HPV (Human Papillomavirus)

Human Papillomavirus (HPV) is the most common sexually transmitted infection in the world, with over 150 known strains. Nearly every sexually active person will contract HPV at some point in their lives — most without ever knowing it.

HPV strains are divided into low-risk (types 6 and 11 — cause genital warts) and high-risk (types 16 and 18 — cause approximately 70% of cervical cancers, plus cancers of the anus, penis, vagina, vulva, and oropharynx). In India, cervical cancer is the second most common cancer in women — 99% of cervical cancers are caused by HPV.

• MOST INFECTIONS: No symptoms at all. The immune system clears the infection naturally.
• GENITAL WARTS (low-risk strains 6, 11): Soft, flesh-coloured or pink growths on the genitals, inner thighs, anus, or (rarely) in the mouth. Usually painless, but may itch or bleed. Can appear weeks to months after exposure.
• HIGH-RISK STRAINS (16, 18 and others): Completely silent. Detected only through cervical screening (Pap smear or HPV test). Abnormal cervical cells detected in screening may progress to precancer, which is highly treatable if caught early.

• Skin-to-skin contact during vaginal, anal, or oral sex
• Genital-to-genital contact even without penetration
• HPV is not fully prevented by condoms because the virus can be on skin not covered by a condom
• Very commonly transmitted by partners who have no visible symptoms

Testing differs significantly between women and men:

• WOMEN — Pap smear (cervical cytology): Detects abnormal cervical cells caused by HPV. Recommended every 3 years from age 21.
• WOMEN — HPV co-test: Pap smear + HPV DNA test together. Recommended every 5 years from age 30. More sensitive than Pap alone.
• WOMEN — VIA (Visual Inspection with Acetic Acid): A simple, low-cost screening tool widely used at primary health centres in India.
• MEN: No approved HPV test for men. Genital warts are diagnosed visually. Regular anal Pap smears may be recommended for gay and bisexual men.
• There is no general blood test for HPV.

Free cervical cancer screening is available under India's National Programme for Prevention and Control of Cancer (NPCC) at government hospitals and health centres.

There is no antiviral cure for HPV itself. Treatment focuses on manifestations:

• GENITAL WARTS: Topical treatments (imiquimod cream, podophyllotoxin), cryotherapy (freezing), or minor surgical removal. Warts may recur because the virus persists.
• PRECANCEROUS CERVICAL CELLS: LEEP (Loop Electrosurgical Excision Procedure), cryotherapy, or laser ablation — highly effective when detected early through regular screening.
• CERVICAL CANCER: Surgery, radiotherapy, and/or chemotherapy depending on stage.
• PREVENTION: Gardasil-9 vaccine prevents HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. Two doses for ages 9–14; three doses from age 15 upwards. Now available in India.

• WOMEN: First Pap smear at age 21 (or 3 years after becoming sexually active). Every 3 years from 21–29; every 5 years with HPV co-test from 30–65.
• If you have ever had genital warts, or a partner has disclosed genital warts
• If a Pap smear comes back as 'abnormal' or ASCUS
• VACCINATION: All girls and women aged 9–26 are recommended the HPV vaccine. Boys and men 9–26 are also eligible.