HPV, HPV Vaccination, and Molluscum#

Human Papillomavirus (HPV) is the most common sexually transmitted infection. Most Canadians will have an HPV infection at some point in their life - usually without symptoms - and the body clears most infections within 12 months. There are more than 200 strains of the HPV virus.

HPV can cause anogenital warts. It is also linked to 80-90% of anal cancers, 40% of vaginal and vulvar cancers, 40-50% of penile cancers, and 25-35% of mouth and throat cancers - most of these cancers are caused by high-risk types 16 and 18.

HPV is transmitted through sexual skin-to-skin or mucosa-to-skin contact - vaginal, anal, or oral. It can also be passed from parent to baby during vaginal delivery, although this is uncommon. A partner can carry and transmit HPV without ever having visible warts.

Studies estimate a 75% lifetime risk of having at least one HPV infection. This is normal - most people clear the infection without symptoms and without treatment, and never know they had it. The lifetime risk reflects how common HPV is, not how dangerous it is for any one person.

Time to clearance is similar for men and women - on average 8 months for women and 7.5 months for men. Some high-risk strains, particularly type 16, may persist longer, especially in women. Persistent infection with a high-risk strain is what raises the long-term cancer risk - which is why regular cervical screening matters.

High-risk subtypes (e.g., types 16 and 18) are most commonly associated with pre-cancerous or cancerous changes. Both are covered by the HPV vaccine.

Low-risk subtypes (e.g., types 6 and 11) have low or no cancer risk but cause most genital warts and minor cervical changes.

HPV is so common that almost any sexually active person can benefit from the vaccine. People who especially benefit from vaccination and regular cervical screening include those with:

• A previous STI
• Earlier age at first intercourse
• A higher number of lifetime sex partners
• Tobacco or marijuana use
• Immunosuppressant medication or an immune-suppressing condition
• HIV infection
• New or anticipated new sexual partners

This is not a checklist of "who is at fault" - it is a way to identify who gains the most from preventive care.

Yes. Unprotected oral sex is a risk factor for acquiring HPV - approximately 10% of men and 3.6% of women have oral HPV at any given time. Most clear it within a couple of years, but persistent infection can affect the back of the throat, tongue, and tonsils. About 70% of oropharyngeal cancers are caused by HPV.

Only complete abstinence from sexual contact eliminates the risk of HPV. For sexually active people, the most effective ways to reduce - but not eliminate - risk are:

• HPV vaccination - the single most effective step.
• Condoms and dental dams - they reduce risk substantially but do not fully prevent HPV because the virus can infect skin not covered by the barrier.
• Open communication with partners about sexual health and screening status.
• Regular cervical screening for patients with a cervix - this does not prevent infection but catches pre-cancerous changes early.

For most pregnant patients with HPV, there is no significant impact on pregnancy outcomes. A few things to know:

• Transmission to baby is rare. A very small number of babies born to parents with active genital warts develop recurrent respiratory papillomatosis (laryngeal warts) - this is rare and not a routine reason to avoid vaginal delivery.
• Vaginal delivery is usually still recommended even when warts are present, unless warts are very large and obstruct the birth canal.
• Warts can grow larger during pregnancy because of immune system changes - they often regress on their own after delivery.
• Most topical wart treatments are NOT used in pregnancy - if treatment is needed, cryotherapy is preferred. See the treatment-in-pregnancy accordion below.
• The HPV vaccine is deferred until after delivery if you become pregnant mid-series, but breastfeeding is fine.

If you have warts during pregnancy, raise it with your prenatal-care provider for in-person assessment.

There is no routine HPV screening test for men or for patients who don't have a cervix. HPV testing is currently validated only as a screening tool for cervical cancer, where the natural history of high-risk HPV → pre-cancer → cancer is well established.

For anal HPV testing in higher-risk groups (e.g., gay, bisexual, or men who have sex with men, especially with HIV co-infection), some specialty clinics offer anal Pap or anal HPV testing - this is not part of routine screening but may be appropriate in some clinical scenarios. Discuss with a sexual-health clinic or HIV specialist.

Genital warts are small, skin-coloured growths that appear in the genital or anal area. They are caused by certain HPV types - most commonly low-risk types 6 and 11. Not everyone infected with HPV develops warts; the immune system often clears the virus on its own.

Genital warts are transmitted the same way as HPV itself - through sexual skin-to-skin contact (vaginal, anal, or oral). The important nuance: a partner can carry and transmit the virus without ever having visible warts. Most HPV transmission happens from people with no symptoms.

For most people, warts appear 1 to 6 months after exposure - though some develop them much later (sometimes years later) when the immune system temporarily allows the virus to become active. This delay means it is often impossible to know exactly when or from whom HPV was acquired.

Genital warts can appear as small bumps or clusters that may be smooth or rough, flat or raised. They often cause no discomfort, but some people experience itching, burning, or tenderness. They can develop anywhere in the genital area - vulva, vagina, cervix, penis, scrotum, anus, or thighs.

Genital warts are diagnosed by visual examination by a clinician. There is no HPV test performed on visible warts to identify the subtype - the diagnosis is clinical. Cervical screening is a separate process; see Pap and HPV Cervical Screening for details on how that's changing across Canada.

Some do. Approximately 10-30% of anogenital warts clear spontaneously within three months, and 30-40% within four months. For small, asymptomatic warts, watchful waiting is a reasonable option. Treatment speeds clearance but is not always necessary.

Yes. Recurrence rates range from 20% to 30% within the first three months after treatment, because HPV can persist in surrounding skin even after visible warts clear.

There is no medical rule against it, but a few practical points:

• Active warts are more contagious than HPV without warts. If you can, it is reasonable to abstain from genital contact with new partners until warts have cleared.
• Tell partners. They can decide for themselves and consider HPV vaccination if they have not already had it.
• Topical treatments need a wash-off period. Most prescription wart creams must be washed off before sexual contact, both to avoid transferring the medication and because the medication can weaken latex condoms.
• Condoms reduce but do not eliminate transmission risk.

Possibly, yes. Visible warts are more contagious than HPV alone, but the virus can remain in surrounding skin for months after treatment. There is no test that confirms a person is no longer infectious. The good news: most HPV infections resolve on their own within 12 months, so contagiousness decreases over time even when you cannot prove it directly.

Genital warts themselves are generally not cancerous. The HPV types that cause most genital warts (6 and 11) are not the same as those that cause most cancers (16 and 18). Having genital warts does not mean you will develop cancer. Regular cervical screening (for patients with a cervix) and HPV vaccination remain the most important steps to reduce cancer risk.

• HPV vaccination - the most effective prevention; the vaccine covers types 6 and 11 (the most common causes of genital warts).
• Condoms reduce but do not eliminate the risk.
• Limiting the number of sexual partners.

No. HPV is not classified as a notifiable condition, so there is no legal requirement. However, partner notification can help reduce transmission and encourage vaccination, screening, and open conversations about sexual health.

Most patients use a self-applied topical at home; clinician-applied options exist for harder-to-treat cases.

Self-applied at home (topical) - what TeleTest can prescribe:

• Antimitotic topical solution / gel / cream - a plant-derived medication that stops wart cells from growing. Typically applied twice daily for 3 days per week, repeated weekly for up to 4 weeks. Clearance rates: roughly 45-77% across studies. Not recommended in pregnancy.
• Immune-response topical cream (two strengths available) - boosts the local immune response to help clear warts. The stronger version is applied 3 times per week at bedtime for up to 16 weeks; the milder version is applied daily for up to 8 weeks. Clearance rates: roughly 28-56% depending on strength and study. Not recommended in pregnancy.
• Plant-extract topical ointment (green-tea-derived) - applied 3 times daily for up to 4 months. Clearance rates: up to about 58% with 6-9% recurrence at 12 weeks. Not recommended in pregnancy or for children under 12.

Clinician-applied (at a walk-in clinic or specialist office):

• Cryotherapy (liquid nitrogen) - the most common in-person option; quick but typically requires multiple visits.
• Topical chemical cautery - an acid-based liquid applied by a clinician to destroy wart tissue.
• Electrosurgery or laser treatment - reserved for resistant cases.

The clinician considers wart location, size, number, your preferences, prior treatment, and pregnancy status when recommending an option. Some patients try one option and switch if it does not work after the recommended course.

Yes. TeleTest prescribes the self-applied topical treatments (antimitotic and plant-extract options) for at-home use. Select Anogenital Wart Treatment through the STD category.

Cryotherapy and other clinician-applied treatments are not available through TeleTest - those require an in-person visit at a walk-in clinic or dermatology office.

All topical wart treatments can cause local skin reactions at the application site - redness, burning, itching, soreness, mild erosion, or pain. These are common, especially during the first course, and usually manageable. Applying too much medication makes side effects worse.

Rare but more serious side effects can include severe inflammation, ulceration, or allergic reactions. Stop the medication and seek medical care if you have severe pain, ulcers, swollen lymph nodes, or signs of allergy.

The immune-response cream can sometimes cause headache, muscle aches, fatigue, or general malaise - the stronger version more often than the milder version.

If warts persist after the recommended course, options include:

• Switching to a different topical class (e.g., from antimitotic to immune-response cream).
• Clinician-applied cryotherapy (liquid nitrogen) at a walk-in clinic - the most common in-person option.
• Topical chemical cautery, electrosurgery, or laser for resistant cases (referral to dermatology).

About 30-40% of genital warts self-resolve within 4 months without treatment, so for small, asymptomatic warts, no treatment is also a reasonable choice.

Most self-applied topical wart treatments are NOT recommended in pregnancy - either due to limited safety data (antimitotic, plant-extract) or potential systemic effects (immune-response cream).

Cryotherapy is generally the preferred option in pregnancy because the liquid nitrogen does not get absorbed into the body and so cannot reach the baby.

Warts often grow larger during pregnancy because of immune system changes, and many regress on their own after delivery. If you are pregnant and have genital warts, see your prenatal-care provider for in-person assessment.

Unfortunately, no. HPV can remain in the skin surrounding a treated wart, or in areas where no wart existed. Most HPV transmission occurs from people without symptoms. There is no test that confirms a person is no longer infectious. The good news is most HPV infections resolve within 12 months on their own.

The HPV vaccine protects against nine types of HPV that cause the majority of HPV-related cancers (cervical, vulvar, vaginal, anal, penile, oropharyngeal) and genital warts.

What it covers: the current 9-valent vaccine covers HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58.

• Types 16 and 18 cause most HPV-related cancers.
• Types 6 and 11 cause most genital warts.

How it differs from older versions: Earlier vaccines were 4-valent (6, 11, 16, 18) or 2-valent (16, 18 only). The 9-valent version adds protection against five additional cancer-causing high-risk types (31, 33, 45, 52, 58).

How it works: stimulates the immune system to recognize and fight the virus before it can establish an infection. It is recommended for boys, girls, men, and women.

The HPV vaccine is recommended for all boys and girls aged 9-26, ideally before any sexual activity. Adults aged 27-45 can also receive the vaccine - effectiveness may be lower if you have already been exposed to some strains, but you still benefit from protection against strains you have not encountered. People with new or anticipated sexual partners, those living with HIV, men who have sex with men, and immunocompromised patients especially benefit.

Yes - the HPV vaccine is strongly recommended for gay, bisexual, and other men who have sex with men. This group has a substantially higher lifetime risk of anal cancer and anogenital warts caused by HPV. Many provinces (including Ontario and BC) fund the vaccine free of charge for men who have sex with men up to age 26 through public health units. Patients over 26 can still receive the vaccine privately through a TeleTest prescription.

For individuals over 45, HPV vaccination is considered "off-label" in Canada - meaning it is not formally listed in this age group's product monograph, but a clinician can prescribe it based on your individual situation.

The vaccine still works in older adults, but the picture is less complete than in younger age groups. Like most vaccines, the antibody response tends to be somewhat lower as we age, and large trials focused on younger populations because public-health programs prioritized them first. There is no reason to believe the vaccine "stops working" at any particular age - it still generates an immune response and still protects against the strains you have not yet been exposed to. What is less precisely measured is the absolute size of the long-term protection in adults over 45.

The vaccine can be a sensible choice for adults over 45 who anticipate new sexual exposures. Common situations include:

• Re-entering dating life after a long-term relationship ends (separation, divorce, bereavement, or simply a change in relationship status).
• Starting or expanding a new sexual relationship - whether single, partnered, in a new monogamous relationship, or in a non-monogamous arrangement.
• A current or future partner has had HPV exposure or a related diagnosis.
• You did not have access to HPV vaccination earlier in life and would like the protection now, regardless of current sexual activity.

A few honest caveats:

• If you have already been exposed to some of the strains the vaccine covers, the vaccine will not clear an existing infection - but it will still protect against the strains you have not yet encountered.
• The vaccine costs approximately $200 per dose, and over-45 vaccination is generally not covered by provincial drug plans or private insurance.

If this is something you are considering, a TeleTest clinician can review your situation and discuss whether the vaccine fits your goals - there is no presumption about your relationship status, sexual orientation, or future plans.

Yes. You may have been exposed to one or more HPV types already, but you will still benefit from protection against the strains you have not been exposed to. The vaccine does not treat existing infection or pre-cancerous changes, but it reduces your risk of acquiring new strains - especially relevant if you may have new sexual partners in the future.

Yes. The vaccine series can be resumed where you left off - you do not need to restart the entire series even if there has been a long delay between doses.

No booster is currently recommended for healthy adults who completed the original series. Antibody levels remain detectable for at least 10+ years, and real-world data continues to show ongoing protection. If guidance changes in the future (or if you are immunocompromised), your clinician can advise. There is no need to retest antibody levels or "top up" doses for the average patient.

It depends on the age when you start the series:

• Under age 15 - 2 doses (given 6-12 months apart) - approximately $400 total.
• Age 15 or older - 3 doses on a 0, 2, and 6-month schedule - approximately $600 total.
• Immunocompromised patients - 3 doses regardless of age.

The HPV vaccine costs approximately $200 per dose at most Canadian pharmacies. Many private insurance plans cover the cost - check with your insurance provider before paying out of pocket. Some public-health programs cover the vaccine free of charge for eligible groups - see below.

Each province runs its own publicly funded HPV vaccination program. Eligibility varies, but common patterns:

• Ontario - free through the school-based program for students in grades 7 to 12, and free for men who have sex with men up to age 26 (gay, bisexual, or trans-identifying). Eligible patients can access through a public health unit. See the Ontario HPV program.
• British Columbia - free through the school-based program in grade 6, plus free catch-up programs for eligible groups (e.g., HIV-positive patients, men who have sex with men up to 26). See BC Centre for Disease Control.
• Other provinces - most provinces fund a school-based HPV program in grades 4-9, with varying catch-up eligibility. Check with your provincial public health unit for the most current criteria.

If you do not qualify for free vaccination, TeleTest can write a private prescription that you fill at any pharmacy.

After a brief consultation, the clinician sends a prescription to your preferred pharmacy for the complete series. Most patients receive their first dose the same day as their consultation - your local pharmacy can typically dispense and administer the vaccine in one visit. Your pharmacist, walk-in clinic, or primary-care clinician (nurse practitioner or family doctor) can give the injection; in Ontario and BC, pharmacists are authorized to administer the HPV vaccine directly, so a separate appointment at a clinic is usually not needed.

The most common side effects are mild or moderate injection-site reactions (pain, redness, swelling). Muscle aches and fatigue can also occur. Hundreds of millions of doses have been administered globally, with no consistent signal for serious adverse events. Serious allergic reactions are very rare.

The vaccine is not given to people who have had a serious allergic reaction to a prior dose or to vaccine components, or who are currently pregnant (limited safety data in pregnancy - the vaccine can be deferred to after delivery). The HPV vaccine can be given to breastfeeding patients.

Molluscum contagiosum, sometimes called "water warts," is a common skin condition caused by the molluscum contagiosum virus (MCV) - a member of the poxvirus family. It produces small, round, dome-shaped lesions on the skin. It is not related to HPV, but is often discussed alongside it because both are common viral skin conditions.

The virus spreads through direct skin-to-skin contact or indirectly through shared towels, clothing, sponges, razors, or toys. Spread through wet environments (pools, hot tubs) has been proposed but is uncertain. In adults, genital molluscum is most often spread through sexual contact.

Molluscum is considered contagious as long as visible lesions are present. Once all lesions have resolved - whether on their own or after treatment - transmission risk effectively ends. There is no carrier state where the virus persists in skin without visible lesions, which is one key difference from HPV.

The lesions, called mollusca, are firm, white to skin-coloured, and dome-shaped, often with a small central dimple (umbilication). They typically range from 1 mm to 1 cm in diameter. They can appear singly or in clusters, anywhere on the body, including the genital area in sexually active adults.

While anyone can develop it, it is most commonly diagnosed in:

• Young children (ages 2-5) - usually on the trunk, arms, or legs.
• Sexually active teenagers and adults - typically in the genital, lower abdomen, or inner-thigh area.
• People with weakened immune systems - lesions may be more extensive and harder to clear.
• People with eczema - the broken skin barrier allows easier spread through scratching (autoinoculation).

A clinician usually makes the diagnosis based on the appearance of the lesions. Biopsy is rarely needed.

There is no strict medical rule, but a few practical points:

• Active lesions are contagious. Genital contact while lesions are present can transmit the virus to a partner.
• Condoms reduce but do not eliminate transmission risk because lesions can be outside the area a condom covers (lower abdomen, inner thighs).
• Tell partners so they can decide for themselves and watch for new lesions.
• Avoid shaving, waxing, or scratching the affected area - this can spread lesions to other parts of your own body (autoinoculation).

Once lesions have fully cleared, transmission risk ends.

No treatment is also a reasonable option for most patients - molluscum often resolves on its own within 6 to 12 months, sometimes longer in immunocompromised individuals.

When treatment is preferred (cosmetic concerns, large numbers of lesions, or to reduce transmission risk), options include:

• Self-applied antimitotic topical - the same medication used for genital warts, applied off-label to molluscum lesions.
• Cryotherapy (liquid nitrogen) at a walk-in clinic or dermatology office.
• Curettage - physical removal of lesions by a clinician.
• Laser treatment - reserved for resistant or extensive cases.

Yes - for adult and adolescent patients with a limited number of lesions. TeleTest prescribes the same antimitotic topical used for genital warts, applied off-label to molluscum. It is not formally Health-Canada-approved for that specific indication, but published studies show effective clearance with low recurrence.

When in-person assessment is preferred:

• Lesions in children under 12 - in-person assessment is recommended.
• Extensive lesions (many lesions, large body areas).
• Lesions on the face, eyelids, or near the eye - cryotherapy by a clinician is safer.
• Immunocompromised patients with rapidly spreading lesions.

The clinician will discuss whether off-label antimitotic treatment is appropriate for your case during the consultation.

Complications are uncommon but can include:

• Autoinoculation - spreading the virus to other parts of your own body through scratching, shaving, or rubbing. Particularly common in people with eczema.
• Local inflammation or secondary bacterial infection from scratching.
• Conjunctivitis if lesions are on the eyelids.
• Scarring - unusual unless lesions are scratched, scraped, or aggressively treated.