What is human papilloma virus (HPV)?
Human papilloma virus (HPV) is a contagious virus that is spread by skin-to-skin contact.
HPV can infect the outer layer of skin and the smooth, moist linings of the mouth, the rectum, the anus and genital areas of people of all sexes and genders.
There are over 100 different types of HPV. Many of these types cause the common warts that appear on hands and feet. Other low-risk types, usually HPV 6 and 11, cause genital warts. High-risk types such as HPV 16 and 18 have been linked to cancer, particularly cancer of the cervix.
For some people, warts from HPV may go away without treatment. Once you have an HPV infection, the virus usually stays in your body. This means it is possible to pass on HPV, even if you do not have any symptoms.
What are genital warts?
Genital warts can appear in different forms, sometimes weeks, months or years after being infected with HPV. There can be one or many in the genital areas or around the anus. They can be flat or raised. When the warts are raised, they may look like cauliflower. The warts can be pink, brown or the same colour as your skin.
HPV is passed on by contact with the virus
HPV is passed on by skin-to-skin contact. Genital HPV infections are usually passed on by having contact with an infected person, with sexual contact being the most common in adolescents and adults. When a child has HPV, it is not always clear how the virus was passed on and there is no test that can determine how they got the virus. Because it spreads with skin-to-skin contact, the virus can be passed on in the following ways:
- A pregnant individual who has HPV can pass on the infection to the fetus through the bloodstream before birth or through the vaginal canal during birth. This is called perinatal transmission.
- Children with warts on their hands can transmit the virus to their genital area by touching the warts on their hands and then touching their own genitals. This is called autoinoculation.
- A caregiver with warts on their hands or genitals can transmit the virus by skin-skin contact with the hands or the genitals of the child. This is called heteroinoculation.
- HPV can be passed on from the skin of a person to the genital area of a child through sexual contact. This is why sexual abuse needs to be considered in children who are diagnosed with genital wards.
Diagnosing HPV and genital warts
Any child with genital warts needs a complete medical examination, which includes the following:
- A health-care provider will do a physical examination and look at the child's anus and genital area.
- They will ask the child’s caregivers if they have ever had an abnormal Pap test, known HPV infection or past genital or common warts.
- They may ask the child’s caregivers about any concerns they have for sexual abuse and may look for signs of sexual abuse on the child.
- Testing for other sexually transmitted infections may be considered.
Testing for HPV
Most HPV infections come and go without any symptoms. It is possible to test for HPV directly, but this is not usually recommended because HPV is so common. Testing to find out the type of HPV does not give any extra information about when or how the person was infected.
The presence of genital and/or anal warts may indicate an infection, and there is treatment that is available for the management of warts.
Treatment for genital warts
Once genital warts are diagnosed, the health-care provider and patient decide together which approach is best. There are several options for treating genital warts. Some treatments work better than others. Some treatments have risks or side effects, including causing some pain. These treatments will usually be avoided unless necessary. Which treatment is chosen will usually be based on the number, site, and size of the warts. It will also be based on what the patient prefers, the cost and the side effects. Some people may choose not to have any treatment.
Genital warts may go away and come back
Without treatment, genital warts may go away by themselves, or they may last for years. Even if they have been treated, genital warts may come back in time.
There are vaccines that protects against HPV
There are two vaccines on the market in Canada: Gardasil 9 and Cervarix.
Gardasil 9 covers nine strains of HPV. This is the vaccine recommended by the Canadian Pediatric Society for all individuals between the ages of 9 and 26 and is covered by most public immunization programs.
The Cervarix vaccine provides immunity to only two strains, HPV 16 and HPV 18.
For more information, see the article on Human papillomavirus (HPV) vaccine.
Genital warts and cancer
There are many types of HPV; the type of HPV that causes genital warts is considered low-risk for cancer. However, a person can be infected by more than one type of HPV. Other types of HPV are high-risk (types 16 and 18). These can lead to cancer of the cervix; less often, they can lead to cancer of the vagina, penis or scrotum. Currently, it is impossible to test warts for all described types of HPV.
Salvadori MI; Canadian Paediatric Society, Infectious Diseases and Immunization Committee. Human papillomavirus vaccine for children and adolescents. Paediatr Child Health 2018, 23(4):262–265. Retrieved from https://cps.ca/documents/position/HPV.