HPV treatment: understanding your options

Most (more than 80%) of sexually active people get infected with human papillomavirus (HPV) at some point in their lives, making it the most common sexually transmitted infection (STI) (NFID, 2019). According to the Centers for Disease Control and Prevention (CDC), there are about 14 million new cases of HPV each year (CDC, 2019). Most of these cases affect men and women in their late teens and early 20s (CDC, 2019). Like many other STIs, HPV is transmitted by oral, anal, or vaginal sex; however, unlike the other STIs, you can also get HPV via non-sexual skin-to-skin contact through a cut or small tear in your skin.

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HPV infections are usually harmless and go away on their own within a few years in people with healthy immune systems. In most cases, HPV infection does not cause any symptoms, or if it does, the symptoms don’t develop until months or years after infection. Some symptoms don’t appear until serious health problems arise, depending on the strain involved (see below). There is no cure or treatment for HPV, but there are treatments for the symptoms and health effects of the virus.

There are many—over 100—types of HPV; at least 40 are known to affect the genital area. In most cases, there are no symptoms during an HPV infection; most people who are infected never know that they are carrying the virus. However, some strains have been linked to genital warts, skin warts, and some cancers.Approximately 90% of all genital warts are caused by HPV types 6 and 11 (CDC, 2018). These are referred to as “low-risk” HPV strains since they are not linked to the development of cancers. On the other hand, HPV strains 16, 18, 31, 33, 45, 52, and 58 are the “high risk” strains because they are associated with cervical cancer, oropharyngeal (mouth and throat) cancer, anal cancer, and penile cancer.

Both women and men can get genital warts. Their appearance varies; sometimes they appear as single warts and other times as clusters. They can look raised, flat, or cauliflower-shaped. Approximately 1% of sexually active adults have genital warts (CDC, 2019).  Genital warts can be treated with medication or surgery. There is no definitive treatment that works for everyone, so often therapies are combined. Medical options (applied directly to warts) include:

• Imiquimod cream — stimulates the immune system to help the body fight off the virus in the skin cells to kill the wart

• Podofilox gel — kills the skin of warts; avoid in pregnant women

• Trichloroacetic acid or bichloroacetic acid — these acids destroy the proteins holding the wart together causing it to fall apart

• Sinecatechins cream – derived from green tea extracts; avoid in pregnant women

Surgical options (performed by your healthcare provider) include:

• Cryotherapy — uses liquid nitrogen to freeze and kill the warts

• Excision — warts can be removed using a scalpel, laser treatment, electrocautery (electric current), or curettage (scraping)

Discuss with your healthcare provider which method is right for you.

Cervical cancer is the most common HPV-associated cancer in women, with 90% of all cervical cancers attributed to the presence of HPV infection (CDC, 2019). Cervical cancer often develops months or years after the initial HPV infection. The CDC estimates that nearly 12,000 women living in the U.S. will be diagnosed with cervical cancer each year (CDC, 2019). Sixty-six percent of cervical cancers are associated with HPV types 16 and 18; HPV types 31, 33, 45, 52, and 58 cause another 15% of cases (MMWR, 2015). Cervical cancer does not cause symptoms until it is in advanced stages, so screening is vital. Your healthcare provider can look for abnormal cervical cells with a Pap test. He or she uses an instrument, called a speculum, to gently open the vagina and visualize the cervix. Samples of cervical cells are collected and sent for testing to look for any abnormal cells, suggesting the presence of HPV.

What happens when the screening shows abnormal cells? In some cases, your provider may decide to monitor you to see if the abnormal cells resolve on their own. These abnormal cervical cells are called cervical dysplasia, precancerous lesions, or cervical intraepithelial neoplasia. Sometimes your provider may recommend treatment of the cervical dysplasia, using one of the following methods:

• Cryotherapy — uses liquid nitrogen to freeze and kill the abnormal cervical cells

• Laser therapy — removes the abnormal cells using high-intensity light (laser)

• Loop electrosurgical excision procedure (LEEP) — a wire loop that is heated by an electrical current and used to remove the abnormal cells from the cervix

• Cold Knife Cone biopsy- uses a scalpel or laser to remove a cone-shaped piece of cervical tissue containing abnormal cells; these can then be sent for microscopic evaluation to look for signs of cancer.

If cervical dysplasia is left untreated, it can lead to cervical cancer. Similarly, anal warts that persist can become anal cancer. Once an HPV-related health problem is diagnosed as cancer of any type (anal, oral, cervical, penile, etc.), additional testing will need to be done to determine the stage, and thereby treatment of that particular type of cancer. Talk to your health care provider to learn more about the treatment of HPV-related cancers.

The HPV vaccine was first approved in 2006, and it was designed to prevent infection with the strains of HPV that cause the most health problems: genital warts and most of the HPV-related cancers. The newest HPV vaccine targets types 6, 11, 16, 18, 31, 33, 45, 52, and 58.

The HPV vaccine is approved for both boys and girls; the CDC recommends that it is routinely administered at 11 or 12 years of age (MMWR, 2015). However, it may be given as early as age 9 and as late as age 26. In some situations, it may be appropriate for you to get the vaccine if you haven’t been vaccinated, even if you are aged 27-45 years; talk to your provider to see if the vaccine is right for you. HPV vaccines are not approved for use in adults aged >45 years (MMWR, 2019).Since the widespread usage of the HPV vaccine, there has been a significant decrease in the number of HPV infections (for the types targeted by the vaccine) (MMWR, 2019). Also, there has been a reduction in the rate of genital warts and cervical precancers when compared to the pre-vaccine era. For the vaccine to be most effective, it needs to be given before a person’s first sexual contact. If used correctly, it can prevent more than 90% of genital warts and over 70% of HPV related cancers (MMWR, 2015). However, once you have been infected with one of these HPV types, you are at risk of having health issues in the future.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

September 10, 2019

Written by

Chimene Richa, MD

Fact checked by

Tzvi Doron, DO

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About the medical reviewer

Tzvi Doron, DO

Dr. Tzvi Doron is Board Certified in Family Medicine by the American Board of Family Medicine.