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Symptoms
By Mayo Clinic staff
HPV infections often go undetected because they don't cause warts or other lesions. Even if you don't exhibit signs and symptoms of the infection, they may emerge later and you may transmit the virus to someone else.
The signs and symptoms that do appear vary according to the type of HPV infection you may have:
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Genital warts. Genital warts are nonmalignant and appear as a flat lesion, a tiny cauliflower-like bump or a tiny stem-like protrusion. HPV infections of types 6 and 11 cause most genital warts. These HPV types are generally not associated with cancer.
In women these warts appear most commonly on the vulva but may also occur near the anus, on the cervix or in the vagina. In men these may appear on the penis and scrotum or around the anus. Genital warts rarely cause discomfort or pain.
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Pre-malignant genital lesions. Certain HPV infections can cause cellular changes that result in precancerous lesions. These abnormalities are most often detected by a Pap test, a simple procedure to collect cells from the cervix or vagina for laboratory examination.
Abnormalities that are determined to be "low grade" usually resolve — the cells return to normal — without treatment. HPV infections of types 6 and 11 are common causes of these low-grade abnormalities.
High-grade abnormalities are less likely to resolve, and some will advance to cancer of the cervix, vagina or vulva. HPV infections of types 16 and 18 are the most common causes of high-grade abnormalities.
- Oral and upper respiratory lesions. Some HPV infections may cause warts and other lesions to form on your tongue, tonsils, soft palate, and larynx and in your nose. These lesions may be the result of low-risk HPV types, such as 6 and 11, or high-risk types, such as 16 and 18.
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Cervical cancer and other tumors. Most genital HPV infections of high-risk types don't develop into cancer; however, persistent infections — generally lasting more than two years — create a greater risk of cancer. Abnormal vaginal bleeding, such as excessively heavy menstrual bleeding or bleeding between periods, are common symptoms of cervical cancer.
Virtually all cases of cervical cancer are caused by HPV infections. An estimated 11,000 women in the United States are diagnosed with cervical cancer annually, and more than 3,800 die of the disease each year. Worldwide, cervical cancer is far more common because many women lack access to Pap test screening. HPV types 16 and 18 account for about 70 percent of all cases of cervical cancer.
HPV infections of type 16 and 18, as well as other high-risk types, may also contribute to cancers of the genitals, anus, mouth and upper respiratory tract.
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Common warts. Common warts are nonmalignant skin growths that usually appear on your hands, fingers or around fingernails. These warts appear as rough, raised bumps. They're generally nuisances because of their appearance, but they may also be painful or susceptible to injury or bleeding.
Most children and adolescents have been exposed to HPVs that cause these warts, but only a small percentage actually get warts. Most people don't get common warts after age 20.
- Plantar warts. Plantar warts are hard, grainy, nonmalignant growths that usually appear on the heel or ball of your feet, areas that feel the most pressure. These warts may cause discomfort or pain. Although plantar warts are common in adulthood, most adults first encountered them during childhood or adolescence.
- Flat warts. Flat warts are flat-topped, slightly raised, nonmalignant lesions darker than your regular skin color. They usually appear on your face, neck, hands, wrists, elbows or knees. HPV infections that cause flat warts usually affect children, adolescents and young adults.
When to see a doctor
If you or your child has warts of any kind that cause embarrassment, discomfort or pain, seek advice from your doctor.
For women, it's important to have regular Pap tests. A Pap test is the best tool to detect an HPV infection that could lead to cervical cancer. The American College of Obstetricians and Gynecologists recommends that a woman begin annual Pap tests about three years after first having sexual relations or at age 21. Most women age 30 and older may have a Pap test every two to three years if tests are normal for at least three consecutive years.
- Human papillomavirus: HPV information for clinicians. Centers for Disease Control and Prevention. http://www.cdc.gov/std/hpv/common-clinicians/ClinicianBro-fp.pdf. Accessed Jan. 30, 2009.
- Warts, herpes simplex, and other viral infections. In: Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. Philadelphia, Pa.: Mosby Elsevier; 2004. http://www.mdconsult.com/das/book/body/118486619-4/0/1195/75.html?tocnode=51441112&fromURL=75.html. Accessed Jan. 30, 2009.
- Reichman R. Epidemiology of human papillomavirus infections. http://www.uptodate.com/home/index.html. Accessed Jan. 30, 2009.
- Cancer facts & figures 2008. American Cancer Society. http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf. Accessed Jan. 30, 2009.
- Reichman R. Clinical presentation and diagnosis of human papillomavirus infections. http://www.uptodate.com/home/index.html. Accessed Jan. 30, 2009.
- Human papillomaviruses and cancer: Questions and answers. National Cancer Institute. http://www.cancer.gov/cancertopics/factsheet/Risk/HPV. Accessed Feb. 2, 2009.
- Reichman R. Treatment and prevention of human papillomavirus infections. http://www.uptodate.com/home/index.html. Accessed Jan. 30, 2009.
- Reichman RC. Human papillomavirus infections. In: Fauci AS, et al. Harrison's Principles of Internal Medicine. 17th ed. New York, N.Y.: McGraw-Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aID=2895508&searchStr=human+papillomavirus. Accessed Feb. 2, 2009.
- HPV vaccine information for young women. Centers for Disease Control and Prevention. http://www.cdc.gov/std/Hpv/STDFact-HPV-vaccine.htm. Accessed Feb. 2, 2009.
- The Pap test. The American College of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp085.cfm. Accessed Feb. 2, 2009.
- Centers for Disease Control and Prevention, et al. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recommendations and Reports. 2006;55:1. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5511a1.htm. Accessed Feb. 2, 2009.
