Cervical Cancer: Understanding the HPV Link

Did you know that virtually all cases of cervical cancer are caused by the human papillomavirus (HPV)? Cervical cancer was once the leading cause of cancer deaths among women in the US. Thanks to cervical cancer screening and HPV vaccines, however, this cancer is now one of the most preventable.

Discover the link between cervical cancer and HPV with answers to common questions from Nathan Ratchford, MD, FACOG, a board-certified gynecologist at Phelps Health.

What is HPV?

HPV is the most common sexually transmitted infection (STI) in the world, with over 200 genotypes (strains). Some of these types can cause health problems, including genital warts and cancers. The most common ways to contract HPV infection are via skin-to-skin contact and penetrative intercourse (vaginal, anal or oral). An infected person can pass the infection to someone even when they have no signs or symptoms.

What, if any, symptoms does HPV cause?

Generally speaking, most people with HPV don’t have symptoms. Occasionally, people may develop cutaneous (skin) warts, but even these can be overlooked or mistaken for an unrelated lesion (sore).

What is the best way to prevent HPV?

The answer is two-fold. If you are sexually active, take the following precautions:

• Use condoms every time you have sex, to lower your chances of getting the virus. However, HPV can infect areas the condom does not cover. So, condoms may not fully protect against getting HPV; and
• Be in a mutually monogamous relationship (have sex only with someone who only has sex with you).

Secondly, get vaccinated, if you are in the recommended age groups (see below). The HPV vaccine is safe and shown to decrease the rates of HPV positivity and the prevalence of HPV-related cancers.

Who should get the HPV vaccine?

Ideally, the best time to receive the HPV vaccine is before exposure. In the US, the Centers for Disease Control and Prevention (CDC) recommends the HPV vaccine for all preteens (including boys and girls) at age 11 or 12. Nationally, the vaccine is approved for ages 9-45. When the vaccine was first approved in the US, the initial recommendation was for ages 9-26, so patients seeking a vaccination after age 26 may have difficulty getting the vaccine covered by their insurance.

For some populations, the vaccine may not be recommended. Because of this, be sure to talk with your primary care provider (PCP) about the best plan of action for you or a loved one.

Reported side effects of the HPV vaccine are typically mild and include muscle aches, headaches, fever and pain at the injection site.

How does HPV cause cancer?

HPV uses normal cell division to replicate itself. In doing so, the genetics of normal cells become disrupted, potentially leading to genetic mutations and eventually cancer. In addition to cervical cancer, HPV also can cause vaginal, vulvar, anal, penile and oropharyngeal (head and neck) cancer.

Can you get cervical cancer without having sex?

Although cancerous mutations can arise spontaneously in almost any tissue in the body, virtually all cervical cancers are caused by an HPV infection.

How does a married/monogamous woman get HPV?

Without new exposure, it’s impossible for a married/monogamous woman to acquire a new HPV infection. However, a woman who is currently monogamous may have been exposed through a former partner and be unaware. The virus can exist in a latent (resting) phase in the body for years, only to become active later. In fact, cervical cancer may take 20 years or longer to develop after an HPV infection.

Can you get cervical cancer without HPV?

Cervical cancer is the fourth most common gynecologic (affecting the female reproductive system) cancer worldwide. Virtually all cases of cervical cancer are attributed to HPV infection. HPV 16 is the most common type of the virus to cause cervical cancer. (HPV 18 is another common culprit.) In the US and other countries where the HPV vaccine is routinely given, cervical cancer rates have drastically decreased.

Can you get cervical cancer after a hysterectomy?

For most patients, a hysterectomy involves removing the cervix. In these patients, since the cervix was removed, they cannot develop cervical cancer. Therefore, routine cervical cancer screening is not recommended. In rare cases, HPV can lead to vaginal cancer after a hysterectomy. Because of this risk, women should continue their regular well-woman exams and seek medical attention for any concerning symptoms.

In the event of a supracervical hysterectomy, (where the cervix is left in place), patients should continue with routine cervical cancer surveillance (i.e., Pap smears). This procedure is not common, however, representing only a small portion of hysterectomies performed.

If you’ve had a hysterectomy and are uncertain of your risks, talk with your healthcare provider for more information.

How is someone tested for HPV? Are self-test kits available?

The only clinically relevant and recommended tests for HPV detection are cervical cancer screening tests, (i.e. Pap smears or Pap tests). A Pap smear is a test where cervical cells are swiped from the cervix and sent to a lab to evaluate for cervical cancer.

Concerning head and neck cancer, a biopsy would have to be performed to confirm a diagnosis.

Over-the-counter self-test kits have not yet proven to be accurate and are not approved by the Food and Drug Administration (FDA).

How is oral HPV acquired, and what does “HPV tongue” look like?

Like any other HPV infection, oropharyngeal (oral) HPV is acquired through skin-to-skin contact, which includes either open-mouthed kissing or unprotected oral intercourse. Most oral HPV infections, including those affecting the tongue, aren’t associated with obvious lesions like an “HPV tongue,” for example. Your PCP or dentist would need to examine your mouth to confirm oral HPV and/or to evaluate any suspicions lesions.

What is the likelihood of developing throat cancer from HPV?

Oral HPV infection is less common than genital HPV infection. (Approximately 10% of the US population has an oral HPV infection.) This risk increases with more sexual and open-mouthed kissing partners, older age and smoking. The most common HPV-related oral cancer is squamous cell carcinoma, which accounts for 55,000 cases annually in the US. 

What does an “HPV bump” look like?

The most common manifestations (indicators) of HPV infection of the skin are warts. These can have a varied appearance depending on the HPV subtype and location on the body. That being said, the majority of people with HPV don’t have symptoms.

What are flat warts? Are they contagious?

Flat warts are smooth, small bumps on your skin. Flatter and smaller than other warts, flat warts usually appear in groups on your face or hands.

Flat warts are caused by the HPV virus, are contagious and can spread through skin-to-skin contact. Specifically, HPV types 3, 10, 28 and 49 cause flat warts. These strains of HPV are noncancerous (benign). They’re not caused by the same strain of HPV that causes genital warts.

What’s the difference between HPV and herpes?

As the names imply, both HPV and herpes simplex virus (HSV) are viruses. Additionally, both viruses are common, highly contagious, can have a latent phase and are acquired through skin-to-skin contact and penetrative intercourse.

Beyond these similarities, the two viruses are different in many ways. For example, HSV only has two subtypes compared to HPV’s 200-plus. And while some HPV genotypes may cause warts, HSV tends to cause a painful ulcerative disease, which may result in genital lesions or cold sores in the mouth.

Does HPV go away on its own?

HPV infection typically regresses (retreats) spontaneously in 12 months. A variety of factors can affect this, such as repetitive new HPV exposure, tobacco use and the effectiveness of the immune system.

How do I know if an HPV infection is gone?

The only currently available clinical means of testing for clearance of HPV is through cervical cancer screening (Pap smears). Otherwise, the absence of warts is a good sign of resolved infection and likely decreased risk of transmission, but does not rule out latent (hidden, inactive) infection.