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High-Risk HPV Types

Medically reviewed on November 16, 2023 by Jillian Foglesong Stabile, MD, FAAFP. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

Human Papilloma Viruses (HPV) are a group of more than 100 DNA viruses that affect human epithelial cells. HPV is responsible for the most common sexually transmitted infection in the world and causes almost all forms of cervical cancer.[1] There are 40 strains of HPV that cause genital infections: most commonly genital warts and cervical cancer.

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What Is The Difference Between Low-Risk And High-Risk HPV?

The 40 strains of HPV that cause genital infections are split into two groups: low-risk and high-risk. Low-risk strains of HPV are associated with genital warts, whereas high-risk groups are associated with abnormal cervical cells (also called cervical dysplasia), cervical cancer, and anal cancer. These strains of HPV can also infect other parts of the body such as the oral mucosa where they can cause respiratory papillomatosis and head and neck cancers.

HPV is the most common type of sexually transmitted infection in women and people assigned female at birth with up to 79% of sexually active these individuals having an infection at some point during their lives. Most people who have HPV infections are not symptomatic.

Genital warts are very contagious. They have a high viral load and about 65% of people who are exposed to genital warts become infected. It is possible to have more than one type of HPV at the same time.[1] In fact, one study showed that 31% of cases of genital warts contain both low-risk and high-risk types of HPV.[3]

What Are The High-Risk HPV Types?

There are 12 high-risk types of HPV: HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59.[2] Of these types of HPV, subtypes 16 and 18 are responsible for the majority of cases of cervical cancer. HPV can be responsible for other types of cancer as well. In addition to cervical cancer, HPV is associated with

  • Anal cancer
  • Throat cancer (also known as oropharyngeal cancer)
  • Penile cancer
  • Vaginal wall cancers
  • Vulvar cancers

You may be wondering how common HPV-related cancers are. In the United States each year, there are over 37,000 HPV-caused cancer diagnoses.[2] Worldwide, HPV causes 630,000 cancers yearly which accounts for about 5% of all cancer diagnoses.

Of the high-risk subtypes of HPV, HPV 16 is responsible for the most aggressive infections. The presence of HPV 16 increases the risk for high-grade dysplasia and cancer.[4]

What Are The Symptoms Of HPV?

How do you know if you have HPV? What symptoms might you experience? HPV infection can have latent, subclinical, or clinical presentations.[1] In latent infections, the virus is present, but it is not causing any clinically significant symptoms. Up to 90% of people who have an HPV infection will clear the infection spontaneously within two years. It is the 10% of infected people who do not clear the infection who are at increased risk for progression to cancer [1]. The latent period for HPV (time from infection to onset of symptoms) is long for HPV. It can take 10 to 20 years for symptoms to progress to cancer.[2]

In people who don’t clear HPV infection spontaneously, changes can occur in the infected tissues. The cells can become abnormal and dysplasia can develop. Dysplasia doesn’t usually cause any symptoms and is usually found on screening tests such as PAP smears. If dysplasia is not detected and treated, it can progress to pre-cancer and cancer. It is also possible that the abnormalities will regress back to a normal state.[4]

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How Do You Know If You Have HPV?

The idea of a virus that can cause cancer but has no symptoms is scary, so how do you know if you have HPV? The short answer is to have a screening test. Of the six types of cancer associated with high-risk HPV, only cervical cancer screening is recommended as part of regular health maintenance exams.[2] There are no standard screening tests for anal, oropharyngeal, penile, vaginal, or vulvar cancer in most populations.

PAP smear is the screening test of choice for cervical cancer. Pap smears are recommended every three years in people aged 21-30 who have a uterus. If you’ve ever had an abnormal pap, then the exam should be annual. Over the age of 30, pap smears can be extended to every 5 years as long as you’ve never had an abnormal pap, your HPV test (done on the pap smear) is negative, and you don’t have new partners. Abnormal pap smears are usually associated with the HPV virus. Before the age of 21, women or people assigned female at birth (AFAB) are likely to clear the HPV virus without treatment. In women and AFAB who have never had an abnormal pap, pap smears can stop at age 65.[5]

While there is no routine screening test for anal cancer, certain populations are at an increased risk of HPV infection. These populations include:

  • Men who have sex with men
  • Women and people assigned female at birth who have had cervical or vulvar cancer
  • People who are HIV positive
  • Organ transplant recipients

In these high-risk populations, an anal pap test can be performed to look for precancerous and cancerous anal lesions. Regular screening can significantly decrease the risk of developing HPV-related anal cancer.

Can HPV Be Prevented?

If you’re wondering if HPV infection can be prevented, the short answer is, yes. A vaccine for HPV was introduced in 2006. Since the introduction of the vaccine, HPV infections have dropped by more than 80% in adolescent women.[6] The HPV vaccine is recommended starting at age 11 or 12 in both girls and boys. The vaccine is administered in a 2 or 3-shot series depending on the age at which it was started. There are three vaccines currently approved in the United States.

Other ways of decreasing the risk of HPV infection include limiting your number of sex partners, delaying first intercourse until an older age, and consistently using condoms. For people who have become infected with HPV, quitting smoking and avoiding alcohol may decrease the risk of HPV persisting and developing into advanced dysplasia or cancer.[3]

How Is HPV Treated?

There is no treatment for the HPV virus itself.[8] Your healthcare provider can treat the conditions that result from HPV. Genital warts can be treated with cryotherapy (freezing) or with certain medications. Untreated genital warts may continue to spread or grow. Cervical dysplasia can be treated with cryotherapy or procedures to cut out the abnormal cells. Other HPV-related cancers can also be treated if they are caught early.

Taking Control Of Your Sexual Health With Everlywell

Your sexual health is important, and there are many ways to access care. You can talk to your healthcare provider. If you are concerned about your exposure to HPV or other STDs, you can visit us at Everlywell where you can get an online STD consult. In addition to speaking with one of our healthcare providers, you can also get online access to at-home testing for high-risk HPV and even treatment for some STDs. At Everlywell, we’re committed to empowering you to take control of your health.

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Is HPV Deadly?

What Percentage Of High-Risk HPV Turns To Cancer?

References

  1. Juckett J, Hartman-Adams H. Human papillomavirus: clinical manifestations and prevention. American Family Physician. 2020;82(10):1209-1214. https://www.aafp.org/pubs/afp/issues/2010/1115/p1209.html.
  2. HPV and cancer. National Cancer Institute. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer. October 18, 2023. Accessed November 1, 2023.
  3. Quinlan JD. Human papillomavirus: screening, testing, and prevention. American Family Physician. 2021;104(2): 152-159. https://www.aafp.org/pubs/afp/issues/2021/0800/p152.html.
  4. Schiffman M, Wentzensen N. Human papillomavirus infection and the multistage carcinogenesis of cervical cancer. Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):553-60. doi: 10.1158/1055-9965.EPI-12-1406. PMID: 23549399; PMCID: PMC3711590.
  5. Cervical cancer: screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening. August 21, 2018. Accessed November 1, 2023.
  6. Human papillomavirus (HPV) vaccination: what everyone should know. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/vpd/hpv/public/index.html. November 16, 2021. Accessed November 1, 2023.
  7. HPV and oropharyngeal cancer. Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/hpv/basic_info/hpv_oropharyngeal.htm. September 12, 2023. Accessed November 1, 2023.
  8. Human papillomavirus (HPV) treatment and care. Centers for Disease Control and Prevention. https://www.cdc.gov/std/hpv/treatment.htm. July 22, 2021. Accessed November 1, 2023.
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