HPV myths and facts

Unfortunately, myths and misconceptions about genital HPV abound, and in some cases do considerable harm. Bad information can cause a person to suffer terrible anxiety unnecessarily, to doubt a partner’s faithfulness, or even to undergo painful and expensive treatment that could have been avoided. Most dangerous of all, misinformation may lead people to neglect a very simple procedure that saves lives.

But why? One reality is that some aspects of the virus are still poorly understood, even by medical researchers. There simply are no proven answers to many common questions.

At the same time, much new information about HPV has been learned in recent years, reversing some previous assumptions about the virus. The result is that older publications may be inaccurate, when they mention HPV at all. Likewise, healthcare professionals, writers, and educators who have not kept up with recent research findings may continue to spread misconceptions.

Another difficulty is that to some degree, the overall topic of genital HPV is complex and confusing to everyone, lay person and scientist alike.

Below I take on some of the most common myths and misconceptions I’ve encountered on the topic of genital HPV and offer clear and accurate information in response.

„HPV is an STD (sexually transmitted disease)”

HPV is an STI, or sexually transmitted infection, not a disease. The distinction between an STI and a sexually transmitted disease (STD) is an important one. An infection occurs when a virus is present in your body, but it doesn’t become a disease until symptoms or abnormalities occur.

Many infections can exist in your body and stay dormant, never causing any symptoms or diseases. An STI always a cause of an STD, but not every STI develops into a disease. In the case of HPV, the disease that occurs as a result of the infection is often cervical cancer, anal cancer or genital warts. Other rare cancers of the genitalia may also occur.

„I’m the only person I know with HPV”

It’s easy to understand why so many people hold this misunderstanding about HPV. After all, public awareness of the virus is extremely low. The net result is that very few people ever have the chance to place genital HPV in an accurate context, as the very common virus it really is. According to an article published in 1997 in the American Journal of Medicine, about 74 percent of Americans—nearly three out of four—have been infected with genital HPV at some point in their lives.

Among those ages 15-49, only one in four Americans has not had a genital HPV infection.

It’s true that most often genital HPV produces no symptoms or illness, and so a person who has been infected may never know about it. Experts estimate that at any given time, only about 1% of all sexually active Americans have visible genital warts.

„There is treatment for HPV”

There is no treatment for HPV, but about 90 percent of HPV infections go away on their own – that is, if you’ve been told you have HPV, your immune system will likely fight it off in a couple of years. And because most cases are asymptomatic, it’s possible to contract and fight off the virus without ever knowing it. If you’ve been monogamous with a partner for a long time, it is likely that you share the same strain of HPV.

The STDs caused by HPV, on the other hand, can be treated. Genital warts can be treated with medicine, surgery or by frozen off. To get medicine or surgery for genital warts you’ll have to see a doctor. Cervical, vulva and anal cancers can be treated like many other cancers with surgery, radiation therapy or chemotherapy.

„Only people who have casual sex get STIs”

Many people believe that only “someone else”—for example, people who have multiple partners, sex outside of marriage, or a different lifestyle—are at risk.

It is true that a higher number of sexual partners over the course of a lifetime does correlate with a higher risk for STIs, including HPV. This is simply because the more sexual partners you have, the more likely you will have a partner who (knowingly or unknowingly) is carrying an STI.

However, STIs can be passed along as readily in a loving, long-term relationship as in a one-night stand. And HPV is the virus to prove it. At least one study of middle-class, middle-aged women, most of them married with children, found that 21% were infected with cervical HPV. According to another study, about 80% of people who have had as few as four sexual partners have been infected with HPV.

„An HPV diagnosis means someone has cheated”

This myth has been responsible for a great deal of anger, confusion, and heartache. It has led many people to tragically wrong conclusions because it fails to take into account one of the most mysterious aspects of genital HPV: its ability to lie latent.

The virus can remain in the body for weeks, years, or even a lifetime, giving no sign of its presence. Or a genital HPV infection may produce warts, lesions, or cervical abnormalities after a latent period of months or even years.

As mentioned above, most people who are infected with genital HPV never know it; their virus does not call attention to itself in any way. In most cases, a person is diagnosed with HPV only because some troubling symptom drove him or her to a health care professional, or some abnormality was revealed in the course of a routine exam.

But although careful examination can identify genital HPV infection, and laboratory tests may even narrow down the identification to a specific type among the two dozen or so that inhabit the genital tract, there is simply no way to find out how long a particular infection has been in place, or to trace it back to a particular partner.

In a monogamous relationship, therefore, just as in an affair or even in an interval of no sexual relationships at all, an HPV diagnosis means only that the person contracted an HPV infection at some point in his or her life.

„Genital warts lead to cervical cancer”

No one knows how many sleepless nights can be laid at the door of this myth. The truth, however, is that the fleshy growths we call genital warts are almost always benign. In the vast majority of cases, they do not lead to cancer, turn into cancer, or predispose a person toward developing cancer.

There are more than 100 types of human papillomavirus, and most are quite specific in the sites they can invade and the pathology they can cause. Those most strongly associated with cancer are HPV types 16, 18, 31, 45, and, to a lesser degree, half a dozen others. These are known as the “high-risk” types, not because they usually or frequently cause cancer–in fact, cervical cancer is a rare disease in the United States today, and penile cancer even more so–but because, in the infrequent event that cancer does develop, it can usually be traced back to one of these types. Even so, it bears repeating: most women with high-risk HPV on their cervix will not develop cervical cancer.

As for ordinary genital warts, these are caused by HPV types that are virtually never found in cancer. These are the “low-risk” types, 6, 11, 42, 43, and 44.

In practical terms, a man with genital warts is no more likely than any other sexually active man to transmit cancer-causing HPV types to a partner. Experts do recommend that a woman exposed to genital warts–or any other STI–have regular Pap tests. This is because she may have been exposed to high-risk HPV types during unprotected sexual activity. Regular Pap tests are also recommended for any sexually active woman, since HPV infection is very common. It is worth keeping in mind that both men and women may be infected with, and infectious for, high-risk HPV, regardless of whether or not they have genital warts.

„If I have HPV, I will have recurrences”

Warts do recur (come back) in some cases, but by no means all. When they recur, they show varying persistence: Some people experience just one more episode, and others several. The good news for most people is that with time, the immune system seems to take charge of the virus, making recurrences less frequent and often eliminating them entirely within about two years.

The limiting factor here is the state of the immune system itself. If an individual’s immune system is impaired—by the use of certain medications, by HIV infection, or by some temporary trauma such as excessive stress, serious illness, or surgery—it may be unable to prevent a recurrence. However, if the immune system is weakened only temporarily, most likely the recurrence will be short-lived.

The concern about life-long recurrences may be based on a misconception rather than a myth. It’s true that at present there is no known cure for genital human papillomavirus. As a virus, it will remain in the infected person’s cells for an indefinite time–most often in a latent state but occasionally producing symptoms or disease, as we have discussed elsewhere. Recent studies suggest that HPV may eventually be cleared, or rooted out altogether, in most people with well-functioning immune systems. However, in at least some cases the virus apparently does remain in the body indefinitely, able to produce symptoms if the immune system weakens.

„Warts aren’t contagious after treatment”

Medical opinion is not settled on this point. The closest to a consensus might be phrased as, “Don’t be too sure.”

Some specialists think that removing genital warts may lower the risk of transmission, since it “de-bulks” the areas of tissue that contain infectious particles. But since the area surrounding any visible warts is also likely to contain infectious HPV particles, removing the warts cannot eliminate the risk.

A person may have good reasons for wanting his or her genital warts removed–they may be uncomfortable physically or psychologically. But removing warts cannot guarantee that the risk of transmission is removed.

„If a woman has an abnormal Pap, her male partner needs to be tested for HPV”

Based on our experience with other infections, this would seem like a good idea. However, thus far there is no diagnostic test that can accurately determine whether a man is carrying an HPV infection. And even if he does, there is no way to treat him for the virus. It’s certainly possible–even likely–that the partner is or has been infected with the virus, although highly unlikely that he will ever show any symptoms. Nor is it possible to determine whether he can spread HPV to a future partner.

However, if a woman has external genital warts, her partner may still consider scheduling a medical exam. It may be useful for a male partner to talk with a health care provider to gain more information. And of course, if a man starts to notice symptoms of his own, such as unexplained bumps or lesions in his genital area, he should get medical attention at once.

„If I have always used condoms, I’am not at risk for HPV”

Unfortunately, this is not always the case. Used correctly, condoms are very effective against STIs such as gonorrhea and HIV that are spread through bodily fluids. However, they are likely to be less protective against STIs that spread through skin-to-skin contact, such as HPV and herpes. The reason is simply that condoms do not cover the entire genital area of either sex. They leave the vulva, anus, perineal area, base of the penis, and scrotum uncovered, and contact between these areas can transmit HPV.

That is not to say condoms are useless. In fact, studies have shown condom use can lower the risk of acquiring HPV infection and reduce the risk of HPV-related diseases, as well as help prevent other STs and unintended pregnancy. For these reasons, condoms should play an important part in any new or non-monogamous sexual relationship.

„HPV vaccines protect you for life”

Getting a vaccine for HPV may be protective for up to a decade, but doctors hope it will work for longer in most people. The two types of HPV vaccines on the market are Gardasil and Cevarix, and data suggest they both work at least 10 years. However, some vaccines need boosters from time to time, and because HPV vaccines are new, it’s too soon to know if this is the case. Only time – and further research – will tell.