Language selection

Government of Canada / Gouvernement du Canada

Search

Human papillomavirus (HPV): For health professionals

On this page

Key information

Human papillomaviruses, or HPV, are the most common sexually transmitted infections in Canada and around the world. Most HPV infections are asymptomatic, and resolve on their own within a couple of years without treatment. HPV infections are responsible for:

Transmission can occur with any close skin-to-skin contact, including through receptive and penetrative vaginal, anal and oral sex, and may be transmitted on fomites.

Some types of HPV can be prevented by vaccination.

Epidemiology

Human papillomaviruses belong to the family Papillomaviridae and are small, double-stranded DNA viruses that infect the epithelium. Over 200 HPV genotypes have been identified.

Most HPV types infect the cutaneous epithelium and cause common skin warts. Around 40 of them infect the genital area, mouth and throat. These are classified into high risk types that can cause cancers, and low-risk types that cause warts.

Persistent infection with a high-risk HPV type (e.g., HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) is the major cause of cervical cancer and can cause other HPV-related cancers, such as cancers of the:

HPV causes nearly:

The degree of oncogenic risk can vary by HPV type, with HPV16 and HPV18 being the most oncogenic. Together, HPV16 and HPV18 are responsible for about 70% of all cases of cervical cancer around the world.

Approximately 1,550 new cases of cervical cancer and 400 deaths were estimated for Canada for 2023.

There has been a steady increase in the proportion of oropharyngeal cancers attributed to HPV infections in Canada in recent decades, making oropharyngeal cancer the most frequent HPV-associated cancer in Canada.

Low-risk HPV types can cause anogenital warts. Low-risk HPV types 6 and 11 cause more than 90% of anogenital warts.

Reservoir

Humans are the only known reservoir of HPV.

Incubation period

For low-risk types, the incubation period for anogenital warts is 3 weeks to 8 months.

For high-risk types, the interval between the acquisition of HPV infection and progression to invasive carcinoma is usually 15 to 20 years or longer.

HPV infections

Note on language relating to sex and gender

The Public Health Agency of Canada (PHAC) acknowledges the diverse gender identities of individuals and understands the challenges of incorporating inclusive language when source material, such as published studies, do not distinguish between sex or gender. In the context of HPV, both elements of biological sex and gender intersect notably with risk, prevention, and outcomes. For the purpose of this page, PHAC will use the terms reported by study researchers to ensure the cited literature is reported accurately. PHAC is committed to actively promoting inclusive language in its web content, and to accurately and thoughtfully reflect the role of sex and gender as determinants of health. Content will adapt to evolving language standards in conveying scientific and medical information.

HPV is estimated to be the most common sexually transmitted infection in Canada and around the world.

A U.S. study estimated that the average lifetime probability of acquiring HPV before HPV vaccination became available in the country among those with at least 1 opposite sex partner to be:

A 2023 systematic review and meta-analysis assessed the prevalence of HPV infection detected in genital specimens among the general male population in 35 countries before the onset of widespread HPV sex-neutral vaccination. It found that the global pooled prevalence was:

Anogenital warts

Anogenital warts are common and are associated with significant healthcare utilization and adverse psychological and sexual effects.

Learn more:

Clinical manifestations

HPV infections are often sub-clinical and asymptomatic, and more than 90% resolve within 2 years even without treatment.

Pre-cancerous cervical lesions

Some individuals with an HPV infection may not clear their infection. Persistent infection with high-risk HPV types is the major cause of cervical cancer.

Anogenital warts

Genital warts can appear either individually or in clusters and are commonly found in the genital or anal region, including the:

Additionally, they may develop on the internal surfaces of the vagina and anus. They can vary in size, ranging from small (less than 5 mm in diameter) to large masses that spread throughout the genital or anal region. Genital warts can be flesh-coloured, brown or pink. Occasionally, they may bleed spontaneously.

Genital warts may result in itching, redness, or discomfort. They can cause significant emotional distress.

Learn more:

Recurrent respiratory papillomatosis

HPV6, HPV11 and other types can result in a rare but serious condition known as recurrent respiratory papillomatosis (RRP), where warts develop on various parts of the respiratory tract, including the larynx. This condition has a low incidence rate of less than 4 cases per 100,000 individuals. RRP is classified into 2 forms:

  1. juvenile onset RRP
  2. adult onset RRP

Juvenile onset RRP is caused by the vertical transmission of HPV, and usually manifests during infancy.

Adult onset RRP is thought to be transmitted horizontally through sexual activity and typically emerges in young adulthood, around the third decade of life.

RRP can result in considerable morbidity, requiring multiple surgical interventions in some cases. In rare cases, lesions can become malignant.

Transmission

Transmission can occur with any close skin-to-skin contact, including through receptive and penetrative vaginal, anal and oral sex.

HPV may also be transmitted on fomites such as sex toys.

Co-infection with multiple HPV types occurs. Immunity against one HPV type does not provide protection against infection with other HPV types. Re-infection with the same HPV type is also possible.

Vertical transmission of HPV is possible but clinical disease in infants and children is uncommon. Vertical transmission of HPV types 6 and 11 can rarely result in juvenile onset RRP.

Risk factors

Anyone who is sexually active is at risk of HPV infections, regardless of their sex, gender identity or sexual orientation. People who have received the HPV vaccine are at much lower risk of HPV infection.

The risk factors for the progression from infection to HPV-associated cancers are not well understood.

Learn more:

Diagnosis and laboratory testing

Visual inspection is the usual means of diagnosing anogenital warts.

The goal of treating anogenital warts are removal and symptom relief. Treatment options for anogenital warts may include:

Learn more:

Screening to detect precancerous cervical lesions

Screening offers protective benefits and is associated with a reduction in the incidence of cervical cancer and cervical cancer mortality.

Screening approaches to cervical cancer prevention include:

Learn more:

Screening for anal cancer in those at higher risk

There is no consensus about the use of screening options for anal cancer in those at higher risk, including:

Screening options can include:

Access to anal cytology and high-resolution anoscopy may vary by jurisdiction. Consult local practice or consensus guidelines for recommendations about screening and follow-up of abnormal results.

Learn more:

Prevention and control

HPV vaccination is the most effective way to prevent HPV infections and their consequences. Along with cervical cancer screening, vaccination can contribute to the elimination of HPV-related cancers in Canada.

A publicly funded HPV vaccine program is available in every province and territory in Canada. Individuals who are not included in their jurisdiction's publicly funded HPV vaccine program may still access HPV vaccine through private purchase.

The National Advisory Committee on Immunization (NACI) recommends the 9vHPV vaccine as it provides protection against the greatest number of HPV types and associated diseases.

The 9vHPV vaccine provides protection against 7 high-risk HPV types, accounting for 90% of all cervical cancers. Among these, HPV16 and HPV18 are responsible for over 70% of cases. 9vHPV vaccine also protects against 2 low-risk HPV types (HPV6 and HPV11), which cause about 90% of anogenital warts and can also cause a rare but serious condition known as RRP.

In most provinces and territories, the HPV vaccine is offered in schools to adolescents between the ages of 9 and 14 years.

NACI recommends a 1 or 2 dose schedule depending on the recipient's age and other factors.

The 9vHPV vaccine is authorized for use in Canada for individuals aged 9 to 45 years. The vaccine is best given at a younger age before exposure to HPV. However, those who are already sexually active are still expected to derive benefit.

Some provinces and territories extend the eligibility period for publicly funded vaccines until the completion of high school and beyond high school for some adults.

Learn more:

HPV vaccine effectiveness

Note on language relating to sex and gender

The Public Health Agency of Canada (PHAC) acknowledges the diverse gender identities of individuals and understands the challenges of incorporating inclusive language when source material, such as published studies, do not distinguish between sex or gender. In the context of HPV, both elements of biological sex and gender intersect notably with risk, prevention, and outcomes. For the purpose of this page, PHAC will use the terms reported by study researchers to ensure the cited literature is reported accurately. PHAC is committed to actively promoting inclusive language in its web content, and to accurately and thoughtfully reflect the role of sex and gender as determinants of health. Content will adapt to evolving language standards in conveying scientific and medical information.

HPV vaccine is highly effective at preventing HPV vaccine type-related infection, and therefore at preventing cervical cancer and anogenital warts.

Clinical trials have shown an efficacy of more than 90% against HPV infections, anogenital warts and precancerous lesions caused by HPV types included in the vaccine.

In recent years, the incidence of anogenital warts have decreased markedly in countries where HPV vaccination programs have been introduced. These findings have been affirmed in the Canadian context. A systematic review of studies published between September 1, 2006, and September 1, 2016, found that the incidence of anogenital warts decreased by up to 45% in cohorts eligible for publicly funded quadrivalent HPV vaccines.

Canada has set the goal of eliminating cervical cancer by 2040 by achieving a 90% uptake of a complete series of HPV vaccine in 17-year-olds by 2025.

Results from the 2021 childhood National Immunization Coverage Survey indicate that among 14-year-olds, HPV vaccine coverage has increased significantly since 2019:

HPV coverage in 2021 has not changed for females:

However, uptake has increased among 14-year-old males, further closing the gap in coverage between males and females:

Learn more:

HPV vaccine safety

HPV vaccines have a good safety profile and are well tolerated.

Common local reactions following vaccination with HPV vaccines may include:

The majority of systemic reactions of HPV vaccines are mild and temporary and include:

Rare cases of anaphylaxis have been reported with the HPV vaccine. The extensive existing body of evidence has not found any association between HPV vaccination and other serious adverse events.

Reporting of adverse events following immunization is important to inform vaccine safety surveillance and is mandatory in all provinces and territories. To enable the detection of safety concerns, reports from across the country are compiled and analyzed, along with:

Health care providers should report adverse events following immunization to the local public health authority.

Learn more:

Condom use

Condoms do not eliminate the risk of HPV infections because these infections may be transmitted through skin-to-skin exposure of areas not covered by the condom. However, consistent and correct use of internal or external condoms and dental dams can reduce the transmission of HPV.

Condoms provide protection against many other sexually transmitted and blood-borne infections (STBBI) and against unintended pregnancy.

Related links

Page details

2025-02-14