HPV and Its Link to Cancer: How to Protect Yourself and Your Partners

HPV is the most common sexually transmitted infection in the United States — virtually everyone who is sexually active acquires it at some point — and most infections clear on their own without causing any harm. But a small proportion of HPV infections persist, and persistent infection with high-risk strains is directly responsible for approximately 35,000 cancers in the US annually. Understanding which strains matter, what screening detects them, and how the vaccine prevents cancer is what makes this clinically relevant.

Quick answer: HPV types 16 and 18 cause approximately 70% of all HPV-related cancers, including cervical, oropharyngeal, anal, penile, vaginal, and vulvar cancer. The Gardasil 9 vaccine prevents infection with nine high-risk and low-risk HPV strains and is recommended through age 26 for all, and through age 45 for selected individuals. Cervical cancer screening (Pap test + HPV co-test) detects pre-cancerous changes before they become cancer. Most genital HPV has no symptoms. Testing available in San Francisco, New York City, Houston, Atlanta, and Washington DC.

How HPV Causes Cancer

Of the more than 200 HPV strains, approximately 14 are classified as high-risk for cancer. Types 16 and 18 account for approximately 70% of cervical cancers and similar proportions of other HPV-related cancers. High-risk HPV infects epithelial cells and integrates its DNA into the host cell genome, disrupting normal cell cycle regulation and leading to uncontrolled cell growth — the mechanism of carcinogenesis.

The progression from initial HPV infection to invasive cancer typically takes 10–20 years, which is why regular screening is effective: there is a long window during which pre-cancerous changes (dysplasia, also called CIN or AIN) can be detected and treated before cancer develops. Most HPV infections, including high-risk strain infections, are cleared by the immune system within 1–2 years. Cancer develops only in a minority of people whose immune systems fail to clear the virus and who carry a persistent infection.

HPV-Related Cancers

Cervical cancer is the most established HPV-related cancer. Nearly all cases are caused by HPV, primarily types 16 and 18. Cervical cancer screening (Pap test, HPV co-test, or both) detects pre-cancerous changes before they progress. With adequate screening, cervical cancer is highly preventable.

Oropharyngeal cancer (cancer of the base of the tongue, tonsils, and soft palate) is now more common in the US than cervical cancer, largely driven by HPV type 16 acquired through oral sex. It predominantly affects men. There is currently no approved screening test for oral HPV or oropharyngeal cancer equivalent to cervical screening.

Anal cancer is caused by HPV in approximately 90% of cases, with type 16 predominating. Risk is highest in MSM and people with HIV. High-resolution anoscopy is used for screening in high-risk populations.

Penile, vaginal, and vulvar cancers are less common but also HPV-associated. HPV 16 and 18 account for the majority.

The HPV Vaccine

Gardasil 9 protects against nine HPV strains: high-risk types 16, 18, 31, 33, 45, 52, and 58 (covering approximately 90% of HPV-related cancers), and low-risk types 6 and 11 (which cause approximately 90% of genital warts). It is most effective when given before first sexual exposure, because it prevents infection rather than clearing existing infection. It does not treat existing HPV.

The ACIP recommends routine vaccination at age 11–12, with catch-up vaccination through age 26 for all. Adults aged 27–45 may receive the vaccine after discussing benefits with a clinician — benefit is lower in this group because most will have had some HPV exposure, but partial protection remains possible. The vaccine requires 2 doses if started before age 15, and 3 doses if started at 15 or older.

The vaccine has been transformative in clinical data: countries with high vaccination coverage have seen cervical pre-cancer rates drop by over 85% in vaccinated cohorts compared to pre-vaccination baselines.

Screening: What It Detects and When

Cervical cancer screening for women with a cervix should begin at age 21. From 21–29: Pap test every 3 years. From 30–65: Pap test + HPV co-test every 5 years (preferred), or Pap test alone every 3 years. HPV primary testing (hrHPV test alone) every 5 years is an additional option for 30–65. Screening beyond 65 is not recommended for women who have had adequate prior screening.

There is no routine HPV screening test for men, and no screening equivalent to the Pap test for oropharyngeal cancer. Annual digital anal rectal exam and, for high-risk patients, high-resolution anoscopy are used for anal cancer surveillance in MSM and people with HIV.

When to Seek Evaluation

• Abnormal Pap or HPV co-test result: follow your clinician’s recommendation for repeat testing or colposcopy — timing depends on the specific result.

• Persistent sore throat, difficulty swallowing, or neck lump: evaluation for oropharyngeal pathology, including HPV-related cancer, warranted — especially in adults who have had multiple oral sex partners.

• Anal bleeding, pain, or mass: evaluation warranted, particularly in MSM and people with HIV.

• Genital warts (flesh-coloured, cauliflower-like growths): these are caused by low-risk HPV types 6 and 11, not the same strains that cause cancer, but confirm with a clinician and ensure your screening is current.

Frequently Asked Questions

If I have HPV, do I have cancer?

No. Having HPV — even high-risk HPV — does not mean you have cancer or will develop it. Most HPV infections clear within 1–2 years. Cancer develops only in a minority of people with persistent high-risk infection over many years. A positive HPV test is a reason for appropriate follow-up screening, not a cancer diagnosis.

Can men get screened for HPV?

There is no FDA-approved HPV screening test for use in penile or scrotal tissue in men, and no oropharyngeal HPV screening equivalent to the Pap test. MSM and people with HIV should discuss anal cancer screening with their provider. HPV vaccination is the most effective protective measure for men.

Does the HPV vaccine protect against all HPV strains?

Gardasil 9 protects against 9 strains responsible for approximately 90% of HPV-related cancers and genital warts. It does not protect against all HPV strains, but the strains it covers are responsible for the overwhelming majority of HPV-related disease. It does not treat existing infection.

Related: HPV: The Complete Guide · STDs from Oral Sex · HPV and Oral Health · STD Testing Guide · Get tested today →