Human Papillomavirus (HPV)
We all have heard that Human Papillomavirus (HPV) is almost always linked to cervical cancer. What do we actually know thus far regarding this statement? I have had patients coming into my clinic with genital warts, in such panic and anxious mode, asking me “Doctor does this mean i have cervical cancer?”
What is HPV? HPV is the collective term for a group of over 100 different viruses. This virus is the most common viral infection of the reproductive tract. Most sexually active women and men will be infected at some point in their lives and some may be repeatedly infected. HPV is sexually transmitted, but penetrative sex is not required for transmission. Skin-to-skin genital contact is a well-recognized mode of transmission.
HPVs are attracted to certain cells called squamous epithelial cells. These cells are found on the surface of the skin and on moist surfaces (called mucosal surfaces) like:
- The trachea (windpipe) and bronchi (smaller breathing tubes branching off the trachea)
- The inner lining of the nose, mouth, and throat
- The vagina, cervix, vulva (area around the outside of the vagina), and anus
- The inner foreskin and urethra of the penis
- The inner eyelids
You DO NOT get HPV from:
- Toilet seats
- Hugging or holding hands
- Swimming in pools or hot tubs
- Sharing food or utensils
- Being unclean
Low risk vs High risk HPV
Low-risk mucosal (genital) HPV types: this type tends to cause warts and rarely cause cancer are called low-risk types. Low-risk genital HPV infection can cause warts (usually resembles cauliflower) on or around the genitals and anus of both men and women. In women, warts may appear in areas that aren’t always noticed, such as the cervix and vagina.
High-risk mucosal (genital) HPV types: these are the types of viruses that are usually linked to cancer thus called high-risk types. These types have been linked to certain cancers in both men and women.
HPV Testing
Difference between PAP SMEAR and HPV testing:
A Pap test detects cell changes or abnormal cells in the cervix. These abnormal cells may be pre-cancer or cancer, but they may also be other things, too. Cells are lightly scraped or brushed off the cervix. The Pap test is a very good test for finding cancer cells and cells that might become cancer.
As we all know, HPV is closely linked to cervical cancer. The HPV test checks for the virus, not cell changes. There is an option called co-testing. In this co- testing, Pap smear and HPV testing will be done together. This is by far the most preferred way to find early cervical cancers or pre-cancers in women 30 and older.
Also read: HPV-Warts & Genital Warts Treatment in Malaysia
Should i get tested?
1. Under age 30:
*women between ages 21 and 29 (sexually active females) should have a Pap test every 3 years to test for cervical cancer and pre-cancers. These women should not get the HPV test with the Pap test (co-testing) because HPV is so common in women these ages that it’s not helpful to test for it. However, HPV testing may be used in this age group after an abnormal Pap test result.
2. Woman aged above 30
*It is recommended that women aged above 30 to have an HPV test along with their Pap test (co-testing) every 5 years to test for cervical cancer. It is still Okay to continue to have Pap tests every 3 years.
Should I do co-testing every 5 years? Is that safe?
It takes a very long time for cell changes in the cervix to take place. Recent studies have shown that it usually takes more than 10 years for cell changes to become cancer. In the past, it was told that a Pap smear tests should be done yearly, but now we know that Pap smear tests are not needed every year – every 3 years is enough. In fact, doing Pap tests every year can lead to unneeded treatment of cell changes that would never go on to cause cancer.
One of the benefits of adding testing for HPV is that women can get cervical cancer testing even less often. Getting the Pap test and HPV test (co-testing) every 5 years means fewer tests, follow-up visits, and treatments may be needed if any abnormality is detected. Women with normal Pap and HPV test results have almost no chance of getting cervical cancer within at least 5 years.
Co-testing is preferred, but it’s also OK to continue to have the Pap test alone every 3 years.
*Different scenarios with test results:
- If you are positive for cervical HPV infection and an abnormal Pap test result, you will be referred to a gynaecologist for further treatment such as colposcopy which is a procedure to closely examine your cervix, vagina and vulva for signs of disease.
- If you are positive for cervical HPV infection and a normal Pap test result, it means that you have genital HPV, but no cell changes were seen on your Pap test.
There are 2 options:
- You’ll most likely be tested with an HPV test and a Pap test again in 12 months. In most cases, re-testing in 12 months shows no sign of the virus. If the virus does go away and your Pap test is normal, you can go back to normal screening.
- If the virus is still there or changes are seen on the Pap test, you’ll need more testing.
Also read: The Role of Pap Smear in Early Diagnosis of Cervical Cancer
Should males do HPV testing as well?
It is quite unfortunate that condoms aren’t 100% effective, since HPV is transmitted primarily by skin-to-skin contact. The common HPV types associated with cervical cancer usually do not cause health problems for a heterosexual man having sex with an HPV-infected woman. Although there are studies that have demonstrated that HPV is an etiologic factor in the development of penile cancer, there are no recommended routine screening for HPV in immunocompetent men.
If a man’s long-term sexual partner has HPV, chances are that HPV transmission has already occurred and he most likely also has it. HPV in men may clear from the body more easily than in women. Women, in general, often clear the virus in two years or less. Do note that, if a partner has HPV, it does not necessarily mean they have had sex with someone else recently. The virus can lay dormant in the body for years without causing noticeable symptoms.
However, HPV genotyping may be beneficial if you have had previous partners or you just want to get HPV screening before getting into the next relationship. With this test, you will know if you are going to pass any HPV viruses around.
Re- infection?
There are many types of HPV. You may have one type that goes away, but you can get a different type. It’s possible to get the same type again, but the risk of this is low.
Getting vaccinated with Gardasil 9 will be beneficial as you may protect yourself from getting infected again. Here at DTAP we offer various vaccinations including Gardasil 9!
Also read: HPV vaccine & HPV Prevention with Gardasil 9 in Malaysia
At DTAP we are willing to address your doubts. We also offer anonymous HIV testing. The range of our STI testing is also found here: STD Testing
We also accept Appointments via WhatsApp, please message us at +6017 444 3052.
*cited from American cancer Society
- https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detection/cervical-cancer-screening-guidelines.html
- https://www.cancer.org/cancer/cancer-causes/infectious-agents/hpv.html
- https://www.cancer.org/cancer/cancer-causes/infectious-agents/hpv/hpv-and-hpv-testing.html
