Human Papillomavirus (HPV) is an extremely common group of viruses; nearly all sexually active individuals contract at least one type in their lifetime. While many infections resolve spontaneously, certain high-risk strains can cause cellular changes leading to six different types of cancer, including cervical, anal, and oropharyngeal. Because HPV can affect various parts of the body, its management requires a coordinated effort involving multiple medical specialists for diagnosis, minor treatment, pre-cancer management, and invasive cancer care.
Initial Screening and Primary Care
The management of Human Papillomavirus begins with primary care providers, such as Family Practice Physicians and Internal Medicine Specialists, who focus on preventative care. These doctors are the first point of contact for vaccination and routine screening. Primary care doctors and Obstetrician-Gynecologists (OB-GYNs) play a prominent role in cervical cancer screening through the Pap smear and HPV co-testing.
For women aged 21 to 29, routine Pap smears are recommended every three years. For those aged 30 to 65, the preferred method is co-testing, which combines a Pap smear with an HPV DNA test, conducted every five years. This offers a longer screening interval due to its high accuracy in detecting high-risk types.
If a screening test indicates an abnormality, the primary care physician or OB-GYN initiates counseling and referral. They explain the results, differentiating between low-risk infections (which cause most warts) and high-risk infections (which can cause cancer). A positive result for high-risk HPV or a finding of low-grade cellular changes prompts a referral to a specialist for closer examination or surveillance.
Specialists for Common Manifestations
When an HPV infection manifests as visible, non-cancerous lesions, known as genital or anal warts, specific specialists are engaged for localized treatment.
Dermatologists
Dermatologists are frequently consulted for the treatment of warts on the external skin, including the vulva, penis, and perianal region. They employ various destructive methods, such as cryotherapy (freezing) or electrocautery (burning), or prescribe topical agents for at-home application.
Urologists
Urologists specialize in the male genitourinary tract and are involved when warts are present on the penis, especially near the urethral opening. They manage these external lesions and address any risk of obstruction or involvement deeper within the urethra, sometimes requiring specialized surgical removal.
Proctologists and Colorectal Surgeons
For lesions located in and around the anal canal, Proctologists or specialized Colorectal Surgeons take the lead. They perform high-resolution anoscopy (HRA) to visualize and biopsy internal anal lesions. Treatment options include surgical excision for larger growths, as well as the application of chemical treatments in the office setting.
Managing High-Risk and Pre-Cancerous Conditions
Management shifts to advanced surveillance and localized treatment when high-risk HPV types cause persistent infection and pre-cancerous cellular changes.
Cervical Pre-Cancers
The most common scenario involves cervical intraepithelial neoplasia (CIN). Experienced OB-GYNs perform a colposcopy, a procedure that uses a magnified view of the cervix to highlight abnormal areas. Targeted biopsies confirm the extent and grade of the dysplasia, classifying it as low-grade (CIN 1) or high-grade (CIN 2 or CIN 3).
Low-grade changes are often monitored, as they frequently regress naturally. If high-grade dysplasia is confirmed, treatment is necessary to remove the abnormal cells. The Loop Electrosurgical Excision Procedure (LEEP) is a common treatment, using an electrically charged wire loop to precisely excise the affected tissue. For more complex lesions, a Gynecologic Oncologist may perform a cold knife cone biopsy under anesthesia for complete diagnosis and treatment.
Head and Neck Pre-Cancers
HPV-related pre-cancerous conditions also occur in the oropharynx, affecting the tonsils and base of the tongue. Otolaryngologists, or Head and Neck Surgeons, are the primary specialists. They perform biopsies to diagnose high-grade dysplasia and may use specialized surgical techniques, such as transoral laser microsurgery, to remove the lesions while preserving surrounding tissue function.
Treatment for HPV-Related Cancers
Once HPV-related disease progresses to invasive cancer—such as cervical, anal, penile, or oropharyngeal cancer—treatment involves a highly specialized, multidisciplinary team of oncologists. The core team typically consists of a Surgical Oncologist, a Radiation Oncologist, and a Medical Oncologist. Treatment plans are multi-modal, combining surgery, radiation, and systemic therapy.
Surgical Oncologist
The Surgical Oncologist physically removes the tumor. This can involve complex procedures like radical hysterectomy for cervical cancer or transoral robotic surgery for oropharyngeal tumors. For anal cancer, early-stage tumors may be treated with local surgical excision, but larger tumors often require chemoradiation first.
Radiation Oncologist
The Radiation Oncologist uses high-energy rays to destroy cancer cells, often in combination with chemotherapy (chemoradiation). For cervical and anal cancers, this involves external beam radiation therapy and internal radiation (brachytherapy). For HPV-positive oropharyngeal cancer, de-escalation strategies are often used to reduce the overall radiation dose, minimizing long-term side effects.
Medical Oncologist
The Medical Oncologist manages systemic treatments, primarily chemotherapy and immunotherapy, coordinating them with the other specialists. Chemotherapy is used concurrently with radiation to enhance its effect or alone for metastatic disease. Immunotherapy drugs are increasingly used for advanced or recurrent HPV-related cancers, harnessing the patient’s immune system to target the tumor cells.