HPV: What It Actually Is, What It Does, and What You Can Do About It

"But I've only ever been with my husband."

That sentence, said quietly and often tearfully, is how a great many HPV conversations begin in my clinic. Behind it sits a belief that a positive HPV result is an accusation — of promiscuity, of somebody's infidelity, of having done something wrong.

It is none of those things. HPV is the most common sexually transmitted infection there is, most people who have ever been sexually active encounter it, and the overwhelming majority clear it without ever knowing they had it.

What follows is the whole picture: how it spreads, what it actually does, how the tests work, what a positive result means, and what the vaccine can and cannot do for you.

What is HPV, actually?

Human papillomavirus is a family of over 200 related viruses. They infect skin and the moist linings of the body — the cervix, vagina, vulva, anus, penis, mouth and throat.

Most of them are harmless. A handful are not. The ones we care about clinically split into two groups:

That last point resolves a fear I hear constantly. If you have had genital warts, that is not a cancer risk in itself.

How is HPV transmitted?

Through skin-to-skin contact of the genital area, during vaginal, anal or oral sex — and through close genital contact that does not involve penetration at all.

Several consequences of that fact are worth stating plainly, because they are where the misunderstanding lives:

• Penetrative sex is not required. This is why women who have never had intercourse can still acquire HPV.
• Condoms reduce the risk but do not eliminate it, because the virus can be present on skin a condom does not cover.
• People transmit it without knowing. There are no symptoms in the vast majority of infections, so nobody involved is aware.
• It is not related to hygiene, cleanliness or character. It is a virus, transmitted the way viruses are.

Does a positive test mean my partner has been unfaithful?

No, and I want to be unambiguous about this because I have watched this assumption damage marriages that did not deserve it.

HPV can remain dormant and undetectable for years, sometimes decades, before it is picked up on a test. A positive result today tells us the virus is present now. It tells us nothing reliable about when it was acquired, or from whom.

A woman married for twenty years can test positive for a virus acquired before she met her husband. So can he. There is no test that dates an HPV infection, and anyone who tells you otherwise is mistaken.

What does HPV actually do in the body?

In roughly 90% of cases, nothing at all. Your immune system recognises the virus and clears it, usually within two years. No treatment, no consequences, and you very likely never knew.

The problem is the minority of infections that persist. A high-risk type that stays for years can gradually alter the cells of the cervix. Those altered cells are what a Pap smear detects, and what doctors call CIN or dysplasia. Left unwatched over ten to fifteen years, some of them progress to cancer.

So the sequence is: infection, then persistence, then cell changes, then — only sometimes, and only slowly — cancer. Screening interrupts that sequence in the middle, long before the final step.

HPV also causes cancers beyond the cervix: of the vulva, vagina and anus, of the penis in men, and of the throat and tonsils in both sexes. Cervical cancer is simply the one we screen for, because the cervix is accessible and the precancerous stage is long.

What is an HPV DNA test?

It is a laboratory test that looks for the genetic material of high-risk HPV types in a sample of cervical cells. It answers a different question from the Pap smear.

From your side, all three feel identical. One speculum examination, one small brush, two minutes. The difference is entirely in what the laboratory is asked to do with the sample.

Which test should I have, and how often?

Broadly, and your own doctor may advise differently based on your history:

Our companion guide to Pap smears and cervical screening covers the practicalities — how to prepare, whether it hurts, and what happens next.

My HPV test came back positive. What happens now?

First: this is not a cancer diagnosis, and it is not even close to one. It means a high-risk type of the virus is currently present. Most such infections clear by themselves.

What happens next depends on which type was found and what your cells look like:

• HPV positive, cells normal: usually a repeat test in about a year, to see whether your immune system has cleared it. Many women's have.
• HPV 16 or 18 positive: these carry the highest risk, so a colposcopy is generally advised straight away rather than waiting.
• HPV positive with abnormal cells: colposcopy, to look at the cervix closely and take a small biopsy if needed.

A colposcopy is a magnified examination of the cervix taking ten to fifteen minutes, done at hospital as a day-care appointment. If treatment is needed for higher-grade changes, it is a short procedure that removes the affected area — done long before anything dangerous develops. Our guide to abnormal results and what CIN means covers this in full.

At our clinic we do the Pap smear and the HPV DNA test, explain the result properly, and arrange colposcopy at hospital where it is needed, so the follow-up stays with the same doctor rather than restarting with a stranger.

Can HPV be treated or cured?

There is no medicine, injection or supplement that eliminates HPV. Anything sold to you on that basis is not being honest.

What we treat is what the virus does: genital warts can be removed, and cervical cell changes can be treated. The virus itself is cleared by your own immune system, or it is not.

Two things genuinely influence whether it clears:

• Not smoking. Smoking is consistently associated with persistent HPV infection and with progression of cervical cell changes. If you needed a specific, concrete reason to stop, this is one.
• Immune health. Conditions and medications that suppress immunity make persistence more likely, which is why screening is more frequent for those women.

Can men be tested for HPV?

Not routinely, and this frustrates couples who want a clear answer. There is no approved HPV test for men, and HPV testing is not recommended for screening men at all.

Practically, this means a husband cannot be tested to find out "who gave it to whom" — a question that, as above, has no answer anyway. What men can do is be vaccinated, and be alert to symptoms such as warts or unusual lumps.

Who should have the HPV vaccine, and when?

The vaccine protects against the HPV types that cause most cervical cancer, and against the types that cause most genital warts. It works best before any exposure to the virus, which is why it is given in early adolescence rather than adulthood.

The WHO's recommended schedule:

• Girls aged 9 to 14: one or two doses.
• Aged 15 to 20: one or two doses.
• Aged 21 and over: two doses, six months apart.
• Immunocompromised or living with HIV: a minimum of two doses, and three where possible.

The move to a single dose for younger age groups is relatively recent and surprises people who remember a three-dose course. The evidence supports it.

Should boys be vaccinated too?

There is a strong case for it. HPV causes cancers in men — penile, anal, and of the throat and tonsils — and vaccinating boys also reduces transmission to their future partners.

India's national programme currently targets girls, which is the standard first step for a country beginning HPV vaccination and is where the greatest benefit per dose lies. Vaccination for boys is available privately, and if you have sons as well as daughters it is a reasonable conversation to have rather than assuming the vaccine is a girls-only matter.

I am an adult woman. Is it too late for me?

Not necessarily, and this deserves an honest rather than a promotional answer.

The vaccine gives the most benefit before exposure, so its value does fall with age and with previous exposure. But it does not become useless. You are unlikely to have encountered every type it covers, and it may still protect you against those you have not met. Vaccination is licensed and available for adult women.

What it does not do is treat an infection you already have, or replace screening. If you are an adult considering it, the sensible thing is a proper conversation about your age, history and what you would realistically gain — not a blanket yes or no from an article.

Does HPV affect pregnancy or fertility?

HPV itself does not reduce fertility and does not usually affect a pregnancy. Most women with HPV have entirely normal pregnancies and deliveries.

Two points worth knowing. Genital warts can enlarge in pregnancy because of hormonal changes and increased blood flow, and are usually managed conservatively until after delivery. And treatment for cervical cell changes — not the virus itself — can occasionally affect the cervix in ways that matter in a future pregnancy, which is one reason such treatment is not done casually and is always weighed against the risk of leaving the changes alone.

Screening in pregnancy is a topic in its own right, and if you are pregnant and due a smear, raise it at your antenatal visit rather than skipping it.

Getting tested or vaccinated in Gurugram

Our two clinics — Sector 51 (Mayfield Garden) and Sector 56 — see patients from across Gurugram, Golf Course Road, Golf Course Extension, Sohna Road, the DLF Phases, South Delhi and nearby NCR, 7 days a week including Sundays.

Pap smears, HPV DNA testing and HPV vaccination are all done at the clinic. If a result is abnormal and colposcopy or treatment is needed, that is carried out at hospital and arranged for you, with your results and follow-up staying with the same doctor throughout.

If you are bringing a daughter for vaccination, she is welcome to ask the questions herself — in my experience teenagers ask better questions about this than their parents expect, and they are more likely to complete a course they understand.

You can also book on WhatsApp here or through our contact form. For the wider range of gynaecological care, see our women's health and gynaecology hub.

The bottom line

HPV is the most misunderstood infection in women's health. It is not a moral failing, it is not usually dangerous, and it is not something that happened because of anything you did.

What it is, is the cause of a cancer we now have three separate ways to stop: a vaccine that prevents the infection, a test that finds the virus before it does damage, and a treatment for cell changes that works long before anything becomes dangerous. Very few serious diseases give us three chances.

If you have a fourteen-year-old daughter, get her vaccinated — it is free. If you are thirty or over and have never had an HPV test, have one. And if you have tested positive, come and have it explained properly, rather than reading forum posts at two in the morning and assuming the worst about your marriage.