Abnormal Pap Smears and HPV

What is HPV?

The human papilloma (pronounced "pap-ah-LO-mah") virus, also called HPV, is a common virus that infects the skin and mucous membranes. There are more than 100 types of HPV. Click here to view a magnified, color-enhanced picture of an HPV virus particle.

The types of HPV that cause common warts, such as those found on the hands and feet, are spread through skin-to-skin contact. In addition, it is also possible to get these common types of warts after sharing towels or other objects with a person who has warts.

About 30 types of HPV are spread only through direct genital contact. These "genital" types of HPV are either:

  1. "high-risk" - which means they can cause certain kinds of cancer (most commonly, cervical cancer) if the infection persists, or

  2. "low-risk" - which means they are not associated with cancer, but can cause genital warts. Unless you develop one of these problems, the only way to know whether you have HPV is by being tested.

How common is "genital HPV"?

The Centers for Disease Control and Prevention (CDC) has reported that as many as 80 percent of women - and 50 percent of men and women combined - will get a type of genital HPV at some point in their lives. However, most of those infections go away or are suppressed by the body within one to two years, without causing any problems that require treatment.

How do you get "genital HPV"?

The types of HPV that cause genital warts, abnormal cervical cells (dysplasia) and/or cervical cancer are spread from person to person through sex or intimate skin-to-skin (genital) contact. They are not spread by breathing the air, touching inanimate objects (such as a door knob) or shaking hands.

Condoms provide some protection. However, they cannot prevent infection completely, because they do not cover all areas of the genital region. It is important to know that while having more than one sexual partner increases the risk of getting HPV, it is possible to get the virus from just one person. It also is important to remember that even women who have had only one sexual partner for many years need to be screened for abnormal cells that can turn into cervical cancer. This is because HPV may remain dormant ("hidden") in the cervical cells for months or even many years. While dormant, the virus is inactive; it won't be detected by testing and will not spread or cause any problems. However, the infection may then "re-emerge," perhaps due to changes in the body's immune system. It is impossible to determine exactly when or from whom you acquired an HPV infection.

Is HPV different from other sexually transmitted diseases (STDs), like herpes and HIV?

HPV is often confused with other sexually transmitted infections and diseases, such as herpes or HIV. However, although it can co-exist with these and other sexually transmitted diseases, HPV is different. For more information on each type of sexually transmitted infection or disease, and what makes them similar as well as unique, visit the U.S. Centers for Disease Control and Prevention.

Keep these facts in mind:

  • Genital HPV infections are very common, affecting up to 80 percent of women by the age of 50.
  • HPV by itself is not a disease. Most infections go away or are suppressed by the body, without causing any symptoms or health effects.
  • There is no treatment for HPV itself, only for abnormal cells that may form if an infection becomes long-lasting.
  • There is currently no HPV test for men, and it is impossible to know from whom you got the infection or when.
  • Medical research suggests that after you get a particular type of HPV, you become immune to it and cannot be re-infected with that same type again.
  • Thus, there is no need for "partner tracing." What you tell your partner about your HPV test results is a personal decision.
  • However, although each sexually transmitted infection or disease is different, they may sometimes co-exist and have an exaggerating effect on each other. For example, women whose immune systems are weakened by HIV/AIDS are more at risk of developing cervical disease from HPV.

Can you get HPV through oral sex?

This is a question that is still being researched. Some studies have found that 25-35 percent of oral (mouth and throat) cancers are linked to high-risk types of HPV. However, in light of the widespread practice of oral sex, the American College of Obstetricians and Gynecologists considers the spread of HPV through this route to be rare.

Are lesbians at risk of getting HPV?

Yes. In addition to intercourse, HPV can be spread through genital-genital, finger-vaginal or finger-anal contact. (The role of sex toys inserted into the vagina is unknown, but there is some speculation that the spread of HPV can be facilitated if a device is used by one person and then another, or is not cleansed between partners.) If either woman in the relationship has ever had sex or other intimate contact with a man, she may have HPV and pass the virus to her partner. This is still possible even if it has been many years since the contact with a male. There also have been some reports of HPV-related cervical disease in women who report no previous sexual relationships with men. However, it is less common than among lesbians who reported previous sexual relationships with men.

Despite these facts, a recent study by the University of Washington found that many lesbians are not getting screened for cervical cancer risk as regularly as heterosexual women. The Centers for Disease Control and Prevention strongly advises that women be screened "regardless of their sexual preferences or practices." For more information, visit the CDC's site for lesbian and bisexual women.

Do men get HPV too?

Men get HPV just like women do. As with women, men usually have no symptoms, unless the HPV virus begins to cause abnormal changes in skin cells. However, although HPV infection has been linked to cancer of the penis and anus, these cancers are very rare in men. For this reason, as well as because a good, reliable way to collect a sample of male genital skin cells that would allow detection of HPV has yet to be discovered, there is currently no FDA-approved HPV test for men.

How do you know if you have HPV? Does HPV cause any symptoms?

Most commonly, genital types of HPV do not cause any symptoms at all. Usually, the infection goes away or is suppressed by the body before any problems develop. However, sometimes the infection persists, causing abnormal cells to form. In the case of high-risk (potentially cancer-causing) types of HPV, the only way to know you have the virus before cervical cancer develops is to be screened using both a Pap and (if you are 30 or over) the HPV test. By catching persistent infections while they are still relatively early in their development, abnormal cells can be detected and removed before they become cancerous. That is why periodic testing for HPV is so important.

Signs of cervical cancer may include:

  • unusual vaginal discharge or bleeding (especially after sexual intercourse).
  • lower back pain.
  • painful urination (particularly when there is also pain in the lower abdomen).
  • pain during sex.
  • Warning: These symptoms can have a number of causes. They do not necessarily mean you have cervical cancer. Talk to your doctor or nurse if you have any of these symptoms.

In the case of a "low-risk" type of HPV, the only way you know you have it is if genital warts develop, which can then be treated. While there is a test for low-risk types of HPV (separate from the test for high-risk HPV), its routine use is not recommended by medical experts - and insurance usually will not pay for it. That is because there is nothing that can be done about low-risk HPV infections until warts develop.

If you find out you have HPV, is there reason to feel guilty, or to blame your partner?

Finding out that you have the HPV virus - or cervical disease caused by HPV - often causes women to feel a range of emotions: confused, scared, uncertain, ashamed (due to the fact that it's sexually transmitted) and even angry (perhaps at your spouse or partner). All of these emotions are natural, but they can be helped or even eliminated altogether with information and the support of other women. Visit this Web site's special section on "Coping with the News that You Have HPV."

Should you tell your sexual partner(s) if you have HPV?

If you are tested for HPV and are told by your physician, nurse or other healthcare provider that you have the virus, it is your own, personal decision whether to tell your partner. It is important to remember that most adults will get one or more types of HPV at some point in their lives. Chances are, your partner was already exposed to HPV by the time your infection was detected. Likewise, it is impossible to know for certain from whom you got the HPV virus in the first place. You could have been exposed in another relationship months or years earlier, and the infection may have been dormant ("hidden") in the meantime.

In addition, if your partner is a male, you should be aware that there is currently no FDA-approved HPV test for men. Thus, there is no way to determine whether he has the virus. Fortunately, serious, HPV-related health problems are relatively rare in men. For more information on this topic, visit Talking to Your Partner and our "HPV Information for Men" page.

Can HPV be treated?

Antibiotics or other currently available medicines cannot treat HPV infection. Luckily, the virus usually goes away or is suppressed by the body to a low level without causing any problems. However, if the infection persists, treatment is available only for the abnormal cells that form as a result. For example, genital warts can be treated with gels, creams, lasers or other technologies. Likewise, pre-cancerous cells on the cervix can be removed using surgical procedures such as LEEP (a technique that uses electrical energy) or laser therapy. When invasive cervical cancer already has developed, hysterectomy and chemotherapy usually are needed.

Since no treatment is available for the infection itself, the most effective method of avoiding complications is early detection and treatment of abnormal cells before they become cancerous. That is why it is so critical to get regular screening with a Pap smear and - once a woman is 30 or over - the HPV test. Younger women are very likely to get HPV, but it is rare for women in this age group to develop cervical cancer. Once over the age of 30, HPV infections are less common, but they are more likely to have been present for a long time and thus to cause in abnormal cells. With early treatment of pre-cancerous cells, cervical cancer can be prevented before it has a chance to develop.

If you have HPV, how likely is it that you will get cervical cancer?

In most cases, the body's immune system fights off or suppresses the virus before abnormal cells develop. The Centers for Disease Control and Prevention (CDC) estimates that 70 percent of new HPV infections (including those that are "high risk") go away within one year, and 91 percent are gone within two years.

It's only when high-risk types of HPV stay "active" for a long period of time that the risk of developing abnormal cells that can turn into cervical cancer increases significantly. In one study conducted by the National Cancer Institute, 4 percent of women who were found through testing to have high-risk HPV developed pre-cancerous cervical disease (CIN 3) in the following three years. When watched for 10 years, about 7 percent of the women developed advanced cervical disease.

Overall, it's estimated that women who have a long-lasting infection with high-risk HPV are 200-plus times more likely to develop pre-cancerous cervical disease than those without it.

Can HPV cause any other kinds of cancer besides cervical cancer?

Cervical cancer (which the American Cancer Society says affected an estimated 11,150 women in 2007) is by far the most significant concern. However, high-risk types of HPV also have been linked to less-common cancers of the vulva (3,490 women), vagina (2,140 women), anus (2,750 women and 1,900 men) and penis (1,280 men).

Some research also has suggested a link between high-risk types of HPV and other cancers, such as oral (mouth and throat) cancer. However, these other HPV-related cancers are still being investigated and are thought to be relatively rare.

What can you do to protect yourself from HPV and its effects?

In 2006, the U.S. Food and Drug Administration (FDA) approved the first vaccine designed to protect against four types of HPV: two that most commonly cause cervical cancer, and two others that cause most genital warts. The agency approved the use of the vaccine, called Gardasil® (developed by Merck), for girls and young women age 9-26. However, the FDA cautioned that "females are not protected if they have been infected with [the targeted] HPV types prior to vaccination, indicating the importance of immunization before potential exposure to the virus." In other words, the vaccine is most effective when given before a female has her first sexual relationship. For more information, visit "Quick Facts: The HPV Vaccine and What It Means for You."

However, even immunized women can still be infected with one of the HPV types that are not targeted by the vaccine. Thus, and for many other reasons as well, it's a good idea to:

  • Limit your number of sexual partners.
  • Use condoms if you are not in a monogamous relationship. Condoms do not protect completely against HPV, since they do not cover the entire length of the penis. However, a study published in The New England Journal of Medicine confirmed that consistent use of condoms does significantly reduce the risk of HPV infection. In addition, they protect against other sexually transmitted infections, such as HIV.
  • Don't smoke, because that can prevent the body's immune system from working effectively.
  • Take a folic acid supplement - like the ones recommended for pregnant women - along with your multi-vitamin. One recent study found that women with higher levels of folate - a type of B vitamin - were less likely to get a new HPV infection. And if an HPV infection already exists, it was less likely to persist.

After you get HPV, will it go away? Or will you have it forever?

Medical science does not yet have all the answers to life's mysteries, and this is one of them. The Centers for Disease Control and Prevention (CDC) estimates that more than 90 percent of HPV infections are "cleared" by the body within two years. However, it is not known for certain whether the body actually gets rid of the virus altogether, or - as appears to happen in at least some women - the virus is merely suppressed to a low, undetectable level. It's possible that either scenario can occur, depending on the woman.

The good news is that even if the HPV infection is merely suppressed by the body - "hiding" in the cells at a low level - it cannot cause abnormal cells to form or spread to another person when it is in this non-detectable state. The bottom line: A negative HPV test means you are risk-free for at least the next few years.

However, it is believed that old HPV infections can "re-activate" years later, most likely due to changes in your immune system. (That's why it's important to keep your immune system healthy, by eating well, exercising and not smoking. Some experts also believe that taking a folic acid supplement helps.) In addition, if you have sexual contact with a new partner, you could get a new HPV infection with a different type of the virus. Thus, periodic re-testing is needed. Current medical guidelines recommend that women with normal Pap and negative HPV results be re-tested every three years. For more information on how often you should be tested, visit the section of this site on "Understanding Your Test Results."

In addition, if you are treated for cervical disease, it is a good idea to be re-tested for HPV following the procedure to make sure the infection is really gone.

Does HPV interfere with a woman's ability to get pregnant?

Having HPV does not interfere with a woman's ability to become pregnant. For more information, visit our discussion of reproductive health.

Can a mother with HPV pass the virus to her child?

The Centers for Disease Control and Prevention (CDC) says it's possible for the HPV virus to be passed from mother to child during birth, but it is "rare." In fact, the agency estimates this occurs in no more than 1.1 cases per 100,000 children. In these extremely infrequent cases, the HPV infection is found in the infant's respiratory tract, which can lead to wart-like growths - most commonly, on the larynx. Early diagnosis and care are key.