In women, HPV is the cause of the vast majority of cases of cervical cancer, and it can also cause cancers of the vagina, vulva, anus, and throat.
HPV infections are often asymptomatic, and the virus can live harmlessly in the body for decades or be cleared by the immune system after a few years.
More than 40 types of HPV can infect the genital region and other mucous membranes — such as the anus and rectum, and mouth and throat. These types of HPV are transmitted through intimate, skin-to-skin contact, including vaginal, anal, and oral sex.
And it’s possible to get HPV from someone who has no symptoms and to pass HPV on to other people when you have no symptoms.
Nearly all sexually active individuals will get HPV at some point in their lives, making it the most common viral sexually transmitted disease in the United States.
It’s estimated more than 42 million U.S. residents are living with a form of HPV that’s known to cause disease, and there are around 13 million new HPV infections each year. Rates of many forms of HPV appear to have gone down in recent years, which may be due to a number of factors, including HPV vaccination.
Previously, the Centers for Disease Control and Prevention (CDC) estimated that in 2013 and 2014, about 45 percent of men and 40 percent of women ages 18 to 59 were living with a sexually transmitted form of HPV. High-risk forms of HPV — those most likely to cause cancer — were believed to affect about 25 percent of men and 20 percent of women in this age group.
However, rates of life-threatening HPV infections are falling. From 2008 to 2022, the number of precancerous cervical lesions decreased about 80 percent in women ages 20 to 24 who were screened for cervical cancer. This age group is the most likely to have gotten the HPV vaccine, first recommended in 2006. There was also a 37 percent decrease in precancerous cervical lesions among women ages 25 to 29 years.
In about 9 out of 10 cases, HPV infections go away within two years without causing harm.
About 90 percent of genital warts are linked to HPV types 6 and 11 — different from the types that cause cancer.
In women, genital warts can grow inside or around the anus (even if you haven’t had anal sex), inside the vagina, on the cervix (lower end of the uterus), or around the vulva (opening of the vagina). They can also develop in the mouth and throat and on the tongue and lips.
Genital warts vary in color and are sometimes too small to be seen.
Genital warts may:
Appear weeks to months after infection with HPV
Be flat or raised
Grow in clusters, taking on a cauliflower-like appearance
Be tender, painful, or itchy
Rarely, genital warts may lead to vaginal discharge or bleeding during or after sex.
A persistent infection with some types of HPV can lead to various types of cancer in women.
Nearly all cases of cervical cancer are caused by HPV, and most of these cases are tied specifically to HPV types 16 and 18. HPV causes approximately 10,800 cases of cervical cancer each year in the United States.
Early stages of vaginal and cervical cancers may not cause any symptoms, making regular screening important. More advanced-stage cancer can lead to abnormal vaginal bleeding or discharge and pain during intercourse.
The Pap test, or Pap smear, is one of two screening tests, and was invented by the doctor and scientist George Papanicolaou. This has long been the standard for detecting abnormal cells — called cervical dysplasia — in the cervix. The Pap test involves scraping some cells from the surface of the cervix and examining them under a microscope.
Cervical dysplasia is not cancer, but in some cases it develops into cancer.
Follow-up care for cervical dysplasia depends on its severity. For mild dysplasia, the doctor may recommend a repeat test for a year later to see whether the dysplasia has worsened or has disappeared on its own. For severe dysplasia, a procedure to remove the abnormal cells may be called for.
A newer test, called the HPV test, checks for the virus itself in cervical cells, not for changes in the appearance of the cells. The U.S. Food and Drug Administration (FDA) has approved several different HPV tests, some of which are approved as a primary HPV test — meaning that no Pap test is needed.
Currently, it’s recommended that women ages 25 to 65 get a primary HPV test every five years. If a primary HPV test is not available, then a Pap test along with an HPV test can be performed every five years, or a Pap test alone can be performed every three years.
If you don’t identify as a woman but do have a cervix, you should still be screened regularly for cervical HPV or dysplasia in order to detect and treat early evidence of cervical cancer.
Paying for Cervical Cancer Screening
Most health insurance plans cover recommended cervical cancer screenings, often at no cost to the individual beyond the cost of an office visit. This fee may also be waived if the tests are done as part of an annual physical exam.
Insurance plans purchased through the HealthCare.gov Marketplace must cover Pap tests and HPV tests without charging a copayment or coinsurance, as long as the screening tests are done by a healthcare provider in your plan’s network.
If you have no health insurance, your insurance does not cover screening exams, or your yearly income is at or below 250 percent of the federal poverty level, you may be eligible for free screening through the CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP). The NBCCEDP offers both Pap tests and HPV tests, as well as diagnostic testing and referrals to treatment if results are abnormal.
In women, HPV is also linked to about 7 in 10 cases of oropharyngeal (mouth and throat), vulvar, and vaginal cancers.
Oropharyngeal cancer may cause:
Persistent throat or ear pain, hoarseness, or coughing
Trouble swallowing
Unexplained weight loss
A lump in the neck
Almost all women with vulvar cancer have symptoms, including:
Changes in vulvar skin color and thickness
Itching
Lumps, bumps, or wart-like growths
An open sore that lasts for a month or more
Oropharyngeal, vaginal, and vulvar cancers are diagnosed by taking a sample of abnormal cells, which are examined under a microscope.
Gardasil 9, the HPV vaccine currently available in the United States, protects against HPV types 16, 18, 31, 33, 45, 52, and 58 — all of which can cause cancer — as well as types 6 and 11, which cause genital warts.
The HPV vaccine has been proven safe in studies with millions of participants.
The CDC recommends that all girls (and indeed, all youth) get the HPV vaccine at age 11 or 12. At this age, most children will not have been exposed to the strains of HPV that the vaccine protects against, so they will get the full benefit of the vaccine.
For girls and women who didn’t get the HPV vaccine at age 11 or 12 or didn’t finish the schedule of shots, the CDC recommends the vaccine for everyone through age 26.
Women can also be vaccinated with Gardasil 9 through age 45, based on a discussion with their healthcare provider about whether this makes sense for them.
HPV causes most cases of cervical cancer, and can cause vaginal, vulvar, anal, and throat cancer.
You can get screened for HPV with the HPV test, recommended every five years — or a Pap test every three years.
Rates of precancerous cervical lesions are decreasing, likely due to vaccination.
The HPV vaccine is recommended for most people ages 11 to 26. If you’re older than 26, the vaccine still may be right for you. Talk to your doctor about your options.
