What is Human Papillomavirus (HPV) and how is it transmitted, is it curable?

Human Papillomavirus (HPV): Transmission and Curability

Human Papillomavirus (HPV) is a sexually transmitted virus that cannot be cured, though most infections clear spontaneously within 1-2 years through the body's immune response. 1, 2

What is HPV?

HPV is a DNA virus that infects epithelial cells in various mucous membranes and skin surfaces. It is one of the most common sexually transmitted infections worldwide 3. There are over 120 different genotypes of HPV, which can be categorized into:

• High-risk types (such as HPV-16 and HPV-18): Associated with development of cervical, anal, vaginal, vulvar, penile, and oropharyngeal cancers
• Low-risk types (such as HPV-6 and HPV-11): Cause benign conditions like genital warts 3

How is HPV Transmitted?

HPV is primarily transmitted through:

1. Sexual contact 1, 2:

   • Genital-to-genital contact, usually during sexual intercourse
   • Other types of genital contact (oral-genital, manual-genital)
   • The number of sexual partners is the most consistent predictor of infection

2. Non-sexual routes (less common) 1, 4:

   • Mother-to-newborn transmission during childbirth
   • Self-inoculation
   • Possibly through shared objects that contact mucous membranes

The CDC reports that condoms are not fully protective against HPV transmission because the virus can infect areas not covered by a condom 1, 2.

Is HPV Curable?

HPV itself is not curable - there is no treatment that eliminates the virus from the body. However:

• 70% of new HPV infections clear within 1 year
• Approximately 90% clear within 2 years
• The median duration of new infections is 8 months 1

Important points about HPV management:

• The virus itself is never treated, only the symptoms and signs (like warts or precancerous lesions) 1
• Treatment options for genital warts include:
  • Cryotherapy with liquid nitrogen
  • Topical treatments (TCA or BCA 80-90%)
  • Surgical removal 1
• A healthy immune system typically suppresses the virus over time 1
• Experts disagree on whether the virus is completely eliminated or reduced to undetectable levels 1

Prevention of HPV

1. HPV vaccination:

   • Highly effective in preventing infection with common high-risk HPV types
   • Most effective when administered before sexual activity begins
   • Two vaccines are available that protect against HPV types causing 70% of cervical cancers; the quadrivalent vaccine also protects against types causing 90% of genital warts 1, 5

2. Safe sexual practices:

   • Limiting number of sexual partners
   • Consistent condom use (though not fully protective)
   • Mutual monogamy 1, 2

Important Counseling Points

• HPV is extremely common - most sexually active people will get HPV at some point
• Most infections cause no symptoms and clear spontaneously
• A diagnosis of HPV in one partner does not indicate infidelity
• HPV does not affect fertility or ability to carry a pregnancy 1, 2

Clinical Considerations

• Regular cervical cancer screening is essential for early detection of HPV-related precancerous changes
• People with compromised immunity may have increased susceptibility to HPV infection and persistence
• HPV tests are available for cervical cancer screening in certain women but are not useful for screening for warts 1, 2

HPV infection represents a significant public health concern, but with vaccination, regular screening, and appropriate management of symptoms, the burden of HPV-related diseases can be substantially reduced.