Human papillomaviruses – HPV for short – are the most common sexually transmitted pathogens worldwide. The numbers are staggering: an estimated 80 to 90 percent of all sexually active people will be infected with HPV at least once in their lifetime. Despite this prevalence, knowledge about HPV is often incomplete, and the topic is shrouded in unnecessary shame. It's time for education without taboos.

HPV is not a single virus, but a family of over 200 different types. Most are harmless and are eliminated by the immune system within one to two years without you ever noticing. About 40 types infect the genital area and are sexually transmitted. Of these, about 14 are so-called 'high-risk' types that can cause cancer if the infection persists – most notably types 16 and 18, which are responsible for about 70 percent of all cervical cancer cases.

The low-risk types, especially HPV 6 and 11, do not cause cancer, but can trigger genital warts (condylomas). While these are harmless, they are often cosmetically and psychologically distressing. Approximately 90 percent of all genital warts are caused by these two types.

Transmission occurs through direct skin-to-skin contact, primarily during sexual intercourse – vaginal, anal, and oral. Condoms reduce the risk but do not offer complete protection, as HPV can also infect areas of skin not covered by the condom. An HPV infection says nothing about a person's sexual behavior – it is so common that it is practically unavoidable if you are sexually active.

The good news: Highly effective vaccines exist against the most important HPV types. And even without vaccination, the immune system eliminates most infections on its own. Problems only arise when an infection with a high-risk type persists – then, over years or even decades, cell changes can develop that, without treatment, can lead to cancer. This is precisely why screening is so important: It detects these precursors long before cancer develops.

HPV infections can cause a wide range of diseases – from harmless skin warts and genital warts to various types of cancer. Understanding these connections helps to put the importance of prevention and screening into perspective.

Genital warts (condylomas) are the most visible manifestation of an HPV infection. They appear as soft, flesh-colored or grayish growths in the genital or anal area. Sometimes they are solitary, sometimes they occur in clusters that can resemble cauliflower. Genital warts are almost exclusively caused by the low-risk HPV types 6 and 11. They are not dangerous, but can be bothersome and often require treatment (cryotherapy, laser, topical medications). Recurrences can occur even after successful treatment.

Cervical cancer is the most well-known HPV-associated cancer. Virtually all cases – over 99 percent – ​​are caused by HPV. The path from infection to cancer typically takes 10 to 20 years and progresses through precancerous stages (CIN – cervical intraepithelial neoplasia), which can be detected and treated through screening. In Germany, approximately 4,400 women are diagnosed with cervical cancer each year, and about 1,600 die from it – figures that could be dramatically reduced through consistent screening and vaccination.

Other HPV-associated cancers affect both sexes: anal cancer (approximately 90 percent HPV-related), oropharyngeal cancer (approximately 70 percent HPV-related and increasing), penile cancer, vulvar cancer, and vaginal cancer. HPV-related oropharyngeal cancer, in particular, is on the rise – it primarily affects men and is now more common than cervical cancer in some countries.

The link between HPV and cancer was discovered in the 1980s by Harald zur Hausen, for which he received the Nobel Prize in 2008. This finding was revolutionary: For the first time, a virus could be identified as the cause of a common cancer, thus laying the foundation for prevention through vaccination.

The HPV vaccine is one of the most effective cancer prevention measures available. It protects against the HPV types responsible for most HPV-related cancers and genital warts. After more than 15 years of use and millions of doses administered, its safety and efficacy are exceptionally well documented.

In Germany, the 9-valent vaccine Gardasil 9 is currently the standard. It protects against nine HPV types: the high-risk types 16, 18, 31, 33, 45, 52, and 58 (together responsible for approximately 90 percent of cervical cancer cases) and the low-risk types 6 and 11 (responsible for approximately 90 percent of genital warts). The protective efficacy against the types included in the vaccine is over 90 percent.

The STIKO (Standing Committee on Vaccination) recommends vaccination for all girls and boys aged 9 to 14. At this age, two doses at least five months apart are sufficient. For vaccination from age 15, three doses are required (at 0, 2, and 6 months). Ideally, vaccination should take place before first sexual contact, as it protects against infection but does not treat an existing infection.

Adults can also benefit from the vaccination. While it's more likely that they've already been exposed to some HPV types, the vaccination still protects against the types they haven't yet been infected with. Many health insurance companies cover the cost of the vaccination up to the age of 26, and some even beyond. An individual cost-benefit analysis is advisable.

The safety of the HPV vaccine has been extensively studied. Common side effects include pain at the injection site, mild swelling, and occasionally headaches or fatigue – typical for vaccinations in general. Serious side effects are extremely rare. Claims about alleged serious side effects circulating on social media have been scientifically refuted. The World Health Organization, the Robert Koch Institute, and virtually all medical societies worldwide strongly recommend the HPV vaccine.

Even with vaccination, screening remains important – the vaccine does not protect against all HPV types, and many women were not vaccinated before its introduction. Cervical cancer screening is a success story of early cancer detection: Since the introduction of the Pap smear in the 1970s, mortality from cervical cancer in Germany has decreased by approximately 70 percent.

The Pap smear (named after its inventor, George Papanicolaou) examines cells from the cervix under a microscope for abnormalities. It detects precancerous lesions and early stages of cancer, allowing treatment to begin before invasive cancer develops. The sensitivity of a single Pap smear is around 50-70 percent – ​​not perfect, but with regular testing, most relevant changes are detected.

The HPV test detects the virus itself and is more sensitive than the Pap smear. A negative HPV test indicates a very low risk of cervical cancer in the coming years. Since January 2020, women aged 35 and over in Germany have been entitled to a combined test (co-test): a Pap smear plus an HPV test every three years. Women between 20 and 34 continue to receive an annual Pap smear.

A positive HPV test does not automatically mean cancer or even precancerous lesions. Most HPV infections clear up on their own. A positive result leads to closer monitoring to ensure that no problematic cell changes develop. An abnormal Pap smear or persistent HPV infection is typically followed by a colposcopy – a magnified examination of the cervix with possible tissue sampling (biopsy).

Screening in men is more complicated. There is no established routine screening for HPV-related cancers in men. Anal Pap smears are recommended for high-risk groups (MSM, HIV-positive individuals) in some guidelines, but are not widely available. The most important preventive measure for men is vaccination.

Not every woman regularly attends gynecological checkups – whether due to lack of time, shame, negative experiences, or lack of motivation. HPV self-tests offer an alternative: the sample is taken at home, and the result provides clarity about the individual risk.

The process is simple: You take a vaginal swab yourself using a special swab or brush. The sample is sent to a lab and tested for high-risk HPV types. You receive the results online or by mail. If the result is negative, your risk of developing cervical cancer in the coming years is very low. If the result is positive, you should see a doctor for further evaluation.

Studies show that self-collection for HPV tests is just as reliable as collection by medical personnel. The sensitivity for detecting high-risk HPV is over 90 percent. Important: The self-test does not replace a complete gynecological examination, which also includes other aspects of genital health. It is a supplement, not a replacement.

For whom are self-tests particularly useful? For women who, for various reasons, don't go for regular checkups. For women who want reassurance between regular screening appointments. For women who feel uncomfortable during gynecological examinations. As an easy way to get started, which, if the result is positive, motivates a doctor's visit.

There are currently no validated self-tests for HPV in men. Diagnosis in men is generally more difficult because there is no established sampling site like the cervix. If genital warts or other HPV-related lesions are suspected, a visit to a urologist or dermatologist is recommended.

HPV is important, but it's not the only sexually transmitted infection that deserves attention. A comprehensive view of sexual health also includes other common STIs – especially since many are asymptomatic and can have serious consequences if left untreated.

Chlamydia is the most common bacterial STI in Germany. Many infections are asymptomatic, but if left untreated, they can lead to infertility, especially in women. A simple urine test or swab provides clarity. Treatment involves antibiotics. Annual screening is recommended for women under 25.

Gonorrhea (the clap) more frequently presents with symptoms than chlamydia – discharge, burning during urination – but can also be asymptomatic. Increasing antibiotic resistance makes treatment more complex. Testing is done via swab or urine sample.

Syphilis is making a comeback. The infection progresses in stages and, if left untreated, can cause serious organ damage. A blood test is reliable and should be performed after potential exposure.

Thanks to modern therapy, HIV is no longer a fatal disease, but early diagnosis remains crucial. Every sexually active person should know their HIV status. Rapid tests provide results within minutes, but are less reliable in the early stages than laboratory tests.

Hepatitis B and C can be sexually transmitted. There is an effective vaccine against hepatitis B, which can also be administered in adulthood. Hepatitis C is now curable.

The DoctorBox STI test offers a comprehensive check for the most important sexually transmitted infections – discreetly, reliably, and conveniently from home. It covers HIV, syphilis, and hepatitis C – precisely the infections where early detection makes all the difference. Regular testing is part of responsible sexual health.

A positive HPV test result can be worrying – but it's important to understand what it means and what it doesn't. A positive HPV test does not mean you have or will get cancer. It means you have an infection with a high-risk HPV type, which in most cases will clear up on its own.

The first step is to stay calm. Most HPV infections – about 90 percent – ​​are eliminated by the immune system within one to two years. A positive test simply shows that you have an active infection at that time. It says nothing about how long you've had it, who you got it from, or whether it will persist.

If the HPV test is positive but the Pap smear is abnormal, a follow-up examination after one year is typically recommended. During this time, the immune system has a good chance of clearing the infection. You can support your immune system by not smoking (smoking significantly increases the risk of persistent infections and cell changes), getting enough sleep, eating a balanced diet, and managing stress.

If an HPV test is positive with an abnormal Pap smear, a colposcopy usually follows. During this examination, the cervix is ​​examined with a magnifying lens, often after staining with acetic acid, which makes cell changes visible. Tissue samples are taken if necessary. Depending on the findings, observation, a minor surgical procedure (conization – removal of a cone-shaped piece of tissue), or other treatment may be indicated.

The psychological burden of a positive HPV test is often underestimated. Feelings of shame, fear, or anger towards one's partner are understandable, but not helpful. HPV is extremely common and not a sign of 'misconduct'. Open communication with one's partner and, if needed, psychological support can help.

An HPV diagnosis inevitably raises questions about the relationship. Where did the infection come from? Do I have to inform my partner? Can I infect him or vice versa? These questions are understandable, but the answers are often less clear than one might hope.

The origin of the infection is usually impossible to determine. HPV can remain detectable for years or even decades after infection, or it may only cause cell changes later. A positive test today could stem from contact many years ago. Therefore, a positive test is not proof of infidelity and should not be interpreted as such.

Informing your partner is a personal decision. Unlike infections such as HIV or syphilis, there is no legal obligation to disclose an HPV diagnosis. In stable relationships, it can be assumed that partners have likely already been exposed to each other. An HPV diagnosis generally does not change behavior or precautions within an existing relationship.

Condoms reduce the risk of HPV transmission, but do not offer complete protection. For people in new relationships or with multiple partners, condoms are still advisable – they protect against many other STIs and also partially reduce the risk of HPV.

Vaccinating your partner is advisable if they haven't already been vaccinated. Even if one partner is already HPV-positive, the vaccination protects against types they haven't yet been exposed to. In long-term relationships, mutual HPV transmission has likely already occurred, but the vaccination protects against reinfection after any HPV clearance and against other types.

The most important message: HPV is so common that it's almost an unavoidable part of sexually active life. It's no reason for blame or relationship crises. Open, informed communication and joint preventative care are the best ways to deal with it.

The discussion about HPV often focuses on women and cervical cancer. But HPV affects men just as much – they are infected just as frequently, can transmit the virus, and also develop HPV-related diseases. The vaccination recommendation explicitly applies to boys as well, and for good reason.

Men are less likely than women to develop HPV-related cancers, but the cases are not negligible. HPV-related oropharyngeal cancer affects men three to four times more often than women and is increasing rapidly—in some countries, it has already surpassed cervical cancer as the most common HPV-related cancer. Anal cancer is particularly common among MSM (men who have sex with men). Penile cancer is rare, but it does exist.

Genital warts affect men and women about equally. They are harmless, but often bothersome and can be psychologically distressing. Vaccination also protects against them.

Screening in men is more problematic than in women. There is no established routine test. HPV DNA tests can theoretically be performed on penile smears, but they are not standardized and are not routinely recommended. Anal Pap smears are recommended for high-risk groups in some guidelines, but are not widely available.

The most important preventive measure for men is vaccination. It protects against genital warts, penile cancer, anal cancer, and – indirectly – HPV-related oropharyngeal cancer. Furthermore, vaccination of boys and men also protects the women they come into contact with by reducing virus transmission (herd immunity).

Men should pay attention to changes: New growths in the genital area, lumps, non-healing wounds, difficulty swallowing, or persistent hoarseness should be checked by a doctor. If risk factors are present (MSM, HIV, multiple partners), an open discussion with a doctor about screening options is advisable.

Can HPV be cured?

There is no treatment that eliminates the HPV virus itself. What can be treated are the consequences of the infection: Genital warts can be removed (cryotherapy, laser, topical treatments), and cervical cell changes can be surgically removed (conization). The good news is that the immune system eliminates most HPV infections on its own within one to two years. After clearance, reinfection with the same type is unlikely, as the immune system has developed some immunity – however, this does not protect against other HPV types.

Is it possible to have HPV without knowing it?

Yes, and that's actually the norm. Most HPV infections cause no symptoms at all. You don't notice anything, and your immune system eliminates the virus without you ever knowing. That's why screening is so important: it detects infections and cell changes before they cause problems. The only visible signs of an HPV infection are genital warts—and these are caused by low-risk types that don't cause cancer.

Is the HPV vaccination also advisable for adults?

Yes, adults can also benefit. While the vaccination is most effective before first sexual contact, it also protects against HPV types with which there has been no prior contact. Since very few people have been infected with all the types included in the vaccine, the vaccination almost always offers an additional benefit. The cost-benefit analysis is individual – many health insurance companies reimburse the vaccination up to age 26, and some even beyond. A consultation with a doctor can help with the decision.

Do condoms protect against HPV?

Partially. Condoms reduce the risk of HPV transmission by about 30-50 percent, but they don't offer complete protection. The reason: HPV is transmitted through skin-to-skin contact, and condoms don't cover all potentially infected areas of skin. Nevertheless, condoms are important: They protect against many other STIs and also reduce the risk of HPV, at least partially. The most effective prevention is the combination of vaccination and condoms.

Do I have to tell my partner about an HPV diagnosis?

There is no legal obligation to get vaccinated, unlike with some other infections. Whether you do is a personal decision. In established relationships, it's likely that transmission has already occurred. A conversation can be helpful to discuss prevention and vaccination together. It's important to understand that a positive HPV test is not proof of infidelity – the virus can persist undetected for years.

Can HPV be transmitted through oral sex?

Yes, HPV can be transmitted through all types of sexual contact, including oral sex. HPV infections in the mouth and throat can lead to oropharyngeal cancer—a type of cancer that is increasing, especially in men. Vaccination also protects against these infections. Routine screening for oral HPV infections does not exist because there is no validated test available, and most infections clear up on their own.

How often should I get tested?

For women, the following screening recommendations apply: an annual Pap smear from age 20, and a combined test (Pap plus HPV) every three years from age 35. More frequent checkups may be necessary if abnormal results are found. There is no routine screening for men. Individual screening strategies can be discussed with a doctor for men with risk factors (MSM, HIV). HPV self-tests for women can provide additional reassurance between regular check-ups.

Can I get infected again after an infection?

Reinfection with the same HPV type is unlikely after clearance – the immune system has built up some immunity. However, there are over 200 HPV types, and infection with one type does not protect against others. Therefore, you can still contract other HPV types despite a past infection. The vaccine protects against the most common types, even if you have already been infected with some others.

Does HPV affect fertility?

HPV does not directly affect fertility. However, in rare cases, treatments for cervical cell changes (conization) can increase the risk of premature birth because the cervix shortens. This is why early screening and preventing cell changes through vaccination are so important. If you are planning a pregnancy and have received an HPV diagnosis, you should discuss the next steps with your gynecologist.

Do genital warts disappear on their own?

Sometimes, yes. About 30 percent of genital warts disappear within a few months without treatment, as the immune system controls the infection. However, they can also persist, grow larger, or spread. Treatment speeds up healing, eliminates the cosmetic concern, and may reduce the risk of transmission. Whether to treat or wait and see—the decision should be discussed with a doctor.