“How do I know I have HPV?”, asked Ms C
What are the HPV symptoms in women?
“Unfortunately, high-risk strain HPV symptoms in women are rare. This is why it is very important to test for and learn about HPV.”
Human Papilloma Virus (HPV) is generally a silent infection.
There is no pain, itch, or discharge.
Genital warts and common warts are a sign of HPV infection. However, these are not the ominous types of HPV and are just an inconvenience.
You might have also heard your friends mention HPV testing or read about it on social media. This is the latest screening weapon in our fight against cervical cancer. You can do HPV DNA testing at the same time as, or instead of, your pap smear.
It is fast becoming the gold-standard screening.
Read on to find out why with these 7 topics.
- What is HPV?
- Can HPV be cured?
- Why should we test for it?
- From what age should you test for HPV?
- How is it Performed?
- What if I test positive?
- Can HPV infection be prevented?
What is HPV?
Human Papilloma Virus (HPV) is a common sexually transmitted infection.
It is found in women and men. However, screening tests focus on female health. This is because the cervical cells are very vulnerable to HPV infection and are easy to sample for testing.
There are 100s of HPV strains.
Harmless strains that cause common warts that, as kids, we believed were caused by touching frogs. Some variants cause genital warts.
Other high-risk strains may lead to cancer after long-term infections. 1,2
“This sounds terrifying, but don’t fear. Most healthy immune systems contain and kill these viruses before they can cause problems.”
Three out of four ladies that test positive for HPV, with no abnormal cell changes, will have clear tests three years later. 1
Can HPV be cured?
“No, there is no cure for HPV. Infections can, however, be managed.”
High-risk HPV infections of the cervix
Management differs depending on the strain in the cervix sample and if the cells are abnormal.
Infections can be monitored with regular testing. Most infections will clear without treatment.
Pre-cancerous cells can be removed by:
- Cryotherapy to freeze the changed cells.
- Cautery or laser to burn away the affected cervix.
- Surgical excision for more serious changes.
The appropriate treatment is decided on and performed by a specialist gynecologist.
Warts
- Cryotherapy, which freezes warts, may get rid of them. This might require multiple treatments.
- Topical Imiquimod cream stimulates your immune system to fight the virus.
Why should we test for HPV?
PAP smears are already available to screen for cancer of the cervix. Why do an HVP test instead?
Two good reasons:
- It is more accurate than the classic PAP smear. There is less risk for error, as the test does not rely on someone looking at cells under a microscope. 1,5
- Longer intervals between negative tests. If you are HPV-free, there is no testing for five years. 2,3
When would we not test for HPV?
It is expensive.
As with most things, the sad answer to this is cost. Most patients in third-world countries have no access to this incredible test. 4
Image by Steve Buissinne from Pixabay
From what age should you test For HPV?
From 30 years of age, most experts agree. However, some sources say from age 25. 2,3
Remember that you need to start pap smear testing at age 21.
Also read: ‘Are Pap Smears Painful? #1 Absurd Myth Busted’.
“If my patients in their early twenties request HPV testing, I will not refuse them.”
If a pap smear/cytology test is abnormal, we can request HPV testing on the same sample. This will assess risk in younger age groups.
How is testing performed?
The sample is taken in the same way as a pap smear.
Also read: My blog post about pap smears.
“I recommend co-testing (pap/cytology and HPV test) if you have the option.”
The combination gives very useful information.
- Are you high-risk HPV positive?
- And if so, have the cells started changing?
What if I test positive?
- High-risk strains 16 and 18 are usually referred immediately to the gynecologist. These are the two we do not entertain.
- Other high-risk strains require follow-up once or twice a year.
Can HPV infection be prevented?
Does my partner need treatment or screening?
- No, male partners require no HPV DNA testing. To date, there are no accurate methods other than cervical screening.
- As with all sexually transmitted infections, condom use will reduce the transmission risk.
Vaccination facts
HPV vaccines have received bad press on social media in the past. Read this article on six HPV vaccine myths debunked.
“I was vaccinated against HPV in 2008. I was 33 years old at the time and experienced no adverse effects.”
- The vaccine was initially registered for men and women from 9 years old to 26 years of age. Subsequently, benefits have been shown up to the age of 45. Even if you have been infected previously, there are other high-risk strains that the vaccine will protect you against.
- Kids under 15 require only two doses—three doses from 16-year-olds upwards.
- Vaccinate boys and girls, ideally before they become sexually active.
- Men are at less risk of HPV-related cancer, but if vaccinated, it will help reduce the transmission rate. This, in turn, will reduce cervical cancer.
“I recommend Gardasil. It offers protection against genital warts, as well as cervical cancer. Let’s face it: who wants genital warts?”
In Summary
- High-risk HPV symptoms in women are non-existent until the disease is advanced.
- Pap smears and HPV DNA testing help to alert us to a problem early in the infection.
- Cervical cancer is preventable; chat with your doctor about adding HPV testing at your next pap smear appointment.
There is nothing I love more than a visual summary. Most people learn with pictures. I’ll leave you with this delightful animation by Emma Bryce.
References
- Gilham C, Sargent A, Kitchener HC, Peto J. HPV testing compared with routine cytology in cervical screening: long-term follow-up of ARTISTIC RCT. Health Technol Assess. 2019;23(28):1-44
- JOHNSON, T. R. A. C. I. C. (Ed.). (2022, August). Information about human papillomavirus (HPV). WebMD. Retrieved November 15, 2022, from https://www.webmd.com/sexual-conditions/hpv-genital-warts/hpv-virus-information-about-human-papillomavirus
- Cervical cancer screening. National Cancer Institute. (n.d.). Retrieved February 25, 2023, from https://www.cancer.gov/types/cervical/screening
- Krivacsy, S., Bayingana, A., & Binagwaho, A. (2019, December 1). Affordable human papillomavirus screening needed to eradicate cervical cancer for all. The Lancet Global Health.https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30423-1/fulltext
- World Health Organization. (n.d.). WHO recommends DNA testing as a first-choice screening method for cervical cancer prevention. World Health Organization. Retrieved February 25, 2023, from https://www.who.int/europe/news/item/11-09-2021-who-recommends-dna-testing-as-a-first-choice-screening-method-for-cervical-cancer-prevention
