HPV Symptoms and Diagnosis

Whether they know it or not, most people will be infected with one or more types of the human papillomavirus — or HPV — at some point in their lives. HPV is a group of more than 150 related viruses, and the symptoms that result from an HPV infection depend in part on which type of the virus a person has.

About 75 percent of HPV types can cause common skin warts (noncancerous growths), according to the American Cancer Society. Common warts often appear on the hands or feet, but they can appear anywhere on the body.

The other 25 percent of HPV types can infect the mucosal surfaces of the body — such as the vagina, anus, and inner nose, mouth, and throat. Some of these types of HPV can cause genital warts, and some can cause cellular changes, called dysplasia, that may progress to cancer.

But just because a type of HPV can cause warts or dysplasia doesn’t mean it will. In many cases, infection with HPV causes no symptoms and goes unnoticed.

In fact, about 90 percent of genital HPV infections are temporary and go away on their own, according to the Centers for Disease Control and Prevention (CDC).

Here’s what to look for — and what tests you and your doctor may consider — to find out if you’ve been infected with HPV.

Skin warts may form when certain types of HPV are transmitted through contact with another person, or contact with another part of the body on the same person, according to Cedars-Sinai.

There are a few common varieties of skin warts.

Common warts Common warts most often appear on the fingers, around the fingernails, and on the backs of the hands. They may also grow elsewhere on the arms or on the face. The growths may feel like rough bumps and may have tiny black dots in them.

Common warts are more likely to grow in areas where the skin is frequently broken or irritated, according to the American Academy of Dermatology.

Plantar warts Warts that grow on the soles of the feet are called plantar warts. They sometimes grow in clusters, in which case they’re known as mosaic warts.

Typically hard and grainy, plantar warts may be flat or may grow inward. They can be painful to walk on.

Similar to plantar warts are palmar warts, which grow on the palms of the hands.

Flat warts As the name implies, flat warts are typically flat-topped and are usually smaller and smoother than other warts. They often grow in large numbers (20 to 100 at a time) and can occur anywhere, but frequently occur on the face in children, the beard area in men, and the legs in women.

Filiform warts These warts resemble finger-like projections or long threads. They often appear on the face and often grow quickly.

Periungual warts Most commonly seen in people who bite their nails or pick at their cuticles, periungual warts form in clusters around fingernails or toenails and may extend under the nails as well. They typically appear as cauliflower-like thickened skin and may be fissured, inflamed, or tender. Periungual warts are difficult to treat and have a high recurrence rate.

Warts that develop in the genital and anal regions are caused by a group of HPV types that are different from those that cause skin warts.

So-called genital warts can also form on other mucosal surfaces, like the inside of the nose, mouth, and throat. They may also occur in the trachea and bronchi (the windpipe and smaller air passages leading to the lungs) and on the inner eyelids.

HPV types that cause genital warts are usually, but not always, transmitted during intimate sexual contact.

About 90 percent of genital warts are caused by HPV types 6 and 11, according to the CDC.

Genital warts, which are sometimes too small to see, may be:

• Flat or raised
• Grouped in clusters, resembling cauliflower
• Pink or flesh-colored
• Soft to the touch
• Painful or itchy

They typically grow:

• Inside or around the anus
• On the upper thighs
• In the groin area
• On the scrotum and penis, including under the foreskin and in the urethral opening
• Inside the vagina, on the cervix (lower end of the uterus), or around the vulva (area outside the vagina)

Genital warts that go untreated may eventually cause abnormal urine flow in men if they are present in the urethra. They may also cause vaginal discharge or bleeding from the urethra, vagina, or anus.

The HPV types that cause genital warts are not linked to cancer, but some other types of HPV that infect the same kinds of mucosal surfaces are linked to cancer.

While most of infections with potentially cancer-causing HPV types never cause any symptoms or lead to cancer, some infections cause changes in the cells that eventually can lead to cancer.

High-risk types of HPV can cause:

• Cervical cancer
• Vulvar cancer
• Vaginal cancer
• Penile cancer
• Anal cancer
• Oropharyngeal cancer (cancer of the back of the throat)

Two different tests can be used to screen for cervical cancer: the Pap test, which can detect changes in the cells of the cervix, and the HPV test, which detects the presence of the human papillomavirus.

There are no screening tests for the other types of cancer caused by HPV, so it’s important to notice any changes in appearance, lumps, pain, abnormal bleeding, or any other abnormalities in areas of the body that could be potentially infected with HPV.

Skin warts and genital warts can usually be diagnosed on sight during a physical examination, but your doctor may also refer you to a dermatologist for a biopsy (removal of tissue for examination under a microscope) to be sure your skin condition is a wart.

For women, a doctor may perform a colposcopy — a procedure that uses a light and a low-power microscope — to find genital warts on your cervix that are too small to see with the naked eye, or to look for precancerous changes in the tissue of the cervix, vagina, or vulva.

The HPV test can detect HPV types 16 and 18 — considered the highest-risk HPV types for cancer — and provide broad results for 12 other high-risk HPV types in tissue of the cervix.

The Pap test can detect precancerous changes in tissue of the cervix, and may be used for screening when a primary HPV test (an HPV test approved for stand-alone use) isn’t available. It can be administered by itself or along with an HPV test.

Women who have an abnormal Pap test or a positive HPV test should seek advice from a doctor on how best to follow up to prevent cervical cancer.

A positive HPV test will generally be followed up with a colposcopy if HPV type 16 or 18 is found. It may be followed up with a Pap test if one wasn’t done at the same time as the HPV test, or with repeat testing in one to three years if types of HPV other than 16 or 18 are found and the results of a Pap test are normal, according to the American College of Obstetricians and Gynecologists.

Cancers or precancerous changes in areas other than the cervix are typically diagnosed by taking a biopsy of abnormal-appearing areas and examining the tissue under a microscope. A biopsy may also be taken from the cervix to assess the severity of precancerous tissue changes.

Additional reporting by Quinn Phillips.