Human papillomavirus (HPV) is a primary risk factor for cervical cancer. HPV 16 and 18 are the two most carcinogenic genotypes and have been reported in the majority of cervical cancer cases. High-risk HPVs (hrHPVs) other than HPV 16/18 cause about a quarter of cervical cancers. Our objective was to present the results of the colposcopy-guided biopsy of women uninfected with hrHPV 16/18 with negative cytology.
This is a retrospective cohort study conducted in 752 patients between the ages of 30-65 years with hrHPV non-16/18 and negative cytology undergoing colposcopy-guided biopsy at a tertiary gynecologic cancer centre between January 2016 and January 2019.
The mean age of the women was 42.35±9.41 years. A 2+ cervical intraepithelial neoplasia (CIN) lesion was detected in 49 (6.5%) women with negative cytology. The rate of CIN 2+ lesions in women with abnormal cytology was 12.8%. Patients with abnormal cytology had about 2.1 and 2.4 times more odds of having a CIN 2+ lesion in cervical biopsy and endocervical curettage samples, respectively. CIN 3+ lesion was detected in 20 (2.7%) women with negative cytology. One (0.1%) of the patients with HPV 39 and negative cytology had invasive cervical cancer. The two most common HPV subtypes were HPV 31 and HPV 51.
The risk of preinvasive cervical lesions is still detectable and cannot be completely eliminated among high-risk HPV-infected women other than 16/18 with negative cytology. Based on the results of this study, referral for colposcopy in women uninfected with hrHPV 16/18 with negative cytology is considered a credible and feasible strategy.
cervical cancer; cervical intraepithelial neoplasia; colposcopy; human papillomavirus.
What is the human papillomavirus (HPV)?
Human papillomavirus (HPV) is the name for a group of viruses that affect the skin and moist membranes of the body, for example, the cervix (entrance to the uterus), anus, mouth, and throat. There are several different strains of HPV: most have no symptoms, go away on their own, and do not cause any health problems, while other strains can cause cancer. There are two main genital HPV infections that you should be aware of.
- those that can cause genital warts: small growths around the genitals that are usually painless and can be treated whenever they appear. They are not cancer and do not cause cancer.
- those that can lead to cervical, anal and other cancers. Most cases of cervical cancer are related to infection with certain types of HPV.
What are the symptoms of HPV?
Not all cases of HPV will have symptoms. Symptoms vary depending on the strain of HPV. Symptoms of genital HPV include:
- Genital warts (called low-risk HPV): See our page on genital warts.
- Cancer-causing HPV (called high-risk HPV): In most cases, these do not cause any symptoms, and you can have HPV for many years without causing health problems.
In addition to cervical cancer, HPV can also cause other types of cancer, such as anal cancer, cancer of the penis, vagina, vulva, and back of the throat, although these are very rare.
How do you get HPV?
HPV infections are spread through skin-to-skin contact, often through a cut, abrasion, or small tear in the skin. Genital HPV infections are very common and are often easily spread through:
- vaginal, anal, or oral sex without a condom (or dental dam), with someone who has an HPV infection (even if you don’t have symptoms)
- sharing sex toys that are not washed or covered with a new condom each time they are used
- Close genital contact: This means that HPV can be transmitted even if there is no penetration, orgasm, or ejaculation.
How do you protect yourself from HPV?
- Use a new condom or dental dam every time you have vaginal, anal, or oral sex. Remember that HPV can affect areas not covered by a condom, so it may not offer complete protection.
- Wear a new dental dam or latex gloves for rimming and fingering (exploring your partner’s anus with your fingers, mouth, or tongue), or wear latex gloves for fisting.
- Cover sex toys with a new condom for each partner and wash them after use.
- Remember, the virus is not only transmitted through penetrative sex and can be transmitted through any genital skin-to-skin contact.
Vaccines are available to prevent certain types of HPV that can cause cancer and warts. These are often offered to adolescent girls, men who have sex with men, and people living with HIV. It’s best to get vaccinated before you start having sex, although it’s sometimes possible to get vaccinated later in life.
Ask a health worker to find out if you can get the HPV vaccine where you are. Remember, the vaccine only protects against certain strains of HPV and does not guarantee that you will not develop genital warts or cancer in the future. Therefore, it is important to use condoms and have regular cervical screening tests (smears) when available.
Talk to your partner
It is important that you are able to discuss your sexual health with your partner. This way, you can let each other know about any symptoms or infections, and discuss how you can have safer sex together.
If you have sex with multiple partners, it’s even more important to use condoms and get regular STI tests. Remember that condoms are the best form of protection against STIs and pregnancy. Other contraceptives, including the birth control pill, do not prevent HPV, and neither does PrEP.
Can I get tested for HPV?
Different strains of HPV are tested in different ways.
- Genital warts (low-risk HPV)
A health professional can quickly examine you to determine if you have genital warts.
- Cancer-causing HPV (high-risk HPV)
For women, genital HPV testing is usually part of cervical screening, which looks for abnormal cells on the cervix (entrance to the uterus). Cervical screening is not a cancer test, it is a test to check the health of the cells in the cervix. If you have changed the cells of the cervix, it does not mean that you have cervical cancer, but in some cases, the abnormal cells need to be removed so that they do not turn into cancer.
For men: There is currently no reliable test for HPV infection, and it is often very difficult to diagnose, as there are no symptoms of high-risk HPV. Some people who are at high risk of having anal HPV and developing anal cancer (for example, men who have sex with men or people living with HIV) may be offered an anal smear that looks for abnormal cells in the anal canal. anal.
How is HPV treated?
Cancer-causing HPV (high-risk HPV): If a cervical screening test shows you have abnormal cells on your cervix, they may need to be removed so they don’t turn into cancer. If cervical cancer develops and is found early, it can usually be treated with surgery.
Genital warts (low-risk HPV): There is no cure for genital warts, but your body may clear the virus over time. Warts can be removed using creams, freezing or heating. Read our page on genital warts to learn more.
HPV and pregnancy
If you are a pregnant woman with HPV, you can pass it to your baby at birth, but this is rare. Talk to your health worker if she is pregnant and concerned about HPV, she will be able to advise you on her options.
HPV, HIV and sexual health
- Having an STI, including genital warts, can increase your risk of getting HIV. This is because having an STI makes it easier for HIV to enter your body and cause an infection.
- People living with HIV are more likely to get HPV because of their weakened immune systems.
- If someone living with HIV also has HPV, her viral load will increase, making her more likely to transmit HIV during unprotected sex, even if she is taking anti-HIV drugs (antiretrovirals). However, if they have an undetectable viral load, there is no evidence that HPV increases the chance of transmitting HIV.
- The risk of developing HPV-related cancers is higher in people living with HIV who do not receive effective treatment. This is because their immune system is usually weaker.
- Being on HIV treatment (antiretrovirals), having an undetectable viral load, and having a higher CD4 cell count (greater than 200) can reduce the risk of developing HPV-related cancers.
- If you’re taking antiretrovirals, it’s important to talk to your healthcare professional about how HPV treatment may interact with your HIV medicines.