High prevalence of HPV infection in young women
Mr Fateh Raslan MB BCh BSCCP FRCOG is a consultant gynaecologist at Bupa Cromwell Hospital and lead colposcopist at West Middlesex University Hospital.
The human papilloma virus, which is also known as HPV, is a common infection that has one hundred different strains with varying effects throughout the body. Thirty of these strains are dangerous due to the health conditions they cause. These strains are capable of causing cancer of the cervix, vulva, vagina, and anus in women.
Lack of symptoms common with HPV
This health condition may be hard to detect at first because there are no symptoms related to this disease. Most people acquire this disease through sexual contact, as it is a commonly known sexually transmitted disease prevalent in young women. Information acquired from the National Health and Nutrition Examination Survey in February 2007 reveals that a total of 26.8% of women overall tested positive for one or more strains of HPV. The signs of this disease range from genital warts to non-malignant conditions in the body. According to the Centers for Disease Control, at least 50% of sexually active people will have genital HPV at some time in their lives.
Transmission and symptoms of HPV
The human papilloma virus affects young females when they are in their twenties to thirties. This virus is often transmitted through skin to skin contact with someone who is infected. Certain parts of the body are more susceptible to this virus, such as the vulva, scrotum and inner thighs which are not covered by a condom. This infectious virus targets certain kinds of cells, such as the keratinocytes and mucous membranes throughout the body but mainly the transformation zone of the cervix. This virus may show itself through different types of warts on the skin, such as common warts, plantar warts, and flat warts, which may be treated with different techniques and medications. The human papilloma virus is not treatable; however, there are treatments for the cell changes in the cervix that HPV can cause.
HPV more common in women
The human papilloma virus is a virus that affects the skin and genital area of both men and women, but is more prevalent in females. When this virus comes into contact with cells, it causes physical changes which are called lesions. High-risk oncogenic HPV sub-types are able to integrate into the DNA of the cell and modify its behaviour in a way that can result in cancer. High-risk HPV sub-types are the cause of nearly all cervical cancers. On the same note, over 80% of women diagnosed with cervical dysplasia have been found to be infected with HPV. The less severe forms of this virus are genital warts which are also known as a condyloma. Some strains of this virus may affect your body in this way but genital warts can disappear on their own after a few months, not causing any cellular damage.
PAP smears and HPV vaccination
PAP smears are an excellent tool to use to diagnose this health condition that can be infectious if not controlled. It has been confirmed that high risk HPV sub-type detection might be used as a tool to identify women at high risk of cervical cancer, in addition to Pap smears. High-risk HPV sub-types are present in over 90% of cervical cancers and in the vast majority of cases of high grade cervical intraepithelial neoplasia. Worldwide, approximately, 70% of cervical cancers are due to HPV sub-types 16 and 18. Generally, it is a good idea for young women to get vaccinated against HPV sub-types 16 and 18 when they are 11 or 12 years old, but this vaccine may also be given between the ages of 13 to 26.Once an individual becomes sexually active, they put themselves at risk due to the large amount of the population that have a strain of this disease but don’t even know it because of the absence of symptoms.
National HPV testing
The national screening program recently decided to implement the use of HPV testing in their screening program for cervical cancer. All patients who have positive cytology on smear test will have HPV sub-type testing which will help in triaging patient to colposcopy clinic.
This implementation is likely to happen in early April 2012. The main concern with this implementation is the time needed to counsel patients prior to doing the smear test. Also we should not under estimate the psychological trauma for patients who will be diagnosed with positive high risk HPV sub-type.
The whole idea of implementing the HPV sub-type testing within the cervical screening program is to concentrate on patients with high risk sub-types only. Hopefully this will reduce the number of patients with negative HPV results from being seen in the colposcopy clinic.
But let’s wait and see what the future of implementing HPV testing will show.