HPV in Women: The Leading Cause of Cervical Cancer

HPV in Women: The Leading Cause of Cervical Cancer

HPV in Women: The Leading Cause of Cervical Cancer
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Human papillomavirus (HPV) is a sexually transmitted infection that can cause common skin warts, genital warts, and certain types of cancer.

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.

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.

 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.

Medical Illustration titled How HPV Affects the Body, man centered surrounded by symptoms including skin warts, genital cancers, genital warts, throat cancer, Everyday Health logo located bottom left
Some kinds of human papillomavirus cause warts, while others put you at higher risk for certain cancers.Everyday Health

Symptoms of Genital Warts in Women

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.

Pap and HPV Tests for Cervical Cancer Screening

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.

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

Oral, Vulvar, and Vaginal Cancers

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.

HPV Vaccine for Girls and Women

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.

The Takeaway

  • 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.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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kara-leigh-smythe-bio

Kara Smythe, MD

Medical Reviewer

Kara Smythe, MD, has been working in sexual and reproductive health for over 10 years. Dr. Smythe is a board-certified fellow of the American College of Obstetricians and Gynecologists, and her interests include improving maternal health, ensuring access to contraception, and promoting sexual health.

She graduated magna cum laude from Florida International University with a bachelor's degree in biology and earned her medical degree from St. George’s University in Grenada. She completed her residency in obstetrics and gynecology at the SUNY Downstate Medical Center in Brooklyn, New York. She worked in Maine for six years, where she had the privilege of caring for an underserved population.

Smythe is also passionate about the ways that public health policies shape individual health outcomes. She has a master’s degree in population health from University College London and recently completed a social science research methods master's degree at Cardiff University. She is currently working on her PhD in medical sociology. Her research examines people's experiences of accessing, using, and discontinuing long-acting reversible contraception.

When she’s not working, Smythe enjoys dancing, photography, and spending time with her family and her cat, Finnegan.

Joseph Bennington-Castro

Author

Joseph Bennington-Castro is a science writer based in Hawaii. He has written well over a thousand articles for the general public on a wide range topics, including health, astronomy, archaeology, renewable energy, biomaterials, conservation, history, animal behavior, artificial intelligence, and many others.

In addition to writing for Everyday Health, Bennington-Castro has also written for publications such as Scientific American, National Geographic online, USA Today, Materials Research Society, Wired UK, Men's Journal, Live Science, Space.com, NBC News Mach, NOAA Fisheries, io9.com, and Discover.