papillomavirus

Human papillomavirus (HPV) is a group of related viruses. They can cause warts on different parts of your body. There are more than 200 types. About 40 of them are spread through direct sexual contact with someone who has the virus. They can also spread through other intimate, skin-to-skin contact. Some of these types can cause cancer.

There are two categories of sexually transmitted HPV. Low-risk HPV can cause warts on or around your genitals, anus, mouth, or throat. High-risk HPV can cause various cancers:

• Cervical cancer
• Anal cancer
• Some types of oral and throat cancer
• Vulvar cancer
• Vaginal cancer
• Penile cancer

Most HPV infections go away on their own and don't cause cancer. But sometimes the infections last longer. When a high-risk HPV infection lasts for many years, it can lead to cell changes. If these changes are not treated, they may get worse over time and become cancer.

HPV infections are very common. Nearly all sexually active people are infected with HPV soon after they become sexually active.

Some people develop warts from certain low-risk HPV infections, but the other types (including the high-risk types) have no symptoms.

If a high-risk HPV infection lasts for many years and causes cell changes, you may have symptoms. You may also have symptoms if those cell changes develop into cancer. Which symptoms you have depends on which part of the body is affected.

Health care providers can usually diagnose warts by looking at them.

For women, there are cervical cancer screening tests which can find changes in the cervix that might lead to cancer. As part of the screening, women may have Pap tests, HPV tests , or both.

An HPV infection itself cannot be treated. There are medicines that you can apply to a wart. If they don't work, your health care provide could freeze, burn, or surgically remove it.

There are treatments for the cell changes caused by infection with high-risk HPV. They include medicines that you apply to the area that is affected and various surgical procedures.

People who have HPV-related cancers usually get the same types of treatment as people who have cancers that are not caused by HPV. An exception to this is for people who have certain oral and throat cancers. They may have different treatment options.

Correct usage of latex condoms greatly reduces, but does not completely eliminate, the risk of catching or spreading HPV. If your or your partner is allergic to latex, you can use polyurethane condoms. The most reliable way to avoid infection is to not have anal, vaginal, or oral sex.

Vaccines can protect against several types of HPV, including some that can cause cancer. The vaccines provide the most protection when people get them before they are exposed to the virus. This means that it is best for people to get them before they become sexually active.

NIH: National Cancer Institute

Cervical cancer is cancer that starts in the cells of the cervix. The cervix is part of the female reproductive system. It is the lower, narrow end of the uterus (womb), which opens into the vagina (birth canal). Cervical cancer screening is an important part of routine health care for people who have a cervix.

Cervical cancer screening tests look for cancer before you have any symptoms. Cervical cancer usually develops slowly. Before cervical cells become cancer, they start to look abnormal. These cells are called "precancers". If they aren't destroyed or removed, they may become cancer cells that grow out of control and spread to other parts of your body.

Screening can help find abnormal cells so you can get treatment to prevent cervical cancer. These tests can also help to find cervical cancer early when it's usually easier to treat.

Cervical cancer screening is usually part of a woman's health checkup during a pelvic exam. These tests use a sample of cervical cells that your health care provider collects with a swab:

• A Pap test (also called a Pap smear or cervical cytology) checks for abnormal cells so they can be treated before they become cancer.
• An HPV (human papillomavirus) test checks for certain HPV infections that can cause cancer. HPV is a group of viruses that spread through sexual contact. The types that cause cancer are called "high-risk HPV."
• The HPV/Pap cotest uses an HPV and Pap test together to check for both high-risk HPV and cervical cell changes.

If your screening tests are abnormal, your provider may do more tests, such as a biopsy. How often you should be screened for cervical cancer and which tests you should get will depend on your age and health history.

Cervical cancer screening saves lives. Screening can detect cervical changes early, lowering your chance of dying from cervical cancer. But, cervical cancer screening has potential harms.

The possible harms of cervical cancer screening include:

The results can sometimes be wrong.

• Getting a false-positive result means that your test results appear abnormal, but there are no precancerous or cancerous cells. A false-positive may lead to:
  • Worry while you have more tests to look for signs of cancer.
  • Follow-up tests or treatment that you may not have needed.
• Getting a false-negative result means that your test results appear normal, but there are precancer or cancerous cells. A false-negative may lead to:
  • You may delay seeking treatment even if you have symptoms.

Talk with your provider about how often you should be screened for cervical cancer and which tests you should get. This will depend on your age and health history. If you have a cervix, it's recommended that you have your first Pap smear at age 21 and begin screening with an HPV test at age 25. You may need screening more often if you:

• Had an abnormal HPV test, Pap smear, or cervical biopsy in the recent past.
• Have had a diagnosis of cervical cancer.
• Have a weakened immune system.
• Were exposed to a drug called DES (Diethylstilbestrol) before you were born. Between the years 1940-1971, DES was sometimes prescribed to prevent miscarriages.

If you are over age 65 and have had regular Pap smear screenings with normal results, your provider may tell you that you no longer need them. If you have HIV, you may need to continue screenings after age 65.

You don't need cervical cancer screening if you had a total hysterectomy (surgery to remove your uterus and cervix) because of a condition that was not cancer. But if your hysterectomy was related to cervical cancer or precancer, ask your provider whether you need screening.

NIH: National Cancer Institute

Cervical cancer is cancer that starts in the cells of the cervix. The cervix is part of the female reproductive system. It is the lower, narrow end of the uterus (womb), which opens into the vagina (birth canal).

Cervical cancer usually develops slowly. Before cervical cells become cancer, they start to look abnormal. These cells are called "precancers." If they aren't destroyed or removed, they may become cancer cells that grow out of control and spread to other parts of your body.

Screening tests for cervical cancer can help find abnormal cells so you can get treatment to prevent cervical cancer. These tests can also find cervical cancer early when it's usually easier to treat.

Almost all cervical cancers are caused by a long-lasting infection with a virus called human papillomavirus (HPV). There are many types of HPV. The types that cause cancer are called "high-risk HPV." High-risk HPV is very common. It can be passed from one person to another through close skin-to-skin touching, usually during vaginal, anal, or oral sex. Most people who are infected have no symptoms and don't know they have it.

If you're infected with high-risk HPV, usually your immune system will get rid of it within a year or two. But if your immune system can't control the infection, it may last for many years. Over time, HPV can turn normal cervical cells into abnormal cells. Without treatment, these cells may keep changing until they become cervical cancer.

Cervical cancer is most common in people over age 30. If you have a high-risk HPV infection in your cervix, you're more likely to develop cervical cancer if you:

• Have a weakened immune system because you:
  • Have a disease that harms your immune system, such as HIV.
  • Take medicine to control your immune system, such as certain medicines to treat cancer or autoimmune diseases
• Smoke tobacco or breathe secondhand smoke.
• Use birth control pills or have given birth to many children.
• Have obesity.
• Were exposed to a medicine called DES (diethylstilbestrol) before you were born. Between 1940-1971, DES was sometimes prescribed during pregnancy to prevent miscarriages. DES was later linked to health problems, including cervical cancer.

Cervical cancer usually doesn't cause symptoms when it first starts to grow. But when it does cause symptoms, they may include:

• Vaginal bleeding that's not normal for you, such as bleeding after sex or between menstrual periods
• Vaginal discharge (fluid) that's watery and has a strong odor or contains blood
• Pelvic pain or pain during sex

If cervical cancer spreads to other parts of your body, symptoms may include:

• Unusual vaginal bleeding or discharge
• Pelvic pain or pain during sex
• Difficult or painful bowel movements (poops) or bleeding from the rectum when having a bowel movement
• Difficult or painful urination (peeing) or blood in your urine (pee)
• Dull backache
• Swollen legs
• Abdominal (belly) pain
• Fatigue

If you have symptoms or had an abnormal result on a screening test for cervical cancer, your health care provider will do more tests to find out if you have cervical cancer. They will:

• Ask about your medical history and your family health history
• Do a pelvic exam
• Suggest tests to diagnose or rule out cervical cancer, including:
  • Colposcopy, a procedure using a device called a colposcope, which helps your provider examine your cervix for abnormal areas
  • Cervical biopsy, a procedure to remove a tissue sample from your cervix so that it can be examined under a microscope to look for signs of cancer. Most biopsies can be done in your provider's office

Different treatments are available for cervical cancer. The best treatment for you depends on your health, how much cancer you have, whether it has spread, and which treatment you prefer. You may have more than one treatment, including:

• Surgery to remove the cancer.
• Radiation therapy, which uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. The therapy may use radiation from a machine, or a radioactive substance may be placed in your body near the cancer.
• Chemotherapy (chemo), which uses special medicines to shrink or kill the cancer. The medicine may be pills, or it may be given through a vein (by IV). Sometimes, both types of chemo are used.
• Targeted therapy, which uses special medicines to block the growth and spread of cancer cells.
• Immunotherapy, which helps your immune system fight cancer cells.

Almost all cervical cancer can be prevented by:

• HPV vaccination. HPV vaccines provide the most protection if you get them before you're exposed to HPV. So, it's best to get vaccinated before you become sexually active. Medical experts recommend vaccinating children between ages 9 and 12.
• Routine cervical cancer screening. Two types of screening tests may be part of your routine health checkup. Both tests use a sample of cervical cells that your provider collects with a swab:
  • A Pap smear checks for abnormal cells so they can be treated before they become cancer
  • An HPV test checks for high-risk HPV infections that can cause cancer.
• Getting the right follow-up treatment if a screening test finds abnormal cells and/or high-risk HPV.

You can lower your risk for cervical cancer by not smoking. Using condoms correctly during sex lowers your risk of getting an HPV infection, but doesn't prevent it completely. Condom use has been linked to fewer cases of cervical cancer. If you or your partner is allergic to latex, you can use polyurethane condoms.

NIH: National Cancer Institute

Genital warts are a sexually transmitted infection (STI) caused by the human papillomavirus (HPV). The warts usually appear as a small bump or group of bumps in the genital area. They are flesh-colored and can be flat or look bumpy like cauliflower. Some genital warts are so small you cannot see them. In women, the warts usually occur in or around the vagina, on the cervix, or around the anus. In men, genital warts are less common. They may have warts on the tip of the penis, around the anus, or on the scrotum, thigh, or groin.

You can get genital warts during oral, vaginal, or anal sex with an infected partner. Correct usage of latex condoms greatly reduces, but does not completely eliminate, the risk of catching or spreading HPV. If your or your partner is allergic to latex, you can use polyurethane condoms. The most reliable way to avoid infection is to not have anal, vaginal, or oral sex. HPV vaccines may help prevent some of the HPV infections that cause genital warts.

Your health care provider usually diagnoses genital warts by seeing them. The warts might disappear on their own. If not, your health care provider can treat or remove them. HPV stays in your body even after treatment, so warts can come back.

Dept. of Health and Human Services Office on Women's Health

During pregnancy, some common infections like the common cold or a skin infection do not usually cause serious problems. But other infections can be dangerous to you, your baby, or both. Some infections may lead to preterm birth and low birth weight babies. Others can cause serious illness, birth defects, and lifelong disabilities, such as hearing loss or learning problems.

Some of the infections that can be dangerous during pregnancy include:

• Bacterial vaginosis (BV)
• Group B strep (GBS)
• Hepatitis
• Sexually transmitted infections (STIs)
• Toxoplasmosis
• Urinary tract infections
• Yeast infections
• Zika virus

To try to prevent infections:

• Don't eat raw or undercooked meat.
• Don't share food or drinks with other people.
• Wash your hands frequently.
• Don't empty cat litter. Cats can transmit toxoplasmosis.
• Talk to your health care provider about vaccinations.
• If you have sex during pregnancy, use a condom every time.

If you do get an infection during pregnancy, contact your health care provider about how best to protect you and your baby. Only some medicines are safe during pregnancy.

Teen sexual health is about how sex affects your physical and emotional health. It means knowing how to form healthy relationships and making decisions about sex that are right for you.

As your body changes during puberty, how you think, feel, and interact with others also changes. You may have new feelings and thoughts about sex. Understanding who you're becoming as a sexual young adult is also part of teen sexual health.

For all teens, taking responsibility for sexual health is part of growing up. Whether you choose to have sex or wait, responsibility includes knowing about:

• Sexually transmitted infections (STIs)
• Birth control
• What a healthy relationship is

Sexually transmitted infections (STIs), or sexually transmitted diseases (STDs), are caused by bacteria, viruses, and parasites that spread from person to person, usually during vaginal, oral, or anal sex. Some STIs are spread by skin-to-skin contact. Without treatment, some STIs can cause long-term health problems.

There are more than 20 types of STIs, including:

• Chlamydia
• Genital herpes
• Gonorrhea
• HIV
• HPV (human papillomavirus)
• Pubic lice
• Syphilis
• Trichomoniasis

STIs don't always cause symptoms. So it is possible to have an infection without knowing it and then pass it on to someone else. The only way to know for sure whether you have an STI is to get tested.

The most reliable way to avoid infection is to not have vaginal, oral, or anal sex. Saying "no" to sex is the right choice for many teens.

If you decide to have sex, "safer sex" practices will lower your chance of getting an STI. They include:

• Talking with your partner about preventing STIs and getting tested before having sex. If you can't talk about STIs, you aren't ready to have sex.
• Getting the HPV vaccine. You can be vaccinated between ages 9 and 26.
• Using condoms correctly every time you have vaginal, oral, or anal sex:
  • External (male) latex condoms provide the best protection against STIs. If you or your partner is allergic to latex, you can use polyurethane condoms.
  • Internal (female) condoms, made of nitrile, are placed inside the body (vagina or anus). They may be less effective against STIs than latex external condoms.
  • Don't use both type of condoms together because that increases the chance they'll rip
  • Use a dental dam (a square piece of latex, polyurethane, or nitrile) to protect the mouth during oral sex
• Having sex with only one person who has sex only with you (mutual monogamy). But first, both of you should get tested for STIs.
• Not mixing alcohol or drugs with sex. You need to think clearly to make safer choices about sex.

The only sure way to avoid pregnancy is not to have vaginal sex.

If you decide to have vaginal sex, birth control can help prevent pregnancy. There are many types of birth control that work in different ways. Your health care provider can help you choose birth control that's best for you.

Condoms are the only birth control method that protects against STIs. But condoms alone aren't the most effective form of birth control. It's safest to use condoms with another form of birth control to prevent both STIs and pregnancy.

Healthy sex starts with a healthy relationship, so it's important to take an honest look at how you and your partner treat each other. Your relationship may be healthy if it includes:

• Respect. You and your partner value each other's feelings. Neither of you pressure the other to do things they don't want to do.
• Trust and honesty. You always tell the truth and trust your partner to do the same.
• Good communication. You feel safe talking openly about your feelings, STIs, and other relationships. And you both listen.

Your relationship may be unhealthy if it includes:

• Jealousy and control. One of you wants to make all the decisions and tries to keep the other from spending time with their friends and family.
• Disrespect. One of you makes fun of the other person's ideas and feelings.
• Pressure. One of you tries to bully the other into doing sexual things they don't want to do.
• Violence. Hitting, shoving, grabbing, and sexual assault should never be part of a relationship. If you don't know how to end a violent relationship, get help.

Your decisions about sex can affect your future health. Make sure that you know the facts so you can decide what is right for you.

Vaginal cancer is a rare type of cancer that starts in the vagina. The vagina is the canal leading from your cervix (the opening of your uterus) to the outside of your body.

You are more likely to develop vaginal cancer if:

• You're age 60 or older.
• You've had certain types of human papillomavirus (HPV) infections.
• You were exposed to a medicine called DES (diethylstilbestrol) before you were born. Between 1940-1971, DES was sometimes prescribed to prevent miscarriages. DES was later linked to different health problems, including vaginal cancer.
• You have had abnormal cells in your vagina, cervix, or uterus.

Vaginal cancer often doesn't have early symptoms. However, see your health care provider if you notice:

• Vaginal bleeding that is not your period
• A vaginal lump
• Pelvic pain
• Pain during sex
• Pain while urinating (peeing)
• Constipation or blood in your stool (poop) or urine (pee)

To find out if you have vaginal cancer, your provider will use tests that examine the vagina and other organs in your pelvis. These tests may include:

• A pelvic exam. Your provider may also do a Pap test and/or an HPV test during your pelvic exam.
• Colposcopy, a procedure to examine your cervix, vagina, and vulva.
• Biopsy, a procedure to remove some cells so they can be checked for cancer.

Vaginal cancer can often be cured if it is found early. Treatments for vaginal cancer may include surgery, radiation therapy, and/or chemotherapy.

Vaccines that protect against HPV infection may reduce your risk of vaginal cancer. The vaccines provide the most protection if you get them before you are exposed to HPV. So it's best to get vaccinated before you become sexually active.

NIH: National Cancer Institute

Vulvar cancer is a rare type of cancer. It forms in a woman's external genitals, called the vulva. The cancer usually grows slowly over several years. First, precancerous cells grow on vulvar skin. This is called vulvar intraepithelial neoplasia (VIN), or dysplasia. Not all VIN cases turn into cancer, but it is best to treat it early.

Often, vulvar cancer doesn't cause symptoms at first. However, see your doctor for testing if you notice:

• A lump in the vulva
• Vulvar itching or tenderness
• Bleeding that is not your period
• Changes in the vulvar skin, such as color changes or growths that look like a wart or ulcer

You are at greater risk if you've had a human papillomavirus (HPV) infection or have a history of genital warts. Your health care provider diagnoses vulvar cancer with a physical exam and a biopsy. Treatment varies, depending on your overall health and how advanced the cancer is. It might include surgery, radiation therapy, chemotherapy, or biologic therapy. Biologic therapy boosts your body's own ability to fight cancer.

NIH: National Cancer Institute

Regular checkups with your health care provider are different from appointments for sickness or injury. Your checkups, which are also called well-woman exams, include physical exams as well as preventive care. They can help find health problems early, when they may be easier to treat.

Your checkup will include screenings for chronic diseases. As a woman, you may also get special exams and screenings, such as:

• A pelvic exam to check the health of your reproductive organs. The provider will look at your vulva, vagina, and cervix. They will also do an internal exam to feel the size and shape of your internal organs such as the uterus and ovaries.
• A cervical cancer screening, which uses a Pap test, an HPV test, or both. The tests can help prevent cervical cancer. A Pap test checks for cervical cancer and for abnormal cells that could turn into cancer. An HPV test looks for the types of HPV which can cause cervical cancer. For both tests, your provider will take a sample of cells from the surface of your cervix and send them to a lab to be examined under a microscope.
• A clinical breast exam to check for breast cancer. The provider will feel and look at your breasts and armpit area for lumps or other changes.

Which tests you get and how often you need them will depend on your age, overall health, and family health history. In some cases, your provider may also recommend other tests as well. For example, if you have a family history of certain cancers, your provider may recommend genetic testing.

During your checkup, you and your provider may also talk about other issues, such as:

• Birth control or family planning
• Menopause
• Menstrual concerns
• Sexually transmitted infections (STIs)
• Vaccines
• Your overall health, including suggestions on how to have a healthy lifestyle

To make the most of your next checkup, bring a list of any questions or concerns you have, so you can talk about them with your provider.