What are the key signs and symptoms of HPV-related conditions that I should be aware of during routine examinations?

Key signs and symptoms of human papillomavirus (HPV)-related conditions to be aware of during routine examinations include:

• Anogenital warts: These present as soft, flesh-coloured or grey growths on the external genitalia, perianal area, or anal canal. They may be keratinized or non-keratinized and can vary in size and number. Warts may be asymptomatic or cause itching, discomfort, or bleeding.
• Abnormal cervical changes: Detected primarily through cervical screening, these include precancerous lesions such as cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ. On colposcopy, abnormal areas may appear acetowhite after application of acetic acid or fail to stain with iodine, indicating potential HPV-related dysplasia.
• Signs suggestive of cervical cancer: On examination, the cervix may appear abnormal with visible lesions, ulceration, or masses. Symptoms may include abnormal vaginal bleeding, post-coital bleeding, or unusual vaginal discharge.
• Other anogenital cancers: Although less common, HPV is associated with vulval, vaginal, anal, and penile cancers. Signs include unexplained lumps, ulcers, or masses in these areas, which warrant urgent referral.

Routine examinations should include inspection of the anogenital area for warts or lesions, and cervical screening for women aged 25–64 years to detect precancerous changes early. Referral to specialists is recommended if suspicious lesions or cancers are suspected.

Preventive advice includes encouraging HPV vaccination in eligible populations and promoting barrier contraception to reduce HPV transmission risk.

References: NICE CKS, NICE CKS, NICE CKS, NICE CKS, NICE NG12