HPV (Human Papillomavirus)
Dr Danie Schneider
Obstetrician and Gynaecologist, Somerset West

HPV (Human Papillomavirus)

Background

Each year 7735 women are diagnosed with cervical cancer in South Africa. Cervical cancer is the number one ranked cancer in women aged 15 to 44 in Southern Africa and one of the leading female cancer death causes in South Africa. HPV (Human Papillomavirus) is directly linked with causing cervical cancer and is a very common viral infection. There are more than a 100 types of HPV (it is actually a whole family of viruses) and some types can cause genital warts, while others cause cancer of the cervix, vagina, vulva, penis, anus, mouth and throat. 80% of sexually active people will get HPV at some stage in their lives. The USA alone has 79 million people infected with the virus and 14 million new cases per year.

What does it mean if I have HPV?

Most people will not know that they have HPV unless they are tested specifically for the virus. The only sure sign that you have HPV is the development of a genital wart. The HPV types that can cause a genital wart are different from the HPV type that can cause cervical cancer. An HPV infection of the cervix usually has no symptoms. Your immune system will normally fight the HPV infection and clear it from your body in 1-3 years.

With or without symptoms, an infected person can spread the HPV to others. It is not possible to determine how long ago or when someone contracted the virus. If one partner has HPV, the other would normally also get it. The virus is very contagious. Testing positive for HPV does not mean that your partner has been unfaithful or means that you or your partner is having sex outside of your relationship. There is no sure way of knowing who gave you the virus or when it was contracted. A person can have HPV for many years before it is found.

We are not worried about HPV per se, only about what the virus can do. It is only when the HPV stays on the cervix of a woman over many years that it can cause pre-cancer or cancer. If you have HPV it does not necessarily mean that you will develop cancer. If your body does not clear the virus, persistent infection can develop. For women with persistent infection regular screening with a Pap test, in conjunction with a colposcopy (microscope test of the cervix), can detect pre-cancerous cells. The pre-cancerous cells can be removed with a simple procedure.

What is a HPV test?

The HPV test is used to look for human papillomavirus (HPV) in the cells from your cervix. We test for the HPV virus in conjunction with the standard Pap test. The decision to test or not will be made during the consultation and after discussion with you.

Your HPV result is reported as either negative for HPV or positive for HPV. A negative test means that no HPV has been found in your cervical cells. A positive test means that high-risk HPV, the type of HPV that can cause cervical cancer, has been found in your cervical cells. Some HPV tests can tell you if you have specific types of HPV, in particular HPV 16 or 18. HPV 16 and 18 are responsible for 70% of all cervical cancers.

Who should be tested for HPV?

Most women over 30 years of age should be tested for HPV, as well as women with Pap test results that are inconclusive. We do not normally advise testing young women less than 25 years for HPV, as statistically the virus was recently acquired and your body will most likely develop immunity against the virus over time.

We do advise a regular Pap test for woman between 25 and 30 years. We do not advise testing for HPV before vaccinating young women. If you had a total hysterectomy for reasons other than cancer, you may not need a HPV test. This will be discussed with you in consultation and after reviewing your records/history.

I have tested positive for HPV, now what?

Remember HPV is very common and stay calm, keeping in mind that HPV usually goes away on its own. Most people do not know that they have HPV and pass it on to their partner unknowingly. All women who have ever had sexual contact (consensual or forced) are at risk of having HPV. A positive result does however mean that you have the HPV type that may be linked to cancer, and this could be a warning. Make a formal appointment to discuss your results and have your questions answered. Invite your partner along if you want to.

Depending on your specific virus test results, a repeat Pap test in one year or a colposcopy and biopsy will be advised. This is a minor procedure done as a day case. A colposcopy is a microscope test where we look for abnormal cells on your cervix and it can be removed if needed. The results are usually available in 48 hours. If follow-up is advised, it is very important that you return for retesting in one year. Remember that cell changes take time to develop. We usually need further testing and follow-up before we can tell you whether the HPV will go away or cause changes.

HPV is just as common in men, but easier to find in women. At present there is no HPV test for men.

Having HPV should not affect your chances of falling pregnant or having a healthy baby. The treatment can possibly have implications for fertility in rare cases and this will be discussed with you in detail during consultation.

Can HPV be treated?

Most people who acquire HPV will clear the infection over time, because they develop immunity. Although there are currently no medicines available that treats HPV infection,
there are treatments for the HPV related diseases that develop.

HPV causes almost 90% of all genital warts, but treatment is available. The average person may need several treatments to get rid of genital warts. Precancerous lesions of the cervix can be removed with a Lletz procedure (excision procedure of the cervix).

Remember that most women with HPV are asymptomatic and not at risk of cancer, as long as they have appropriate follow-up. Your specific follow-up plan will be discussed during consultation.

How can HPV infection be prevented?

The best prevention is the HPV vaccine. It is safe and effective in preventing the majority of cervical cancers, pre-cancers and abnormal Pap smears.

By abstaining from sexual intercourse and any skin-to-skin contact in the genital area, you can also avoid getting HPV. If you limit your sexual partners to just one partner, who also has sex only with you, you can further limit your risk of infection.

Finally, use condoms. Condoms do not fully protect you from HPV, but they can lower your chance to get it.