What Women Should Know - American Sexual Health Association

What Women Should Know

Each year, approximately 12,000 women are diagnosed with cervical cancer in the United States. In most cases cervical cancer can be prevented through early detection and treatment of abnormal cell changes that occur in the cervix years before cervical cancer develops. We now know that these cell changes are caused by human papillomavirus, commonly known as HPV. The traditional test for early detection has been the Pap test. Now tests for HPV are available that can be used with the Pap test in women starting at 30 years of age and in women of any age when the Pap test alone has found slightly abnormal cell changes.

FAQs

What is HPV?
HPV is a virus that is very common. In fact, most men and women are infected with HPV at some time in their lives. There are approximately 100 types of HPV. Some HPV types typically infect the genital area and may cause warts, some cause mild changes in cervical cells that do not turn into cancer, and some cause changes that may become cervical cancer if present for many years. The types of HPV that are found in the genital areas are usually passed on during sexual contact (sexually transmitted). HPV types that cause warts on the hands or feet do not cause genital warts or cervical cell changes, nor do genital HPV types generally spread outside the genital area.

What is the Pap test?
The Pap test finds changes in the cells of the cervix (the mouth of the womb) that are not normal. The test involves taking a small sample of cells from the cervix, usually during a routine pelvic exam. The cells are sent to a laboratory where they are prepared and evaluated under a microscope.

What is an HPV test?
HPV tests can find any of the high-risk types of HPV that are most commonly found in cervical cancer. The presence of any of these HPV types in a woman for many years can lead to cell changes that may need to be treated so that cervical cancer does not occur. The HPV test is most often done at the same time as the Pap test by using a small soft brush to collect cervical cells that are sent to the laboratory, or the HPV testing sample may be taken directly from the Pap sample. (One HPV test can now be used as primary cervical cancer screening, that is, it can be done alone without a Pap test.)

How common is HPV?
HPV is the most common sexually transmitted virus. It has been estimated that 75% or more of sexually active Americans will contract HPV sometime in their lives. This means that anyone who has ever had sexual relations has a high chance of being exposed to this virus, but only a small number of women infected with HPV develop cell changes that need to be treated. In almost all cases, the immune system will keep the virus (including the cancer-related HPV types) under control or get rid of it completely. However, if HPV infection does not go away over many years, there is a greater chance of developing cell changes that may lead to cervical cancer. Only very rarely does the presence of HPV lead to cervical cancer.

Can HPV infections be treated?
There is currently no treatment available for the virus itself. However, good treatments do exist for the diseases HPV can cause, such as cervical cell changes or genital warts. Your healthcare provider will discuss these treatment options with you, if you need them.

Should I have an HPV test?
In women 30 and over, screening using both an HPV test and a Pap test is the recommended approach. If both tests are negative (normal), a woman may safely have her next Pap and HPV test in five years depending on her past Pap test findings and other risk factors. For this reason, some women now may have an HPV test when they have their Pap test. It will still be important to continue having routine recommended preventative health exams.

Recently one HPV test—the cobas® test—was approved for use with women age 25 and older for primary cervical cancer screening (meaning it can be done alone without a Pap test). With HPV primary testing, women who test positive for high risk HPV will than have a Pap test, while those positive for the more aggressive HPV 16 and HPV 18 will be referred for colposcopy (where a health care provider uses a special lighted microscope to examine a woman’s cervix directly).

It’s also acceptable to continue screening women with Pap tests alone. The most common abnormal Pap result is called ASC-US, or atypical squamous cells of undetermined significance. About half of the women with ASC-US have these cell changes because of the presence of HPV, while the other half do not. Women with ASC-US Pap tests often have a follow-up HPV test: if the HPV test is negative, you probably will continue with normal, routine screening. Usually only women with ASC-US who test positive for HPV need further evaluation. HPV testing is helpful at any age for determining which women with ASC-US need follow-up.


What if the HPV test and Pap test are both normal?
If both the HPV test and the Pap test are normal you have very little risk of any worrisome changes occurring in your cervix over the next 5 years. You should discuss with your physician the optimal time for follow-up testing according to professional recommendations and the physician’s assessment of your clinical history.

If I tested positive for HPV, what does this mean for me?
Most HPV infections go away without treatment because the immune system finds the virus and either gets rid of it or suppresses it to the point that it is unlikely to cause additional problems. Cell changes that may eventually lead to cervical cancer only occur when this does not happen and HPV stays for many years. Even though HPV is found in cervical cancer, most people testing positive for HPV are not at risk for getting cervical cancer because they have the virus for only a short time (months rather than many years). Therefore, women with a normal Pap who test positive for HPV will usually be tested for HPV again in 12 months. Testing positive a second time does not mean that there is great risk of cervical cancer, or even of cell changes that may lead to cervical cancer, but it does mean that further evaluation will likely be recommended.

Another option is to have an HPV 16/18 Genotyping test that checks directly for HPV types 16 and 18, which together are responsible for approximately 70% of cervical cancers. This test is approved for use (in combination with a Pap test and Cervista HR test) as primary cervical cancer screening with women age 30 and older to determine if HPV 16/18 are present with ASC-US Pap results.


If I test positive for HPV, how did I get it?
HPV is usually acquired by direct skin-to-skin contact during intimate sexual contact with someone who is infected. Most men and women are not aware that they have the virus. Condoms do not offer complete protection from HPV. Increasing numbers of partners increases the risk of getting HPV, but the virus is so common that having only a single lifetime partner does not assure protection. It is usually impossible to determine when, and from whom, HPV was caught. HPV may be detected fairly soon after exposure, or may not be found until many years later. For all these reasons, it is not helpful, nor fair to blame your partner.

What does my positive HPV test mean for my partner?
Most sexually active couples share HPV until the immune response eliminates the infection. Partners who are sexually intimate only with each other are not likely to pass the same virus back and forth. When HPV infection goes away the immune system will remember that HPV type and keep a new infection of the same HPV type from occurring again. However, because there are many different types of HPV, becoming immune to one HPV type may not protect you from getting HPV again if exposed to another HPV type.

If I have HPV, is there anything I can do?
Don’t smoke. Smoking has been shown to increase the chance that cell abnormalities might progress to more severe changes. Be sure to keep your follow-up doctor appointments.

What about partners?
Most sexually active couples share HPV until the immune response suppresses the infection. Partners who are sexually intimate only with each other are not likely to pass the same virus back and forth. When HPV infection goes away the immune system will remember that HPV type and keep a new infection of the same HPV type from occurring again. However, because there are many different types of HPV, becoming immune to one HPV type may not protect you from getting HPV again if exposed to another HPV type.

Will I have the HPV virus forever?
Probably not. HPV infection is very common, but it usually clears, or is suppressed by the immune system, within 1-2 years.

Key Points to Remember

Almost everyone gets HPV at some time. HPV is not likely to change your life. If you have tested positive for HPV there may be a short period of time during which follow-up may seem to be a bother, but little more. Cervical cancer, the most serious problem associated with HPV, is rare and almost always prevented through regular testing for cervical cell changes that could lead to cancer.

Cervical cancer is preventable. Early detection of abnormal cell changes is important.Almost all women and men will have HPV at some point, but very few women will develop cervical cancer. The immune system of most women will usually suppress or eliminate HPV. Only HPV infection that does not go away over many years can lead to cervical cancer, for example.It can be helpful to know your HPV status. This can help determine how often your clinician will recommend that you be tested.Don’t blame yourself or your partner. Your HPV status is not a reliable indicator of your sexual behavior or that of your partner.

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