, especially for Influenza B. A negative result doesn’t always mean that you’re flu-free, so further testing may be needed if there is strong clinical suspicion11,12.
Molecular-Based Tests: These tests detect the virus’s genetic material (RNA) and are more accurate than antigen-based tests. They can also distinguish between influenza A and B viruses. Tests like reverse transcription polymerase chain reaction (RT-PCR) are usually done in a laboratory and are considered the most reliable.Moreover, rapid molecular assays are also available that provide quick and accurate results11,12.
Viral Culture: The virus is grown in a laboratory for detailed study. Although this is a highly accurate test, due to its slow processing time, this is rarely used for immediate diagnosis10.
Other laboratory tests includeimmunofluorescence and serological assays to detect virus-specific antigens/antibodies. However, molecular tests have largely replaced these now11.
Complications
High-risk individuals should be especially vigilant for influenza B complications such as13
Pneumonia (viral or bacterial)
Sinus and ear infections
Myocarditis (heart inflammation)
Encephalitis (brain inflammation)
Myositis or rhabdomyolysis (muscle inflammation or breakdown)
Sepsis (a life-threatening response to infection)
Worsening of existing medical conditions
Influenza B Treatment Options
Most cases of influenza B can be managed at home with supportive care, but antiviral medications may be recommended in some situations, especially for those at high risk of complications. Common influenza B treatment options include:
1. Antiviral Medications
Image Source: freepik.com
Drugs such as the following can help reduce the severity and duration of influenza B symptoms, especially when started within 48 hours of symptom onset.
These drugs are especially recommended for all hospitalised patients, those with severe or progressive illness, and high-risk individuals (e.g., elderly, pregnant women, people with chronic conditions, etc.), regardless of how long symptoms have been present10,11,12.
2. Rest
Adequate rest helps the body recover and conserve energy to fight the infection2.
3. Hydration
Drinking plenty of fluids prevents dehydration, especially if fever is present2.
4. Over-the-Counter Pain Relievers
Image Source: freepik.com
Fever and pain-relieving medications, when taken under medical supervision, can help relieve fever, headache, and body aches. Common mediactions include:
Note: Do not give aspirin to children as it has been associated with the risk of Reye’s Syndrome15.
Prevention Tips
To protect yourself and those around you, it’s important to follow these effective prevention measures:
Get vaccinated annually: The flu vaccine (quadrivalent influenza vaccine offers broader protection by covering both lineages) is the most effective way to reduce your risk of influenza B infection and its complications2,5.
Practice good hand hygiene: Wash your hands regularly with soap and water (for at least 20 seconds) or use an alcohol-based hand sanitiser.
Avoid close contact: Stay away from people who are sick, and if you’re unwell, keep your distance to prevent spreading the virus15.
Cover coughs and sneezes: Use a tissue (or your elbow) to cover your mouth and nose when coughing or sneezing. Wearing a mask will also help prevent the spread of infection15.
Clean and disinfect surfaces: Frequently clean high-touch surfaces like door handles, mobile phones, and countertops to lower the risk of contamination15.
Maintain a healthy lifestyle: Support your immune system by getting enough sleep, eating a balanced diet, staying hydrated, managing stress, and staying physically active15.
Many patients think Influenza B is just a common cold or that antibiotics will cure it, which leads to delayed treatment. It’s actually a serious viral infection that can cause high fever, body aches, and pneumonia, and it needs timely antiviral care and rest, not antibiotics.
The quadrivalent flu vaccine is designed to guard against four distinct viral threats: two influenza A subtypes (H1N1 and H3N2) and two influenza B lineages (Victoria and Yamagata). For over a decade, it served as the global standard to prevent B-lineage mismatch20.
While quadrivalent vaccines may still be available in some settings,some public health authorities have recommended a transition to trivalent influenza vaccines. This is because B/Yamagata viruses have not been detected in global influenza surveillance since March 2020 and are not currently considered to be actively circulating in people.
Trivalent Influenza Vaccines
The updated trivalent vaccine streamlines protection by targeting exactly three actively circulating strains: the H1N1 and H3N2 A-subtypes, and B/Victoria lineage based on current surveillance and vaccine recommendations. This formulation does not include a B/Yamagata component, in line with current public health recommendations and surveillance findings19.
Most individuals recover from influenza B within 5 to 14 days, though symptoms like cough may persist for longer than 14 days2,16.
However, in some cases, symptoms may worsen or lead to serious complications. It’s important toconsult a doctor immediately if you experience any of the following16:
Worsening of existing symptoms
Difficulty breathing or shortness of breath
Chest pain or pressure
Sudden dizziness, confusion, or disorientation
Persistent high fever that doesn’t improve
Bluish lips/face
Severe muscle pain, extreme weakness, or trouble walking
Little or no urine output
Flare-up of chronic health conditions (such as asthma or heart disease)
Understanding and effectively managing influenza B is crucial for reducing the spread of infection and minimising the risk of complications, especially among vulnerable groups like children, elderly, and those with weakened immune systems.
While often milder than influenza A, influenza B can still lead to a serious illness. Timely diagnosis, appropriate influenza B virus treatment (such as antiviral therapy), preventive measures like vaccination, and awareness of warning signs, all play a vital role in controlling the impact of this seasonal virus. Thus, by staying informed and proactive, individuals and communities can better protect themselves and others during flu season.
No. It’s important to stay home until at least 24 hours after your fever subsides without the use of fever-reducing medications to prevent spreading the virus15.
How soon should antiviral treatment begin for influenza B?
Antiviral medications work best when started within 48 hours of symptom onset, but they may still be helpful later for high-risk individuals or those with severe illness10.
Is there a specific season for influenza B in India?
In India, Influenza B circulates year-round, especially in central and southern regions. In northern areas, it peaks during winter (November to March), often alongside influenza A, with additional mild peaks seen post-monsoon (September to November)17.
What is the incubation period for influenza B?
The incubation period for influenza B (the time between exposure to the virus and the appearance of symptoms) is typically around 2 days but can range from 1 to 4 days2.
References
Ashraf MA, Raza MA, Amjad MN, Ud Din G, Yue L, Shen B, Chen L, Dong W, Xu H, Hu Y. A comprehensive review of influenza B virus, its biological and clinical aspects. Front Microbiol. 2024 Sep 4;15:1467029. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11408344/
Centers for Disease Control and Prevention. Types of Influenza Viruses [Internet]. Centers for Disease Control and Prevention; [cited 2025 May 28]. Available from: https://www.cdc.gov/flu/about/viruses-types.html
Paget J, Caini S, Del Riccio M, van Waarden W, Meijer A. Has influenza B/Yamagata become extinct and what implications might this have for quadrivalent influenza vaccines? Euro Surveill. 2022 Sep;27(39):2200753. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9524051/
Coleman BL, Fadel SA, Fitzpatrick T, Thomas SM. Risk factors for serious outcomes associated with influenza illness in high- versus low- and middle-income countries: Systematic literature review and meta-analysis. Influenza Other Respir Viruses. 2018 Jan;12(1):22-29. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5818335/
Gaitonde DY, Moore FC, Morgan MK. Influenza: Diagnosis and Treatment. Am Fam Physician. 2019 Dec 15;100(12):751-758. Available from: https://pubmed.ncbi.nlm.nih.gov/31845781/
Vemula SV, Zhao J, Liu J, Wang X, Biswas S, Hewlett I. Current Approaches for Diagnosis of Influenza Virus Infections in Humans. Viruses. 2016 Apr 12;8(4):96. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4848591/
InformedHealth.org [Internet]. Cologne (Germany): Institute for Quality and Efficiency in Health Care (IQWiG). Overview: Influenza [updated 2022 Nov 22; cited 2025 Jun 11]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279459/
Centers for Disease Control and Prevention. Signs and Symptoms of Flu [Internet]. Centers for Disease Control and Prevention; [cited 2025 May 28]. Available from: https://www.cdc.gov/flu/signs-symptoms/index.html
Saha S, Chadha M, Shu Y; Group of Asian Researchers on Influenza (GARI). Divergent seasonal patterns of influenza types A and B across latitude gradient in Tropical Asia. Influenza Other Respir Viruses. 2016 May;10(3):176-84. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4814861/
Mustafa Hellou M, Virk A, Strasburg AP, Harmsen WS, Vergidis P, Kooda K, Kies KD, Donadio AD, Mandrekar J, Schuetz AN, Patel R. Performance of BIOFIRE FILMARRAY pneumonia panel in suspected pneumonia: insights from a real-world study. Microbiol Spectr. 2025;13(7):e00571-25. doi:10.1128/spectrum.00571-25. Available from: https://journals.asm.org/doi/10.1128/spectrum.00571-25
Centers for Disease Control and Prevention. Trivalent influenza vaccines [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2026 May 11 [cited 2026 Jun 26]. Available from: https://www.cdc.gov/flu/vaccine-types/trivalent.html
Tisa V, Barberis I, Faccio V, Paganino C, Trucchi C, Martini M, et al. Quadrivalent influenza vaccine: a new opportunity to reduce the influenza burden. J Prev Med Hyg. 2016 Mar;57(1):E28-E33. PMID: 27346937; PMCID: PMC4910440. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4910440/
Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.
