Is HPV a Sexually Transmitted Disease (STD)?

Learn about how human papillomavirus (HPV) is spread

Woman receiving a vaccination against HPV, an STD
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The human papillomavirus (HPV), which has more than 100 different strains, is an extremely common virus that currently affects more than 20 million Americans. While many people carry the virus and experience no symptoms or medical problems, certain strains of this virus can cause health conditions, including genital warts and cancer. While most people are aware that HPV can be spread by sexual contact, a commonly asked question is "Is HPV a sexually transmitted disease (STD)?

The answer is more complicated than a single yes and no. Let's talk about why that is the case.

Is the Human Papillomavirus (HPV) a Sexually Transmitted Disease (STD)?

Whether human papillomavirus (HPV) is a sexually transmitted disease (STD) requires looking at two questions. One is how it is transmitted. Not all STD's are transmitted by vaginal penetration, and we'll look at this issue. The other concerns whether HPV is truly (or always) a disease.

Sexually Transmitted Infections vs Sexually Transmitted Diseases

Sexually transmitted infections (STIs) are infections that are transmitted through some aspect of sexual contact. STIs come in many forms and can be caused by bacteria, viruses, or even parasites. The human papillomavirus is considered to be one of the most common sexually transmitted viruses. It is transmitted through sexual skin contact (not through semen), which means that there doesn't have to be penetration in order for it to pass from one person to another.

 

Put more simply, the human papillomavirus is spread through skin-to-skin contact. Genital-on-genital rubbing can be enough to spread the virus. In other words, virgins can become infected with HPV.

Vaginal and anal intercourse are also methods of HPV transmission, as is oral sex, though it is less common.

Though HPV is considered to be an STI because of its mode of transmission, it is not always categorized as a sexually transmitted disease (STD). This is because the term "disease" can suggest a clear medical problem that has obvious signs or symptoms. When a person who has HPV experiences no symptoms, HPV can be described as an infection that may or may not result in a disease. It should be noted, however, that not all medical professionals make this distinction.

The majority of infections with HPV are cleared within 12 to 24 months and do not go on to cause disease.

How to Reduce Your Risk of Contracting HPV

Since human papillomavirus can be passed on by mere skin contact and not just via penetration, prevention can be difficult. The only guaranteed means of preventing human papillomavirus is through absolute abstinence (not participating in any form of sexual conduct); however, this is unrealistic for most.

Condoms can help (and are recommended if you want to help prevent other sexually transmitted infections and diseases, as well as pregnancy), but keep in mind that they provide only limited protection from HPV because there are parts of the genitals that are left unprotected during sexual activities.

 

Due to the difficulty preventing HPV physically, "social prevention" comes into play. This means trying to know a new partner well before having any form of close contact. Limiting the number of partners you come in contact with is also helpful. And for those who may become infected, quitting smoking is important, as it appears that smokers are more likely to have the infection become a disease (smoking may reduce the ability of the body to clear the virus).

The HPV vaccine is also helpful, but in order to understand the different vaccines, it's important to understand the different strains of the virus.

Types and Strains of HPV

There are over a hundred strains of the HPV virus, but these strains vary significantly in their ability to cause disease. They are broken down into high-risk and low-risk strains as follows:

  • Cancer-causing strains (high-risk strains). HPV 16 and 18 account for roughly 70 percent of cervical cancers. In addition to HPV 16 and 18, strains of HPV linked with cancer include 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59. There are other cancers which are linked with HPV infections, including head and neck cancers (especially tongue and tonsillar cancers, most commonly associated with HPV 16), anal cancer, rectal cancer, vulvar cancer, and penile cancer. Questions are being raised about other cancers as well, such as a possible connection between  HPV and lung cancer.
  • Genital wart causing strains (low-risk strains). HPV 6 and 11 account for around 90 percent of genital warts in men and women. These warts may occur on the genitals, in the mouth, or on the throat. Low-risk strains of HPV may also cause respiratory papillomatosis, a condition in which nodules form on the vocal cords causing shortness of breath and other symptoms.

The HPV Vaccine

The HPV vaccine is another method that helps prevent the virus. It's important to note that there are 3 different vaccines that are effective against different strains of the virus, and none of the vaccines protect against every strain of HPV which can infect man. This is a long way of saying that the protective methods above are still extremely important even if you are vaccinated against some strains of HPV. Currently available vaccines include:

  • Gardasil. Approved in 2006, Gardasil was the first HPV vaccine to be approved. It is effective against HPV 6 and 11, the cause of 90 percent of genital warts, and HPV 16 and 18, the cause of 70 percent of cervical cancers. It is FDA-approved for both females and males between the ages of 9 and 26.
  • Cervarix. Cervarix was the second vaccine to be approved and has been available since 2009. It is effective against HPV 16 and 18. It is approved for women aged 9 to 25.
  • Gardasil 9. Gardasil 9 was approved in 2014 has the broadest coverage of the HPV vaccines. It is effective against HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58. This vaccine is approved for females between the ages of 9 and 26 to prevent cervical, vulvar, vaginal, and anal cancer, and in males between the ages of 9 and 15 to prevent anal cancer.

It's noteworthy that different vaccines offer different coverage, and one is approved only for females. Your decision about which vaccine is best for you may be determined by your insurance coverage (unless you wish to self-pay for a different vaccine). Some insurance companies cover one of the vaccines but not the others. Before making an appointment with your doctor, check with your insurance company about coverage.

Any HPV vaccine is most effective when it's given before a person becomes sexually active and is potentially exposed to the virus. 

Screening for HPV-Related Disease

Getting vaccinated against HPV and using a condom each time that you have sex are both excellent ways to reduce your risk of contracting human papillomavirus. But even with these precautions, it is best to keep up with your routine checkups and screenings—especially when it comes to women and Pap smears.

For instance, in women, even if HPV causes abnormal changes in the cervix that might develop into cervical cancer, a regular Pap smear from your gynecologist can help catch this early so you can be treated before the health problem potentially becomes life-threatening and harder to treat. 

Keep in mind that men need to be aware as well. It's thought that around 2 percent of cancer cases in men are related to HPV. Any abnormalities of the genitalia or head and neck should be evaluated by a physician, as many of these conditions have precancerous stages.

Bottom Line on HPV as a Sexually Transmitted Disease

HPV is usually considered a sexually transmitted disease, but the exact definition is more complicated. Most people who develop an HPV infection (a sexually transmitted infection) do not go on to develop HPV-related disease, such as genital warts or precancerous/cancerous changes of the cervical, vulva, vagina, anus, penis, or head and neck.

HPV is usually transmitted by close human contact, but vaginal penetration is not needed to acquire the virus. Due to transmission by skin to skin contact (including that in the oral and anal area), condoms may be ineffective in preventing the infection. Vaccination with one of the HPV vaccines may prevent HPV-related disease, depending on the coverage of the particular vaccine.

Screening with regular Pap smears, and consulting a doctor with any symptoms that might suggest changes due to HPV, is important for anyone who is sexually active, or has intimate human contact.

Sources:

de Sanjose, S., Brotons, M., and M. Pavon. The Natural History of Human Papillomavirus Infection. Best Practices and Research. Clinical Obstetrics and Gynaecology. 2018. 47:2-13.

Serrano, B., Brotons, M., Bosch, F., and L. Bruni. Epidemiology and Burden of HPV-Related Disease. Best Practices and Research. Clinical Obstetrics and Gynaecology. 2018. 47:14-26.

Ventimiglia, E., Hornblas, S., Muneer, A., and A. Salonia. Human Papillomavirus Infection and Vaccination in Males. European Urology Focus. 2016. 2(4):355-362.