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HPV in Women: Causes, Symptoms, and Treatment Options

By Dr. Vishesh Bharucha +2 more

Introduction

It is estimated that around 80% of sexually active women will be exposed to at least one type of HPV during their lifetime1. HPV is a common viral infection that affects both men and women. However, it may go unnoticed as it usually does not present with symptoms2

HPV is caused by a virus that is primarily transmitted through skin-to-skin sexual contact. While some types of HPV do not cause any harm, other types may lead to the development of cancer (especially cervical cancer) or genital warts. Understanding the causes, symptoms, and treatment options for HPV in women can help lower your chance of infection2

hpv in women

What Is HPV?

Are you wondering what HPV is and what causes HPV in females? Human papillomavirus, or HPV, is a group of more than 200 types of HPV viruses. Certain mucosal or genital types of HPV viruses are transmitted through sexual contact. The other types can cause the formation of warts, which may not sexually transmitted3,4.  

HPV primarily spreads through close skin contact, particularly during vaginal, anal, or oral sexual activity. Many individuals may have been exposed to HPV in our lives5. Most HPV infections disappear on their own within 1-2 years without needing any treatment, especially in healthy young individuals. However, sometimes, they may last longer and lead to the development of cancer5.  

How HPV Affects Women

Based on their potential to cause cancer and their effects, HPV can be classified into 2 types3,6,7

  • Low-risk HPV: This can lead to the development of warts (skin growth) on the genitals, mouth, anus, or throat. These are not linked to cancer. 
  • High-risk HPV (such as HPV 16 and HPV 18): This can lead to the development of precancerous lesions, which may progress to cancer over time. 

In many cases, high-risk HPV infections remain at the cervix (lower portion of the uterus), without causing any symptoms. This persistent infection can cause cervical intraepithelial neoplasia (precancerous changes in the cervix). If these cell changes are not detected through regular screening (like a Pap smear or HPV test), they can eventually lead to the development of cervical cancer3

Types of HPV Linked With Cervical Disease

Certain HPV types are classified as high-risk because of their association with cervical cancer3. A study6 has shown that there are 13 HPV types (HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68) that are linked with cervical disease in HPV female patients8. The two high-risk types of HPV (HPV 16 and HPV 18) are responsible for 70% of cervical cancers worldwide7

Any sexually active woman may become infected with HPV. Usually, the body fights off this infection or the infection resolves on its own in 1-2 years, especially in young, healthy individuals. However, if the infection persists for a long period of time, it could lead to changes in the cervical cells, eventually leading to the development of cervical disease7,8

Symptoms and Signs of HPV in Women

Generally, most HPV infections are asymptomatic and do not show any signs or symptoms (especially high-risk types). The infection often passes unnoticed in women. If symptoms occur, they include3,4

  • Genital warts: Usually caused by low-risk HPV type, these are small elevations that may be present in the genital area. Genital warts can appear as raised or flat growths and may occur alone or in clusters. Symptoms will only arise if complications develop, such as cervical intraepithelial neoplasia or cancer. Low-risk HPV types (types 6 and 11) are responsible for 90% of genital warts. 
  • Abnormal Pap smear test results: This is normally detected during cervical cancer screening. Abnormal results on the Pap smear test may indicate cytological changes due to the presence of any high-risk HPV and show changes in the cells of the cervix (cervical dysplasia)9
  • Signs of cervical cancer noticed in HPV female patients: This includes bleeding from the vagina (after intercourse, between periods, or after menopause), watery vaginal discharge with a foul odour, pain during intercourse, or pelvic pain. It is important to note that vaginal bleeding (especially postcoital), foul-smelling discharge, and pelvic pain are late signs of invasive cervical cancer4,10

Understanding the HPV symptoms women commonly experience is essential for early detection and prevention of complications3,4

Types of HPV and Risk Levels

HPV is a common viral infection that includes a wide range of virus types. The virus types are classified as11

  • Low-risk HPV types: HPV 6 and HPV 1111
    • These are generally associated with genital warts.  
    • Rarely cause cancer. 
    • These warts may also be noticed in the vagina and the cervix. 
  • High-risk HPV types: HPV 16, HPV 18, HPV 31, HPV 33, and HPV 4211
    • They can cause cancer. 
    • Your body’s immune system cannot fight off this type of viral infection, which may cause damage to normal cells, resulting in cellular dysplasia, eventually leading to cancer. 
    • In women, high-risk HPV strains have been linked to cancers of the cervix, oropharynx, vagina, anus, and vulva. 

Low-risk HPV types are mainly associated with non-cancerous growths like warts, while high-risk types, especially HPV 16 and 18, are strongly associated with cervical cancer and other cancers7,11

Testing and Diagnosis

Are you wondering how to test for HPV in females? As HPV is usually asymptomatic, regular screening is essential to detect early signs of infection and prevent complications. Your doctor may recommend the following tests for the detection of HPV12

  • HPV Test: Checks for high-risk HPV types that cause cervical cancer.  
  • Pap Test (or Pap Smear or cervical cytology): During this test, a few cells are collected from your cervix to check whether they are precancerous or cervical cancer cells. It may incidentally detect any cellular changes or inflammation, suggestive of infection. 
  • HPV/Pap Co-test: Combines both the HPV and Pap tests to check for high-risk HPV types and cervical cell changes. 
  • Colposcopy and Biopsy: This method uses a special instrument to visualise the cervix, vagina, and vulva closely and provide a magnified view. Biopsies are taken from the suspicious areas. A colposcopy may be recommended if your Pap test is abnormal or if high-risk HPV has been identified. This test can help in early detection and can help reduce the incidence of cervical cancer13

Health Impact of HPV in Women

HPV can have a wide range of effects on women’s health. Although most HPV infections clear up without treatment, some high-risk types may result in significant health issues. These include14

  • Cervical cancer: This is usually caused by high-risk HPV types (HPV 16 and HPV 18). Persistent infection can lead to the development of precancerous lesions, which may progress to cancer (vaginal, vulvar, anal, and oropharyngeal cancer), if left untreated. 
  • Genital warts: Low-risk HPV types can result in genital warts, which are non-cancerous. 
  • Psychological stress: HPV can lead to psychological stress due to stigma or fear of cancer. 
  • Pregnancy complications: A few studies have shown the association of HPV with spontaneous abortion and preterm birth. However, there is no clear evidence of HPV being a direct cause of miscarriage or preterm labour. 

Early detection and timely treatment are vital in reducing the health risks associated with HPV14

Treatment Options

There is no cure for HPV. However, treatment options are available for the removal of genital warts and HPV-related cancer. These include15

  • Cryotherapy or cryosurgery: This is a procedure in which the tissue of the genital wart is frozen and destroyed. A colposcopy may be done before your treatment to visualise the wart and guide the biopsy. 
  • Excision procedures: The commonly followed procedures include: 
    • Loop electrosurgical excision procedure (LEEP): Uses a thin wire loop to remove abnormal tissue from your cervix. 
    • Cold knife cone biopsy (Conization): Extensive type of cervical biopsy where a cone-shaped piece of cervical tissue is removed. 
  • Laser therapy: Usually, a carbon dioxide laser is used in this technique, in which a focused beam of light helps to remove the abnormal tissue and simultaneously cauterise it, reducing bleeding and pain. 
  • Electrosurgery: This method uses electric current to burn the pre-cancerous lesions or warts. 
  • Hysterectomy: In this procedure, the uterus is removed. Based on your doctor’s advice and the surgical plan, it may or may not involve the removal of the ovaries or fallopian tubes.  
  • Trichloracetic acid: This acid is directly applied by the doctor to the wart to burn it off. It is said to be effective in removing up to 50% of the lesion. 
  • Topical ointments: Topical ointments (e.g., imiquimod and polyphenon) can be applied to treat the genital warts. 

HPV Prevention and Vaccination 

Many individuals (approximately 80% of women) will get HPV at some point in their lives. Simple methods to protect yourself from HPV include1,16

  • Getting vaccinated to protect yourself from developing cervical, throat, vulva, vaginal, and anal cancers. 
  • Using condoms is an effective method to reduce your risk of infection; however, this method does not eliminate the risk of HPV. 
  • Avoiding direct contact (genital contact) with another person. 
  • Regular screening for cervical cancer. 

HPV Vaccination

Vaccines available for HPV include17,18

  • Gardasil-9 (9vHPV): Helps provide protection against 9 types of HPV (HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58). 

Earlier vaccinations available include17,18:

  • Quadrivalent HPV vaccine (Gardasil, 4vHPV): Helps provide protection against HPV types 16 and 18. 
  • Bivalent HPV vaccine (Cervarix, 2vHPV): Helps provide protection against HPV types 16 and 18 that cause most HPV cancers. 

Vaccination is most effective if given before exposure to the virus. HPV vaccination can be started at the age of 9 years5. Recommended HPV vaccination and the dose schedule are as mentioned below17,18

Age Group Vaccination Recommendation Dose Schedule 
9-10 years HPV vaccination can be started at this age 2 doses (0 months, 6-12 months) – if started before age of 15 years 
11-12 years Routine vaccination recommended 2 doses (0 months, 6-12 months) – if started before age of 15 years 
13-14 years Vaccination recommended if not already vaccinated 2 doses (0 months, 6-12 months) – if started before the age of 15 years 
15-26 years Vaccination advised for those who have not completed the recommended vaccination schedule earlier. 3 doses (0, 1-2, and 6 months) 
27–45 years Not routinely recommended. Consider vaccination after consulting your doctor regarding the risk of developing HPV and the benefits of vaccination 3 doses (0, 1-2, and 6 months) 
Immunocompromised individuals (including HIV), 9–26 years Vaccination recommended if not already vaccinated 3 doses (0, 1–2, and 6 months). 

Can HPV Be Cured?

No, there is no cure for HPV. In most cases, your body’s defence system will fight against the infection so that it resolves on its own3,5.  

Moreover, there are effective treatments for the health problems it can cause (such as genital warts and cervical cancer). Early diagnosis and detection are key for reducing your risk of complications15

Living with HPV

Being diagnosed with HPV can be challenging, but it is important to remember that in most cases, this infection resolves on its own19

Women living with HPV should prioritise19

  • Regular medical tests, such as Pap smears or HPV tests, to monitor for any changes that might require treatment.  
  • Maintaining a healthy lifestyle: A healthy lifestyle, which includes a nutritious diet, regular physical activity, avoiding tobacco use, and stress management, can support overall well-being. 
  • Taking care of your mental health and talking to your doctor can help ease anxiety or fears. 

Open communication with partners and staying informed about HPV can empower women to manage their health confidently19

Conclusion

HPV is a widespread and often silent infection that can have serious health consequences for women, including cervical cancer and genital warts. While many infections resolve on their own, high-risk HPV types require close monitoring and early detection. Regular screening, timely vaccination, and healthy lifestyle practices play a crucial role in managing HPV successfully. 

Frequently Asked Questions (FAQs)

What are the factors that increase the risk of cervical cancer in a person suffering from HPV? 

If you have a weak immune system, smoke (or if you are exposed to second-hand smoke), are obese, or use oral contraceptive pills (or birth control pills), you may have an increased risk of developing cervical cancer7

When should I get screened for cervical cancer? 

The updated guidelines recommend starting screening for cervical cancer at age 25 years with an HPV test every 5 years until 65 years of age. Alternatively, you can also choose to get a HPV or Pap co-test every 5 years or just a Pap test every 3 years13

Can HPV be transmitted without having sexual intercourse? 

Yes, HPV spreads through intimate skin-to-skin contact, including genital touching, but without penetration20

Can I have a normal pregnancy if I have HPV? 

If you have HPV, you are likely to face genital warts or abnormal cervical cell changes during your pregnancy. It is best to consult your doctor and get regular screenings for cervical cancer to ensure good overall health5

References

  1. Myers ER, McCrory DC, Nanda K, Bastian L, Matchar DB. Mathematical Model for the Natural History of Human Papillomavirus Infection and Cervical Carcinogenesis. American Journal of Epidemiology [Internet]. 2000 Jun 15;151(12):1158–71.  Available from: https://pubmed.ncbi.nlm.nih.gov/10905528/ 
  2. Office on Women’s Health. Human papillomavirus [Internet]. 2017. Available from: https://womenshealth.gov/a-z-topics/human-papillomavirus 
  3. MedlinePlus. HPV [Internet]. National Library of Medicine; 2017. Available from: https://medlineplus.gov/hpv.html 
  4. Luria L, Cardoza-Favarato G. Human papillomavirus [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448132/ 
  5. Centers for Disease Control and Prevention. About HPV [Internet]. 2024. Available from: https://www.cdc.gov/hpv/about/index.html 
  6. Centers for Disease Control and Prevention. Basic Information about HPV and Cancer [Internet]. 2024. Available from: https://www.cdc.gov/cancer/hpv/basic-information.html 
  7. National Cancer Institute. Cervical Cancer Causes, Risk Factors, and Prevention [Internet]. 2022. Available from: https://www.cancer.gov/types/cervical/causes-risk-prevention 
  8. National Cancer Institute. HPV and Cancer [Internet]. 2025.  Available from: https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer 
  9. National Cancer Institute. HPV and Pap Test Results: Next Steps after an Abnormal Cervical Cancer Screening Test [Internet]. 2022.  Available from: https://www.cancer.gov/types/cervical/screening/abnormal-hpv-pap-test-results 
  10. National Cancer Institute. Cervical cancer symptoms [Internet]. 2022. Available from: https://www.cancer.gov/types/cervical/symptoms 
  11. American Cancer Society. Types of HPV [Internet]. 2024. Available from: https://www.cancer.org/cancer/risk-prevention/hpv/types-of-hpv.html 
  12. National Cancer Institute. Cervical cancer screening [Internet]. 2025.  Available from: https://www.cancer.gov/types/cervical/screening 
  13. Cooper DB, Goyal M. Colposcopy [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2023.  Available from: https://www.ncbi.nlm.nih.gov/books/NBK564514/ 
  14. Qaderi K, Mirmolaei ST, Geranmayeh M, Farnam F, Sheikh Hasani S. “Does HPV affect my fertility?” Reproductive concerns of HPV-positive women: a qualitative study. Reproductive Health [Internet]. 2021 Apr 1;18(1).  Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8017806/ 
  15. Rosales R. Immune therapy for human papillomaviruses-related cancers. World Journal of Clinical Oncology [Internet]. 2014;5(5):1002. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4259927/ 
  16. News in Health. Protect yourself against HIV [Internet] Available from: https://newsinhealth.nih.gov/2013/10/protect-yourself-against-hpv 
  17. Centers for Disease Control and Prevention. HPV vaccine recommendations [Internet]. CDC. 2021. Available from: https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html 
  18. Centers for Disease Control and Prevention. HPV Vaccination [Internet]. 2024. Available from: https://www.cdc.gov/hpv/vaccines/index.html 
  19. Galeshi M, Shirafkan H, Yazdani S, Motaghi Z. Challenges and Needs of HPV-Positive Women. INQUIRY: The Journal of Health Care Organization, Provision, and Financing [Internet]. 2023 Jan;60:004695802211500. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9893350/ 
  20. Petca A, Borislavschi A, Zvanca M, Petca RC, Sandru F, Dumitrascu M. Non-sexual HPV transmission and role of vaccination for a better future (Review). Experimental and Therapeutic Medicine [Internet]. 2020 Oct 13;20(6):1–1. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579832/pdf/etm-20-06-09316.pdf 

Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.

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