HPV in Women: The Leading Cause of Cervical Cancer

The human papillomavirus (HPV), a group of more than 150 related viruses, can affect both women and men.

Some types of HPV can cause common skin warts, some can cause genital warts, and some can cause certain types of cancer.

In women, HPV is the cause of the vast majority of cases of cervical cancer, and it can also cause vaginal, vulvar, and anal cancer, as well as oropharyngeal cancer — cancer on the back and sides of the throat, tonsils, and base of the tongue.

HPV infections of all types 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.

But 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.

Sexually Transmitted HPV Prevalence in Women

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 — according to the Centers for Disease Control and Prevention (CDC). These types of HPV are transmitted through intimate, skin-to-skin contact, including vaginal, anal, and oral sex.

Nearly all sexually active individuals will get HPV at some point in their lives, making it the most common sexually transmitted disease in the United States, according to the CDC.

The CDC estimated in 2021 that more than 42 million U.S. residents were living with a sexually transmitted form of HPV, and there were 13 million new HPV infections that 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 vaccination.

Previously, the 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.

About 90 percent of genital warts are linked to HPV types 6 and 11, according to the CDC.

In women, genital warts can grow inside or around the anus (even if you haven’t had anal sex), on the upper thighs, 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 tend to be pink or flesh-colored but 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 cause vaginal discharge or bleeding from the vagina or anus.

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, according the National Cancer Institute.

The Pap test, or Pap smear, was invented by the doctor and scientist George Papanicolaou, per an article in the National Library of Medicine. 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, the American Cancer Society (ACS) recommends that women ages 25 to 65 get a primary HPV test every five years if this test is available. If a primary HPV test is not an option, 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, and that 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, or 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.

To see if you’re eligible for free screenings, contact a local program in your area.

In women, HPV is also linked to about 7 in 10 cases of oropharyngeal (mouth and throat), vulvar, and vaginal cancers, according to the CDC.

Oropharyngeal cancer may cause:

• Persistent throat or ear pain, hoarseness, or coughing
• Trouble swallowing
• Weight loss
• A lump in the neck

Early vaginal and vulvar cancers — as well as cervical cancers — may not cause any symptoms. But advanced-stage cancer can lead to abnormal vaginal bleeding or discharge and pain during intercourse.

Vulvar cancer can also cause:

• 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.

There's no cure for an HPV infection, but treatments are available to alleviate symptoms.

Nongenital skin warts can be treated with:

• Salicylic acid (available at any drugstore)
• Over-the-counter or doctor-administered cryotherapy (freezing)
• Cantharidin, a chemical doctors can apply
• Surgical techniques, including electrosurgery, excision, and laser treatment
• Immunotherapy, in severe or persistent cases

Genital warts are treated with various self-applied or doctor-applied topical medications as well as surgical treatments. Topical medications include:

• Imiquimod cream (Aldara)
• Podofilox solution or gel (Condylox)
• Sinecatechins (Veregen)

Precancerous cervical growths can be removed surgically, which helps prevent cervical cancer from developing.

Cancers caused by HPV are treated with standard cancer therapies, including chemotherapy, radiation therapy, and surgery.

Learn More About HPV Treatment

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 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.

Additional reporting by Quinn Phillips.