Human papillomavirus (HPV) is one of the most common viruses in the world, affecting the majority of sexually active individuals during their lifetime. It infects the deeper layers of the skin and mucous membranes. There are more than 100 known types; while many are harmless, others are oncogenic and can cause serious diseases, including cervical, anal, vulvar, vaginal, penile, and oropharyngeal (throat) cancers.
To reduce this risk, the most effective form of prevention is vaccination. HPV vaccines are non-live, safe, and provide a high level of immune protection that significantly exceeds the immunity gained from a natural infection.
What is HPV?
Human papillomavirus (HPV) is a non-enveloped, double-stranded DNA virus from the Papillomaviridae family. To date, more than 200 types have been identified. HPV infects epithelial tissues—primarily the skin and mucous membranes—and is the most common sexually transmitted infection (STI) globally. Transmission occurs mainly through direct skin-to-skin contact or sexual contact.
Most HPV infections are asymptomatic and transient, clearing within 1–2 years. However, persistent infection with certain HPV types can lead to disease. HPV types are categorized into:
- “Low-risk” (e.g., HPV 6 and 11): These cause benign lesions such as genital warts.
- “High-risk” (e.g., HPV 16 and 18): These are oncogenic and responsible for the majority of HPV-related cancers—nearly all cases of cervical cancer, as well as a significant portion of anal, vulvar, vaginal, penile, and oropharyngeal cancers.
The oncogenic potential of high-risk HPV types is linked to the viral proteins E6 and E7, which disrupt cell cycle regulation and promote malignant transformation.
Who is most commonly affected by HPV?
The risk of HPV infection is highest among sexually active adolescents and young adults, particularly those aged 15–24, who account for approximately half of all new HPV cases. The prevalence of the infection peaks in women aged 20–24 and in men aged 25–30.
Additional high-risk groups include individuals with multiple sexual partners, those who begin sexual activity at an early age, people with a history of other STIs (including HIV), and immunocompromised individuals. Men who have sex with men (MSM), individuals who do not use barrier contraception, and smokers are also at increased risk.
Symptoms of HPV
HPV infections often show no symptoms, as most cases are asymptomatic. When symptoms do appear, they depend on the virus type and the location of the infection:
Genital warts (condylomata acuminata) These are the most common symptomatic manifestations caused by low-risk HPV types (6 and 11). Warts are painless, flesh-colored growths that may appear papillary, flat, or cauliflower-like in the genital, perineal, or anal areas.
Skin warts (verrucae)
- Common warts: Usually found on fingers and hands, resembling small, hard “cauliflowers.”
- Flat warts: Smaller and smoother, often appearing on the face or legs.
- Plantar warts: Grow on the soles of the feet. Due to the pressure of walking, they are pushed inward and can be quite painful.
How to recognize a plantar wart (verrucae)
Plantar warts are often mistaken for blisters or corns. These signs help distinguish them:
- Black dots: Tiny black specks may be visible in the center. These are not “seeds” but thrombosed capillaries.
- Flat shape: Unlike warts on hands, plantar warts are often flattened because the pressure of walking pushes them deeper into the skin.
- Pain when squeezed: They usually hurt more when squeezed from the sides than when direct pressure is applied from above.
- Interruption of skin lines: Natural skin patterns (like fingerprints or footprints) go around the wart rather than through it, unlike a standard callus.
Note: HPV infection is typically NOT associated with discharge, itching, burning, or pain. Most women with a genital HPV infection report no symptoms. Clinical diagnosis is usually based on visual recognition or pre-cancerous lesion screening.
Respiratory papillomatosis A rare manifestation of HPV infection that presents as hoarseness or stridor due to papillomas in the airway. It is most commonly associated with HPV types 6 and 11.
Pre-cancerous lesions and hpv-associated tumors Cervical intraepithelial neoplasia (CIN), anal intraepithelial neoplasia (AIN), and HPV-associated malignancies usually do not cause symptoms until the disease reaches an advanced stage. At that point, symptoms may include abnormal bleeding, pain, or a palpable mass.
Treatment of HPV
The treatment of HPV infections depends on the clinical manifestation and the patient’s individual factors.
Genital warts (condylomata acuminata) Treatment may involve patient-applied medications or provider-administered procedures:
- Cryotherapy: Liquid nitrogen is applied until the lesion freezes; repeated every 1–2 weeks.
- Trichloroacetic acid (TCA) (80–90%): Applied once a week for up to 6 weeks.
- Surgical excision: Tangential excision with scissors or a blade, curettage, electrosurgery, or laser surgery.
Respiratory papillomatosis The primary treatment is the surgical removal of papillomas using microlaryngoscopy with excision or laser ablation. Due to recurrences, procedures often need to be repeated.
Skin and oral warts Similar destructive methods are used, including cryotherapy, lasers, surgical removal, and immunomodulatory therapies. If oral warts interfere with function or aesthetics, surgical removal is preferred.
Crucial Fact! HPV itself is not cured by any of these therapies. Currently, no treatment eliminates the virus from the body. Therapy focuses on removing visible lesions and alleviating symptoms. Recurrences are common.
What HPV vaccines are available?
Historically, three vaccines have been available for HPV prevention:
- Bivalent vaccine (2vHPV, Cervarix): Protects against types 16 and 18.
- Quadrivalent vaccine (4vHPV, Gardasil): Protects against types 6, 11, 16, and 18.
- 9-valent vaccine (9vHPV, Gardasil 9): Provides the broadest protection against types 6, 11, 16, 18, 31, 33, 45, 52, and 58.
In Latvia, since 2020, vaccination is performed exclusively using the 9-valent HPV vaccine.
Why is HPV vaccination so important?
HPV causes serious diseases in both genders HPV is responsible for 99% of cervical cancers, 95% of anal cancers, and a significant portion of oropharyngeal, vulvar, vaginal, and penile cancers. The risk exists for both men and women.
Natural infection does not provide sufficient protection The immune response triggered by a natural infection is weak and temporary, meaning reinfection is possible. Vaccines, however, induce a very high and sustained level of antibodies.
Vaccination is the most effective protection against future cancer The Center for Disease Prevention and Control (SPKC) emphasizes that vaccination is a vital step in preventing cervical and other HPV-induced cancers, especially for those under 25.
The role of a gynaecologist in HPV prevention
In Latvia, the state-funded 9-valent HPV vaccine is provided for both girls and boys aged 12 to 17. As of 2025, this has been expanded to include young adults up to the age of 25 and specific risk groups.
A gynaecologist helps patients understand:
- How HPV is transmitted and behavioral strategies to reduce risk.
- Why condoms do not provide 100% protection (since HPV spreads via skin contact).
- Why vaccination is important even for women who have already been exposed to the virus.
FAQ
No. Even vaccinated women require regular cervical cancer screenings (Pap tests), as the vaccine does not protect against all rare HPV types.
Girls and boys aged 12 to 25.
Adults in risk groups, such as women with pre-cancerous changes (CIN2/3, VIN, VaIN, AIN), immunocompromised individuals, and HIV-positive patients.
The nine-valent vaccine protects against nearly all high-risk HPV types that most commonly cause malignant tumors.
