Cervical cancer ranks as the second leading cause of female cancer in India. However, India's vaccination rates remain low.
Published Jul 26, 2025 | 7:00 AM ⚊ Updated Jul 26, 2025 | 7:00 AM
HPV in boys. (Representative image)
Synopsis: At a Hyderabad conclave, doctors warned that one in three Indian boys unknowingly carry HPV, a silent virus linked to cervical and other cancers. Experts stressed vaccinating boys to curb spread and protect both genders. With low vaccination and screening rates, experts urged urgent policy inclusion and awareness to prevent HPV-related cancers.
Dr M Surendranath sees the numbers every day in his paediatric practice at Vijay Marie Hospital in Hyderabad. One in three boys in India carry the Human Papillomavirus(HPV) without knowing it. These boys transmit the virus to others while remaining unaware of their role in a health crisis that kills one woman every eight minutes in India.
The Serum Institute of India launched its “Conquer HPV & Cancer Conclave 2025” campaign in Hyderabad on Thursday, 24 July. Medical professionals gathered to highlight the need for preventive measures against HPV, the primary cause of cervical cancer and several other cancers affecting both men and women.
“Most of the time, boys carry the HPV virus and transmit it to others,” said Dr Surendranath, Head of Pediatrics and DNB Faculty at Vijay Marie Hospital and former President of the Pediatric Academy of Telangana.
He further added, “According to Western statistics, 1 in 3 people are infected with HPV by the age of 15. Even in India, studies suggest that nearly 1 in 3 boys have the HPV virus.”
The virus operates in silence. Boys carry it without symptoms while it spreads through their social networks. “The issue is that while the virus may not cause immediate problems in boys, it gets transmitted to girls, increasing their risk of cervical cancer,” explained Dr Surendranath. Controlling HPV in boys, he emphasized, is key to reducing its spread and protecting girls.
Adding that the HPV infections don’t show symptoms immediately, Dr Surendranath noted, “The virus enters your body, and in most people, the immune system clears it within six months. But in some, the virus persists — silently — without causing any noticeable signs.”
Pointing out that, unlike most viral infections which announce themselves with fever or symptoms within days, Dr. Surendranath adds that HPV takes a different approach. “Unlike many viral infections that cause fever or other symptoms within a week or 10 days, HPV remains asymptomatic. That’s the main problem — people don’t even know they’ve been infected.”
The virus plays the long game. “Over two or three decades, the virus can gradually multiply within the body’s cells and eventually manifest as cancer. Only when the cancer starts developing — when abnormal cells grow rapidly — do symptoms begin to appear.”
This stealth strategy fuels the crisis. “So the virus itself doesn’t cause any immediate illness, and that’s why people don’t feel concerned. They assume they’re fine. This is one of the main reasons there is very little awareness about HPV. Most people don’t know they’re carrying it.”
The misconception that HPV only threatens women has shaped India’s prevention strategy. “It’s a misconception that HPV only causes cervical cancer,” Dr Surendranath said. “It is also linked to other cancers — anal cancer, penile cancer, and oropharyngeal cancer, which affects the throat. So, vaccination protects not just from transmission, but also from cancers in boys themselves.”
Speaking of the types of HPV which create visible problems, Dr Surendernath added, “There are specific HPV types — 6 and 11 — which cause anal and genital warts. These appear as small swellings and can lead to psychological distress because of their appearance.”
Claiming that Australia demonstrates what works, he added, “In countries like Australia, HPV vaccination for boys was introduced through their national immunisation programme. Since then, the incidence of genital warts has dropped significantly.”
Dr Surendranath outlined the case for vaccinating boys. “So vaccinating boys is essential — to prevent genital warts, penile and anal cancers, throat cancers, and also to stop the spread of HPV.”
India faces staggering numbers. The ICO/IARC Information Centre on HPV and Cancer reports over 1.23 lakh new cervical cancer cases annually, with more than 77,000 deaths.
Nearly 99 percent of cervical cancer cases link to HPV, making it one of the few cancers that can be entirely prevented through vaccination and early screening.
Prof M Tripura Sundari, Head of the Department of Obstetrics and Gynaecology at KIMS, Secunderabad, moderated the conclave session. She stressed that cervical cancer remains fully preventable through vaccination before the person becomes sexually active to ensure stronger and longer-lasting immune response.
The numbers reveal the scope of the problem. Cervical cancer ranks as the second leading cause of female cancer in India. However, India’s vaccination rates remain low. Less than 1 percent of girls receive vaccination and less than 2 percent of Indian women have ever been screened according to NFHS-5. The country needs to reach the 2030 elimination target of 90 percent of girls fully vaccinated with HPV vaccine by age 15.
Meanwhile, the statistics worldwide show the male burden. One in three men worldwide carry at least one genital HPV type. One in five men carry one or more high-risk HPV types. Males spread HPV to their female partners while lacking routine screening tests available to detect HPV-related disease in girls.
Dr D Leela, Consultant Gynaecologist and Gynaecological Oncologist at St. Theresa’s Hospital and Asvins Hospital in Hyderabad detailed the virus classification. “Yes, we do have targeted tests for HPV. There are over 200 types of HPV, but 14 of them are considered high-risk. Among these, HPV types 16 and 18 are responsible for over 80 percent of cervical cancers. Types 6 and 11 are classified as low-risk but are known to cause genital warts.”
The testing process identifies specific strains. “When we conduct an HPV test, we typically screen for HPV 16 and 18 — and sometimes for the other 12 high-risk types. This is known as genotyping, where we identify exactly which strain of the virus is present. If a woman tests positive for type 16 or 18, we manage the case more aggressively. If other high-risk types are detected, we follow a different protocol — all based on established clinical guidelines.”
Dr Leela explained India’s screening approach. “So even though most people never know they were infected, it’s that small percentage with persistent infections who are at risk. This is where screening becomes essential — it’s our secondary prevention strategy, after vaccination.”
The government recommends starting cervical cancer screening from age 30. “The most commonly used test in government programmes is Visual Inspection with Acetic Acid (VIA). It involves applying acetic acid (vinegar) on the cervix and checking for abnormal changes using a light source.”
Multiple testing methods exist. “The Pap smear or cytological screening is another effective method used widely in hospitals and labs that have the necessary infrastructure. And the most advanced test — though not yet routine — is HPV DNA testing, which detects the presence of the virus directly in cervical or vaginal samples.”
HPV DNA testing shows high accuracy. “A negative HPV test result is highly predictive — with around 95 percent sensitivity — meaning the risk of developing cervical cancer is negligible in such cases. Unfortunately, HPV DNA tests are still relatively expensive in India and are imported, although they are available through validated platforms.”
India’s screening remains opportunistic rather than systematic. “As of now, India follows mostly opportunistic screening, meaning we test women when they visit clinics for other gynaecological issues. Ideally, we should have a population-based screening programme, but that is still a gap. That said, many voluntary organisations and NGOs are working on community-based screening drives using VIA, Pap smears, or HPV testing.”
Speaking of the vaccines, she added, “The vaccines currently in use — the quadrivalent vaccines — are designed to protect against HPV types 6, 11, 16, and 18. This helps us not just prevent cervical cancer, but also reduce the incidence of genital warts.”
Dr Leela noted screening improvements. “In recent years, screening uptake has improved, even more than vaccination. Many women are now coming forward for screening, which is an encouraging trend.”
Dr D. Leela, explained the transmission dynamics. “HPV enters the body through sexual or even skin-to-skin contact. More than 90 percent of the population will have at least one HPV infection by the time they turn 30. Thankfully, over 90 percent clear it naturally. Only around 10 percent of people, especially those who are immunocompromised, end up with persistent infection — and that’s where the risk of cancer comes in.”
The solution arrives through CERVAVAC, India’s first indigenous quadrivalent HPV vaccine. The Serum Institute of India developed it in collaboration with the Department of Biotechnology and Biotechnology Industry Research Assistance Council. International HPV vaccines cost ₹ 4,000 per dose. CERVAVAC costs ₹2,000 per dose.
CERVAVAC protects against HPV types 6, 11, 16, and 18. The vaccine covers girls and women aged 9-26 years and boys and men aged 9-26 years. Phase 3 Clinical Data appears in Lancet Oncology Journal. Clinical trials established comparable safety and immunogenicity data versus the qHPV vaccine from MSD.
The trials covered 12 institutes across India including AIIMS New Delhi, Tata Memorial hospital Mumbai, and CMC Vellore. Researchers studied 2,307 subjects in age groups 9-14 years and 15-26 years, both females and males. None of the serious adverse events related to the study vaccine and no solicited adverse events with severity of grade 3 or more occurred.
The dosing schedule follows established patterns. Ages 9-14 receive two doses given 6 months apart. Ages 15-26 follow a three-dose regimen at 0, 2, and 6 months.
India’s policy framework moves slowly toward inclusion. “Right now, the HPV vaccine is not part of India’s National Immunisation Programme,” Dr Surendranath explained.
“Last year, the finance minister did announce it as a priority — but the initial focus was on preventing cervical cancer in girls. So, the government decided to begin by vaccinating girls first,” he added.
Medical professionals push forward despite policy gaps. “Although the national rollout hasn’t started yet, as part of the paediatric advisory board, we’ve been recommending HPV vaccination for boys as well. In the private sector, we’ve already begun vaccinating boys.”
Noting that approval process required specific research, Dr Surendernath added, “Usually, for a vaccine to be approved, it must undergo studies in the population it’s intended for. The Serum Institute of India conducted studies on both boys and girls, analyzing their antibody levels after vaccination. Based on that data, they submitted the findings, and the Drugs Controller General of India (DCGI) has now granted approval for the HPV vaccine to be given to boys.”
Testing remains limited due to costs and treatment options. “There are tests available that can detect early changes in cells or even the presence of the virus itself — but they’re expensive, and there’s no specific treatment for HPV infection itself. So unless it’s for academic or research purposes, we don’t routinely test for HPV,” Dr Surendranath said.
Doctors suggested HPV testing can cost around ₹10,000, while the vaccine itself costs just about ₹2,000. So ideally, getting vaccinated is more practical and preventive than spending on testing without actionable outcomes.
(Edited by Sumavarsha)
