Human papillomavirus (HPV) is a very common sexually transmitted infection that can cause health problems like genital warts and certain cancers. There are over 100 types of HPV, with around 13 high-risk types that can lead to cancer. HPV often has no symptoms, so many people don’t realize they have it. Fortunately, most HPV infections go away on their own within 1-2 years.
What is high risk HPV?
High risk HPV types include HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68. These types are more likely to lead to cancer than other HPV types:
- HPV 16 and 18 account for around 70% of cervical cancers
- HPV 16 also causes most cancers of the anus, penis, vagina, vulva, and back of the throat
- Other high risk types like 31, 33, 45, 52 and 58 can also lead to cancer but less commonly
High risk HPV can stay dormant in your body for months or even years without symptoms. But over time, it can cause cell changes that develop into cancer. HPV-related cancers often take 10-20 years to develop after initial HPV infection.
How long does it take for a high risk HPV infection to go away?
Most people naturally clear a high risk HPV infection within 1-2 years. According to the CDC:
- About 90% of new HPV infections, including high risk types, go away within 2 years
- About 70% clear within 1 year
- In 5% of people, HPV persists longer than 2 years and may cause cancer
So even with high risk HPV types, your immune system will usually get rid of the infection on its own over time before it leads to cancer. But there’s no way to know for sure if or when your body will clear the virus.
Factors affecting how long HPV lasts
Certain factors can affect how long it takes an HPV infection to go away:
- Age – HPV is more likely to persist and progress to cancer in people over 30. The immune system has a harder time clearing HPV as you get older.
- Overall health – People with weakened immune systems from HIV, organ transplant medications, chemotherapy, etc. have a harder time clearing HPV.
- HPV type – Some high risk types like HPV 16 may persist longer than other types.
- HPV viral load – Higher amounts of the virus can take longer to clear.
- Smoking – Smoking makes it harder for the body to clear HPV infections.
Can high risk HPV go away without treatment?
Yes, most HPV infections resolve spontaneously within 1-2 years. Early cell changes caused by high risk HPV can also sometimes go away without treatment.
According to guidelines from the American Society for Colposcopy and Cervical Pathology (ASCCP):
- Up to 60% of mild cervical dysplasia (CIN 1) regresses back to normal within 2 years
- Over 40% of moderate dysplasia (CIN 2) regresses without treatment
- Even 33% of more severe dysplasia (CIN 3) may regress back to normal
So even higher grade cervical changes can sometimes resolve without treatment as the HPV infection clears. But more severe dysplasia is less likely to regress and has a higher risk of progressing to cancer. That’s why managing abnormal cell changes is important.
How to help clear high risk HPV infections
There’s no treatment that gets rid of HPV completely. But there are some things you can do that may help clear HPV infections faster:
- Get the HPV vaccine if you haven’t already – It can prevent future infections with HPV types you don’t have
- Don’t smoke and limit alcohol – This helps your immune system
- Eat a healthy diet high in fruits/veggies – A healthy diet supports immune function
- Manage stress and get enough sleep – Keeping stress low and getting 7-8 hours of sleep per night enables your body to clear infections
- Consider supplements like vitamin C, zinc, and folate – Some research shows these supplements support immune health
- Ask your doctor about topical treatments – Prescription creams with zinc sulfate or imiquimod may accelerate HPV clearance
Your doctor can monitor cell changes caused by HPV over time to determine if they persist or regress. Treatment options like cryotherapy, LEEP, or cone biopsy are available if cell changes remain or progress.
How to monitor high risk HPV
Monitoring is important for managing high risk HPV infections and abnormal cervical cells. Guidelines recommend repeat testing at certain intervals to check if an infection or cervical changes persist, regress, or progress.
HPV DNA testing
HPV DNA tests check for high risk HPV types in cervical cells. At minimum, guidelines recommend repeat testing in 12 months after an initial positive HPV test. If high risk HPV is still detected after 12 months, testing every 3 years is recommended until HPV clears or cervical changes are found.
Pap tests
Pap tests check for any cervical cell changes, which may be caused by high risk HPV. Recommended Pap test follow-up intervals after abnormal results are:
| Pap test result | Repeat Pap test |
| Normal | Every 3 years |
| ASC-US or LSIL | In 12 months |
| HSIL | In 6-12 months |
| ASC-H | In 6-12 months or colposcopy |
| HSIL or worse | Colposcopy |
Pap tests may be done more frequently in some cases based on factors like age, health issues, and HPV status. Colposcopy with biopsy is recommended for more severe findings to check for cervical precancer or cancer.
HPV genotyping
This test identifies the specific high risk HPV type if HPV is detected on co-testing. Knowing the type provides more information on cancer risk and helps guide management.
HPV E6/E7 mRNA testing
This advanced test looks for overexpression of E6/E7 viral oncogenes that can lead to cell transformation. Persistently elevated E6/E7 levels indicate higher risk of progression to cancer.
Is high risk HPV forever?
An initial high risk HPV infection usually clears within 1-2 years as your immune system is able to overcome it over time. But in some people, HPV can linger in the body for many years or even decades after exposure before causing cellular changes that may progress to cancer.
According to some estimates:
- At least 25% of HPV infections persist longer than 2 years
- About 10-20% remain detectable after 5 years
- 5-10% after 10 years
- Only 5% have true lifelong infections
So while most high risk HPV clears spontaneously, some infections do persist. There’s no way to know if HPV will clear or turn into cancer for a given person. That’s why continued monitoring and cancer screening is essential.
Some key points about persistent high risk HPV:
- Older age and weakened immunity make it harder to clear HPV
- Having HPV for many years increases cancer risk
- HPV can remain dormant in basal cells and reactivate later
- Having one HPV type does not prevent getting other types
- Using condoms reduces but does not eliminate HPV risk
Thankfully, even infections lasting 5-10 years or longer rarely progress to cancer if monitored appropriately. While occasional “missed” infections are possible, diligent screening/management makes HPV-related cancers highly preventable.
Can your body eventually clear high risk HPV?
In most cases, yes. As mentioned earlier, about 90% of all HPV infections go away within two years as the immune system clears the virus.
However, high risk HPV is harder to clear than low risk types. According to some estimates:
- About 60-70% of high risk infections clear within 1 year
- About 80% clear within 2 years
- 90% eventually clear within 5 years
So while it may take longer for high risk HPV to clear compared to low risk types, the majority of infections do eventually resolve. But the lingering 10-20% of infections remaining after 2 years have a higher chance of leading to cancer. Again, it’s impossible to predict clearance times for individual infections.
Why can high risk HPV persist longer? A few reasons:
- E6/E7 proteins of high risk HPV disrupt the cell cycle and p53/pRb tumor suppressor pathways more than other types
- High risk types are better able to evade and suppress immune detection
- The virus can “hide” in basal stem cells where immune activity is lower
- Repeated exposure to HPV can also hinder clearance
The bottom line is that while most high risk HPV does eventually clear, infections persisting beyond 2 years have a higher risk of leading to cancer. Careful monitoring and management of any abnormalities is crucial. Getting vaccinated, not smoking, eating healthy, exercising, and managing stress can help maximize HPV clearance.
What happens if high risk HPV doesn’t go away?
For the minority of high risk HPV infections that don’t clear within 2 years, the risk of developing precancer or cancer is higher. Although many HPV cancers take years or decades to develop, some consequences of persistent high risk HPV include:
- Increased risk of cervical precancer (CIN 2 or 3)
- Potential to progress to cervical cancer or other HPV cancers
- Need for additional testing and more frequent monitoring
- Higher likelihood of requiring excisional treatments
- Chance of treatment complications like cervical stenosis
- Rarely, metastatic cervical cancer if undetected and unmanaged
The prevalence of HPV-related precancers and cancers is highest in people with HPV lasting 5-10 years or longer. However, cancer is very preventable with proper screening, monitoring, and treatment as needed.
Some key points about persistent high risk HPV:
- May require multiple excisional treatments over time
- Can recur even after treatment due to viral persistence
- Eventual clearance still possible after many years
- Doesn’t mean cancer is definitely going to develop if monitored
- Cervical cancer is highly preventable with diligent screening
Talk to your doctor about ongoing monitoring recommendations if high risk HPV persists beyond 2 years. Precancer/cancer risks are still low with careful management, even if HPV doesn’t clear.
Conclusion
Most high risk HPV infections clear within 1-2 years as the immune system overcomes the virus over time. But some persist longer, which raises the risk of cervical and other HPV cancers. Monitoring with HPV testing, Pap tests, and potential colposcopy is critical for managing persistent infections and precancerous cell changes. While there’s no cure for HPV, cervical cancer is highly preventable with proper screening and follow-up. Getting vaccinated, not smoking, eating healthy, exercising, and reducing stress can help maximize HPV clearance as well. With diligent surveillance and management as needed, the risk of HPV cancers is low even if the virus doesn’t go away.