By age 50, 80% of women will have been infected with the human papillomavirus (HPV).For most, the virus – which comes in more than 100 types – will clear up on its own without any treatment. But an infection with the HPV genotypes 16 and 18 puts women at risk of developing cervical cancer.2 Left untreated or undetected until reaching an advanced stage, cervical cancer can be deadly.

We talked to Dr John O’Leary, Professor of Histopathology at Trinity College Dublin and cervical cancer expert, and asked him to explain what a woman should expect after HPV screening reveals she has a high-risk infection.

I'm a woman who has just found out I have a high-risk HPV infection. What should I do next?

Learning this news can be surprising and distressing. You should discuss the HPV test results in more detail with your doctor. You may be referred to gynaecological outpatient care, which in most countries will mean undergoing a colposcopy. This procedure allows the gynaecologist to examine your cervix more closely and, if there seems to be any abnormalities, take a small amount of tissue for further analysis. Or if they find any signs of pre-cancer or early cancer, they might remove that tissue at the same time.

When I talk with my doctor, what questions should I ask?

You need to find out whether the HPV genotype is 16 or 18. Both are high risk, but genotype 16 carries the highest risk for high-grade precancerous changes. When you go for colposcopy, ask the gynaecologist or gynaecology nurse what potential treatment options might be available. Antiviral treatment usually isn’t effective.4

What else should I be aware of?

That HPV is sexually transmitted, usually from man to woman, and that the course of the infection can vary, depending on your age. With younger women, the infection might be short-lived and clear quickly. If you’re diagnosed with HPV at an older age, it’s more likely to be a persistent infection with a much higher risk of pre-cancer.5

Most women get infected with only one genotype, but some do have a mixed genotype – that is, an infection of more than one genotype.

You will probably need to be re-tested about 12 to 18 months after the initial positive test results. Re-testing is likely to continue until the virus has cleared or suspicious lesions have been removed. A high-risk HPV infection means engaging with the healthcare system for several years.

Should I tell my partner that I’m infected with high-risk HPV?

Yes. If your partner is a man, he is at a greater risk of developing penile cancer, but the risk is low.6 If your partner is a woman, she’s at a greater risk of also being infected and developing cervical cancer. You also need to tell your partner that if they are in any other sexual relationships, those people may also be at greater risk of HPV infection.

However, you don’t have to tell all partners from your past – that is, more than 18 months or two years ago. Most HPV infections clear in 12 to 16 months.7 As we say, ‘the past is another country’.

Dr O’Leary from the Trinity College in Dublin is answering our questions regarding HPV and cervical cancer.
Dr John O’Leary, Professor of Histopathology at Trinity College Dublin

If my partner is tested and the results are negative, should they be re-tested at a later date?

If your partner is a woman, re-testing might be considered about 18 months after the initial test – that would be enough time to see if the virus has cleared or whether your partner has been re-infected.

What percentage of high-risk infections become cervical cancers?

Only 2% to 4% of high-risk infections lead to clinically significant lesions. The risk is higher, however, if your HPV infection is persistent. HPV testing is a ‘risk test’. If the test is negative, there’s a more than 95% chance you won’t develop cervical cancer.8

Why does it take 10 to 15 years for a high-risk infection to turn into cervical cancer?

HPV is actually a very simple virus, but it has a remarkable genetic constitution. Its proteins can make cells malignant, but it takes time to undermine your cervical cells’ ‘machinery’ – and from what we’ve learned, that’s how long the process takes.

Are there things that could potentially speed up the development of cervical cancer?

Yes. If your immune system is compromised – for example, if you have lymphoma or leukaemia. Having multiple partners or being infected with HIV or other sexually transmitted diseases (STDs) are also factors that could lead to a faster conversion to cervical cancer. Becoming sexually active at a young age also seems to be a risk factor – we don’t know why exactly, but early sexual activity seems to transform cells in the cervix. Having other STDs, especially herpes or syphilis, seems to change the mucosal lining of your cervix. Smoking also accelerates the risk of developing cervical cancer.

And are there things that could slow down the conversion?

A virus that clears naturally could slow this down. As could removing any pre-cancerous lesions.

Does having a high-risk infection affect my fertility? Or if I’m pregnant, can I transmit the infection to my baby?

HPV does not affect fertility unless you have had repeated cervical infections from other STDs. If you have HPV and other STDs, you could develop pelvic inflammatory disease, which can affect fertility. If you’re pregnant, you don’t pass on the HPV infection to your unborn child. However, during childbirth, if you’re infected with the low-risk HPV genotypes 6 and 11, it’s possible you could transmit the virus to the baby in the birth canal, potentially leading to a condition known as recurrent respiratory papillomatosis, or RRP. If this happens, your child’s larynx might be affected. But it’s a very rare occurrence.9

Any final thoughts?

HPV screening is all about giving and gathering information to safeguard women’s health. With proper screening, women should not be developing cervical cancer. When we see a woman with invasive cervical cancer, we’re seeing a failure of the health screening system.

What is a cleared virus?

The symptoms of your HPV infection, including genital warts, may disappear on their own within two years -- that means the virus has ‘cleared’. But even though you may have no symptoms of HPV infection, that doesn’t mean you no longer have the virus in your body. Antibodies in your body may have suppressed the virus so that it doesn’t cause any symptoms of HPV or show up on tests. But the virus itself may still be present.

References

  1. Chesson HW et al. Sex Transm Dis. 2014;41(11):660-664
  2. De Sanjose S et al. Lancet Oncol. 2010
  3. https://www.cancer.net/cancer-types/cervical-cancer/statistics
  4. https://emedicine.medscape.com/article/219110-treatment
  5. Blanks RG et al. BJ of Cancer 2009; 100(11): 1832 – 1836
  6. https://www.cancer.org/cancer/penile-cancer/causes-risks-prevention/risk-factors.html
  7. http://www.who.int/mediacentre/factsheets/fs380/en/
  8. https://www.cancer.gov/news-events/press-releases/2014/HPVscreeningPredictor
  9. https://www.webmd.com/sexual-conditions/hpv-pregnancy#1

Related links

Tags: People, Patients