HPV – what it is and how to prevent it

What is HPV?

HPV stands for ‘human papillomavirus’. It’s the name for a group of more than 200 viruses that infect humans. So how many people have HPV? It’s very widespread, with an estimated 79 million Americans infected.

“Most people with HPV won’t even know they’ve been infected,” says Dr Ann Nainan, family doctor and Healthily expert. So how can you protect yourself against these silent viruses, which can cause genital warts and, in rarer cases, some cancers? Here’s everything you need to know.

How is HPV spread?

People often ask “can you get HPV without having sex?”

Here are the facts:

• most people catch HPV by having vaginal, anal or oral sex with someone who has the virus
• it can also be spread through genital-to-genital touching with someone who has it
• sharing sex toys is another way of becoming infected

Why is HPV spreading?

• you can be infected with HPV and have no symptoms, so you won’t know you’re passing it on to someone else
• symptoms can develop years after you were infected, so it can be difficult to work out who infected you
• there’s still low take-up of the HPV vaccine in eligible people who could protect themselves against infection

Effects of HPV – symptoms and health problems

“Most people will clear HPV from their body within 1 to 2 years without any symptoms,” says Dr Ann. “But if it doesn’t go away, some types of HPV can go on to cause symptoms or health issues.”

• 2 main types of HPV can cause genital warts – painless lumps or growths around your vagina, anus or penis. “The types of HPV that cause warts are different from the types that cause cancers,” says Dr Ann. “So if you get HPV warts, it doesn’t mean you’ll go on to get cancer.” Read about genital warts treatment
• some types of HPV can cause some types of cancer – including cervical cancer, vulval cancer and penis (penile) cancer, and mouth and throat cancer

Does HPV go away?

In most cases, yes – usually within 1 to 2 years. But it’s still possible to pass the virus on to someone else during this time, and some types of HPV can stay in your body.

Why women need to be HPV-alert

“It’s important for women to know that HPV can put them at risk in ways they may not have realized,” says Dr Ann. “Because with safe sex, the HPV vaccine and regular screening, you can do something about it.”

Women are at higher risk of getting HPV-related cancers

It’s rare to get cancer from an HPV infection, as your immune system usually clears the virus from your body. But women get more HPV-related cancers than men. In the US, high-risk HPV causes 3% of all cancers in women, and 2% in men.

Research also shows that the rates of some of these cancers are increasing. For example, US data shows the number of vaginal, vulval, anal and mouth/throat cancers increased in women of all ages and racial or ethnic groups from 2001-2017.

And although cervical cancer cases have decreased overall in the US, rates have increased in white women aged 50-74, black women aged 50-64, and Hispanic women of all ages.

• nearly all cases of cervical cancer are caused by HPV – “it’s the 4th most common cancer in women worldwide,” says Dr Ann. There are 342,000 deaths from cervical cancer each year, so the HPV vaccine has been a milestone for women’s health
• over 90% of anal cancers are caused by HPV – anal cancer is fairly rare, mainly found in older adults, and can often be effectively treated. But in the US, nearly twice as many women get anal cancer as men, and the number of cases is rising
• 75% of vaginal cancers and 70% of vulval cancers are caused by HPV – though again, both these cancers are rare. In the US, vaginal cancer accounts for 1-2% of cancers in the female genital tract, while vulval cancer accounts for just 0.3% of all cancers. Read about how to do a vaginal self-exam to help you know if you have any symptoms you should get checked out (there’s no screening test for these cancers)
• 70% of mouth or throat (oropharyngeal) cancers are caused by HPV – these cancers are more common in men (lifetime risk is about 1 in 60 for men and 1 in 141 for women). The number of new cases is rising each year, and these are now the most common HPV-related cancers in the US
• over 60% of penis cancers are caused by HPV – but this is rare, with fewer than 1 in 100,000 men diagnosed each year in the US

Too many women are missing out on the HPV vaccine and cervical screening

The HPV vaccine has been shown to be up to 99% effective at preventing HPV-related cancers and genital warts. And cervical screening – sometimes also known as ‘a pap smear’ or ‘smear test’ – can pick up HPV infection, and check for cell changes that might lead to cancer.

But data shows the number of people who take advantage of these protective measures is surprisingly low:

• in the US, while HPV vaccine rates have increased since 2013, figures from 2018 show that only 35% of women aged 18-26 were fully vaccinated. In 2020, 54.5% of people aged 13-15 had received the recommended vaccine doses
• worldwide, only 15% of women and girls in the target age for the HPV vaccine are fully protected
• in the US, the number of women overdue for cervical screening has been steadily growing – from 14% in 2005 to 23% in 2019
• in the UK, the latest figures show that nearly a third of women aren’t going for their routine cervical screening when it’s due

Get the treatment and tests you need – and tell other women!

Lack of knowledge about the options available to help protect women is a key problem, says Dr Ann. But there are other issues, too.

“Talk to your insurance company, your doctor or healthcare provider; contact Medicaid to find out what is available for you, and make sure you get it,” says Dr Ann. “And talk to your friends and loved ones about it. It’s also important that you get your children vaccinated, when they’re eligible.”

Issues affecting women’s access to protection against HPV include:

• lack of vaccine knowledge – a 2022 survey in Virginia found that 25% of adults had never heard of the HPV vaccine. This was 15 years after its approval by the Food and Drug Administration (FDA). Read more about the HPV vaccine and who can have it
• lack of knowledge about cervical screening and what it means – according to recent US research, this is the main reason screening numbers dropped between 2005 and 2019. “Find out more about cervical screening, and tell your friends about it, too” says Dr Ann
• worries about costs and lack of health insurance – most health insurers will cover routine vaccinations. And if you don’t have health insurance, the Vaccines for Children (VFC) program can offer vaccines for people under 19. Cervical screening is mandated by the Affordable Care Act – Medicaid covers it, as do many individual insurers. Find out more from the American Cancer Society and by contacting your insurer
• reports about HPV vaccine side effects – “stories on social media, online or between friends can stop people feeling confident about the effectiveness of the vaccine,” says Dr Ann. “But there are many myths that don’t have evidence to back them up. Or people end up thinking a side effect is very likely, when it’s actually exceptionally rare.” Myths about vaccines include that they cause long-term conditions, such as infertility, chronic fatigue, and complex regional pain syndrome. But there’s no evidence of higher rates of these conditions in people who are vaccinated. Read more about HPV vaccine safety
• worries about embarrassment, lack of modesty or pain with cervical screening – find out how to reduce any emotional and physical discomfort with our tips to make cervical screening more comfortable
• lack of understanding about why children who aren’t sexually active need to be vaccinated – “the vaccine is a prevention measure, not a treatment for a sexually transmitted infection (STI),” says Dr Ann. “It works best if it’s given before someone becomes sexually active”

HPV testing

Unlike HIV, there’s no test that can tell you your ‘HPV status’.

But you can get checked for HPV during cervical screening – which checks the health of cells in the entrance to your womb (cervix).

How cervical screening fights HPV and cancer

“HPV testing can pick up high-risk HPV,” says Dr Ann. “If a high-risk HPV infection shows up, then more cells from the sample can be tested to check for cell changes that are at a precancerous or cancerous stage.”

“The good news is that these changes can be detected early, then treated before any cancer develops or spreads.”

How often to get your HPV and pap test

An HPV test looks for the types of high-risk HPV that can cause cell changes. A pap test looks for any precancerous cell changes on your cervix, which may become cervical cancer.

• in the US – how often and how you get tested depends on your age, medical history and the results of previous tests. But generally speaking, if you’re 21-65 you should have an HPV or pap test, or both (co-testing), every 3 or 5 years. Talk to your doctor about what’s right for you
• in the UK – HPV tests are recommended as part of the national cervical cancer screening program for women aged 25-64. They’re every 3 years if you’re 25-49, and every 5 years when you’re 50-64

What happens if you have HPV or cell changes

• if HPV is found (HPV positive result), but no precancerous or cancerous cells – your doctor will advise you, as it depends on your individual risk, but usually you’ll have more frequent screening appointments
• if precancerous or cancerous cells are found – “you may need to have these cells removed,” says Dr Ann. “Or you’ll just have close monitoring, with more frequent screening”

Treatments for precancerous cell changes

If abnormal cells are picked up on your pap test, your doctor will discuss a course of treatment with you. This could include:

• colposcopy – this is a procedure to take a closer look at your cervix and check for abnormal cell changes
• cryotherapy – a treatment to freeze and remove precancerous cells
• loop electrosurgical excision procedure (LEEP) – a treatment that uses an electrical current to remove precancerous cells

Make sure you talk to your doctor and get the support you need to talk about your results, and to follow up on any precancerous or cancerous cell changes. Watch this CDC video, where Ana talks about the importance of understanding and acting on abnormal results.

Read about how cervical cancer is treated.

HPV testing in men

The CDC doesn’t recommend routine HPV screening for men. Some sexual health clinics may offer HPV pap tests to men at higher risk of anal cancer, such as men who have sex with men.

Men who notice anything new or unusual affecting their penis, balls (scrotum), bottom (anus), mouth or throat should see their doctor. There are lots of more common issues that can affect these areas, such as warts and skin infections. But see a doctor, so they can help you work out what’s going on.

What it feels like to have HPV

Rachel got an HPV positive result after she went for cervical screening, and later had a colposcopy to check her cervix for cell changes.

“My first reaction was panic. I had the idea that cervical screening was a test for cancer, and my letter was full of medical jargon that I didn’t understand.”

But she says finding out the facts about HPV helped her a lot – particularly learning that it’s really common, which made her realize she wasn’t alone.

“My big piece of advice for anyone who has just received their HPV positive letter is talk about it, talk about your feelings, and normalize it. It’s the only way to reduce the stigma surrounding HPV.”

How to prevent HPV

• use condoms and/or dental dams – using a condom or other barrier method of contraception every time you have vaginal, oral, or anal sex will reduce your chances of catching HPV. But because HPV can be spread by skin-to-skin genital contact, it won’t cut the risk completely
• don’t skip cervical screening – if you’ve been infected with high-risk HPV, HPV testing will tell you, and your cervix can be checked for any abnormal changes
• get vaccinated if you’re eligible – the HPV vaccine protects against catching HPV, but it doesn’t treat existing infections. This is why vaccination is recommended at a young age, before you’re sexually active

HPV vaccination

• in the US, Gardasil 9 is the vaccine used against HPV (other countries may use different vaccines)
• it protects against 9 types of HPV that can lead to genital warts or cancer
• since it was introduced in 2006, HPV infections have fallen a lot
• if you get your shots before starting to have sex (as recommended), it can lower your chances of getting genital warts and cancer caused by HPV by up to 99%

Who can get the HPV vaccine?

• in the US, routine vaccination against HPV is recommended for boys and girls aged 11 or 12
• in the UK, the HPV vaccine is offered to girls and boys aged 12-13. The 2nd dose is given 6 to 24 months later (you need both for full protection)
• it’s also recommended for everyone aged through to 26 in the US (or 25 in the UK) who hasn’t been vaccinated when younger
• it’s not routinely recommended for anyone older than this
• if you’re 27-45, you might decide to get it, after a discussion with your doctor, if you didn’t have it when younger. But the vaccine works best before any exposure to HPV, and most sexually active adults will have already been exposed

HPV vaccine schedule

In the US, the HPV vaccine schedule is as follows:

• 2 doses are recommended for people under 15, with the 2nd dose given 6-12 months after the 1st (3 doses should be given if there’s less than 5 months between the 1st and 2nd)
• 3 doses are recommended for 15-26 year olds, with the 2nd dose given 1-2 months after the 1st, and the 3rd dose 6 months later
• 3 doses are also recommended for immunocompromised people aged 9-26

HPV vaccine safety

HPV vaccines are very safe. Before Gardasil 9 was licensed by the FDA, it was studied in more than 15,000 people, and found to be safe and effective.

“From what we know right now, the benefits of the HPV vaccine really do outweigh the risk of adverse effects, which tend to be minor and temporary.” says Dr Ann. “Remember, it’s the only vaccine to protect against some types of cancer.”

HPV vaccine side effects

Reported HPV vaccine side effects include:

• injection site redness, swelling or pain – reported by between 20% and 90% of people who had the shot in clinical trials
• a raised temperature of 100°F – reported by about 1 in 10 people in the 15 days after their shot. But a similar number reported this side effect in a fake treatment (placebo) group
• dizziness, nausea, muscles aches and pains, and feeling unwell (general malaise) – these other reported side effects also happened just as often in the placebo group

Some people can faint after any medical procedure. So you’re usually advised to sit down for 15 minutes after your shot, in case this happens.

You should also tell your doctor or nurse if you have a severe allergy to yeast or latex.

How long does the vaccine protection last?

HPV vaccines offer long-lasting protection against HPV infection. Researchers followed vaccinated people for 12 years, with no signs of the protection waning.

News about HPV: watch this space

Scientists hope that period blood might one day be used to screen for HPV infections, reducing the need for more invasive pap tests.

Research published by Stanford University trialed a modified menstrual pad as a method of testing for HPV, comparing it with pap tests by clinicians and swabs taken by the women themselves.

The researchers found that 94% of women preferred the menstrual pad method over a pap test – and the results were similar to the pap test in terms of how many cases of HPV they picked up.

They concluded that testing menstrual blood looks like a promising approach, but more research is needed.