HPV - Human Papillomavirus

There are hundreds of types of human papillomavirus (HPV); the vast majority are harmless. A small subset of HPV is considered “high-risk” because it is more likely to progress into cervical cancer. HPV is typically transmitted through skin-to-skin contact, and it is equally common in men and women. Almost all sexually active people have an HPV infection at some point in their lives. 

In most cases, the body’s immune response controls a high-risk HPV infection, and it regresses to undetectable levels. The small percentage of persistent and detectable high-risk HPV, however, calls for an effective screening program that monitors HPV infection and intervenes to prevent its progression to cervical cancer as necessary. 

Different screening tests are available; the most widely known is the Pap smear. A Pap smear detects cervical cell abnormalities that may be a sign of pre-cancer. Visual inspection with acetic acid (VIA) is a low-cost screening option that detects cervical abnormalities immediately (i.e., small lesions), avoiding sample processing delays. Both the Pap smear and VIA tests, however, have high probabilities of false positive or false negative results. Another screening test, an HPV molecular test, detects the presence of high-risk HPV and is the most sensitive option currently available. 

An HPV infection that has regressed to undetectable levels may resurface in the future. Because of this, there is no way of knowing whether a newly detected HPV was acquired last week or ten years ago. Modifiable risk factors for the progression of HPV to cancer include long duration (>5 years) of oral contraceptive use, more than five full term births, and tobacco use. However, the most effective way to avoid cervical cancer is to undergo routine screening and adhere to treatment recommendations when necessary.