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Introduction
Human papillomavirus (HPV) is one of the most common viral infections globally and a major contributor to preventable disease and cancer. It is primarily transmitted through skin-to-skin contact during sexual activity, and it is estimated that up to 80–90% of sexually active individuals will acquire HPV at some point in their lives 1.
Virology and Classification
HPV is a non-enveloped, double-stranded DNA virus belonging to the Papillomaviridae family. More than 200 genotypes have been identified and are broadly classified into low-risk and high-risk types based on oncogenic potential 2,3.
Low-risk HPV types, such as HPV 6 and 11, are associated with benign conditions including genital warts. In contrast, high-risk types, particularly HPV 16 and 18, are responsible for the majority of HPV-related cancers 3. Persistent infection with these oncogenic strains is a necessary cause of cervical cancer and contributes to a range of anogenital and oropharyngeal malignancies 3.
Epidemiology
HPV infection is highly prevalent worldwide and represents a substantial public health burden. Globally, HPV is responsible for approximately 5% of all cancers 3. In Australia, prior to the introduction of vaccination programs, HPV infection rates were high among young adults; however, national immunisation efforts have significantly reduced the prevalence of vaccine-covered strains 4.
Population-level data demonstrate marked declines in genital warts and high-grade cervical abnormalities among vaccinated cohorts, highlighting the effectiveness of these interventions 4.
Transmission
HPV is transmitted primarily through direct contact with infected skin or mucosal surfaces. This most commonly occurs during vaginal, anal, or oral sexual activity, although penetration is not required for transmission 2. The virus can be spread even when an infected individual is asymptomatic 1.
Vertical transmission from mother to infant during childbirth is rare but has been documented 2. The high transmissibility and often silent clinical course make HPV difficult to control without structured public health measures.
Pathogenesis
In most individuals, HPV infection is cleared naturally by the immune system within one to two years 2. However, persistent infection with high-risk HPV types can lead to cellular transformation and cancer development.
The pathogenesis of HPV-related malignancy involves viral oncogenes (E6 and E7), which disrupt normal cell cycle regulation by inactivating tumour suppressor proteins 3. This results in uncontrolled cellular proliferation, genomic instability, and eventual malignant transformation.
The progression from infection to cancer is typically slow, often occurring over decades, providing a critical window for early detection and intervention 3.
Clinical Manifestations
HPV infection is commonly asymptomatic. When clinical disease occurs, manifestations vary depending on the viral type.
Low-risk HPV types may cause genital warts (condylomata acuminata), which are benign but may cause discomfort and psychosocial distress 2. High-risk HPV types are associated with precancerous lesions and invasive cancers, including cervical, anal, oropharyngeal, penile, vulvar, and vaginal cancers 3.
Prevention
Vaccination
Vaccination is the most effective strategy for preventing HPV infection and its complications. In Australia, the nonavalent HPV vaccine (Gardasil 9) is provided through the National Immunisation Program and protects against nine HPV types 4, 5.
The vaccine is routinely administered to adolescents prior to sexual debut. High vaccination coverage has resulted in significant reductions in HPV prevalence, genital warts, and cervical abnormalities 4, 5.
Screening
The National Cervical Screening Program is central to HPV-related cancer prevention in Australia. It utilises primary HPV DNA testing every five years for individuals aged 25–74 years 5.
This method allows for earlier detection of high-risk HPV infections before cellular abnormalities develop, enabling timely clinical management 5. Screening remains essential even among vaccinated individuals.
Safe Practices
Barrier protection, such as condom use, can reduce HPV transmission but does not eliminate risk due to skin-to-skin spread 2. Public health strategies therefore prioritise vaccination and screening.
Management
There is currently no antiviral treatment that eradicates HPV infection. Management focuses on treating clinical manifestations and preventing complications.
Genital warts may be treated with topical therapies, cryotherapy, or surgical removal 2. Precancerous lesions require monitoring or excision, while HPV-related cancers are managed multidisciplinary approaches including surgery, chemotherapy, and radiotherapy 3.
Public Health Significance
HPV remains a leading cause of preventable cancer globally. Australia is recognised as a global leader in HPV prevention and control due to its comprehensive vaccination and screening programs. These initiatives have placed the country on a trajectory toward eliminating cervical cancer as a public health problem 4, 5.
References
- World Health Organization. Human papillomavirus (HPV) and cervical cancer [Internet]. Geneva: WHO; 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
- Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook: HPV [Internet]. Australian Government; 2026. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/human-papillomavirus-hpv
- Cancer Council Australia. Human papillomavirus (HPV) information [Internet]. Sydney: Cancer Council Australia; 2024. Available from: https://www.cancer.org.au/cancer-information/causes-and-prevention/what-is-hpv
- Department of Health Disability and Aging. HPV (human papillomavirus) vaccine [Internet]. Canberra: Australian Government; 2025. Available from: https://www.health.gov.au/topics/immunisation/vaccines/human-papillomavirus-hpv-immunisation-service?language=en
- Department of Health Disability and Aging. National Cervical Screening Program [Internet]. Canberra: Australian Government; 2024. Available from: https://www.health.gov.au/our-work/national-cervical-screening-program
PUBLISHED 30 APRIL 2026