What is HPV ?

Human Papilloma Virus (HPV) is the name for a group of viruses that affect your skin and moist membranes lining your body.

Examples of this include your:

  • Cervix
  • Anus
  • Mouth and throat

Human papillomavirus (HPV) is an extremely common virus. At some point in our lives most of us will catch the virus. Worldwide, HPV is the most widespread of all sexually transmitted viruses; four out of five (80%) of the world's population will contract some type of the virus once in their life. If you catch HPV, in the majority of cases the body's immune system will clear or get rid of the virus without the need for further treatment. In fact, you may not even know that you had contracted the virus.

There are over 100 identified types of HPV and each different type has been assigned a specific number. HPV infects the skin and mucosa and different types affect different parts of the body, causing lesions. The majority of HPV types infect the skin on external areas of the body, including the hands and feet. For example, HPV types 1 and 2 cause verrucas on the feet.

Around 40 of the HPV types affect the genital areas of men and women, including the skin of the penis, vulva (area outside the vagina), anus, and the linings of the vagina, cervix and rectum. Around 20 of these types are thought to be associated with the development of cancer. The World Health Organization (WHO) International Association for Research on Cancer (IARC) defines 13 of these 20 types as oncogenic (cancer causing). This means there is direct evidence that they are associated with the development of cervical cancer and are considered high risk. These high-risk types of HPV are HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 . A person infected with a high-risk genital HPV will show no symptoms, so they may never even know they have it.

In addition, there are nine HPV types that may also be associated with the development of cervical cancer, these are HPV 26, 53, 64, 65, 66, 67, 69, 70, 73 and 82. However, there is currently not enough evidence to indicate that these are high-risk types for cervical cancer.

The remaining genital HPV types have been designated low risk as they do not cause cervical cancer but they can cause other problems, such as genital warts.

How did I get HPV ?

Anybody who has ever been sexually active is at risk of contracting HPV. Genital HPV is transmitted primarily by skin-to-skin contact, including genital-to-genital contact, vaginal and anal intercourse, and oral sex. The time from exposure to the virus to the development of warts or cervical disease is highly variable and the virus can remain dormant in some people for long periods of time. Often it is not possible to determine exactly when or from whom the infection originated.

High-risk HPV infections are very common and infected individuals will have no symptoms; therefore, it is very difficult to tell whether an individual is infected. There is no treatment for a high-risk HPV infection; usually the body’s own immune system will clear the infection.

Practising safe sex through the use of condoms can help reduce the risk of being infected with HPV, but it will not completely eradicate the risk as HPV lives on the skin in and around the whole genital area.

  • HPV is a very common virus. Up to 80% of people will be infected with a genital HPV infection at some time during their lives.
  • Your first sexual experience puts you at risk of infection.
  • You are still at risk of contracting HPV even if you do not have penetrative sex as the virus is transmitted through genital skin-to-skin contact.
  • Infection with HPV does NOT imply either infidelity or promiscuity.
  • If you get high-risk HPV you will not require treatment nor will your partner. However, if your cervical screening test detects abnormal cells and high-risk HPV you may be sent for further examination.
  • A strong immune system can help your body to clear an HPV infection.
  • Smoking can make it harder for the body to clear HPV.
  • It can take 12–18 months to clear a high-risk HPV infection.
  • An HPV infection can persist in the body without causing any problems for many years.

What can HPV do??

Infection with some types of genital HPV can cause:

  • genital warts - which is the second most common sexually transmitted infection (STI) in England
  • abnormal tissue growth and other changes to cells within your cervix-which can sometimes lead to cervical cancer

Girls aged 12-13 are offered a vaccination against HPV to help protect them against types of HPV that can cause cervical cancer. Women aged 25-64 are offered cervical screening to check for abnormal cells in the cervix.

Other types of HPV infection can cause minor problems, such as common skin warts and verrucas.

Can genital HPV be prevented??

Using condoms can reduce your risk of getting a genital human papilloma virus (HPV) infection. You can also be vaccinated against some types of HPV.

Using a condom

Using a condom during sex can help to prevent an HPV infection. However, condoms don’t offer complete protection. HPV can be present all over the area around your genitals and anus, and is spread through skin-to-skin contact of the genital area- not just penetrative sex.

If you've been treated for genital warts (which are caused by HPV), you should use a condom for three to six months after your treatment finishes. This may reduce the risk of passing the virus on to your partner if they haven't already been exposed.

HPV vaccination

All girls aged 12-13 are offered a vaccination against HPV to help protect them against types of HPV that can cause cervical cancer. The vaccination also helps to protect against the more common types of HPV that cause genital warts.

Can I be tested for HPV??

HPV testing is part of the NHS Cervical Screening Programme. If a woman’s cervical screening result shows changes in the cells of the cervix or mild abnormalities (called borderline change or low grade (dyskaryosis), an HPV test will be carried out.

There is no blood test for HPV.

In men, there’s currently no reliable test for HPV infection and it's often very difficult to diagnose as there are no symptoms of high-risk HPV. Some people who are known to be at a high risk of having anal HPV and of developing anal cancer may be offered an anal smear.

Genital warts are a sign of infection with low-risk types of HPV and can be diagnosed in men as well as women.

Cervical screening test results

If your Cervical screening test sows changes in the cells of your cervix, the results may be reported as cell changes or abnormal cells (dyskaryosis) and you’ll be also be tested for high-risk HPV infection. The same sample of cells can be used so you don’t need to have another sample taken.

Only 15-20% of women with borderline change or low grade cell changes will need treatment. The HPV test helps to identify which women with borderline changes or low grade dyskaryosis may need treatment.

If your cervical screening test result shows high-grade dyskaryosis (moderate or severe), you will be referred for a colposcopy examination. This is a way of looking closely at your cervix to see if you need treatment.

HPV test results

If you have borderline change or low-grade dyskaryosis test results, and no evidence of high-risk HPV infection, you’re very unlikely to develop cervical cancer and can continue with routine screening every three or five years, depending on your age.

If your HPV test result shows you have high-risk HPV infection, it means that your risk of developing cancer is greater than if the test result was negative. However, only a tiny proportion of such infections develop into cancers. Regular cervical screening can prevent cancers developing

You'll be invited to go for a colposcopy examination to see if you need treatment.

Can Genital HPV infections be treated??

Although there’s no treatment for the HPV virus itself, treatments are available for its effects. Most HPV infections don't cause any serious harm and are cleared by your immune system within two years.

Genital warts

Genital warts can be treated by either:

  • applying creams, lotions or chemicals to the warts
  • destroying the tissue of the warts by freezing, heating or removing them

Cervical cancer

In women, persistent infection with certain "high-risk" types of HPV can cause changes to cells in the cervix, which can increase the risk of cervical cancer. The types of HPV that cause genital warts are "low-risk" and aren’t associated with an increased risk of cervical cancer.

Abnormal cells in the cervix can be treated if detected early, which is why it’s important to attend cervical screening when invited.

HPV vaccination

All girls aged 12-13 are offered a vaccination against HPV to help protect them against types of HPV that can cause cervical cancer. The vaccination also helps to protect against the more common types of HPV that cause genital warts.

The HPV vaccines

Each year in the UK, over 3,000 women are diagnosed with cervical cancer and around 300,000 women are told they may have some form of cervical abnormality. A very common virus, called Human Papilloma Virus (HPV), causes cervical cancer.

There are around 13 high-risk types of HPV that are responsible for almost all cervical cancers. Within the high-risk group, types 16 and 18 are the most prevalent and are responsible for 70% of cervical cancers. An HPV infection can cause changes to the cells of the cervix, creating abnormalities. Once these abnormalities become severe they can develop into cancer, which is why cervical screening and HPV vaccination are important in helping to prevent cervical cancer.

There are currently two HPV vaccines that provide protection against the two high-risk types of HPV (types 16 and 18) that cause 70% of all cervical cancers. One of the vaccines is also designed to provide protection against genital warts, which are caused by low-risk types of HPV. Low-risk types of HPV do not cause cervical cancer.

Research indicates that the HPV vaccine could prevent two thirds of cervical cancers in women under the age of 30 years old by 2025, but only if uptake of the HPV vaccination is at 80%. To date, the UK has achieved this level each year in the national HPV immunisation programme.

The Vaccines

There are currently two vaccines, which protect against HPV infection, which are called Gardasil and Cervarix.

  • Gardasil, produced by Sanofi Pasteur MSD, is designed to protect against four types of HPV:
    • 16 and 18 (high risk for cervical cancer)
    • 6 and 11 (these types do not cause cervical cancer, but they do cause 90% of genital warts)
  • Cervarix, produced by GlaxoSmithKline, is designed to protect against HPV types 16 and 18 only

Both vaccines are licensed in the UK. The NHS currently uses Gardasil to vaccinate girls.

There is also a third vaccine called Gardasil 9. This protects against high risk HPV types 16, 18, 31, 33, 45, 52 and 58, as well as HPV 6 and 11. Gardasil 9 has been approved for licensing by the Committee for Medicinal Products for Human Use of the European Medicines Agency. This vaccine is likely to be given its licence by the European Commission later this year. If it gains its licence it is likely that the department of health will ask the Joint Committee on Vaccination and Immunisation (JCVI) to look at whether it would be cost effective to use Gardasil 9 in place of Gardasil for the immunisation program as it offers protection against more HPV types.

The UK HPV Vaccination Programme

In the UK, girls aged between 11 and 14 are offered the Gardasil HPV vaccine. This vaccine protects against genital warts as well as cervical cancer. Girls have 2 injections of the vaccine. The second injection is usually a year after the first but it can be any time between 6 to 24 months later.

A letter about the vaccine and a consent form is sent to the parents of the girl before she has the vaccine. It is up to her whether she has the vaccine.

It is possible to have the vaccination privately. The cost for private treatment varies from doctor to doctor.

If girls take up the vaccination at school, the programme will prevent at least 7 out of 10 cancers of the cervix (70%) and possibly even more in the future. But it takes between 10 and 20 years for a cancer to develop after HPV infection. So any benefits in reducing cervical cancer won’t be seen for quite a long time. But the number of cases of pre cancerous changes in the cervix (CIN) will fall quite rapidly.

The vaccination gives protection for at least 10 years. It is expected that the vaccines should last for life but more research is needed to find out if this is the case. It may be that women will need a booster dose at some time.

If girls are sexually active before having the vaccine

The vaccine is being offered to girls from the age of 12 because they are unlikely to be sexually active and to have caught HPV. The research so far has shown that the vaccine works best at preventing HPV infection in younger women. If you are sexually active before you have the vaccine you may already have HPV and the vaccine won’t get rid of it. But there are still benefits from having the vaccine. There are many different types of HPV so even if you have HPV it may not be HPV 16 or 18. Types 16 and 18 are the types that are most likely to cause cancer of the cervix and it is these high risk types that the vaccines protect against.

If girls become sexually active during the course of the vaccine injections it is important to complete the course of injections. It is only after completing the whole course that we know the vaccine is protective.

Side effects of the HPV vaccine

The side effects are usually mild and may include

  • A headache
  • Dizziness
  • Aching muscles
  • Redness and soreness around the site of the injection
  • A slightly raised temperature
  • Feeling and being sick
  • Stomach pain
  • Diarrhoea
  • Itching and a skin rash

Do I still need cervical cancer screening?

Yes, you will definitely still need the cervical screening programme in the UK. The vaccines don't prevent infection with all types of HPV. Also from the research so far, we don't think the vaccines will help prevent cervical cancer in women already infected with HPV.

It takes about 10 to 20 years after HPV infection for a cervical cancer to develop. So it’s very important to remember that women will still need cervical cancer screening (smear tests) for many years to come.

Can girls who missed HPV vaccination still have it?

Yes, if a girl misses either of her HPV vaccinations, for whatever reason, speak to her nurse or doctor about making another appointment, ideally as close as possible to the original one.

Girls can have the HPV vaccination on the NHS up to age of 18.

Girls who have the HPV vaccination after the age of 15 will need three doses as the response to two doses is not so good in older girls.