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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. Testing for HPV can help detect its presence early. Consider taking an HPV test to know your status; Everlywell offers an at-home HPV test for women.

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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.

The odds of getting HPV are high, as it's the most common type of sexually transmitted infection in women and people assigned female at birth. Studies suggest that up to 79% of sexually active these individuals having an infection at some point during their lives. Despite its prevalence, most people with HPV do not exhibit symptoms, which can make detection challenging.

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]

Who is at the highest risk for an HPV infection?

Although any kind of skin contact can transmit HPV, sexually active individuals are at the highest risk for HPV transmission and infection due to increased contact with intimate areas of thin skin. Even genital-on-genital rubbing can spread the virus. According to the CDC, this population group includes teenagers over the age of 14 and young adults under 26, encompassing all sexualities and genders.

Other risk factors can increase the likelihood of contracting HPV. These factors include [5]:

  • Becoming sexually active when you're younger than 18
  • Having many sexual partners over your lifetime or being with a partner with many sexual partners
  • Having unprotected sexual contact or intercourse
  • Being transgender
  • Being a man who has sex with men
  • Having a partner with HIV
  • Having an immune disease or being immunocompromised (like HIV or Lupus)
  • Having another untreated infection, such as chlamydia or HIV, at the time of contact

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.[7] 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.

Side effects and risks of the HPV vaccine

After your vaccine, you may experience nausea or dizziness, low-grade fever, headache, and pain or redness at your injection site.

Individuals who should not get the vaccine include those who:

  • Are over 26 years of age – According to the CDC, this age group has likely already been exposed to HPV. Consider consulting a healthcare professional to access lifestyle and identify alternative preventative recommendations.
  • Have allergies to components of the HPV vaccine – The U.S. vaccine contains yeast, which is often cited as an allergen.
  • Are pregnant or nursing – While no direct harm from receiving the HPV vaccine during pregnancy has been reported, check with your healthcare provider before getting the HPV vaccine if you are pregnant.

How Is HPV Treated?

There is no treatment for the HPV virus itself.[9] 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.

Supporting Your Body's Response to HPV

Although there is no cure for HPV, you can take steps to support your body's natural response. Maintaining a healthy immune system is crucial in combating the virus, which means adopting healthy lifestyle habits. Eating a balanced diet with plenty of fruits and vegetables can provide essential vitamins and minerals like vitamin C, vitamin E, folic acid, zinc, and selenium, which are associated with immune health [9].

Regular exercise, reducing stress, and avoiding harmful habits like smoking or excessive alcohol consumption can also boost your body's ability to fight infections, including HPV. These practices may not kill the virus directly, but they can strengthen your immune system, helping it clear HPV over time [9].

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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Untreated Hepatitis C: Who Is Most at Risk and What to Do

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. Medical Citation URL.
  2. HPV and cancer. National Cancer Institute. Medical Citation URL. October 18, 2023. Accessed November 1, 2023.
  3. Quinlan JD. Human papillomavirus: screening, testing, and prevention. American Family Physician. 2021;104(2): 152-159. Medical Citation URL.
  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. Chelimo C, Wouldes TA, Cameron LD, Elwood JM. Risk factors for and prevention of human papillomaviruses (HPV), genital warts and cervical cancer. J Infect. 2013;66(3):207-217. doi:10.1016/j.jinf.2012.10.024 Medical Citation URL. Accessed October 12, 2022.
  6. Cervical cancer: screening. Medical Citation URL. August 21, 2018. Accessed November 1, 2023.
  7. Human papillomavirus (HPV) vaccination: what everyone should know. Centers for Disease Control and Prevention. Medical Citation URL. November 16, 2021. Accessed November 1, 2023.
  8. HPV and oropharyngeal cancer. Centers for Disease Control and Prevention. Medical Citation URL. September 12, 2023. Accessed November 1, 2023.
  9. Human papillomavirus (HPV) treatment and care. Centers for Disease Control and Prevention. Medical Citation URL. July 22, 2021. Accessed November 1, 2023.
Jillian Foglesong Stabile, MD, FAAFP is a board-certified Family Physician. Since completing her residency training in 2010, she’s been practicing full-scope family medicine in a rural setting. Dr. Foglesong Stabile’s practice includes caring for patients of all ages for preventative care as well as chronic disease management. She also provides prenatal care and delivers babies. Dr. Foglesong Stabile completed a teaching fellowship in 2020 and teaches the family medicine clerkship for one of her local medical schools. Dr. Foglesong Stabile’s favorite thing about family medicine is the variety of patients she sees in her clinical practice.
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