IPVS Consensus Statement on the Natural History of Cervical HPV Infection

Marc D Ryser; Ignacio G Bravo; Nicole G Campos; Anne Hammer; Anne F Rositch; Patti E Gravitt; IPVS Working Group on Cervical HPV Latency; IPVS policy committee

doi:10.1093/infdis/jiaf574

IPVS Consensus Statement on the Natural History of Cervical HPV Infection

J Infect Dis. 2025 Nov 14:jiaf574. doi: 10.1093/infdis/jiaf574. Online ahead of print.

Authors

Marc D Ryser^{1

2}, Ignacio G Bravo³, Nicole G Campos⁴, Anne Hammer^{5

6}, Anne F Rositch⁷, Patti E Gravitt^{8

9}; IPVS Working Group on Cervical HPV Latency; IPVS policy committee

Collaborators

IPVS Working Group on Cervical HPV Latency:
Clare Gilham, Anna-Barbara Moscicki, Rachel L Winer, Margaret Stanley, John Doorbar, Bettie M Steinberg, Samuel Alizon, Andrew Brouwer, Emily Burger, Talía Malagón, Cari Van Schalkwyk, Marc Steben, Rebecca Perkins, Neerja Bhatla, Suzanne Garland
IPVS policy committee:
Suzanne Garland, Julia Brotherton, Kimon Chatzistamatiou, Sarah Feldman, Andreas M Kaufmann, Anna-Barbara Moscicki, Margaret Stanley, Nicolas Wentzensen

Affiliations

¹ Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
² Department of Mathematics, Duke University, Durham, NC, USA.
³ Laboratory MIVEGEC (Univ Montpellier, CNRS, IRD), French National Center for Scientific Research (CNRS), Montpellier, France.
⁴ Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Cambridge, MA, USA.
⁵ University Clinic for HPV-related gynecological disease, Department of Gynecology and Obstetrics, Gødstrup Hospital, Herning, Denmark.
⁶ Department of Clinical Medicine, Aarhus University, Denmark.
⁷ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁸ US National Cancer Institute Center for Global Health, Bethesda, MD, USA.
⁹ Private Consultant, Baltimore, MD, USA.

PMID: 41239758
DOI: 10.1093/infdis/jiaf574

Abstract

Background: Changes in cervical type-specific human papillomavirus (HPV) detection may reflect both natural variation in detectability and recent infection or clearance.

Methods: The Policy Committee of the International Papillomavirus Society (IPVS) convened a multidisciplinary working group to review scientific evidence and terminology related to the natural history of cervical type-specific HPV infections.

Results: The group proposes an updated model that distinguishes three cervical states: no HPV infection, undetectable HPV infection, and detectable HPV infection. An undetectable HPV infection refers to either a state of low viral genome load below the cutoff of the assay used, or to a particular state of viral latency. These two states are virtually indistinguishable, and viral latency remains a topic of ongoing research and debate. The transition from HPV not detected to HPV detected is consistent with several possible events, including (i) acquisition from a partner, (ii) autoinoculation, (iii) transition from undetected to detected HPV infection, and (iv) transient deposition of viral material. Conversely, the transition from HPV detected to HPV not detected is consistent with (i) viral clearance, (ii) transition from detected to undetected HPV infection, and (iii) inadequate sampling. The likelihood of each possible explanation depends on context, including screening history, exposure, age, and immune status.

Conclusion: By distinguishing true cervical states from observed test results, the updated model acknowledges uncertainties that complicate the interpretation of HPV test result patterns in research and practice. Adopting this model may improve clarity and ensure consistency in scientific and clinical communication about cervical HPV infections.

Keywords: clearance; human papillomavirus; immune control; persistence; viral latency.

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