Cervical cancer screening can save young women’s lives

MYTHS AND FACTS ABOUT HPV

Myth: I'm the only person I know with HPV

It's easy to understand why so many people hold this misunderstanding about HPV. After all, public awareness of the virus is extremely low. Most people who contact us with questions about HPV have never even heard of HPV until they were diagnosed.

Those struggling with this troubling condition or strange new diagnosis rarely discuss it with others, since it would seem unlikely that they would understand. And others--your second-best friend, your cousin, your co-worker, your neighbour across the street--likewise feel constrained to keep silent about their HPV, thinking that you wouldn't understand.

The net result is that very few people ever have the chance to place genital HPV in an accurate context, as the very common virus it really is. According to statistics, about 74 % of people--nearly three out of four--have been infected with genital HPV at some point in their lives. Among those ages (15-49), only one in four people has not had a genital HPV infection.

It's true that most often genital HPV produces no symptoms or illness, and so a person who has been infected may never know about it. Experts estimate that at any given time, only about 1% of all sexually active persons have visible genital warts. Far more women have abnormal Pap tests related to HPV infection, but in many cases health care providers do not explain the link between HPV and cervical infection, perpetuating the misunderstanding.

Myth: Only people who have casual sex get STIs

Even with billions of people contracting a sexually transmitted infection (STI) each year, many people continue to believe that only "someone else" - for example, people who have multiple partners, sex outside of marriage, or a different lifestyle - are at risk.

It is true that a higher number of sexual partners over the course of a lifetime does correlate with a higher risk for STIs, including HPV. This is not because of any moral judgment concerning "casual" sex as compared with "committed" sex, but simply because the more sexual partners you have, the more likely you will have a partner who (knowingly or unknowingly) is carrying an STI.

However, STIs can be passed along as readily in a loving, long-term relationship as in a one-night stand. And HPV is the virus to prove it. At least one study of middle-class, middle-aged women, most of them married with children, found that 21% were infected with cervical HPV. In other studies, according to Nancy Kiviat, MD, a researcher at the University of Washington, about 80% of people who have had as few as four sexual partners have been infected with HPV.

Myth: An HPV diagnosis means someone has cheated

This myth has been responsible for a great deal of anger, confusion, and heartache. It has led many people to tragically wrong conclusions because it fails to take into account one of the most mysterious aspects of genital HPV: its ability to lie latent.

The virus can remain in the body for weeks, years, or even a lifetime, giving no sign of its presence. Or a genital HPV infection may produce warts, lesions, or cervical abnormalities after a latent period of months or even years.

As mentioned above, most people who are infected with genital HPV never know it; their virus does not call attention to itself in any way. In most cases, a person is diagnosed with HPV only because some troubling symptom drove him or her to a health care professional, or some abnormality was revealed in the course of a routine exam.

But although careful examination can identify genital HPV infection, and laboratory tests may even narrow down the identification to a specific type among the two dozen or so that inhabit the genital tract, there is simply no way to find out how long a particular infection has been in place, or to trace it back to a particular partner.

In a monogamous relationship, therefore, just as in an affair or even in an interval of no sexual relationships at all, an HPV diagnosis means only that the person contracted an HPV infection at some point in his or her life.

Myth: Genital warts lead to cervical cancer

No one knows how many sleepless nights can be laid at the door of this myth. The truth, however, is that the fleshy growths we call genital warts are almost always benign. In the vast majority of cases, they do not lead to cancer, turn into cancer, or predispose a person toward developing cancer.

According to Katherine Stone, MD, genital warts need not "raise a red flag with regard to cancer in anyone's mind." There are more than 70 types of human papillomavirus, and most are quite specific in the sites they can invade and the pathology they can cause. Those most strongly associated with cancer are HPV types 16, 18, 31, 45, and, to a lesser degree, half a dozen others. These are known as the "high-risk" types, not because they usually or frequently cause cancer but because, in the infrequent event that cancer does develop, it can usually be traced back to one of these types. Even so, it bears repeating: most women with high-risk HPV on their cervix will not develop cervical cancer.

As for ordinary genital warts, says Doug Lowy, MD, chief of the Laboratory of Cellular Oncology at the National Cancer Institute, "These are caused by HPV types that are virtually never found in cancer." These are the "low-risk" types, 6, 11, 42, 43, and 44. When not causing genital warts they may cause a transient abnormality in Pap test results, or most often produce no symptoms at all.

In practical terms, a man with genital warts is no more likely than any other sexually active man to transmit cancer-causing HPV types to a partner. Experts do recommend that a woman exposed to genital warts - or any other STI - have regular Pap tests. This is because she may have been exposed to high-risk HPV types during unprotected sexual activity. Regular Pap tests are also recommended for any sexually active woman, since HPV infection is very common. It is worth keeping in mind that both men and women may be infected with, and infectious for, high-risk HPV, regardless of whether or not they have genital warts.

Myth: An abnormal Pap means a woman is at high risk for cervical cancer

First of all, an abnormal Pap test can be caused by factors other than the presence of a high-risk HPV type. When a Pap test comes back as "abnormal," it means just that: Under the microscope, the appearance of a few cells in this sample differs in some way from the classic appearance of healthy, intact cervical cells. The difference could be due to local irritation, a non-HPV infection, a low-risk HPV type, or even a mistake in the preparation of the cell sample.

To help sort out the various possibilities, a woman with an abnormal Pap test is often asked to come back to the doctor's office and have the test repeated. Most nonsignificant reasons for an abnormal result last only a short time, and so repeating the Pap test after a few months usually weeds these out. Even if the result is again abnormal, this rarely means that cancer is imminent. In an overwhelming majority of cases, a truly abnormal Pap test is due to pre-invasive disease, not invasive disease per se.

Follow-up tests such as colposcopy and biopsy can help evaluate the abnormality and remove any potentially malignant cells. If further treatment is recommended, the patient and her healthcare provider usually have several options to consider, and time in which to consider them.

What if a woman with a persistently abnormal Pap test does not receive treatment? This scenario is very unlikely in the developed countries, where the follow-up measures described above are standard practice. But even supposing that a woman went untreated after repeated abnormal Pap results, she still would have the odds on her side, because only one out of four cases of cervical lesions will progress to cancer if left on its own. And treatment is almost always successful in preventing cervical cancer if the abnormal cells are found in time.

But this very effective system of protection can work only when each woman takes responsibility for the first step herself, by having a Pap test at regular intervals. According to the National Cancer Institute, about half of women with newly diagnosed cervical cancer have never had a Pap test, and another 10% have not had a test in the past five years.

Myth: If I have warts or dysplasia, I will have recurrences for the rest of my life

Warts and dysplasia do recur (come back) in some cases, but by no means all. When they recur, they show varying persistence: Some people experience just one more episode and others several. The good news for most people is that with time, the immune system seems to take charge of the virus, making recurrences less frequent and often eliminating them entirely within about two years.

The limiting factor here is the state of the immune system itself. According to Thomas Sedlacek, MD, adjunct professor of obstetrics and gynaecology at Allegheny University, if an individual's immune system is impaired - by the use of certain medications, by HIV infection, or by some temporary trauma such as excessive stress, serious illness, or surgery - it may be unable to prevent a recurrence. However, if the immune system is weakened only temporarily, most likely the recurrence will be short-lived.

The concern about life-long recurrences may be based on a misconception rather than a myth. It's true that at present there is no known cure for genital human papillomavirus. As a virus, it will remain in the infected person's cells for an indefinite time - most often in a latent state but occasionally producing symptoms or disease, as we have discussed elsewhere. Recent studies from the Albert Einstein College of Medicine and from the University of Washington suggest that HPV may eventually be cleared, or rooted out altogether, in most people with well-functioning immune systems. However, in at least some cases the virus apparently does remain in the body indefinitely, able to produce symptoms if the immune system weakens.

Myth: Older women don't need Pap tests

Unfortunately, this myth is shared by many women and healthcare providers alike. Women who are past reproductive age may no longer visit a gynecologist, believing that they no longer need regular Paps. In many cases, no other provider recognizes the need for continued Pap screening. Data from the 1992 National Health Interview Survey indicate that one-half of all women age 60 and older have not had a Pap test in the past three years.

The result can be deadly: One in four cases of cervical cancer, and 41% of deaths, occur in women age 65 and older. Continued Paps may be recommended because HPV can recur even after years of latency.

However, according the guidelines published by the American Cancer Society in 2002, women age 70 and older may discontinue screening if they have 3 or more normal Pap tests, and no abnormal tests in the last 10 years.

What's best for you? Speak with your healthcare provider to see what is recommended, given your own medical history

Myth: Treatment of warts means they are no longer contagious

Medical opinion is not settled on this point. The closest to a consensus might be phrased as, "Don't be too sure."

Transmission of HPV poses a major challenge to researchers, not only because it involves sexual behaviour, which people may or may not feel free to talk about, but also because HPV's long and variable period of latency makes it virtually impossible to trace back to a specific partner. When considering the infectiousness of treated or untreated warts, therefore, researchers must fall back on indirect observations and on reasoning from what they do know about this virus. Some specialists think that removing genital warts may lower the risk of transmission, since it "de-bulks" the areas of tissue that contain infectious particles. But since the area surrounding any visible warts is also likely to contain infectious HPV particles, removing the warts cannot eliminate the risk.

A person may have good reasons for wanting his or her genital warts removed--they may be uncomfortable physically or psychologically. But removing warts cannot guarantee that the risk of transmission is removed.

Myth: A pregnant woman with genital warts is very likely to have a child with respiratory papillomatosis

This myth refers to a possibility that, during childbirth, the baby may contract the human papillomavirus while passing through the mother's HPV-infected birth canal. The risk is real but quite small, and has been associated with only two specific types of HPV: 6 and 11.

If a baby does contract HPV during birth, and if the infection persists, it may cause the child to develop lesions on the vocal cords that can interfere with breathing. This condition, known as respiratory papillomatosis, can be treated.

Delivery by cesarean section offers a baby some protection against HPV infection, but not a guarantee. Overall, the risk of respiratory papillomatosis for the baby is far smaller than the general risk of complications arising from a C-section. Pregnant women with genital warts should discuss the risks and options with their physician well before their due date and decide for themselves what they would like to do.

Myth: Lesbians don't need regular Pap tests

This myth is based on an overly simple view of how HPV can be transmitted. Certainly, penile-vaginal sex can pass the virus along from one partner to another, but HPV can be passed through other forms of skin-to-skin contact as well.

The most recent evidence for this comes from a study under way at the University of Washington, which has found a number of genital HPV infections among lesbian women--even in some women who had never had sex with a man. Genital HPV in lesbians has not yet been extensively studied, but researchers suspect the prevalence rates will be lower than among heterosexuals. Even so, the rates will not be low enough to rule out the risk of cervical cancer altogether, so a regularly scheduled Pap test is a smart health measure for gay and straight women alike.

Myth: If a woman has an abnormal Pap, her male partner should get an HPV test

Based on our experience with other infections, this would seem like a good idea. However, thus far there is no diagnostic test that can accurately determine whether a man is carrying an HPV infection. And even if he does, there is no way to treat him for the virus.

According to recent guidelines drafted by the CDC, "examination of sex partners is not necessary" as follow-up to an abnormal Pap test. It's certainly possible--even likely--that the partner is or has been infected with the virus, although highly unlikely that he will ever show any symptoms. Nor is it possible to determine whether he can spread HPV to a future partner.

However, if a woman has external genital warts, her partner may still consider scheduling a medical exam. It may be useful for a male partner to talk with a health care provider to gain more information. And of course, if a man starts to notice symptoms of his own, such as unexplained bumps or lesions in his genital area, he should get medical attention at once.

Myth: If I've always used condoms, I'm not at risk for HPV

Unfortunately, this is not always the case. Used correctly, condoms are very effective against STIs such as gonorrhea and HIV that are spread through bodily fluids. However, they are likely to be less protective against STIs that spread through skin-to-skin contact, such as HPV and herpes. The reason is simply that condoms do not cover the entire genital area of either sex. They leave the vulva, anus, perineal area, base of the penis, and scrotum uncovered, and contact between these areas can transmit HPV.

That is not to say condoms are useless. In fact, studies have shown condom use can lower the risk of acquiring HPV infection and reduce the risk of HPV-related diseases, as well as help prevent other STs and unintended pregnancy. For these reasons, condoms should play an important part in any new or non-monogamous sexual relationship.

http://www.nccc-online.org/index.php/faq

Concern about getting infected again

Many women worry about becoming infected with HPV again after they have had treatment for abnormal cervical cells. Viruses are difficult to treat and your body gets rid of them by developing immunity to them. This may take from a few months to a few years.

Some women worry about whether their partner has the virus and could reinfect them. Men aren’t routinely tested for HPV because the only way for a man to find out if he has the virus is to have several biopsies. Even then, a negative result only means that HPV wasn’t found on those biopsies and not necessarily that he doesn’t have HPV at all. Our bodies clear the virus. So, even if a man has the virus when he is tested, his immune system may get rid of it before the test result comes back.

As there are more than 100 types of HPV, it is possible to be immune to one type but not another. So it may seem that you have been reinfected but in fact you may just have a different type of HPV.

Treating abnormal cells in the cervix

You may require treatment if the results of your colposcopy indicate abnormal cells in your cervix.

Treatment typically aims to remove the area of abnormal cells. This usually involves removing an area of the cervix about the size of a finger-tip.

The specific type of treatment recommended will depend on the number of abnormal cells in your cervix and how advanced the abnormalities are.

The aim of treatment is to remove the abnormal cells while minimising damage to healthy tissue. Treatment is nearly always 100% successful, and it is unlikely cell changes will occur again.

Timing of treatment

It is often possible to have treatment at the same time as your colposcopy. This may be more convenient for you than having to make another appointment for treatment at a later date.

Some women find waiting for treatment causes anxiety, and prefer to be treated as soon as possible. Others prefer time to think about their treatment and schedule it for another time.

Some more intensive treatments cannot be done on the same day as a colposcopy. Your colposcopist will advise about the best time for your treatment to be carried out. They will also be able to discuss treatment options with you, and what each type of treatment involves.

Some available treatments are discussed below

       1.      Large loop excision of the transformation zone (LLETZ)

The large loop excision of the transformation zone (LLETZ) is the most common treatment for abnormal cervical cells. LLETZ is also known as loop diathermy, loop cone, loop biopsy or loop excision.

LLETZ can sometimes be carried out at the same time as a colposcopy and involves cutting out the area of the cervix where abnormal cells have developed. This is done using a thin wire loop that is heated with an electric current. A small ball electrode is used to seal the wound.

LLETZ usually takes 5-10 minutes. It is usually carried out under local anaesthetic (medication that numbs the area), which is injected into your cervix with a needle. The procedure is not usually painful, although you may feel some pain similar to period pain.

If a larger area of the cervix needs to be treated, the procedure will take longer and you may need a general anaesthetic (where you are put to sleep).

You will need to bring a sanitary towel with you as you will bleed after having LLETZ. You may also have some light bleeding for several weeks after the procedure.

After having LLETZ you should avoid:

- using tampons for four weeks (use sanitary pads instead)

- having sexual intercourse for four weeks

- heavy exercise for two to three weeks

These all increase your risk of developing an infection after the procedure has been carried out.

There is some evidence to suggest women who are treated with the LLETZ procedure have an increased risk of premature birth in future pregnancies. However, in the most cases benefits of treatment will greatly outweigh this small risk. Your doctor can advise further about this if necessary.

      2.     Cone biopsy

It is not possible to carry out a cone biopsy at the same time as a colposcopy. A cone biopsy is a minor operation that may require an overnight stay in hospital. It is carried out less commonly than LLETZ and is only really used if a large area of tissue needs to be removed.

A cone biopsy is carried out under general anaesthetic. A cone-shaped piece of tissue is cut away from your cervix with a scalpel. The section of tissue removed may include the whole area of cervix where the abnormal cells are located. The tissue will be sent to a laboratory for closer examination under a microscope.

Following a cone biopsy, a piece of gauze (a dressing made of absorbent material) may be placed in your vagina to help stop any bleeding. If you require a gauze pack, you may also need a catheter inserted (a thin tube that drains urine from your bladder) as the pack can sometimes press on your bladder. You may need to stay in hospital overnight – please ask your doctor or nurse for more advice.

It is normal to bleed for up to four weeks after having a cone biopsy. You may also have some period-like pain, although any discomfort should only last for a couple of hours. Painkillers can be used to help ease the pain.

Take plenty of rest during the first week after having a cone biopsy. You will not need to stay in bed but you should avoid tasks such as heavy lifting. Also avoid vigorous exercise and having sex during the first four to six weeks after the biopsy. After this time, the tissue in your cervix should have healed.

While recovering from your operation you may also find it useful to arrange for a relative or friend to stay with you for a few days to help with difficult tasks.

Other treatments

Abnormal cells can be treated in several other ways, without removing them. Your doctor can give you more information and advice about the procedures briefly outlined below and whether they are appropriate to your circumstances.

      1.      Cryotherapy

Cryotherapy is a form of treatment that involves freezing and destroying any abnormal cells. During the procedure, you will lie on a couch and a doctor will insert an instrument called a speculum into your vagina. They will then freeze and destroy any abnormal cells.

During cryotherapy, liquid carbon dioxide is passed through a probe and directed at the abnormal cells. The tissue will be frozen for two to three minutes, and the process may be repeated if necessary.

You may feel period-like pain during cryotherapy, and for a short time after the treatment has finished.

      2.     Laser treatment

      Laser treatment involves the doctor using a laser to pinpoint and destroy any abnormal cells on your cervix. A local anesthetic will be used to numb the area being treated.

The abnormal area will be burned away using a hot beam of light produced by the laser. There may be a burning smell during this procedure, but this is normal and nothing to be worried about. 

You can return home as soon as the laser treatment is finished.

      3.     Cold coagulation

Cold coagulation involves applying a heat source to the cervix that burns away and removes the abnormal cells. You may feel period-like pain during cold coagulation treatment, and for a short time afterwards.

      4.     Hysterectomy

A hysterectomy (surgical removal of your womb) will only be considered if abnormal cells on your cervix have been found more than once or if they are severely abnormal.

Removing your womb will usually only be an option if you have decided not to have any more children or you have had the menopause.

After treatment

Following treatment on your cervix, you are likely to be advised to avoid:

-  using tampons for four weeks after your treatment

-  having sexual intercourse for four weeks after your treatment

-  going swimming for two weeks after your treatment

The Colposcopy

Maybe one of the most frightening times in a woman's life is when the gynaecologist calls and says that the Pap smear results are abnormal.  Although women might think an abnormal Pap smear means cervical cancer, the fact is that the majority of abnormal Pap smears are not caused by cervical cancer but more likely is the result of inflammation or a vaginal infection.

Also, abnormal cervical smear test result usually means that changes have been found in the cells of your cervix. Abnormal cells found during cervical screening can be pre-cancerous. Again, this doesn’t mean cervical cancer. It means that some of the cells are a little abnormal and if left untreated, they could develop into cervical cancer in the future.

Because the Pap smear can only screen for potential problems, not diagnose them, the gynecologist may want to take a closer look at the cervix to determine the cause of the abnormal Pap smear results. He/she will perform an examination called a colposcopy.

The doctor may also recommend a colposcopy if there are symptoms such as bleeding in between periods or after sex, blood-stained vaginal discharge or pain in the pelvis. A colposcopy can help to show whether the symptoms are due to cervical cancer, or if they may be caused by something else.

So…what exactly is a Colposcopy?

Colposcopy is a procedure carried out after some abnormal cervical screening tests. It involves a detailed examination of the neck of the womb (cervix) using a special microscope that acts like a lighted magnifying glass that looks like a pair of binoculars, called a colposcope. A camera can be attached to the colposcope to take pictures or videos of the vagina and cervix.

A liquid ( vinegar - acetic acid and sometimes iodine solution) is painted on the vagina and cervix with a cotton swab or cotton balls to see problem areas more clearly.

During colposcopy a small piece of tissue will be taken from the cervix. This is known as a biopsy. The tissue is then examined in even closer detail in the laboratory to allow further assessment of the cells. Treatment for any abnormal cells can sometimes be given at the same time as the colposcopy examination.

Before the colposcopy

Every woman should receive clear information about the procedure in advance of the appointment. There are some things to think about before the colposcopy that can help you prepare:

*  Some clinics prefer not to perform colposcopy whilst a woman is having her period. This is because it can be difficult to get a good view of the neck of the womb (cervix) if there is a lot of blood. Also, some women may prefer not to have an intimate examination whilst bleeding. If your period starts and you anticipate you will still be bleeding when you have your appointment, it is probably best that you telephone the clinic for advice. In some cases the appointment may be rearranged. Do not feel embarrassed about this - it is completely out of your control, and colposcopy clinics are very used to this sort of thing.

* You should avoid sex and not wear a tampon for 24 hours before your colposcopy.

* You should not use any vaginal creams for 24 hours before your colposcopy. This includes lubricants, thrush treatments, douches and spermicides.

* You may want to wear a loose, full skirt on the day of your colposcopy so that you do not have to remove all of your lower clothing.

* It is often a good idea to bring someone with you who can take you home after your colposcopy. This is most important if the clinic has told you that you may have treatment at your first appointment. They do not have to come into the examination room with you (but if you do want a friend or relative with you during your examination this is also possible).

Tell your doctor if you:

- Are or might be pregnant. A blood or urine test may be done before the colposcopy to see whether you are pregnant. Colposcopy is safe during pregnancy. If a cervical biopsy is needed during a colposcopy, the chance of any harm to the pregnancy (such as miscarriage) is very small. But you may have more bleeding from the biopsy. A colposcopy may be repeated about 6 weeks after delivery.

- Are taking any medicines.

- Are allergic to any medicines.

- Have had bleeding problems or take blood thinners, such as aspirin, etc.

- Have been treated for a vaginal, cervical, or pelvic infection.

What happens during a colposcopy?

During a colposcopy, you lie down in a special type of chair which has padded supports for you to rest your legs on. A device called a speculum is gently inserted into your vagina and opened to allow your colposcopist to see your cervix (the same as when you have a cervical smear test).  Your cervix is then examined with a colposcope and a biopsy is taken, if needed. This should not be painful, although you may feel a slight stinging sensation. If necessary, you may be given a local anaesthetic (medication to numb the area).

The examination lasts about 20 minutes, but the whole appointment can take about an hour.

It is usually a painless procedure, although some women find it uncomfortable. If you are concerned, you could take a painkiller, such as paracetamol, beforehand. However, do not take aspirin or ibuprofen as they may increase your chance of bleeding afterwards.

If your colposcopist is relatively certain abnormal cells are present on your cervix they may recommend treatment straight away rather than a biopsy.

After the colposcopy

You will usually be able to go home or work straight after having a colposcopy. Following the examination and for a few days afterwards you may have a slight brown or black vaginal discharge. You may want to bring a sanitary towel with you to use after the examination.

Seek advice from your doctor  if, after having a colposcopy, you experience:

* a high temperature (fever) of 38ºC (100.4ºF) or above

* bright red heavy vaginal bleeding (where you need to use one sanitary pad or more an hour)

* severe cramps and lower tummy pain

* chills

These symptoms may indicate the presence of an infection.

It is usually recommended that you wait until any bleeding stops before having sex or using tampons, vaginal creams and pessaries.

Will I need any follow-up?

This depends on the results of your colposcopy and whether you needed any treatment. Some women may need a follow-up colposcopy examination. Other women may just need a follow-up cervical screening test, usually after about four months. The doctor or nurse who performs your colposcopy will advise what follow-up you will need. Most colposcopy clinics will see you again 4 to 6 months after your first examination or treatment.

If all is well at your follow-up appointment, you will be given advice about when you should have your next cervical screening test. This test can be carried out by your usual clinic or the gynaecologist. You will usually be advised to have a cervical screening test every year for a number of years. If you have any further abnormal cervical screening test results you may need to have another colposcopy examination.

Human Papillomavirus (HPV) Test

A Human Papillomavirus (HPV) test is done to find a high-risk HPV infection in women. An HPV test checks for the genetic material (DNA) of the Human Papillomavirus. Like a Pap test,  an HPV test is done on a sample of cells collected from the cervix.

There are many types of HPV. Some types cause warts that you can see or feel. Other types do not cause any symptoms. Most people do not know they have an HPV infection.

This test will identify whether a high-risk type of HPV is present. In women, high-risk types of HPV (which I mentioned in the past posts) cause changes in the cells of the cervix that can be seen as abnormal changes on a Pap test.  Abnormal cervical cell changes may resolve on their own without treatment. But some untreated cervical cell changes can progress to serious abnormalities and may lead to cervical cancer over time if it is not treated.

Although HPV is found in both men and women, this test is not used on men. Also, your doctor can usually diagnose visible genital warts with a physical exam, so this test is not used to diagnose genital warts caused by low-risk types of HPV.

Why is it done

An HPV test is done to:

·         Check for high-risk types of Human Papillomavirus (HPV) in women who had a Pap test that showed abnormal cervical cells called atypical squamous cells.   An HPV test can help look for one or more high-risk types of HPV. If an HPV test shows that high-risk types of HPV are present, further testing, such as a colposcopy or cervical biopsy, may be recommended.

·         Check for HPV in women older than age 30 as part of screening for abnormal cervical cells.

·         To help check for abnormal cervical cells after treatment of a high-risk HPV infection.

·         The HPV test may be done at the same time as the Pap test. The results of this test can help doctors decide if further tests or treatments are needed.

How to prepare for the HPV test

·         Before an HPV test, do not douche, use tampons, or use vaginal medicines for at least 48 hours.

·         You will be asked to empty your bladder just before the test, both for your own comfort and to help with the examination.

·         Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean.

How is it done

An HPV test can be done in a doctor's office or clinic by:

·         A gynecologist

·         An internist

·         A family medicine physician

·         An urologist

·         A physician assistant (PA)

·         A nurse practitioner

For this test, you need to remove your clothes below the waist and drape a paper or cloth covering around your waist. You will then lie on your back on an examination table with your feet raised and supported by stirrups. This allows your doctor to examine your vagina and genital area.

Your health professional will insert an instrument called a speculum into your vagina. The speculum gently spreads apart the vaginal walls, allowing the inside of the vagina and the cervix to be examined.

Your health professional will then use a cotton swab or a small brush to collect several samples of cells from the cervix. Cells are collected from the visible part of the cervix as well as cells from inside the opening of the cervix (endocervical canal). The samples are then placed in collection tubes and sent to a laboratory for analysis.

An HPV test can also be done on a cell sample taken during your Pap test if a technique called a liquid-based Pap test was used. For a liquid-based Pap test, cells are collected by rotating a plastic brush on the cervix. The samples are then placed in a jar of solution and sent to a lab for examination. If you have this type of Pap test and it shows abnormal cells, an HPV test may be done later on the same sample.

How does it feel

You may feel some discomfort when the speculum is inserted, especially if your vagina is irritated and tender or if it is narrow. You may also feel pulling or pressure when the sample of cervical cells is being collected.

Risks

There is very little chance of a problem from an HPV test. You may worry or feel frightened if you need more testing.

After the procedure

·         You may have a small amount of vaginal bleeding or gray-green discharge after this test, and you may want to use a pantyliner to protect your clothes from any spotting.

·         Do not have sex until your doctor tells you it is safe to do so.

Results

A Human Papillomavirus (HPV)  test is done to find a-high risk HPV infection in women. HPV test results are generally available in 1 to 2 weeks.

Human Papillomavirus (HPV)
Normal:	High-risk HPV is not found.
Abnormal:	High-risk HPV is found. If high-risk HPV is found, you may have a higher chance of having precancerous cervical cell changes. Further testing-including repeat Pap or HPV tests, colposcopy or cervical biopsy  -may be recommended by your doctor, depending on your medical history and the results of this test.

What affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

·         The use of douches, tampons, and vaginal creams or vaginal medicines within 48 hours before the test.

·         A cervical cell sample that is too small.

·         Your Pap smear shows abnormal cells that are already known to be caused by a high-risk type of HPV.

What to think about

·         A Human Papillomavirus (HPV) test is not routinely used to diagnose genital warts. It is usually done to find out whether an abnormal Pap test result may be caused by one or more high-risk types of HPV.

·         An HPV test may be done along with a Pap test in women age 30 and older. It may be done as a follow-up test after treatment for an abnormal Pap test.

·         A positive HPV test does not mean that you have cervical cancer. It may mean that you are infected with one or more high-risk types of HPV, which increases your chance of having precancerous cervical cell changes. Your doctor may recommend repeat testing or further testing, such as a colposcopy and cervical biopsy, to find out whether precancerous changes are present. The type of testing recommended will depend on your medical history and the findings of the HPV test.

·         An HPV test is highly reliable for finding HPV when it is present. But an HPV test may come back positive when you do not have an HPV infection. This is called a false-positive test result.

·         An HPV test is done only for women. Currently, an HPV test for men is done only in a research setting.

·         If you are age 26 or younger, you can get the HPV shot. The vaccines Cervarix and Gardasil protect against two types of HPV that cause cervical cancer. Gardasil also protects against two types of HPV that cause genital warts.