There are only few characteristic symptoms

Others may suggest developing cervical cancer

HPV symptoms in women

Human papillomavirus infection is the most common sexually transmitted infection throughout the world.  It is especially common among sexually active adolescents and young adults.  Nearly 50% of all infections occur in this age group.

Recently, two visitors asked about specific symptoms of HPV in women.  This article will discuss HPV symptoms likely to occur in females.

 

Genital warts

These are regarded as by far the most common symptoms of human papillomavirus infection in women.

Genital warts may vary in shape and size. 

They can be flat or raised, small (<1 cm) or large (>1 cm).  As they grow, they may initially appear as pink, tiny bumps in the skin.  Over the next several days or weeks, these bumps will grow in size and their characteristic shape of a wart. 

The most characteristic is a wart resembling cauliflower: pointing upward, with irregular texture (1).

Warts may occur anywhere in the area of genital tract, but most commonly can be found:

  • at the vaginal opening (introitus)
  • inside the vagina
  • cervix
  • urethra
  • perineum (area of the skin surrounding the vagina and anus).

In some cases, warts may be found inside the anus.  This is especially likely to occur in persons practicing anal sex.

Warts affecting simultaneously the cervix and anus occur in about 13% cases (2).

In 90% of cases, genital warts are caused by HPV types 6 and 11. 

Other types of HPV also associated with warts, but to a much lesser extent, include types 16, 18, 31, 33, and 35.

Diagnosis of genital warts is usually made clinically by inspection by a clinician. 

Biopsy may be performed in rare cases where the lesion does not resemble a characteristic HPV wart or in cases where the infection is not responding to standard medical therapy.  If that is the case, a physician will first make sure that the patient has taken the medications as prescribed and that there was no re-infection.  Having unprotected sex during therapy increases the risk of becoming infected again.

 

Facial warts

Interestingly, HPV warts may not be limited to the genital region.  For instance, HPV types 6 and 11 are known to cause warts on the conjunctiva (ie. eyelids), in the nose, oral cavity and larynx. 

These cases are usually caused by an infection through oral sex.

 

HPV and vaginal itching

Vaginal itching commonly occurs in conjunction with HPV warts.  However, it may also be caused by other STIs.

Causes of vaginal itch:

  • Trichomoniasis
  • Yeast infection
  • Bacterial vaginosis
  • Irritation by soaps and detergents

 

HPV and pain during sex

Dyspareunia, or pain during sexual activity, is not commonly associated with HPV infection. 

However, it may occur in certain cases where a genital wart is located near the vaginal opening or inside the vagina or anus, causing pain during sexual intercourse.  If that is the case, bleeding from the wart may also occur.

Other causes of pain during sex, include:

  • Vaginal infection
  • Urinary tract infection
  • Pelvic inflammatory disease
  • Endometriosis
  • Lichen planus
  • Vaginal dryness
  • Vaginismus

 

HPV and vaginal discharge

Isolated human papillomavirus infection is usually not associated with vaginal discharge. 

In rare cases, bleeding from a wart may occur, especially if its location (vagina, cervix, anal opening) makes it vulnerable to injury during sexual intercourse.

Commonly, discharge may be caused by co-infection with another STI or by endometriosis.

More importantly, vaginal bleeding may be a sign of developing cervical cancer, which is usually caused by an HPV infection (3).  The discharge may be pale, watery, bloody or pink, foul-smelling or not.

 

Summary

Symptoms of HPV infection are fairly limited.HPV summary

In most cases, they do not produce any symptoms at all.  This makes it easier to contract HPV from a sexual partner who is unaware of his or her infection status.

Genital warts, especially those that resemble a cauliflower, are particularly characteristic symptom of human papillomavirus infection.  Other warts associated with HPV may be flat or slightly raised.

Genital, or vaginal itching is the second symptom of infection that is usually found in symptomatic persons.  Hwever, it is not specific for HPV and can be caused by other infections or genital irritation.

Vaginal bleeding is an ominous sign associated with HPV.  In simple cases it may simply be caused by a bleeding wart, but characeristically vaginal bleeding is the sign of cervical cancer.  Women with vaginal bleeding should consult their healthcare provider as soon as possible, to rule out cervical cancer.

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