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Frequently asked questions on HPV

This page has a selection of different questions that Jo's Cervical Cancer Trust has received about HPV. The answers have been reviewed by Jo's medical advisers.

What is human papillomavirus (HPV)?
Do all HPVs cause cervical cancer?
Who can get HPV?
How can I reduce the risk of becoming infected with HPV?
Am I more likely to get persistent HPV if I smoke? 
If HPV is so common, and it affects nearly all of us, why don't more women get cervical cancer?
If I've got genital warts, am I likely to develop cervical cancer?
What other cancers does HPV cause?
If I have had cervical cancer, does that mean I am at risk of getting another related HPV cancer?
If I have had cervical abnormalities, does that mean I am at risk of getting a related HPV cancer?
I have had cervical cancer/cervical abnormalities caused by HPV, can I be reinfected with HPV?
I've had an HPV infection, what can I do to protect myself from reinfection?
If I have a persistent HPV infection, can I transmit it to my partner and can they then reinfect me?
I've read that HPV can lie dormant. Is this true or once I have cleared the infection I am no longer at risk of developing abnormal cells? 
If I haven't been sexually active in many years, could I still have the HPV virus?
How likely is it that I could come into contact with HPV after 50?
As an older woman will my ability to clear the virus be reduced?
If I have been through the menopause am I still at risk of HPV?
If I have only had sexual contact with one partner, am I still at risk of having HPV?
Am I still at risk of contracting HPV if I have a new sexual partner but use contraception?
I am sexually active but no longer have penetrative sex, am I still at risk of getting HPV?
If I haven't been sexually active for several years and never had a cervical abnormality, should I get the HPV vaccination as a precautionary measure?
When I was younger I had abnormalities that went away on their own, does this mean my immune system is now strong enough to fight HPV on its own?

 

What is human papillomavirus (HPV)?
HPV is an extremely common virus. There are over 100 identified types of HPV. Some types of HPV can cause changes in the cells of the cervix, creating abnormalities. Once these abnormalities become severe they may develop into cancer.

Do all HPV types cause cervical cancer?
No. Some HPV types cause non-cancerous skin warts that commonly appear on the hands and feet.

Around 40 HPV types affect the genital area, and these are divided into those that have no risk for cervical cancer (called low risk) and those that can cause cancer (called high risk). High-risk HPV can cause cancer of the cervix, vagina, anus, vulva, penis and some head and neck cancers. High-risk types – the types most likely to cause cervical cancer – include types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68. Types 16 and 18 cause 70% of all cervical cancers. Low-risk HPV types, such as HPV 6 and 11, cause non-cancerous genital warts.

Who can get HPV?
Anybody who has ever been sexually active is at risk of contracting HPV. Genital HPV is transmitted primarily by genital-to-genital skin contact, and vaginal, anal and oral sex. The time from exposure to the virus to the development of warts or cervical disease is highly variable and the virus can remain dormant in some people for long periods of time. Often it is not possible to determine exactly when or from whom the infection originated. HPV is classified as a sexually transmitted virus. It is more common in young, sexually active people, with the peak prevalence in women usually occurring between the ages of 16 and 25.

The risk of infection increases with the number of sexual partners and women who have had multiple sexual partners or whose partners have had multiple partners. However, having HPV is NOT an indication of promiscuity or infidelity. You can contract HPV on your first sexual encounter. The infection rate in men has not been evaluated to the same extent as in women, but is likely to follow the same pattern as for women.

How can I reduce the risk of becoming infected with HPV?
HPV infections are very common and the majority of infected individuals will have no obvious signs or symptoms. Therefore, it is very difficult to tell whether an individual is infected and the only way to entirely avoid the possibility of being exposed to HPV is abstinence. This is unlikely to be a popular option for most people, although people should be reminded that it is primarily a sexually transmitted infection and the risk will, therefore, be reduced if you and your partner have had few sexual partners and have avoided casual sex.

You can reduce your risk by the practising the following:

  • Safe sex: Practising safe sex through the regular use of condoms can help reduce the risk of being infected with HPV, but it will not completely eradicate the risk as HPV lives on the skin in and around the whole genital area [1]. Genital HPV in men affects the skin of the penis, scrotum, anus and rectum [2]. In women it affects the vulva (area outside the vagina), linings of the vagina, cervix and rectum.
  • Leading a healthy lifestyle: Keep your immune system – your body's natural defence against disease and infection – strong. A weakened immune system could mean that your risk of cervical cancer is higher than average.
  • Not smoking: Smoking stops your body's immune system from working properly, leaving you more likely to develop infections that do not clear up and, therefore, increasing your chance of developing cervical cancer [3].

Am I more likely to get persistent HPV if I smoke?
Smoking can increase your risk of developing a persistent HPV infection and also has an impact on the cervical cells. By leading a healthy lifestyle, you can reduce the risk of persistent infection and cell changes. Eating healthily, exercising, and not taking up or stopping smoking can all help to prevent cervical abnormalities through keeping your immune system healthy.

If HPV is so common and it affects nearly all of us, why don't more women get cervical cancer?
The majority of women clear the infection through their immune systems, but for those who do not, regular cervical screening can pick up abnormalities in cervical cells before a cancer develops. These abnormal cells can then be removed and in the majority of cases this is highly successful. In a small minority of women, changes occur more rapidly in the interval between cervical screening or, occasionally, the changes are not detected by screening.

If I've got genital warts, am I likely to develop cervical cancer?
No. Cancer and genital warts are caused by different types of HPV, so having genital warts does not mean that you are more likely to get cancer. There are about 100 types of HPV, the majority of which do not cause any health problems. Research has identified specific HPV types that are high risk and low risk for cervical cancer. The most common types that cause cervical cancer are high-risk HPV types 16 and 18, while the low-risk types that cause genital warts are HPV types 6 and 11.

What other cancers does HPV cause?
HPV is responsible for 5% of all cancer diagnoses [4]. HPV has been linked to the following cancers: cancer of the penis, anus, vagina and vulva. Some, but not all, mouth and throat cancers are also caused by HPV. HPV affects mucous skin cells and this means you can have an HPV infection in the mouth, throat, anus and genital areas and HPV can infect both men and women. HPV can also cause abnormal cells to develop at other sites and this can in time lead to cancer; however, this is very rare.

If I have had cervical cancer, does that mean I am at risk of getting another related HPV cancer?
Women who have had a cervical cancer diagnosis are at an increased risk of developing another HPV-related cancer; however, we have very little data on the scale of this risk.

If I have had cervical abnormalities, does that mean I am at risk of getting a related HPV cancer?
Not all mild cervical abnormalities are due to high-risk HPV types, so it does not necessarily follow that you are at increased risk. 

I have had cervical cancer/cervical abnormalities caused by HPV, can I be reinfected with HPV?
Unfortunately we don't have a definite answer to this question. In theory if you and your partner have been infected with HPV you should be immune to that type and so reinfection should not occur. However, studies have shown that natural immunity to HPV is poor and women can be reinfected with the same virus type [5][6]. So in some cases the answer will be yes, in others it will be no.

I've had an HPV infection, what can I do to protect myself from reinfection?
Make sure you keep healthy so that your immune system is able to fight off the virus. In particular, don't smoke or give up smoking if you do smoke. Smoking has been shown to double your risk of cervical cancer. 

Condoms can help prevent infection with HPV, but they don't guarantee protection.

Recent evidence shows that having the HPV vaccine, even after you have had an infection with HPV, offers women protection from both infection with other HPV types and reinfection by the same type in the future [7] [8]. However, the vaccine is only available on the NHS for free until the age of 18.

If I have a persistent HPV infection, can I transmit it to my partner and can they then reinfect me?
This is a possibility, but whether your partner actually carries it and reinfects you will depend on whether their immune system can clear the infection.

I've read that HPV can lie dormant. Is this true or once I have cleared the infection I am no longer at risk of developing abnormal cells?
Little is known about HPV transmission when symptoms (lesions, such as warts, or cell changes) aren't present, so experts cannot fully answer this question. However, studies show that in most cases a healthy immune system will eventually clear an HPV infection. Unfortunately, in some cases an infection may persist for years and result in recurrent abnormalities; however, this is very rare and an exception to the norm. In research studies, most people who test positive for a genital HPV infection eventually test negative, often within a year or two.

Many researchers and clinicians say the chances of transmitting the virus years after the last clinical episode (where warts or cervical abnormalities were detected) becomes reduced over time. This is not easy to prove and the lack of a solid 'yes' or 'no' answer makes it difficult to answer this question. However, HPV does not seem likely to always be active.

If I haven't been sexually active in many years, could I still have the HPV virus?
HPV can remain dormant in the body but little is known about this. Studies have show that in most cases a healthy immune system will eventually clear an HPV infection. Unfortunately, in some cases an infection may persist for years and result in recurrent abnormalities; however, this is very rare and an exception to the norm. In research studies, most people who test positive for a genital HPV infection eventually test negative, often within a year or two.

Many researchers and clinicians say the chances of transmitting the virus years after the last clinical episode (where warts or cervical abnormalities were detected) becomes reduced over time. This is not easy to prove and the lack of a solid 'yes' or 'no' answer makes it difficult to answer this question. However, HPV does not seem likely to always be active.

How likely is it that I could come into contact with HPV after 50?
Anybody who has ever been sexually active is at risk of contracting HPV. Genital HPV is transmitted primarily by genital-to-genital skin contact, and vaginal, anal and oral sex. The time from exposure to the virus to the development of warts or cervical disease is highly variable and the virus can remain dormant in some people for long periods of time. Often it is not possible to determine exactly when or from whom the infection originated. HPV is classified as a sexually transmitted virus. It is more common in young, sexually active people, with the peak prevalence in women usually occurring between the ages of 16 and 25. But if you are sexually active at any age you can contract HPV.

As an older woman will my ability to clear the virus be reduced?
There is no simple answer to this question since as we age our ability to respond to any infection does decline but there is still a good protective response in most of us.

If I have been through the menopause am I still at risk of HPV?
Yes you are still at risk of contracting new HPV infections because the risk of exposure and the way you contract high risk HPV through skin-to-skin contact of the genital areas is not altered by the menopause. There is also a risk due dormant HPV infection where there was a previous HPV infection and the virus has been reactivated [9 and 10]. So, women who have gone through the menopause are still at risk of getting high risk HPV and therefore still have a risk of developing cervical cancer.

If I have only had sexual contact with one partner, am I still at risk of having HPV?
The risk of infection with HPV increases with the number of sexual partners and women who have had multiple sexual partners or whose partners have had multiple partners. However, having HPV is NOT an indication of promiscuity or infidelity. You can contract HPV on your first sexual encounter. The infection rate in men has not been evaluated to the same extent as in women, but is likely to follow the same pattern as for women.

Am I still at risk of contracting HPV if I have a new sexual partner but use contraception?
Practising safe sex through the regular use of condoms can help reduce the risk of being infected with HPV, but it will not completely eradicate the risk as HPV lives on the skin in and around the whole genital area [1]. Genital HPV in men affects the skin of the penis, scrotum, anus and rectum [2]. In women it affects the vulva (area outside the vagina), linings of the vagina, cervix and rectum.

The contraceptive pill and other forms of contraception will not help reduce the risk of contracting HPV.

I am sexually active but no longer have penetrative sex, am I still at risk of getting HPV?
Anybody who has ever been sexually active is at risk of contracting HPV. Genital HPV is transmitted primarily by genital-to-genital skin contact, and vaginal, anal and oral sex.

If I haven't been sexually active for several years and never had a cervical abnormality, should I get the HPV vaccination as a precautionary measure?
Recent evidence shows that having the HPV vaccine, even after you have had an infection with HPV, offers women protection from both infection with other HPV types and reinfection by the same type in the future. However, the vaccine is only available on the NHS for free until the age of 18. If you are not eligible for the free vaccine you can pay for it privately. Some local chemists are also offering the vaccine. Check with your pharmacist to see if the vaccine is available near you.

When I was younger I had abnormalities that went away on their own, does this mean my immune system is now strong enough to fight HPV on its own?
Unfortunately we don't have a definite answer to this question. In theory once you have been infected with HPV you should be immune to that type and so reinfection should not occur. However, studies have shown that natural immunity to HPV is poor and women can be reinfected with the same virus type [5] [6]. So in some cases the answer will be yes, in others it will be no. 


References

  1. Winter RL et al., 2003. Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students. American Journal of Epidemiology, 157 (3), 218–226.
  2. Giulano AR et al., 2008. Epidemiology of human papillomavirus infection in men, cancers other than cervical and benign conditions. Vaccine 26 (10), K17–K28.
  3. Cancer Research UK. Cervical cancer risk factors. http://www.cancerresearchuk.org/cancer-info/cancerstats/types/cervix/riskfactors/. Accessed: 19.05.2015.
  4. National Cancer Institute at the National Institutes of Health. HPV and cancer. http://www.cancer.gov/cancertopics/causes-prevention/risk/infectious-agents/hpv-fact-sheet. Accessed:19.05.2015
  5. Schwarz TF et al., 2008. Immune response to human papillomavirus after prophylactic vaccination with AS04-adjuvanted HPV-16/18 vaccine: improving upon nature. Gynecological Oncology 110 (3,1), S1–S10.
  6. Safaeian M et al., Costa Rican Vaccine Trial Group, 2010. Epidemiological study of anti-HPV16/18 seropositivity and subsequent risk of HPV16 and 18 infections. Journal of the National Cancer Institute 102(21), 1653–1662.
  7. Szarewski et al., 2012. Efficacy of the human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine in women aged 15–25 years with and without serological evidence of previous exposure to HPV-16/18. International Journal of Cancer 131 (1), 106–116.
  8. Hauptt R et al., 2011. Impact of an HPV6/11/16/18 L1 virus-like particle vaccine on progression to cervical intraepithelial neoplasia in seropositive women with HPV16/18 infection. FUTURE I and II Investigators. International Journal of Cancer 129 (11), 2632–2642.
  9. Brogaard KA et al., 2014. Detection of oncogenic genital human papillomavirus (HPV) among HPV negative older and younger women after 7 years of follow-up. J Med Virol 86(6), 975-82.
  10. Rositch AF et al., 2012. Contributions of recent and past sexual partnerships on incident human papillomavirus detection: acquisition and reactivation in older women. Cancer Res. 72(23), 6183-90.
Date last updated: 
19 May 2015
Date due for review: 
19 May 2017
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