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  The ABCs of the
  Human Papillomavirus (HPV)

 

Updated July 31, 2009

What is HPV?
Human papillomavirus is the most common sexually transmitted infection in the United States, and is most common in adolescents and young adults. There are more than 30 types of human papillomaviruses (HPVs) that infect the anogenital area (vulva, cervix, anus and penis).

How is HPV related to cervical cancer?
Based on their risk of causing cervical cancer, HPVs are grouped into low-risk and high-risk categories. Low-risk types cause genital warts and mild cervical cell changes. High-risk HPV types, especially when the infection persists for many years, can cause cervical cells to become precancerous and possibly cancerous. Pathologists agree that an HPV infection, if left untreated, is necessary for the development of precancerous cervical disease that may eventually progress to cervical cancer.

How common is cervical cancer in the United States?
The American Cancer Society estimates that in 2009, about 11,270 cases of invasive cervical cancer will be diagnosed in the United States. About 4,070 women will die from the disease.1

How common is HPV?
HPV is the most common sexually transmitted infection in the United States, and is most common in adolescents and young adults. Approximately 20 million people—both men and women—are thought to have an active HPV infection at any given time. In fact, seventy-five percent of sexually active people will be infected with HPV at some point in their lives.

What are the symptoms of an HPV infection?
If you are infected with HPV, you usually do not even know it, as there are no symptoms. In fact, it is impossible to determine the source of an HPV infection.

Is there treatment for an HPV infection?
While there is currently no treatment for HPV, most infections are only temporary. In healthy people, the virus is usually cleared by the immune system in less than two years, even without intervention.

How does someone become exposed to HPV?
HPV is transmitted through sexual contact (including vaginal, anal, and oral sex), or through skin-to-skin genital contact or rubbing. HPV can spread whether or not genital warts are visible. Because genital HPV infections are often unseen, they can be transmitted by sex partners who do not know they’re infected. A pregnant mother who is infected with HPV can also transmit the virus to her infant during vaginal childbirth.

How is an HPV infection diagnosed?
An HPV infection is identified and diagnosed by a pathologist through a Pap smear and the use, when appropriate, of a HPV DNA test.

What is the HPV DNA test?
A HPV DNA test uses advanced, molecular technology to determine whether one of the HPV virus types that can cause cervical cancer is present in the cervical cells.

Who should receive the HPV DNA test?
Pathologists recommend women 30 years of age and older have both the high risk human papillomavirus (HR-HPV) DNA test and a Pap test at the time of routine screening. These tests, for women in this age group, further increase the chance of identifying precancerous changes. It is important to note that the Pap test is still the most effective tool in identifying precancerous changes. No test is perfect, however, and adding the HPV test enhances the chance of making an early diagnosis in women 30 years of age and older.

What is a Pap test?
A Pap test is a simple procedure in which your primary care physician will obtain cells from the surface of your cervix, often using a special brush to sample the area where most cancer begins to develop. The cells are placed on a glass slide, which is sent to a laboratory to be analyzed by a pathologist. Since the introduction of Pap screening programs in the United States, the number of new cervical cancer cases has decreased by 70 percent.

Why is it important to get a Pap test?
The Pap test is the most effective tool we have available to prevent cervical cancer. A Pap test detects and allows for treatment of early precancerous changes in the cervix before invasive cancer can develop. No test is perfect, however, so the best way to prevent cervical cancer is to have Pap tests at regularly scheduled intervals.

Who should receive a Pap test?
Every woman should have regular Pap examinations within three years of becoming sexually active or by the age of 21, whichever comes first.

How often should I receive the HPV DNA test?
It is appropriate that women 30 years of age or older have both the HR-HPV DNA test and a Pap test at the time of routine screening. If both the HR-HPV DNA test and Pap test are negative, it is highly unlikely a woman has precancerous changes or cancer. When both tests are negative, routine cervical testing does not need to be repeated for three years in women over 30 years of age (because cervical cancer develops so slowly). If the Pap test is negative and the HR-HPV DNA test is positive, both tests should be repeated in 6 to 12 months. If both tests are positive, additional testing is necessary.

Do I need an HPV DNA test if I’m younger than 30 years of age?
Women who are younger than 30 years of age should not have the combined HPV DNA and Pap tests at their routine screening visit. Unlike older women, younger women often have HPV infections. An HPV infection is usually temporary and is usually cleared by the immune system in less than two years in most healthy people.

Should men receive an HPV DNA test?
Although both men and women can become infected with HPV, women are at greater risk for developing HPV related cancer. Therefore, HPV testing is largely targeted at women. It is especially appropriate for women 30 years of age and older.

How can I reduce my risk of being exposed to an HPV infection?
The most effective way to prevent infections caused by HPV is to abstain from genital contact. For persons who do not abstain, reducing the number of sex partners and choosing partners with few or no previous sexual relationships will reduce the risk of HPV exposure. Although condoms lower the rate of HPV infection, they offer incomplete protection.

What is the HPV vaccine?
On June 8, 2006, the Federal Drug Administration approved a new vaccine that will provide protection against two low-risk (HPV 6,11) and two high-risk (HPV 16, 18) HPV types. The vaccine is expected to provide protection against 90 percent of genital warts and 70 percent of cervical cancers. To be most effective, the vaccine should be given before a person is sexually active. It is important to note that even vaccinated women still need to have a Pap test, as the vaccine does not fully protect against other high-risk HPV types.

Who should receive the HPV vaccine?
The vaccine is most effective for individuals who have not yet been sexually active. That’s why it is important that women who have been sexually active continue to receive regular Pap tests. If a woman is 30 years of age or older, it is appropriate for her to also receive an HPV DNA test at the time of her regular Pap screening. Although both men and women can become infected with HPV, women are at greater risk for developing HPV related cancer. Therefore, HPV testing is largely targeted to women at the present time.

References

  1. American Cancer Society - May 2009