HPV

What is HPV?

Human papillomavirus (HPV) is a group of viruses and one of the most common causes of sexually transmitted disease all over the world. There are more than 100 types of HPV, out of them only about 40 HPV types affect genitourinary region.

 

How is HPV contracted?

HPV infection is often transmitted sexually or through other skin to skin contact. Most people acquire HPV infection shortly after the onset of sexual activity.

What are the signs and symptoms of HPV infection?

HPV infection itself is usually asymptomatic. In most of the cases, the infection gets cleared by the body's immune mechanisms. In a few cases, when HPV infection does not get cleared on its own, it may lead to the development of genital warts ( seen as small swellings in the genital areas) or cancer. HPV types causing warts and cancers are not the same.

Does being infected with HPV mean a person will get cancer?

No. In most people, the body's immune mechanisms help in clearing out HPV infection. Only in few cases when the infection does not get cleared, it may lead to warts or cancer. There is no definite way to identify who will develop warts/ cancer. People with weak immune mechanisms (e.g. HIV infection) are more likely to get an HPV related health problem. Please note, it takes decades for cancer to develop after initial HPV infection.

Can HPV infection be cured after it is contracted? 

There is currently no medical cure for HPV infection. Genital warts usually do not need any treatment. Identification of few HPV types however, are associated with high risk for cancer development. Clinical measures can then be taken to diagnose precancerous or early cancerous lesions and treat them effectively. 

What kind of cancers are associated with HPV infection?

HPV is the leading cause of cervical cancer and is associated with more than 99% of cervical cancer cases. Apart from cervical cancer, HPV is also associated with cancers of penis, vulva, vagina, anus and back of the throat (oropharyngeal). 

 

Cervical Cancer

What is the cervix?

The cervix is a part of the female reproductive system. It is the lowermost part of the uterus that opens into the upper part of the vagina.

 

What are the signs and symptoms of cervical cancer?

Woman may experience unusual  bleeding and/ or foul smelling discharge from vagina. In some early stage cases, individuals may experience bleeding after intercourse. The cancer can be asymptomatic till late stages. 

How is cervical cancer diagnosed? 

The disease can often be revealed during a routine gynecological examination and/ or screening tests for cervical cancer.  For diagnosis of cervical cancer, gynecologists usually take out a small portion (few millimeters) of tissue from the cervix and send for pathological examination. This process is called a biopsy. 

Can cervical cancer be treated?

Yes. Treatment depends on the stage of the disease, and options include surgery, radiotherapy and chemotherapy. Palliative care is also an essential element of cancer management to relieve unnecessary pain and suffering due to the disease.

Why is it important for me to know about cervical cancer?

Cervical cancer is one of the most common cancers worldwide and is the leading cause of cancer-related deaths in women. In India, about 140,000 (one hundred and forty thousand) new cases are diagnosed every year with considerable mortality. 

 

What can I do to reduce my risk of cervical cancer?

Getting an HPV vaccine before sexual exposure and regular screening for cervical cancer are the most important steps to reduce the risk of cervical cancer. Other steps could be to stop smoking, limit the number of sexual partners and use of barrier contraceptives during intercourse.

Why do we need to screen for cervical cancer ?

Cervical cancer can be relatively easily prevented, provided it is regularly screened for. Screening is carried out to identify women who are at high risk of developing cervical cancer or to diagnose them at pre-/ early cancer stages. If diagnosed at an early stage, there is a significantly better chance of successful treatment and improved overall survival. 

What are the methods for screening for cervical cancer? 

A PAP smear/ LBC, HPV testing in cervicovaginal sample or inspection of cervix by a Gynecologist or health care professional (Visual inspection of cervix after application of acetic acid, VIA) are three methods of cervical cancer screening. VIA identifies any abnormal looking region on the cervix. Pap smear examines for the abnormal appearing cervical cells which may turn into cervical cancer. HPV test identifies the presence of high risk HPV types which are associated with high risk for cancer development. 

At what age a woman should get screening done? 

The recommended age of starting cervical cancer screening varies in the various guidelines. According to  Federation of Obstetrics and Gynecology of India (FOGSI) recommends screening between 25 - 65 years of age. Screening interval is usually 3-5 years depending upon the screening modality. In a limited resource countries the minimum number of screening recommended are 1-3 in a total life time. 

What if i have undergone surgery for uterus removal (hysterectomy) ?

If cervix has been removed (confirmed by clinical records or biopsy findings) as a part of hysterectomy as a part of benign reasons, then screening for cervical cancer is not recommended. If the hysterectomy has been performed for cervical precancerous (cervical intraepithelial neoplasia, CIN) or cancerous lesions then you need to take an expert opinion by your Gynecologist regarding cervical cancer screening. 

Do I need to undergo cervical cancer screening after 65 years of age ?

If you have never undergone any cervical cancer screening test till the age of 65 years, then getting it done once is recommended. If you have undergone screening before and results are consistently clear in the last 15 years then screening is not required. However it is recommended to take opinion of your health care professional. 

Why should I undergo HPV test? 

HPV test is the most effective way for identifying women who are at high risk of developing cervical precancerous or cancerous lesions. It can be combined with cytology (PAP smear or LBC) or can be done as a standalone test for cervical cancer screening. 

What will the HPV result tell me ?

For cervical cancer screening HPV test is done to identify only 14 high risk HPV types, known to be associated with cervical cancer. Some HPV assay gives information of specific HPV types (16 or 18) which has been detected in your sample. A negative or normal test result means that HPV has not been detected in the cervical sample. This result means that your risk of developing cervical precancer or cancer in the next few years is very low.  are not at high risk of developing cervical cancer. You may choose to undergo a repeat screening test for cervical cancer after 3-5 years. A positive test result does not mean that you have cervical cancer. It only means that you are at high risk for developing cervical cancer or there is a pre-cancer wound on your cervix which can be easily managed by gynecologists. 

What if my HPV result is positive ?

Based on the report, (i) you may be advised to repeat your screening test after a certain interval, or (ii) You may be advised to undergo certain other test (like LBC or HPV genotyping based on the assay performed on your sample) or (iii) you may be referred for a more detailed examination of the cervix (colposcopy) and a small amount of material from the cervix (cervical biopsy) may be collected for further histopathological examination if required. Your clinician/ gynaecologist will advise you on how best to proceed. 

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