HPV infections often don’t cause symptoms, but when they do, they can include genital warts, itching, and, rarely, bleeding or lesions.

HPV infections are often asymptomatic, so many people are unaware they have the virus. In fact, about 13 million Americans develop HPV each year, but 9 in 10 of these infections will clear on their own within 2 years.

Some low risk HPV strains, like types 6 and 11, are more likely to cause symptoms, such as visible warts in the genital area.

High risk HPV strains, such as HPV 16 and 18, are linked to certain cancers like cervical, anal, and oropharyngeal cancers. These strains are often asymptomatic until the disease reaches advanced stages.

Symptoms, when present, can appear in different parts of the body, such as the mouth, genitals, or anus, depending on where the virus initially makes contact with the body’s skin or mucous membranes.

Oral HPV infections rarely cause noticeable symptoms, which can make them difficult to detect without specific testing.

However, in some cases, a persistent oral HPV infection can lead to the development of benign lesions or cancerous tumors in the mouth and throat.

People who get oropharyngeal cancer from HPV have often had the virus for a long time without knowing. Symptoms of oral cancer caused by HPV can include:

It’s important to note that these symptoms can also be caused by other conditions, so it’s essential to consult a healthcare professional for a proper diagnosis.

One 2022 study found a link between certain oral lesions (specifically white, bright, and elevated lesions) and high risk HPV genotypes.

Out of 108 people with oral lesions, 60 tested positive for HPV. Among these, 46.7% had elevated lesions linked to high risk HPV types, while 43.3% had elevated lesions with low risk HPV types.

In flat lesions, 5% were associated with high risk HPV types and another 5% with low risk types.

Anal HPV infections can manifest in various ways, ranging from asymptomatic to symptomatic presentations. Symptoms can include:

  • Visible warts (condylomata acuminata): Warts around the anus can vary in size, appearing as small or large, and may occur as single growths or multiple growths. They typically have a cauliflower-like appearance.
  • Anal discomfort: Occasionally, there may be itching, pain, or bleeding in the anal area.
  • Moisture or mucus discharge: Excessive moisture or mucus may be present from the anus.
  • Painful bowel movements: There may be some discomfort or pain during bowel movements, especially if warts are irritated or located inside the anal canal.

HPV is currently the most common sexually transmitted infection (STI) seen by colorectal surgeons, with a million new cases seen in the United States every year.

When symptoms occur on the penis and scrotum, they can vary in appearance and severity:

  • Warts (condylomata acuminata): These cauliflower-like growths are the most common sign of HPV. They can vary in size and appear on the penis, on the scrotum, or around the anal region, and they may occur singly or in clusters.
  • Flat lesions: Some HPV-related lesions may be flat, pink, red, or flesh-colored, making them harder to notice than typical warts. They can occur on the penis or scrotum.
  • Itching or discomfort: HPV infections can cause itching, discomfort, or a feeling of pressure in the genital area, even without visible warts or lesions.
  • Changes in skin color: In some cases, the skin of the penis or scrotum affected by HPV may appear darker or lighter than the surrounding skin.
  • Moisture or dampness: Areas affected by HPV may appear more moist or damp than usual, especially if warts or lesions are present.

Giant condylomata acuminata of Buschke and Lowenstein (GCBL) is a rare, slow-growing tumor primarily caused by low risk HPV types 6 and 11.

GCBL is most common in people under the age of 50 years who have an uncircumcised penis, but it can also affect the anus and sometimes the armpit.

GCBL starts as a small, rough growth and can grow into a large, cauliflower-like mass up to about 8 inches (20 centimeters) in size.

Although it may look harmless under a microscope, it acts like a cancerous tumor, invading nearby tissues and often returning after treatment.

Most HPV infections are asymptomatic, but when symptoms do occur in the vulva or vagina, they may present in the following ways:

  • Warts: This is the most common HPV symptom. HPV in the vulva can cause small, raised bumps or clusters with a cauliflower-like appearance. They may be flesh-colored, pink, or red.
  • Itching or discomfort: HPV infections can occasionally lead to itching, discomfort, or a burning sensation in the genital area.
  • Changes in skin color: The skin of the vulva affected by HPV may appear darker or lighter than the surrounding skin.
  • Vaginal discharge: HPV can cause changes in vaginal discharge, such as increased or altered discharge.
  • Bleeding: Rarely, HPV-related changes can lead to bleeding, especially during or after penetrative sex.
  • Lesions or ulcers: In rare cases, HPV can cause painful lesions or ulcers in the vulva or vagina.

People with symptoms of HPV or related cancers should consider consulting with a healthcare professional as soon as possible.

Screening schedules typically include:

  • Cervical cancer: People ages 21 to 29 years should have a Pap smear every 3 years. People ages 30 to 65 years can have a Pap smear with an HPV test every 5 years or a Pap smear alone every 3 years.
  • Anal cancer: People who have penetrative anal sex, have a history of genital warts, or are living with HIV should discuss anal cancer screening with a healthcare professional.
  • Penile, vaginal, and oral cancer: There are no routine screening tests; report any concerning symptoms to a healthcare professional.