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HPV infection and it’s role in the genesis of abnormal Pap smears

What is genital HPV?

HPV is a virus that is passed on during  skin to skin contact. It is extremely common in both women and men who have  ever had sex. It can also be transmitted during passage through the birth  canal, ie, is able to be contracted from one’s mother. Around 80% of men and  women will have HPV at some time in their life. Thus, it is a very common and  usually asymptomatic infection. It is very contagious and there are around forty  to fifty kinds of genital HPV. These are called “subtypes” and around fifteen  are classified as high risk due to their association with causing cervical  cancer. Low risk HPV such as type 6 and 11 cause about 90% of genital warts and  most low grade squamous interepithelial lesions (LSIL) on Pap smears.  HPV type 16 and 18 cause 70% or more of  cervical cancers. It is important to remember that most HPV infections are  subclinical, ie, not noticed by the patient and transient. The immune system  appears to clear the virus within one or two years.

How is HPV transmitted?

The virus enters the body through tiny  breaks in the skin but is not spread via blood or body fluids. A Pap smear can  sometimes detect abnormal changes caused by HPV.

What are low grade changes?

Low grade of mild abnormal Pap smear  changes almost always reflect short-term HPV infection. Most of these  infections will clear within one to two years.

HPV and Infidelity

Patients often ask how or why they  contracted HPV. The important thing to remember is that this does not mean that  one’s partner has had other concurrent relationships as HPV infection can  persist for many years without symptoms. An HPV infection may have been  contracted a long time ago and may even have been contracted during birth.

Is it wise to abstain from sex if I have HPV?

There is no reason to stop having sex if  you have HPV changes on a Pap smear. Further, condoms offer limited protection against HPV as they do not cover all of the genital skin.

Can HPV be treated?

Treatment of the virus itself is not needed  as one’s body’s immune system usually clears the infection. If the HPV  infection persists and causes cell changes, these changes can be treated but  this is not always required. It is also important to remember that HPV may exist  in the skin or the cervix without causing any apparent Pap smear changes.

Can  I be re-infected with HPV?

Usually you cannot be reinfected with the  same kind of HPV as your body will almost likely develop immunity against it.  However, you can be infected with new HPV types.

Should  I have the HPV vaccine (Gardisil or Cervarix) if I have got or already have had  HPV?

The simple answer is yes. You might like to  think of the HPV vaccine in a similar way to the seasonal ‘flu vaccination.  There is no practical way of working out what kinds of ‘flu you may have been  exposed to before and what you may be immune to. The vaccination for the ‘flu  virus covers the most likely kinds of ‘flu going around that year. These might  be entirely different to the flu that you have had before. If you have a ‘flu  vaccination and have already had the ‘flu previously, at worst it may be simply  a waste of time or money but will probably cover you against types of ‘flu that  you have not yet been exposed to. The exact same logic applies to HPV  vaccination. Even though one might be over 26, HPV vaccination is still useful.  It costs around $450.00 and is given over three injections which can be done at  either your general practitioner or myself.

Is it wise to have an HPV test?

An HPV test is usually taken as a swab from  the cervix, almost the same as a Pap smear. Because HPV is so very common in  women aged under 30, the test is very often positive and knowing this does not  change one’s management. It is also important to remember that usually the  infection will clear by itself. The HPV test costs around $80.00 and is usually  only free of charge for women who have had treatment for a high grade  abnormality or those who are having annual Pap smears for another reason.

What  are the reasons for having a HPV test?

HPV tests are currently only recommended  for those who have had treatment for a high grade abnormality in the initial  follow-up period. In these cases we look for disappearance of the HPV from the  system, which means that there is a very high chance of not having any further  abnormal cells in the future.

What  is the cervical cancer vaccine?

The vaccine helps to prevent infection with HPV types that causes around 70% of cervical cancers. It is most effective if  given to girls prior to the onset of sexual activity at around the age of 9 or  12. Therefore, the vaccine will probably be less effective or usual in sexually  active women who may already have been exposed to HPV. It is important to  remember that the vaccine, like the ‘flu vaccination, is not absolutely  effective against HPV. Therefore, vaccinated women should continue to have Pap  tests.

More  information

More information regarding HPV, Pap smear  and cervical cancer can be obtained on the website