A Closer Look at HPV

Megan Cole, Diana Zuckerman, PhD, Brandel France de Bravo, MPH, and Janet A. Phoenix, MD, MPH, Cindy Min, MPH, Cathryn Bigham, National Center for Health Research

What is HPV?

The human papillomavirus virus, also known as HPV, is the most common sexually transmitted infection in the U.S. and around the world. Nearly everyone will get an HPV infection during their life. In fact, more than 42 million Americans are currently infected with HPV, and 13 million Americans, including teens, become newly infected every year.[1]

Males and females can become infected with the virus and can transmit it to others without realizing it. There are approximately 150 strains of HPV, some of which may cause warts and others which may cause cancer. More than 40 of these strains can infect the genitals. The virus is transmitted through skin-to-skin contact and is usually sexually transmitted – vaginally, anally, or orally. However, many of the HPV types can be transmitted through non-sexual contact as well.[1,2]

HPV leads to several types of cancer in men and women, including cervical and vaginal cancer in women and penile cancer in men. High-risk HPV strains are linked to 63% of penile cancer and 91% of cervical cancer cases; strains 16 and 18 cause most of these.[2,3] Two other types (strains 6 and 11) cause 90% of genital warts cases.[2,4] About 37,800 cancer cases are caused by HPV each year in the United States.[3] HPV can cause oropharyngeal cancer, which is a cancer of the soft palate, the throat, and the back third of the tongue, and can occur in women and men, as can anal cancer.[5]

Nine out of ten HPV infections go away without treatment within 2 years, and most of those people are asymptomatic.[1] However, when high-risk types of HPV infections persist, abnormal cells can develop on the penis, cervix, vulva, vagina or anus. If those high-risk abnormal cells are not detected and treated, they can eventually cause cancer.[3] It takes about 15-20 years for cancer to develop, and meanwhile, men and women are unlikely to have symptoms. That lack of symptoms makes HPV so dangerous. This is why it is important to have regular Pap smears or other medical care.[6]

Since HPV leads to more than 90% of cervical cancer cases, it is important to consider which women are more likely to get cancer. HPV and cervical cancer are a concern for all women, but in the U.S., the women with the highest rates of cervical cancer are ethnic minorities and low-income women. This is partially due to lack of follow-up after an abnormal screening.[13] Lack of follow-up and delayed care can be due to concern about costs, lack of understanding, language barriers, and distrust or fear of medical treatment.[13] While far fewer women die of cervical cancer in the U.S. compared to many other countries, it is still a deadly disease for thousands of U.S. women every year. The proportion of women with cervical cancer are highest for American Indian and Alaskan Natives (10.3 per 100,000), Hispanic (10.0) and black women (8.4). Death rates per 100,000 are highest for black women (3.1), American Indian and Alaskan Natives (3.0) and Hispanic (2.3) women. In comparison, Asian/Pacific Islander and white women have both the lowest incidence and death rates of cervical cancer.[7] Although the above racial and ethnic counts do not consider the possible impact of income, a study from 2024 shows that low income increases the chances of developing cervical cancer regardless of race, and vice versa.[14]

 

Prevention of HPV

To reduce the chance of getting cancer from HPV, the best prevention strategies are:

  1. Get an HPV vaccine.The CDC recommends 2 doses of the HPV vaccine at ages 11-12 years old, but the vaccination can be started as early as 9 years old or in the late teens or early 20’s. It is often recommended at early ages because it is most effective when given before any sexual activity begins. The vaccination is not always recommended for those over 26 years. For more information about the HPV vaccine, you can read this article.[9] 
  2. Use condoms. They reduce your chances of getting infected with HPV, but they don’t eliminate chance of exposure because skin-to-skin contact still occurs when a condom is used.[12]
  3. Limit your number of sex partners.[10]  The way to think about it is that each sex partner can potentially have been exposed to HPV through many other sex partners, increasing your risk as well as theirs.
  4. Get regular Pap smears or HPV tests (also called hrHPV tests). For women, aged 21 to 29 years, it is recommended to get a Pap smear every 3 years. For women aged 30 to 65 years, there are three different options: Pap smear every 3 years, hrHPV testing every 5 years, or hrHPV testing in combination with a Pap smear every 5 years (cotesting).[11,12]  HPV tests are called “high risk HPV (hrHPV) not because the person is at high risk of HPV but rather because it only tests for the strains of HPV that are most likely to cause cancer.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

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References

  1. Centers for Disease Control and Prevention (CDC) (2024) About HPV. Retrieved from https://www.cdc.gov/hpv/about/index.html 
  2. Centers for Disease Control and Prevention (CDC) (2021) Human Papillomavirus (HPV) Infection. Retrieved from https://www.cdc.gov/std/treatment-guidelines/hpv.htm. 
  3. Centers for Disease Control and Prevention (CDC) (2024) Cancers Linked With HPV Each Year Prevention. Retrieved from https://www.cdc.gov/cancer/hpv/cases.html?CDC_AAref_Val=https://www.cdc.gov/cancer/hpv/statistics/cases.htm. Published September 18, 2024.
  4. Center for Disease Control and Prevention (CDC) (2021) Angogenital Warts. Retrieved from https://www.cdc.gov/std/treatment-guidelines/anogenital-warts.htm#:~:text=Anogenital%20warts%20are%20a%20common,%2C%20oral%2C%20and%20laryngeal%20warts.
  5. Kjaer SK, Nygard M, Sundstrom K, et al. Final analysis of a 14-year long-term follow-up study of the effectiveness and immunogenicity of the quadrivalent human papillomavirus vaccine in women from four nordic countries. EClinicalMedicine. 2020;23:100401. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30145-0/fulltext.
  6. National Cancer Institute (NIH) (2025). HPV and Cancer. Retrieved from https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer 
  7. National Cancer Institute (NIH). Cancer Stat Facts: Cervical Cancer Retrieved from https://seer.cancer.gov/statfacts/html/cervix.html 
  8. Kollman J, Sobotka HL. Poverty and Cancer Disparities in Ohio. Prev Chronic Dis. 2018;15:E152. https://www.cdc.gov/pcd/issues/2018/18_0332.htm
  9. Centers for Disease Control and Prevention (CDC) (August 2024) HPV Vaccination. Retrieved from https://www.cdc.gov/hpv/vaccines/index.html
  10. Centers for Disease Control and Prevention (CDC) (2025) About Genital HPV Infection. Retrieved from https://www.cdc.gov/sti/about/about-genital-hpv-infection.html 
  11. American College of Obstetricians and Gynecologists. (2021). Updated cervical cancer screening guidelines: Practice advisory. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/04/updated-cervical-cancer-screening-guidelines 
  12. Cervical Cancer: Screening. United States Preventive Services Taskforce. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening. Published August 21, 2018
  13. Boitano TKL, Ketch P, Maier JG, et al. Increased disparities associated with black women and abnormal cervical cancer screening follow-up. Gynecol Oncol Rep. 2022;42:101041. Published 2022 Jul 16. doi:10.1016/j.gore.2022.101041 

Amboree T, et al. Recent trends in cervical cancer incidence, stage at diagnosis, and mortality according to county-level income in the USA, 2000–2019. Int J Cancer. 2024 May 01; 154(9): 1549–1555. https://doi.org/10.1002/ijc.34860