7 Facts About HPV I Want Everyone To Know, As A Sex Educator

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In this week's Sex IDK column, Emma McGowan, certified sex educator and writer, answers your questions about HPV.

Q: I don't fully understand HPV. What should I know?

Oh, human papillomavirus, aka HPV. Perhaps the most misunderstood STI in a world of extremely misunderstood STIs! Trust me, reader — you are not the only one who doesn’t fully understand HPV. I myself had a total freakout when I was diagnosed with genital warts at 19, but 13 years later, I know much more about this mostly benign STI. And I want to help everyone else understand it, too!

First of all, let’s talk about how HPV is spread, because I think this is a really big question a lot of people have. HPV is spread from skin-to-skin contact during oral, anal, or vaginal sex — but it’s not spread by bodily fluids or blood. The type of HPV that causes warts on your hands or feet is a cutaneous (or skin) type, while the type that causes genital warts is a mucosal type. That means genital HPV likes to live in mucous membranes of the vagina, vulva, foreskin, anus, and throat. And because HPV can spread even if you’re not showing symptoms, it’s very difficult to protect against it. Condoms provide some protection, but it’s certainly not total protection.

But transmission is just the tip of the iceberg when it comes to questions about HPV! Here’s a thorough breakdown of you need to know about the most common STI. I think it'll help make this diagnosis a lot less scary.

1. Basically, Everyone Has Had It

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HPV is super common. In fact, it’s the most common STI out there! It’s so common that the CDC now says that anyone not vaccinated against HPV will have it at some point in their lives. Think of it as the common cold of the genitals: You’ll very likely contract one or more strains of the virus at some point in your life. And, like the common cold, most strains will do little to no real damage.

2. There Are Many Strains Of HPV

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When we say “HPV,” we’re actually talking about more than 150 different identified strains of the virus. But only 12 of those strains are “high-risk,” meaning they can potentially lead to cancer of the cervix, vagina, vulva, penis, anus, throat, tongue, or tonsils. And of those 12, most cancers are caused by two strains — HPV-16 and HPV-18.

And here’s a fun fact: the strains that cause cancer don’t cause warts, and vice versa. So if you’re diagnosed with genital warts, you do not have to worry about your risk of cancer. They’re completely unrelated!

3. Regular Check-Ups Can Detect Cancerous Cells

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Because the strains of HPV that do cause cancer don’t usually cause any other visible symptoms, it’s important to get regular check-ups. People with vaginas and cervixes should get a regular Pap test, which takes a sample of cells from the cervix to test for pre-cancerous or cancerous cells caused by HPV. The current recommendation is to get tested every three years if you're under 30 and every five years if you're over 30. The doctor can also test specifically for HPV-16 and HPV-18 during that time.

For people with penises, there’s currently no test for HPV. There’s also no way to test for the cells that cause throat cancer, regardless of your genitals or gender. Oral cancers are usually discovered by doctors and dentists when a person already has other symptoms, including lesions on the throat or a persistent sore throat, among others. People who have sex with people with penises can reduce their risk of contracting by wearing condoms during oral sex.

4. HPV Doesn’t Necessarily Stay With You Forever

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There’s a belief that HPV stays with you forever. And while that’s kind of true — viruses aren’t curable, as a rule — it’s also not totally accurate. Many people clear the virus, especially if they contract it when they’re young, which means their immune system attacks it and become immune to it. This also means that their HPV won't lead to cancerous cells.

That’s why it’s more accurate to say “everyone will have HPV at some time in their life” than it is to say “everyone has HPV.” And again, like the cold, it’s also possible to get one strain of HPV, clear it, and then get another strain at another time. You're less likely to have that happen, however, if you have the vaccine, which protects against the most common strains that can cause both warts and cancer.

There's also some evidence that stress — as well as self-medicating stress with alcohol, drugs, or smoking cigarettes — may make it more difficult for peoples bodies to clear the virus. A 2016 study from researchers at UCLA that followed 333 women for years found that in the 11th year, women who were stressed, drank, smoked, or took drugs were more likely to still have an active HPV infection than those who weren't stressed and didn't do those things.

5. Most People Don’t Show Symptoms Of HPV

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Like so many STIs, most people with HPV — both high and low risk strains — don’t show any symptoms at all. This is especially true of people with penises, because HPV really likes to hang out in the moist mucous membranes of the body. Because vulvas and vaginas have more surface area that's mucosal like that, they’re more likely to have warts pop up if they’ve been exposed to a low-risk strain. But, for the most part, people don't even have warts or they have so few that they don't notice. And the high-risk strains have almost no visible symptoms, so it’s important to keep on top of your regular visits to the doctor.

6. Testing For HPV Isn’t So Straightforward

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While it’s standard to test for gonorrhea, chlamydia, and syphilis — all of which are bacterial infections — it’s not standard to test for HPV during a routine STI test. You might be thinking, what the heck? Why aren’t we testing for this super common STI?!

But the reason is actually because it’s so common. Healthcare providers know that many people have HPV but, for the most part, it’s a very low-impact STI. And they also know that STI stigma is real, so people tend to freak out when they hear they have a positive diagnosis. As a result, you’re unlikely to find a provider who will test for HPV in general, meaning all 150 strains. And if you think about it, what would be the point? With the majority of those strains either having no health effect or a very minimal one, why bother testing for them?

If you have a cervix, however, your healthcare provider might choose to test for HPV-16 and HPV-18 while doing your Pap test. That’s especially true if you have an irregular Pap, because that’s a sign you may have pre-cancerous or cancerous cells caused by an HPV infection. There is currently no test for people with penises who aren’t showing symptoms of HPV.

Finally, if you have a bump — regardless of your genitals — your healthcare provider can put a kind of acid on it that will tell them whether or not it’s a wart, and will also dissolve it. If it’s a wart, it was caused by HPV — so that’s one way to know if you have it.

7. But The HPV Vaccine Can Protect You

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The HPV vaccine, Gardasil, protects against HPV-16 and HPV-18 — the two strains of HPV that cause the majority of cancer cases — as well as HPV-6 and HPV-11 — which cause 90% of genital warts cases — and HPV 31, 33, 45, 52, and 58, which can also lead to cancer.

While the vaccine was first recommended only for young people who hadn’t yet become sexually active — and it will still be most effective for people who have not yet had sexual contact — Planned Parenthood recommends that everyone between the ages of 9 and 45 speak to their healthcare provider about getting the vaccine. For people under the age of 15, it’s a series of two shots. For people over the age of 15, it’s a series of three shots. The HPV vaccine won’t get rid of an infection you already have, but it could help you prevent getting a new one — and, since there are so many strains of HPV, it's worth protecting yourself against a potentially cancer-causing one.

But while obviously all this talk of cancer is scary, I want to remind everyone that most HPV infections don't lead to anything. Not warts. Not cancer. Nada. And so, for most people, the biggest harm that an HPV diagnosis does has to do with the stigma and ignorance around it. It's really common for people to shame themselves and also get shamed by people they know when they're diagnosed with HPV which, as you now know, is totally unnecessary.

You've now taken the first step toward reducing HPV stigma by educating yourself about it. The next step? Spreading the word! Talk to your friends about this new knowledge. Correct misperceptions when you hear them. And don't let anyone shame you or anyone else for having an STI that every sexually active person will have at some point in their life. Maybe if we all knew the truth about this super common STI, we could all be a lot less stressed about it.

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