Prior to the 1970s, researchers widely believed cervical cancer was caused by the herpes simplex virus.

That understanding changed when German virologist Harald zur Hausen demonstrated that DNA from human papillomavirus, or HPV, was incorporated into the host-cell genome of people with cervical cancer.

He later identified HPV types 16 and 18 as particularly high-risk strains. Continued research proved HPV to be the culprit behind penile, vulvar, vaginal and oropharyngeal cancers as well. Zur Hausen's discoveries paved the way for the development of HPV vaccines, making HPV immunization one of only two vaccines that prevent cancer, alongside the hepatitis B vaccine.

Contrary to popular belief, HPV transmission is not exclusively sexual. Nonsexual transmission routes include vertical transmission from mother to child, autoinoculation through hand-to-genital or environmental contact and horizontal transmission between anogenital and cervical sites.

A 2012 longitudinal study published in The Journal of Infectious Diseases detected HPV in 45.5 percent of adolescent females before their first vaginal intercourse. Another 2016 prospective study published in the Journal of Pediatric and Adolescent Gynecology identified genital HPV in 34.5 percent of prepubertal children, further supporting nonsexual transmission pathways.

Clinical Infectious Diseases published an article in 2013 documenting evidence of vertical transmission: the detection of HPV DNA in placental tissue, amniotic fluid and newborns.

Several HPV genotypes are considered oncogenic. The National Cancer Institute estimates that HPV types 16 and 18 account for about 70 percent of cervical cancers.

A 2023 JAMA review reported that nearly all cervical cancers worldwide are caused by persistent infection with one of 13 carcinogenic HPV genotypes. According to that review, vaccination between ages 9 and 12 is expected to prevent more than 90 percent of cervical precancers and cancers.

The U.S. Food and Drug Administration approved the first HPV vaccine in 2006. Three HPV vaccines have since been licensed, though only the nine-valent recombinant vaccine, Gardasil, is currently used in the United States. The Centers for Disease Control and Prevention recommends HPV vaccination for all individuals ages 9 to 26, with vaccination starting as early as age 9 to ensure protection before exposure.

Adults ages 27 to 45 may also be vaccinated based on shared clinical decision-making. A two-dose series is recommended for those who begin vaccination before age 15, while a three-dose series is recommended for those who start at age 15 or older. The World Health Organization has endorsed a single-dose schedule to expand global access and coverage.

Although HPV vaccination significantly reduces cancer risk, routine cervical cancer screening remains essential because the vaccine does not protect against all oncogenic HPV types. The U.S. Preventive Services Task Force recommends cervical cancer screening every three years with cytology alone beginning at age 21.

At age 30, patients may switch to primary high-risk HPV testing alone or co-testing every five years if results are negative. The American Cancer Society recommends starting screening at age 25 using primary HPV testing every three years.

HPV self-collection testing represents a major advance in screening accessibility. The FDA approved HPV self-testing in May 2024, followed by updated clinical guidance from the American Society for Colposcopy and Cervical Pathology in February 2025.

Self-testing may benefit patients who face barriers to traditional pelvic examinations, including pain, prior trauma, anxiety, cultural or religious concerns or limited access to care.

Self-collection is not recommended for individuals with a history of cervical cancer, high-grade dysplasia, immunosuppression, HIV infection, solid organ or stem cell transplantation or in utero exposure to diethylstilbestrol. These patients should continue clinician-collected screening.

At Prism Family Medicine, staff take special care to support patients with histories of sexual trauma or vaginismus to ensure cervical cancer screening is conducted with the least possible distress.

Patients who do not qualify for HPV self-testing are encouraged to schedule annual visits to discuss individualized screening strategies and preventive care options.