The human papilloma virus (HPV) is a common group of viruses. Over 100 different types of HPV have been identified, and each one is known by a number. HPV affects the skin and the mucosa. The mucosa is the moist membrane that line parts of the body, such as the insides of the mouth, throat and anus.

Some types of HPV are known to increase the risk of developing different types of cancer. These are called high-risk HPVs. Types 16 and 18 are the types of HPV most often associated with cancer. High-risk HPVs can lead to abnormal changes in the cells, which is sometimes called dyskaryosis. Although these abnormal changes are not cancer, they are sometimes described as being pre-cancerous.

Other types of HPV can cause warts and verrucas. These may appear on different parts of the body, but are most often seen:

• on the hands and feet
• in the genital area
• around the anus. 

The types of HPV that cause visible warts and verrucas are less clearly linked with cell changes that can increase the risk of cancer. They are called low-risk HPVs.

This information is about the high-risk HPV types that can increase the risk of developing cancer.

There are around 40 different types of HPV that can affect the anogenital area (the cervix, vulva, penis and anal area). HPV is spread through skin contact, often during sex. Exactly how a person gets the virus is uncertain, and it is not always possible to find a sexual cause. It is thought there may be other ways of spreading the virus that have not yet been identified.

HPV can affect both men and women. Because the virus is very common, most people who are sexually active will have HPV at some time during their life. Many people do not have any symptoms and do not know they have HPV. For some people the virus may be inactive for weeks, months and sometimes even years after infection. The body’s immune system can usually get rid of an HPV infection, and for most people infections come and go without causing any problems.

Although HPV can increase the risk of developing some types of cancer, most people who have HPV will not develop cancer.

The six main types of cancer associated with HPV are:

• cervical cancer
• vulval cancer
• vaginal cancer
• anal cancer
• head and neck cancers
• penis cancer.

If you are sexually active, it may be difficult to avoid getting HPV.

As most high-risk HPVs do not cause symptoms, it can be impossible to tell whether your partner is infected. Using condoms and other barrier methods of contraception can help reduce the risk of becoming infected. But they do not cover all of the skin and therefore don’t completely protect against infection.

You are more likely to become infected with HPV if you start having sex at a younger age and if you have a lot of sexual partners. Having sex without using a barrier method of contraception can also increase the risk of becoming infected.

HPV infection may be more likely if:

• there are small scrapes (abrasions) or cuts and tears in the skin or mucosa
• the mucosa has been damaged from other infections, such as chlamydia.

Scrapes and tears are more likely to occur during anal sex, or if the vagina is drier than normal (for example after the menopause). In these situations, it can help to use a lubricant during sex, such as Replens^®, Astroglide^®, Sylk^® or the range produced by Durex^®.

Because HPV infection is common and hard to prevent, it is important to look out for any changes in the parts of the body where we know HPV may cause cancer. Cancer diagnosed in the early stages, before it has begun to spread, is much easier to treat and cure. It is important that women have regular cervical smear tests, as these can pick up changes in the cervix at a very early stage.

There is some evidence to suggest that people who smoke and have HPV are more likely to develop cell changes that can lead to cancer than non-smokers who have HPV. If you know you have HPV, and even if you do not know, stopping smoking may help boost your immune system.

Two vaccines have been produced to prevent HPV. These are called Gardasil® and Cervarix®. It is hoped that these vaccines will prevent at least 7 in 10 (70%) of the most common type of cervical cancer (squamous cell). But HPV vaccinations will not replace the need for regular cervical screening tests in women.

Because the HPV virus is passed on during sex, the vaccine works best if it is given to girls before they might start having sex. Girls aged 12–13 are now routinely offered Gardasil. Gardasil protects against two of the most important types of HPV (HPV 16 and 18) that can cause cervical cancer. It also works against the types of HPV that can cause genital warts.

We have more information about HPV vaccines.

As there are usually no symptoms of high-risk HPV, the infection is often not diagnosed. There are no blood tests to detect HPV.

Diagnosis of HPV in women

HPV infection of the cervix is mainly diagnosed in women as a result of the cervical screening programme. A woman may be told she has HPV when she receives her cervical screening result. If an HPV infection is present, changes in the appearance of the cells can sometimes be seen when they are looked at under a microscope during the screening process.

Testing of cervical screening samples for high-risk types of HPV is now being introduced in some areas of the country. This means that if you live in an area where it has been introduced, your cervical screening sample may be tested to see if it contains a high-risk type of HPV. This is explained in more detail in our information about cervical screening. You can also find out more on the Gov.uk website.

Some women who have an abnormal smear test result will attend a colposcopy clinic, where their cervix will be looked at using an instrument like a microscope (called a colposcope). During the colposcopy, the nurse or doctor can apply a solution to the cervix that makes cells infected with HPV turn white. We have a video about colposcopy and abnormal screening results. In it, colposcopist nurse Joyce explains what a colposcopy is and what to expect if you have one.

People who have anal sex are more likely to have anal HPV. They also have a higher risk of developing anal cancer. Men and women who have HIV have an even bigger risk of anal HPV and anal cancer.

An HPV DNA test can sometimes be done using cells collected during a routine cervical screening test or colposcopy. This test can also be done during an anal smear – see below. The HPV DNA test looks at the genetic make-up (DNA) of the HPV in the cells and can detect which type of HPV is present. This can be useful, as it may help identify whether the HPV is a type that may cause pre-cancerous changes. However, HPV DNA tests are not widely available in the UK.

Diagnosis of HPV in men

In men, high-risk HPVs do not cause symptoms and are often hard to diagnose.

Some people who are known to be at a high risk of having anal HPV and of developing anal cancer may be offered an anal smear. Men who have anal sex are more likely to have anal HPV. They also have a higher risk of developing anal cancer. Both men and women who have HIV have an even bigger risk of anal HPV and anal cancer, regardless of their sexual orientation.

The anal smear involves collecting cells from the anal area using a special wipe. An HPV DNA test can also sometimes be done during an anal smear. This test looks at the genetic make-up (DNA) of the HPV in the cells and can detect which type of HPV is present. This may help identify whether the HPV is a type that may cause pre-cancerous changes.

Anal smears are not widely available in the UK. If you are in a high-risk group and more likely to have anal HPV, you can talk to your GP or a doctor at your local sexual health clinic about whether you should have regular anal smears.

Many people feel concerned when they are first told they have HPV and worry that they may develop cancer. You may find the treatments embarrassing, and you may have many different emotions, including anxiety and fear. These are all normal reactions and are part of the process many people go through in trying to come to terms with their condition.

Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, while others prefer to seek help from people outside their situation. Others may prefer to keep their feelings to themselves. There is no right or wrong way of coping, but help is available if you need it. You may wish to contact our cancer support specialists for information about counselling and support in your area.