Introduction of HPV

Human papillomavirus (HPV) is a virus that can be spread through direct skin-to-skin contact or sexual intercourse, and lead to different infections to the body. HPV that is caused by sexual intercourse can be divided into the groups of low-risk and high risk. Most people who become infected with HPV do not know they have it as they do not develop symptoms. Both male and female can receive HPV vaccine to prevent diseases caused by the virus. (Please refer to 9-in-1 HPV Vaccine / Quadrivalent HPV Vaccine for more details)

What is low-risk and high-risk HPV?

HPV that is caused by sexual intercourse (Genital HPV) can be divided into the groups of low-risk and high risk

• Low-risk HPV: does not cause cancer but can cause skin warts on or around the genitals or anus. For example, HPV types 6 and 11 cause 90% of all genital warts.
• High-risk HPV: causes cancer. At least a dozen high-risk HPV types have been identified. HPV types 16 and 18, are responsible for the majority of HPV-caused cancers such as cervical cancer (female), penile cancer (male) etc.

Symptoms

[Symptoms of Infected Men]

Some men who get HPV never develop any symptoms or lead to serious health problems. Patients who are infected with low-risk types (i.e. types 6 and 11) will probably have genital warts. They will feel irritated in the infected area, but this is not a threat to health. For patients who are infected with high-risk types (i.e. types 16, 18), they may have cancers of the penis, anus, or oropharynx3 (back of the throat, including base of the tongue and tonsils.) but this rarely happens.

Below are some of the signs and symptoms for HPV-related diseases:

Low-risk HPV

Genital warts

• You may notice small, fleshy growths, bumps or skin changes on the penis, scrotum, urethra, testicles, groin, upper thighs, or in/around the anus.
• They can be flat or smooth small bumps or quite large, pink cauliflower-like lumps.
• Warts can appear on their own or in groups.
• They are usually painless but may occasionally itch and cause some inflammation.
• Warts may appear from three weeks to many months or even years after coming into contact with the virus.
• They may cause bleeding from the anus or the urethra.

High-risk HPV

Anal cancer

• Anal bleeding, pain, itching, or discharge.
• Swollen lymph nodes in the anal or groin area.
• Changes in bowel habits or the shape of your stool.

Penile cancer

• First signs: changes in color, skin thickening, or a build-up of tissue on the penis.
• Later signs: a growth or sore on the penis. It is usually painless, but in some cases, the sore may be painful  and bleed.

Cancers of the oropharynx

• Sore throat or ear pain that does not go away
• Constant coughing
• Pain or trouble swallowing or breathing
• Weight loss
• Hoarseness or voice changes that last more than 2 weeks
• Lump or mass in the neck

*People can get infected with high-risk HPV without any symptoms

[Symptoms of Infected Women]

Low-risk HPV

Genital warts

• commonly found in vagina, cervix, vulva, penis, anus, rectum or urethra
• Less commonly, mother may pass the virus to newborn baby during labor.

Warts in the throat

• this is a rare condition called recurrent respiratory papillomatosis, or RRP4. When this occurs in children it is called juvenile-onset RRP (JORRP) and can cause tumor in the throat.

High-risk HPV

• Cervical cancer : For women, precancerous cervical lesions will be developed if the high-risk HPV cannot be cleared by the immune system. If the condition worsens, the first stage of Cervical Intraepithelial Neoplasia (CIN1) will be developed in five years, and cervical cancer might eventually be developed.
• Other uncommon but serious cancers: vulva, vaginal anal and oropharyngeal cancer (rear throat, meaning the parts nearby the base of the tongue and the tonsils)

How is HPV passed on

Both men and women can have the virus and pass it on upon sexual intercourse:

• HPV is easily passed from one person to another through genital contact, most often during vaginal and anal sex. It may also be passed on during oral sex.
• HPV can be passed on between straight and same-sex partners, even when the infected partner has no signs or symptoms or with only one lifetime sex partner can get HPV.
• HPV will not pass through a condom but as condoms do not cover all of the genital area, it is possible for unprotected skin to be infected.
• HPV can develop even years after sexual contact with an infected person.
• Most infected persons do not realize they are infected or that they are passing the virus on to a sex partner. It is also possible to get more than one type of HPV.
• Rarely, a pregnant woman with genital HPV can pass HPV to her baby during delivery. Very rarely, the child can develop juvenile-onset recurrent respiratory papillomatosis (JORRP) and develop tumor in the throat 2.

If HPV is developed into warts, it can be infected as follows:

• Infection is likely when warts are present but it is still possible to infect someone after warts have disappeared.
• It is possible, but very rare, to develop warts in the mouth or throat, or on the lips from oral sex.
• Warts can be spreaded from the genital area to the area around the anus without having anal sex.
• It is possible for warts on the hand to be passed to the genitals but this is very rare.

Who are at a higher risk of developing HPV-related disease?

Men who are at a higher risk of developing HPV-related diseases if they are:

• Gay and bisexual
• Having weak immune systems, especially for those who have HIV, are more likely to develop anal cancer. Men with HIV are also more likely to get severe cases of genital warts that are harder to treat.

Reference
http://www.cdc.gov/hpv/WhatIsHPV.html

HPV tests

HPVs can be detected with HPV DNA Genotyping by testing cells sample to see if they contain viral DNA. The tests can identify the type of HPV is whether high-risk or low-risk and sometimes detect HPV even before cell abnormalities are evident.

How soon after sex can I be checked for genital warts?

You can be checked as soon as you think you might have been in contact with the virus.

Do I need to have a check-up to see if the warts have gone?

If you are having treatment at a clinic, it is important to return regularly for treatment. This way, the doctor can check whether the treatments are working or advise any change of treatment. Consult the doctor If you have any questions about the matter.

Reference
http://www.cancer.gov/cancertopics/factsheet/risk/HPV

Treatment

There is no treatment or cure for HPV. But there are ways to treat the health problems caused by HPV in men.

High-risk HPV related disease: cancers

Cancers of the penis, anus, and oropharynx can be treated with surgery, radiation therapy, and chemotherapy. Often, two or more of these treatments are used together. Please be aware that patients with high-risk HPV may not show any symptoms.

Low-risk HPV related disease: genital warts

Infected with low-risk HPV will probably cause genital warts. The treatment will depend on what the warts look like, the size and number of the warts and where they are. The aim of treatment is to remove visible warts and relieve the discomfort caused by the warts. As genital warts are caused by a virus and not bacteria, antibiotics will not get rid of warts. The recurrence frequency depends on the strength of the immune system.

Visible warts can be removed by:

• Topical cream, the treatment duration will last for a few weeks
• Freezing – Cryotherapy (For details, please refer to Our Treatments – Cryotherapy)
• Surgery, using local anaesthetic
• Laser treatment, using local anaesthetic

The above treatments can cause irritation and soreness for a couple of days. As warts often come back within a few months after treatment, sometimes more than one treatment is used at the same time.

If you are having treatment, please take note of the following:

• Perfumed soap, bath oils, bubble baths, creams and lotions may irritate the skin. Avoid having them until the treatment is completed.
• Wart treatments sold at the pharmacy may not suitable for genital warts.

Are there ways to lower my chances of getting HPV?

HPV 9-in-1 Vaccine is a safe and effective HPV vaccine that can protect boys and men against the low-risk HPV types 6, 11 that cause most genital warts, and high-risk HPV types such as HPV 16, 18 that cause anal cancers. However, it does not cure existing HPVs or disease (like genital warts). The vaccine is given in three shots over six months. (Please refer to 9-in-1 HPV Vaccine / Quadrivalent HPV vaccine for more details).

Condoms (if used with every sex act, from start to finish) may lower your chances of passing HPV to a partner or developing HPV-related diseases. But HPV can infect areas that are not covered by a condom, so condoms may not fully protect against HPV.

What happens if genital warts are not treated?

Over time, most warts will eventually go away without treatment. For some people, this may take a long time, particularly if you have an illness that affects the way your immune system works, making it difficult to fight off infection. It is not usually harmful to your health if the warts are not treated but you may find them uncomfortable and may not like the way they look. Treating the warts may reduce the risk of passing them on to someone else.

Reference

http://www.fpa.org.uk/helpandadvice/sexuallytransmittedinfectionsstis/genitalwarts

Lacey, C. J., Lowndes, C. M. & Shah, K. V. (2006). Chapter 4: burden and management of non-cancerous HPV-related conditions: HPV-6/11 disease. Vaccine 24 (Suppl. 3), S35–S41

Arbyn, M., Castellsague´ , X., de Sanjose´ , S., Bruni, L., Saraiya, M., Bray, F. & Ferlay, J. (2011). Worldwide burden of cervical cancer in 2008. Ann Oncol 22, 2675–2686

http://www.cdc.gov/std/HPV/STDFact-HPV.htm

http://www.cdc.gov/std/hpv/stdfact-hpv-and-men.htm

Yip YC et al. Prevalence and Genotype Distribution of Cervical Human Papillomavirus Infection in Macao. Journal of Medical Virology 82:1724–1729 (2010)

http://www.chp.gov.hk/en/static/24008.html