HPV is a very common sexually transmitted infection. HPV is so common that it is thought to be the most common STI in Canada. Most sexually active people will have it at one point in their life. When it comes to an infection like HPV, it’s good to find a balance between caution and calm. The vast majority of people (upward of 99 percent) will clear the virus in a year or two and will never have any symptoms. They may pass the virus to their partners who will pass it on to subsequent partners but most will clear the virus on their own. In the case where people are infected with less benign strains (there are over 100 known types of HPV), preventative measures like regular pap tests (vaginal and/or anal) can mean early diagnoses and effective treatment.
HPV is spread through skin-to-skin contact with someone who carries the virus even if there are no visible symptoms. Some strains cause genital warts that can be treated by a variety of methods like freezing or lasering to remove the warts. Other forms of HPV can lead to the growth of abnormal cells on the cervix or in the rectum that can develop into cervical or anal cancer over time. It is important for people who are (or were) sexually active and have a cervix and/or have anal sex to get regular pap tests to screen for abnormal cells. Some types of HPV can be prevented by vaccination.
Symptoms* for HPV strains that cause genital warts
*Not everyone will experience symptoms
Penis: Warts that may look like small flesh colored cauliflower growths (a collection or mound of bubble-like growths) can occur on the penis, scrotum, and groin.
Vulva: Warts that may look like small flesh colored cauliflower growths (a collection or mound of bubble-like growths) can occur on the vulva, labia, and groin. During pregnancy, warts on or around the vulva may increase.
Cervix and the anal area: Some strains of HPV can lead to the growth of abnormal cells on the cervix or in the anal area that can develop into cervical or anal cancer over time. It is important for people who are or were sexually active and have a cervix and/or have anal sex to get regular pap tests to screen for abnormal cells. Some types of HPV can be prevented by vaccination. The vaccine can play a significant role in preventing the transmission of certain strains. This is especially important in the case of people without access to regular pap tests or who may be at risk of accelerated cervical damage caused by HPV (e.g., those of us who smoke or are HIV-positive).
Transmission and Prevention
HPV can be transmitted through oral, anal, or vaginal sex with someone who has HPV, as well as through touching or rubbing the genitals of someone who has HPV. In rare cases, HPV can also be transmitted from a pregnant individual to their baby during childbirth.
Condoms can help prevent the transmission of HPV but because the areas of the genitals that may have HPV are not always fully covered by a condom, condoms do not provide complete protection.
Pap tests are the most effective way to prevent HPV strains from developing into cervical or anal cancer (not all HPV strains pose that risk). A cervical pap test is a simple procedure that removes a small sample of cells from the cervix so that they can be examined under the microscope. A pap test screens for and helps to diagnose:
- precancerous conditions of the cervix and cervical cancer;
- precancerous conditions of the vagina and vaginal cancer; and
- infection and inflammation in the lower tract.
Pap tests are also done as a follow-up to previous abnormal pap tests, to monitor any potentially precancerous conditions, and to check for cancer recurrence after treatment. People who have a cervix and who are or have been sexually active (regardless of their gender identity or the assigned sex of their sexual partner(s)) should get regular pap tests.
Cervical cancer is considered 90 percent preventable with regular pap screening and treatment. The suggested frequency of pap tests will depend on the guidelines in your home province or territory and typically vary between every 1 and 3 years, depending on your age and other characteristics, such as whether you have received an abnormal pap test result before. Speak with your health care provider to determine how often you should have a pap test.
An anal pap smear is the anal counterpart of the cervical pap smear. It’s used for early detection of anal cancer. Some HPV strains can cause anal cancer while others cause warts on the genitals, the anus, or in the rectum. People who have anal sex, are immuno-compromised, or have a history of cervical, vulvar, or vaginal cancers are at increased risk of getting anal cancer. Vaccination against HPV before initial sexual exposure can reduce the risk of anal cancer. There are currently no specific guidelines for anal pap smears.
There are several treatments available for severe genital warts and for precancerous and cancerous lesions on the cervix and in the anal area. These include (among other things) topical creams/gels, the surgical removal of warts, laser therapy, and cold coagulation and cryotherapy (freezing) that treat the part of the cervix that contains abnormal cells. Talk to your health care provider for more information on available options.
- The HPV vaccine protects against some strains of HPV that can lead to genital warts and cervical, vaginal, and anal cancers. The vaccines available in Canada are:
- 2-Valent HPV Vaccine (Cervarix): effective against infection by the two most common cancer-causing strains of HPV (16 and 18). The vaccine requires three doses to be given over the course of six months (initial, month one, and month six). It is approved for use in females aged 9 to 45. Cervarix has not yet been approved for use in males in Canada.
- 4-Valent HPV Vaccine (Gardasil): effective against infection by the four most common strains of HPV (6, 11, 16, and 18). The vaccine requires three doses to be given over the course of 6 months (initial, month two, and month six). It is approved for use in males aged 9 to 26 and in females aged 9 to 45 years.
- 9-Valent HPV Vaccine (Gardasil 9): effective against infection by HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. It is approved for use in males aged 9 to 26 and in females aged 9 to 45 years.
- People who have been vaccinated need to continue getting regular pap tests. Vaccination only blocks the most common cancer-causing HPV strains.
- Vaccination is most effective before becoming sexually active, the vaccine cannot clear existing infections.
- The potential benefit is greatest before the start of sexual activity. The prime age group recommended for vaccination is 9 to 13.
- Gardasil and Cervarix are demonstrated as effective for people aged 9 to 26, regardless of sexual activity. The vaccines can also be administered for people over 26 (they can still benefit from the protection it offers).
- HPV vaccines are given within six months as a three-dose schedule.
- To know if you or your child is eligible for an immunization program, please check with your provincial/territorial public health department. If you or your child are not eligible for HPV vaccination under a public immunization program, you can speak with your health care provider about purchasing the vaccine.
- It’s your choice whether or not to be vaccinated/have your child vaccinated. The evidence is very clear that the risks associated with HPV infection are much greater than the risks associated with vaccination.
Genital warts caused by HPV are diagnosed through visual inspection by a health care provider. Physical examinations of the penis, anus, mouth, and throat can also be used to look for signs of HPV. Routine pap tests are the most effective way to identify HPV. Blood tests can also be used to look for HPV DNA and detect which strain of HPV you may have.