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HPV Explained · Reviewed by CION Oncologists · NABH Accredited
High-Risk HPV Types — What 16, 18 and the Others Mean
If a report has named a type number, the useful thing to know first is that “high risk” describes the virus, not you. It is a laboratory classification of which HPV types are capable of driving cervical cell change over many years — nothing more. Twelve types carry that label. Two of them, HPV 16 and HPV 18, account for the majority of cervical cancers worldwide, which is why laboratories usually report them by name and group the rest together. Most infections with any of these types are still cleared by the immune system without treatment. This page sets out the list, what makes a type high risk, and what a positive result actually triggers at CION's 7 NABH-accredited Hyderabad locations.
- Twelve types are classed as high risk — 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 and 59
- 16 and 18 dominate — together they cause around 70% of cervical cancers worldwide, per WHO
- High risk is not the same as high probability — most of these infections still clear on their own
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What Makes an HPV Type “High Risk”
There are more than two hundred HPV types, and around forty of them infect the genital tract. They are numbered in the order they were identified, which is why the numbers look arbitrary — 16 is not worse than 18 because it is smaller. The difference between the high-risk and low-risk groups is what the virus does once it is inside a cell.
- Low-risk types make the cell multiply, and stop there. The result is a benign growth — a wart. Untidy, sometimes uncomfortable, but the cell's own repair and self-destruct machinery still works.
- High-risk types disable that machinery. They produce two proteins, usually called E6 and E7, which switch off the cell's internal brakes on division and its ability to retire damaged cells. Errors then accumulate generation after generation.
- Time is the missing ingredient. None of this matters if the immune system clears the infection, which is what usually happens. Damage accumulates only while a high-risk type is still present, year after year — see how HPV leads to cervical cancer for the full sequence.
So “high risk” is a statement about capability, not about your odds. A high-risk type is one that can cause cancer if it persists for many years and nothing is done in the interim. It is a reason for follow-up on a schedule, and it is emphatically not a diagnosis.
Did You Know? The list of high-risk types is not a matter of opinion. The International Agency for Research on Cancer — the WHO body that classifies carcinogens — evaluated the HPV family and classified twelve types as carcinogenic to humans: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 and 59. Every high-risk HPV test in routine use is built around that list. Sources: IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Biological Agents; WHO cervical cancer guidance.
The Types, Grouped by What They Do
Four groups worth telling apart. Only the first two appear on a cervical screening report at all.
Highest risk
HPV 16 and HPV 18
The two types that matter most. WHO attributes around 70% of cervical cancers worldwide to these two between them. HPV 16 is the most common in squamous cell cancers; HPV 18 is over-represented in adenocarcinoma, which arises higher in the cervical canal and is harder for a smear to reach. Both are reported by name.
High risk
31, 33, 35, 39, 45, 51, 52, 56, 58, 59
The other ten carcinogenic types. Individually each accounts for a small share of cervical cancers, but together they are a meaningful minority, and 45 in particular behaves aggressively. Most laboratories report these as a single pooled “other high-risk types” result rather than naming which one.
Low risk
The wart-causing types
A separate group that causes genital warts and other benign changes. They are not on the carcinogenic list, are not looked for by a cervical screening test, and having had them says nothing about your cancer risk. Warts versus the cancer types covers the distinction.
Not relevant here
The skin types
Most of the two hundred-plus HPV types live on ordinary skin and cause common warts and verrucas on hands and feet. They have nothing to do with the cervix, are not sexually transmitted, and are not what a cervical HPV test detects.
A report that says “high-risk HPV detected” without a number means one of the pooled ten. It is followed up in the same way, on the same schedule.
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A Type Number Is Not a Diagnosis
What matters is what the cervix looks like and what the follow-up schedule says. A woman doctor is available on request at every CION location, with same-week appointments across Hyderabad.
Why 16 and 18 Are Reported by Name
This is called partial genotyping, and it exists for a practical reason: knowing which high-risk type is present changes what a clinician does next, even when everything else about the result is identical.
| What the report says | What it means | What usually follows |
|---|---|---|
| High-risk HPV not detected | No carcinogenic type found in this sample | Return to the routine screening interval |
| HPV 16 detected | The type with the highest risk of progression is present | Referral for a closer look at the cervix, usually without waiting for a repeat test |
| HPV 18 detected | The type most associated with adenocarcinoma, which sits higher in the canal | Referral for a closer look, for the same reason |
| Other high-risk type detected | One of the pooled ten, not individually named | Often a repeat test after an interval, or colposcopy if the cell result is also abnormal |
| High-risk HPV detected, cells normal | Virus present, no cell change yet — a common and expected combination | Surveillance. Most such infections clear before anything develops |
Note that no row in this table produces a cancer diagnosis, and none of them produces treatment for the virus itself. What is being managed is a schedule. The full walkthrough of a positive result, including what a colposcopy involves and when it is offered, is in what a positive HPV test result means.
Why the HPV test found this at all: a Pap smear looks at whether cervical cells have already changed, while an HPV test looks for the virus that causes the change — years earlier. WHO now recommends HPV DNA testing as the preferred primary screening method for exactly that reason. Which test you should have, at what age and how often, is set out in HPV DNA test vs Pap smear.
What Actually Changes the Risk from Here
Once a high-risk type has been identified, the type number is fixed. Three other things are not, and they matter more than which of the twelve you have.
1. Whether the infection persists
This is the single biggest determinant, and it is only visible over time. An infection found once and gone at the next test carries no residual risk. The same type still present two or three years later is the situation that follow-up exists to catch. Repeat testing is not the clinic being cautious — it is the only way to distinguish the two.
2. Whether you smoke
Smoking is the best-established modifiable factor in HPV persistence and progression. Tobacco by-products reach the cervical mucus and appear to impair the local immune response that would otherwise clear the infection. It is the one item on this page that a woman can change herself, and the effect is on the part of the process that matters most.
3. Whether your immune system is suppressed
HIV infection, immunosuppressive therapy after a transplant, and long-term steroid or immune-modulating treatment all reduce the rate at which HPV is cleared and shorten the interval over which change can develop. Screening schedules for women in these groups are deliberately more frequent, and that recommendation should be followed rather than negotiated.
4. Whether you attend the follow-up
The most consequential variable in the whole sequence is not biological. Precancer is removed completely in a single outpatient procedure when it is found; the cases that become invasive cancer are overwhelmingly those where a result was never followed up. If a repeat test or a colposcopy has been recommended to you, that appointment is the intervention.
If a cervical cancer has already been diagnosed, HPV type becomes one detail in a much larger assessment — the cervical cancer overview hub explains the diagnostic pathway, and the modalities and how they are chosen are set out on our cervical cancer treatment in Hyderabad page. At CION every confirmed diagnosis goes to a multidisciplinary tumour board before a plan is proposed, in line with NCCN, FIGO and ESMO guidance.
Did You Know? HPV 18 is disproportionately associated with adenocarcinoma of the cervix — a cancer that begins in the glandular cells higher up the cervical canal, where a smear brush reaches less reliably than it does the outer surface. This is one of the clearest arguments for HPV-based screening over cytology alone: the test looks for the virus regardless of where in the canal the change is developing. Sources: WHO cervical cancer screening guidance; IARC Monographs, Biological Agents.
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Most women with a high-risk type never develop anything, because they were tested and then followed up. Both halves of that sentence matter.
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Common questions
High-Risk HPV Types — Frequently Asked Questions
Is HPV 16 more dangerous than the other high-risk types?
It carries the highest risk of progression of the twelve, which is why laboratories name it rather than pooling it. HPV 16 is the type most often found in squamous cell cervical cancer and is more likely than the others to persist rather than clear. HPV 18 is named alongside it because it is over-represented in adenocarcinoma, which develops higher in the cervical canal where a smear samples less reliably. That said, the practical difference is in how quickly you are referred for a closer look, not in whether you will develop cancer. Most women who test positive for HPV 16 do not.
My HPV test found a high-risk type but my Pap result was normal. What does that mean?
It means the virus is present but has not yet produced any visible change in the cells — which is a common and entirely expected combination, and a much better position than the reverse. The virus arrives first; cell change, if it happens at all, follows years later. Most of these infections are cleared by the immune system before anything develops. What this result triggers is surveillance: a repeat test after a defined interval to see whether the same type is still there, or an earlier colposcopy if the type found was 16 or 18. It is a schedule, not a diagnosis.
Why does my report name the type for 16 and 18 but not for the others?
This is called partial genotyping, and it reflects how the result is used. Knowing that HPV 16 or HPV 18 is present changes the immediate next step, because both carry a higher risk of progression and both are common enough to justify separate reporting. For the remaining ten carcinogenic types, the next step is the same whichever one it is, so naming them individually would not change management and most laboratories report them as a single pooled result. If you want to know which of the ten it is, ask — some laboratories can report full genotyping on request.
Can I be infected with more than one high-risk HPV type at the same time?
Yes. Infection with one type gives no protection against the others, and multiple simultaneous infections are not unusual, particularly in younger women. A report may therefore show HPV 16 alongside a pooled positive for other high-risk types. In practice, management follows the highest-risk type present, so a result naming 16 or 18 is acted on as such regardless of what else is detected. Clearing one type also does not confer immunity to the rest, which is why screening continues at the recommended interval even after a previous infection has resolved.
Are the high-risk types the same ones that cause genital warts?
No, and this is one of the most common and most unnecessary worries. Genital warts are caused by low-risk HPV types that are not on the carcinogenic list at all, and a cervical HPV screening test does not even look for them. Having had warts does not mean you have been exposed to a high-risk type, and never having had warts does not mean you have not — the high-risk types produce nothing visible whatsoever. The two groups are related viruses with entirely different behaviour, and a history of one says nothing useful about the other.
Medical disclaimer: This page is general health information, reviewed by a CION oncologist. It explains how HPV types are classified and cannot interpret your individual report or set your follow-up interval. Take any HPV or Pap result to a clinician who can read it alongside your history, and attend the follow-up you are given.