HPV 35: the high-risk type most tests don't name
Worldwide, HPV 35 causes about 2% of cervical cancers. In parts of sub-Saharan Africa it reaches 22 to 30%. In Cape Town it is one of the three most common high-risk types found in women. And it is in none of the licensed vaccines.
Why this matters here. Most HPV testing reports one line: high-risk detected, or not. That is enough almost everywhere else, because almost everywhere else the high-risk types are the ones the vaccine already covers. South Africa is not that place. Knowing which type you carry is a more useful question here than it is in London or Los Angeles.
In short
- HPV 35 is a high-risk type. It causes around 2% of cervical cancers globally but 22% to 30% in some sub-Saharan African countries.
- In Cape Town research, HPV 16, 35 and 58 are the most common high-risk types, with no major difference by HIV status.
- Nationally, HPV 35 is more common than HPV 18.
- No licensed vaccine covers HPV 35, which makes screening and strain typing more valuable here than elsewhere.
- A test that reports only "high-risk detected" cannot tell you whether you are carrying a covered type or an uncovered one.
- Our HPV panel types 28 strains individually, including 35, from a self-collected sample with no speculum.
No appointment, no speculum, no doctor's referral. You collect the sample yourself, at a branch in Observatory, Parktown North or Hillcrest, or from a home kit posted to you anywhere in South Africa. Results in 5 to 7 working days.
Is there an HPV outbreak in South Africa?
No, and the word matters. An outbreak means a sudden rise above the expected level. HPV is endemic: it is common, it is persistent, and its level here has not suddenly jumped.
What is different in South Africa is not the amount of HPV but the mix. The high-risk types circulating here are not in the same rank order as the ones circulating in Europe or North America, and HPV 35 is the clearest example. That difference is stable, repeatedly measured, and has been in the literature for years.
What the Cape Town research shows
The strongest local evidence comes from three sequential cervical screening studies in Khayelitsha, covering 1,371 HIV-positive and 8,050 HIV-negative women aged 17 to 65 who had never been screened before.
HPV 16, 35 and 58 were the most common high-risk types, with no major differences in type distribution by HIV status. An earlier study by the same group had already found HPV 16 and 35 to be the most common high-risk types among HIV-negative women.
Two other things in that data are worth pulling out.
HIV status changes how much, not which. Overall HPV prevalence was 52.4% in HIV-positive women against 20.8% in HIV-negative women, and HIV-positive women were more likely to have CIN 2 or 3. But the type mix stayed much the same across both groups. HPV 35 is not a finding confined to one subgroup.
The youngest women had the most. Prevalence was highest in the 17 to 19 age band, regardless of HIV status, which is the age group least likely to have been screened.
And a detail about who these women were: all three studies recruited from the general population, among women with no history of cervical screening at all. That is the South African reality this research sits inside. A great many women here have never been screened once.
And the national picture
A systematic review and meta-analysis of HPV in South African women found a pooled prevalence of 58%, rising to 63% among HIV-positive women. The leading high-risk types were:
7.5%
HPV 16, the most common high-risk type nationally
4.1%
HPV 35, second among high-risk types
3.9%
HPV 18, the type most people have heard of
Pooled national prevalence figures. HPV 35 outranks HPV 18 in South African women.
In women who already have cervical changes, HPV 35 moves further up. Among 459 unvaccinated women referred to a hospital gynaecology department in the Eastern Cape with abnormal cervical findings, HPV was detected in 84.2%, and the six most common types were HPV 16 at 34.7%, HPV 35 at 17.4%, HPV 58 at 12.1%, HPV 45 at 11.6%, HPV 18 at 11.4% and HPV 52 at 9.7%.
A second Eastern Cape study of women with confirmed cervical intraepithelial neoplasia found HPV 35 was the most predominant type in CIN2 lesions, and HPV 16 and HPV 35 the most frequently detected in CIN3, regardless of HIV status.
Why "not common elsewhere" is exactly right
This is the comparison that makes it worth writing about.
| Globally | Parts of sub-Saharan Africa | |
|---|---|---|
| Share of invasive cervical cancers attributed to HPV 35 | About 2% | 22% to 30% |
| Covered by the nine-valent vaccine | No | No |
The same pattern shows up in cancer genomics rather than only in screening. A database of 290,311 advanced cancers found that among cases carrying high-risk HPV types not covered by the nine-valent vaccine, people of African ancestry were several-fold over-represented, with HPV 35 at 24%. Those non-vaccine high-risk types accounted for 11.4% of HPV-related advanced cancers in people of African ancestry, against 2.4% in everyone else.
So the clinical impression that you see more type 35 here than the international literature would predict is not an artefact. It is what the published data says.
No vaccine covers it
The nine-valent vaccine protects against HPV 16, 18, 31, 33, 45, 52 and 58, plus the two low-risk types that cause genital warts. HPV 35 is not among them, and the manufacturers have confirmed it is not covered in either of the two licensed highest-valency vaccines.
What that costs is measurable. A Malawian study calculated the nine-valent vaccine would prevent 71% of cervical squamous cell carcinoma there, and identified high HPV 35 prevalence as the main reason for the shortfall. A 2026 review described a significant and underappreciated burden of HPV 35 disease in African populations and called for it to be considered for inclusion in future vaccines, work now under way with the International Agency for Research on Cancer.
To be clear. The vaccine works, it protects against HPV 16, and HPV 16 causes more cervical cancer here than anything else. Get it. The reason HPV 35 matters is that it makes screening after vaccination more important in South Africa than the international guidance assumes, not less important than the vaccine.
One more local finding worth knowing
The same South African meta-analysis reported something about the vaginal environment. HPV-positive women had lower Lactobacillus levels and more bacterial vaginosis-associated species such as Gardnerella, which the authors suggest may support HPV persistence.
Persistence is what matters with HPV. Most infections clear on their own; it is the ones that stay that cause cell changes over years. So anything that appears to help an infection persist is worth knowing about.
That is a practical argument for looking at the vaginal flora and HPV in the same test rather than as two separate errands. Our Large panel does both from one self-collected sample: HPV alongside Gardnerella, Atopobium, BVAB2, Mobiluncus, Megasphaera, Prevotella, the lactobacilli and candida. Whether treating the flora changes HPV outcomes is not settled, and we are not going to pretend otherwise. But you cannot look at a relationship you have not measured.
What a strain-typed result tells you that a standard screen does not
Most HPV screening in South Africa answers one question: is a high-risk type present, yes or no. Some tests go a step further and separate out 16 and 18, because those are the two that dominate the global picture. Either way, HPV 35 disappears into a category labelled "other high-risk".
In a country where "other high-risk" includes a type carried by a meaningful share of women and covered by no vaccine, that category is doing too much work.
| The test | What it reports | Can it identify HPV 35? |
|---|---|---|
| High-risk HPV screen | High-risk detected, or not detected | No. It is inside the positive result but not named |
| Partial genotyping | 16, 18, and everything else grouped together | No. It falls into "other high-risk" |
| Full strain typing | Each strain named individually | Yes |
Knowing the type changes three things. It tells you whether you are carrying something your vaccination should have covered, or something it never could. It gives a doctor a clearer basis for deciding how closely to follow you. And on a repeat test months later, it shows whether the same type has persisted or a different one has appeared, which a yes-or-no result cannot distinguish.
Three things worth holding onto
Keep screening after vaccination. True everywhere, more true here.
Most positives clear on their own. Cervical cancer develops from infections that persist over years. A positive result is a reason for follow-up on a schedule, not an emergency.
A laboratory is not a doctor. We can tell you which type you carry. What to do about it is a conversation with a clinician, and the branch team can refer you if you do not have one.
Which HPV test do you need?
There are three ways to have HPV tested at Epicentre, and they answer different questions. This is the part most people find confusing, so here it is plainly.
| If you want to know | Ask for | What it tells you |
|---|---|---|
| Do I have HPV at all? | HPV Basic Screen | Whether HPV is present. The quickest and cheapest route if HPV is your only question. |
| Which strain do I have? | HPV 28-strain panel | Each strain named individually: 19 high-risk including 35, and 9 low-risk. Usually done as a follow-up to a positive basic screen. |
| HPV and the other infections | Medium panel, 9 targets | The smallest panel that includes HPV. Covers the infections but not the causes of similar symptoms. The Small panel does not contain HPV at all. |
| The whole picture in one go | Large panel, 17 targets | HPV, the infections, and the bacterial vaginosis markers and candida that produce the same symptoms. Either finds the cause or rules out seventeen of them. |
The usual path is two steps, not one. Start with a basic screen or a panel that includes HPV. If HPV is found, the 28-strain panel is the follow-up that tells you which type it is, which is the step that matters here given how common HPV 35 is locally and that no vaccine covers it. You do not need to buy both up front.
If your exposure was oral, note that a genital swab and urine sample do not cover it. Our oral screen is a separate test and it includes HPV.
How it works, start to finish
Choose the test
Use the table above, take the 30-second quiz, or message the team on WhatsApp and describe what you want to know. You do not need a doctor's referral.
Collect the sample yourself
A self-collected swab and a urine sample, given together. A vaginal swab with no speculum and no examination, or a penile swab, depending on your anatomy. Do it at a branch in Observatory, Parktown North or Hillcrest, or order a home kit and do it at home. Kits arrive in unbranded packaging.
Send it in
Hand it over at the branch, or use the courier. Free within 10km of a branch or pickup point, R300 anywhere else in the country.
Results in 5 to 7 working days
Sent to you directly. Testing can be anonymous: a pseudonym is accepted, no identity document is needed and cash is fine. If HPV is found and you want to know the strain, that is when the 28-strain panel comes in.
The tests themselves
HPV Basic Screen
Is HPV there?The starting point if HPV is the only thing you want to know about. Self-collected, no speculum. If it comes back positive, the 28-strain panel is the natural next step.
Answers: do I have HPV?
Does not answer: which strain.
HPV 28-strain panel
Strain-level typingThe follow-up test, and the one this article is about. It names 28 strains individually rather than reporting a single high-risk result: 19 high-risk including 35, and 9 low-risk. This is the only route that will tell you whether you are carrying a type your vaccination covered.
Answers: which strain, by name.
High-risk strains typed: 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 69, 73 and 82.
Sample: self-collected, no speculum.
The focused option: Medium panel, 9 targets
Nine targetsThe infections, without the flora. This is the smallest panel that includes HPV, and the right choice if your question is about what you might have caught rather than what might be causing a symptom.
It also covers Mycoplasma genitalium, which most standard STI testing in South Africa leaves out entirely, and both herpes types.
Answers: do I have HPV, plus the core infections?
Does not answer: which HPV strain, and it does not cover the vaginal flora or candida.
Sample: self-collected swab and urine, no speculum, at a branch or from a home kit.
The comprehensive option: Large panel, 17 targets
R1,925One self-collected sample, seventeen answers. This is the panel to take when you want the whole picture rather than a specific question answered: HPV, the sexually transmitted infections, and the organisms that cause exactly the same symptoms without being sexually transmitted at all.
That last part is what makes it comprehensive rather than just larger. Bacterial vaginosis and thrush produce the discharge and irritation that send most people for testing in the first place. A panel that only looks for STIs can come back clear and leave you with the symptom and no explanation. This one either finds the cause or rules out seventeen of them.
It is also the only route that measures HPV and the vaginal flora together, which is the pairing the persistence research points at. It comes in two versions. One uses a self-collected vaginal swab, the other a self-collected penile swab. Both are given together with a urine sample, so whichever anatomy you have, the collection is the same two steps.
Answers: do I have HPV, do I have an STI, and if not, what is causing the symptom?
Does not answer: which HPV strain. That is the 28-strain follow-up.
Sample: self-collected swab and urine, no speculum, at a branch or from a home kit.
Results: 5 to 7 working days.
HPV Basic Screen and HPV 28-strain pricing is on the sexual health page, along with the full panel list and the 30-second quiz. Prices are 2026 cash rates including VAT and may change; in-store pricing applies. Epicentre does not bill medical schemes for these tests, but supplies the correct paperwork so you can claim back yourself.
Find out which type you carry
Strain-level HPV typing on a sample you collect yourself. No speculum, no doctor's referral, no appointment. Four questions and the quiz will tell you which test fits.
Frequently Asked Questions
Is there an HPV outbreak in South Africa?
No. An outbreak means a sudden rise above the expected level, and HPV is endemic rather than epidemic: common, persistent, and not suddenly increased. What differs in South Africa is the mix of types rather than the amount. The high-risk types circulating here are not in the same rank order as in Europe or North America, and HPV 35 is the clearest example.
Why is HPV 35 more common in South Africa?
The pattern is consistently reported across sub-Saharan Africa and in populations of African ancestry elsewhere, so it appears to reflect the types circulating in these populations rather than anything specific to one country or city. Globally HPV 35 is associated with about 2% of invasive cervical cancers, but reaches 22% to 30% in some sub-Saharan African countries. In Cape Town screening research, HPV 16, 35 and 58 were the most common high-risk types.
Does the HPV vaccine cover type 35?
No. The nine-valent vaccine covers high-risk types 16, 18, 31, 33, 45, 52 and 58, plus low-risk types 6 and 11. HPV 35 is not included in either of the two licensed highest-valency vaccines. A 2026 review called for urgent re-evaluation of vaccination strategy to consider adding it, and work is under way toward next-generation vaccines reflecting regional disease patterns.
Should I still get the HPV vaccine if it does not cover type 35?
Yes. The vaccine protects against HPV 16, which causes more cervical cancer in South Africa than any other type. It is still the single best thing you can do. What HPV 35 shows is that you should keep getting screened afterwards, because the vaccine was never built to cover that one.
How do I get an HPV test at Epicentre?
Choose a test, collect the sample yourself, and send it in. No doctor's referral and no appointment are needed. You can walk into the Observatory, Parktown North or Hillcrest branch, or order a home kit in unbranded packaging, couriered free within 10km of a branch or pickup point and R300 anywhere else in South Africa. You give two samples, both self-collected: a swab, vaginal with no speculum or penile, and a urine sample. Results come back in 5 to 7 working days, and testing can be anonymous.
Is HPV included in your sexual health panels, or is it a separate test?
Both, depending on the route. The Medium panel of nine targets is the smallest that includes HPV, and the Large and Extra Large panels include it too. The Small panel of four targets does not. If HPV is the only thing you want to know about, the HPV Basic Screen is the direct route. And if you want to know which strain you carry, that is the 28-strain panel, usually done as a follow-up to a positive result.
Should I start with the basic screen or the 28-strain panel?
Start with the basic screen, or with a sexual health panel that includes HPV. If HPV is found, the 28-strain panel is the follow-up that names the type. You do not need to buy both up front. The reason the second step matters here is that HPV 35 is common in South Africa and is not covered by any vaccine, so knowing which type you carry tells you something a yes-or-no result cannot.
What is the difference between an HPV screen and HPV strain typing?
A high-risk HPV screen reports only whether a high-risk type is present. Partial genotyping separates out 16 and 18 and groups everything else as "other high-risk". Full strain typing names each type individually. In South Africa that distinction matters more than elsewhere, because HPV 35 is common here and covered by no vaccine, so on the first two kinds of test it disappears into the "other" category.
How do I find out which HPV strain I have?
You need a test that types strains individually rather than reporting a single high-risk positive or typing only 16 and 18. Epicentre's HPV panel types 28 strains: 19 high-risk, including 35, and 9 low-risk. The sample is self-collected with no speculum, at a branch or from a home kit, and results come back in 5 to 7 working days.
Does a positive HPV result mean I will get cervical cancer?
No. Most HPV infections clear on their own without treatment. Cervical cancer develops from infections that persist over years, which is why follow-up on a schedule matters more than any single result. A positive is a reason to see a doctor for follow-up, not an emergency. Epicentre is a laboratory: we test and we report, and we do not diagnose or treat.
References
- Distribution of human papillomavirus genotypes among HIV-positive and HIV-negative women in Cape Town, South Africa. Read it
- Mapping the HPV landscape in South African women: a systematic review and meta-analysis of viral genotypes, microbiota, and immune signals. Read it
- Mbulawa ZZA, et al. High human papillomavirus (HPV)-35 prevalence among South African women with cervical intraepithelial neoplasia warrants attention. PLOS One 2022;17(3):e0264498. Read it
- Distribution of HPV genotypes in HIV-negative and HIV-positive women with cervical intraepithelial lesions in the Eastern Cape Province, South Africa. Viruses 2021;13(2):280. Read it
- Murahwa AT, et al. The burden of HPV35 in African cervical pathologies: prevalence, contributing factors, and vaccine prospects. Reviews in Medical Virology 2026. Read it
- Advanced cancers amongst individuals of African ancestry exhibit an almost five-fold higher prevalence of high-risk HPV types not covered by the current 9-valent vaccine. Read it
- Comprehensive human papillomavirus genotyping in cervical squamous cell carcinomas and its relevance to cervical cancer prevention in Malawian women. Read it
This article is general health information and not medical advice, and it is not a reason to decline HPV vaccination. Epicentre is a diagnostic laboratory: we provide testing and reporting, and we do not diagnose, prescribe or treat. Cervical screening should follow the schedule your doctor advises. Please discuss any result that needs attention with a doctor.
