First, some background. HPV vaccines are recommended for use with all adolescents and young adults between the ages of 11 and 26. (HPV vaccines can actually be given as young as age nine). Why so young? The idea is to vaccinate and offer protection prior to the onset of sexual activity. Also, the vaccines generate a stronger response from the immune system of younger people, so the teen years are an ideal time to immunize against HPV.

As to your question, there is no evidence at all that young people who receive an HPV vaccine are more likely to have earlier or riskier sex. In fact, a recently published study (Bednarczyk, Pediatrics) that followed nearly 1,400 girls who were vaccinated against HPV at age 11 found –compared to girls of similar age who did not receive the vaccine- they were no more likely to engage in sex, become pregnant, or be diagnosed with an sexually transmitted infection. We often use the “seat belt” analogy here: just as wearing a seat belt won’t cause someone to suddenly drive faster or recklessly, neither will an HPV vaccine lead someone to become sexually active or be unprotected when they do.

Many parents also find that getting the HPV shot is a good time for discussions of sexually transmitted infections, and about sex in general.

By the way, the HPV vaccine is also recommended for boys.

We know that the HPV vaccine is safe for young people. Millions of doses of HPV vaccines have been safely given around the world. In some places, we are already seeing a reduction in HPV infections and in conditions associated with cervical cancer. If you want to read more, read ASHA’s HPV Vaccine FAQ.

--J. Dennis Fortenberry, MD, MS
Indiana University School of Medicine

Women can have unclear Pap tests for many different reasons. Sometimes HPV-related cell changes are the cause, but other causes such as yeast infections can also result in an abnormal Pap test. To help sort it out, it's not uncommon to repeat the Pap test in a few months or, sometimes with women over age 21, to do an HPV test. Even when HPV is involved, 90% of infections clear up on their own within 24 months, particularly in women younger than 30 years of age.

What if you do have HPV, though? Well, nearly 50%-80% of sexually active people have at least one HPV infection in their lifetimes. The virus is most often harmless and the immune system usually does clear it naturally, but it's important for women to have regular Pap tests and, when appropriate, HPV tests. Women age 26 and under should also talk with their healthcare provider about getting an HPV vaccine. If you follow-up with your clinic as they recommend, it's likely you'll be fine.

As for your partner: Most sexually active men have HPV at some point, too, and the virus is usually silent and harmless. There's no specific test recommended for men who have no symptoms. However, consistent condom use has shown to significantly reduce the risk of transmission of HPV. So, follow up on your test as recommended by your clinician and don't get over anxious!

--Shobha Krishnan, MD

I appreciate your concern about your partner's health and it sounds as if she has done the right thing by getting screened and then treated for the abnormal cells. The goal of Pap tests and in some cases, HPV testing, is to identify women at risk for developing cervical cancer. Now that she has been treated, she will need to keep up with recommended exams to make sure that her tests go back to normal.

I am concerned, however, about the emotional impact this has made in your daily lives. Although HPV has been associated with penile and anal cancers in men, these are far less common than the cellular abnormalities in women. High risk HPV causes no symptoms in men or women- no pain, discharge or bleeding. The HPV test is not approved for use in men as it is not as accurate as it is in women. The HPV vaccine is currently not approved for use in men.

We assume that men, just like most women, will clear the HPV through your immune response. In fact, you may have cleared it already, but again, we have no way of testing to know that for sure. In the meantime, the better support you can give your immune system, the better it will support you in helping to clear the virus. If you smoke, try to stop. Eat a good diet with antioxidant-rich fruits and vegetables and get adequate rest. Manage your stress in whatever way works best for you--exercise, hang out with people you care about, get involved in a cause. The benefits you get back from these healthy behaviors will pay you back in many ways!

Because HPV tends to be so common in younger age groups, it is often the first health concern that is faced and can create personal and relationship stress. If you feel that you are not getting the answers you need, talk to another provider or educate yourself through websites like this one.

--Beth Colvin Huff, MSN, FNP-BC-

Great question, and you're not alone in being confused about just how HPV is transmitted. HPV is spread by skin to skin contact: with genital virus, this can involve vaginal, anal, or possibly oral sex with someone who has this infection. The virus may also be transmitted by fingers from one person's genitals to another. HPV is not transmitted through casual contact such as hugging, shaking hands, or sharing a bathroom or shower with someone. Similarly, hot tubs and swimming pools are not a risk for HPV transmission (unless a couple has sex while they're in there!).

Rest easy about hot tubs and pools, but while we're on the topic keep in mind that up to 80% of sexually active people are estimated to have one or more HPV infections in their lifetimes. Most cases of HPV are harmless and are cleared naturally by the immune system, but it's very important for women to have regular Pap tests (most experts recommend beginning Pap test at age 21, even if you've never had sex). If you're 26 or under, you can also be vaccinated against HPV (but you still need Pap tests!).

--Beth Colvin Huff, MSN, FNP-BC

I hear you about the difficulty of getting treatment when you don't have insurance. That has to be beyond frustrating. Please don't try and freeze the genital warts yourself, as it can be hard to control how much tissue is destroyed, both surface area and depth. Genital skin is much different from that found in other areas, and can be tricky to work with even in medical settings. The units sold online are meant to be used by trained clinical staff and are not approved by the FDA for self-care.

There are at least three prescription medicines you can apply yourself that can be effective in treating genital warts. Some are reasonably inexpensive, although they can take several weeks to show an effect. They are likely to be less costly than the $500 figure you quote above.

Have you tried either your city/county health department, or a Planned Parenthood clinic? Often they offer free or sliding scale treatment options, or can refer you to someone who offers lower cost treatment. Another tactic is to try and see if you can work out a payment plan with a provider. Is there a medical school with a teaching hospital nearby? Get in touch with them to see what they offer.

You can search for clinics in your area by zip code here (provided by the Centers for Disease Control and Prevention).

--J. Dennis Fortenberry, MD, MS

I applaud you for being proactive and asking questions! I also am happy your family physician initiated the important conversation about HPV vaccines. First things first: HPV vaccines are indeed safe, having been tested with thousands of boys, girls, young men and women around the world. The vaccines have been found to be well tolerated, safe and effective in both sexes. Most common side effects include mild skin irritation and redness at the site of the injection. There have been reports of some patients fainting after receiving the vaccines, but this is actually common with vaccines and adolescents in general, and can be avoided by simply sitting or laying down for 15 minutes or so after being vaccinated.

Remember that HPV is most definitely not a "female" infection only. As is the case with females, most males will contract HPV in their lifetimes. HPV can cause genital warts, penile, anal, head and neck cancers in men. Recent studies show that HPV related head and neck cancers are more common in males than females. So far Gardasil® (made by Merck) has been approved in males for prevention genital warts. Their effectiveness to prevent HPV related male cancers is currently being studied. Maybe one day research will show us that HPV vaccines are of value with these cancers, too. As men and women pass the virus among sexual partners, it makes public health sense to vaccinate men in order to reduce the viral load in the society.

--Shobha Krishnan, MD