Your Guide To HPV
There Are Different Types
HPV (human papillomavirus) is a very common virus, explains Dr Marielle Nobbenhuis, gynaecological oncology surgeon at the Royal Marsden. “HPV is mainly spread through sexual contact and, as a result, is linked to cervical, throat, anal, vaginal, vulval and penis cancers. There are two types of HPV – low risk and high risk. Low risk tends to manifest as warts on the hands, feet and genitals – this type is unrelated to cancer. The 14 high-risk types – HPV 16 and 18 are the most common – are linked to cancer.” For these reasons, HPV is deemed an STI, and it’s more common than you may think. Research suggests 80% of us will contract HPV at some point, but having HPV isn’t a sign you’ve slept with a lot of people, as you can get it during your first sexual contact – whether that’s penetrative sex, oral sex, touching or sharing sex toys.
Your Smear Test Picks It Up
Because certain strains of HPV can lead to cervical cancer, attending your smear test is important. In 2016, the process for cervical screening in the UK was changed to improve accuracy, adds Dr Angela George, consultant medical oncologist, also from the Royal Marsden. “Previously, cervical smears checked for abnormal cells as these can go on to develop into cancer. However, abnormal cells sometimes look like normal cells, so can easily be missed, with normal cells often misdiagnosed as abnormal. Instead, the current test first checks for HPV before abnormal cells. The majority of cervical cancers are caused by persistent infection from HPV, which causes changes to the cervical cells.” Angela explains that if HPV is found during a routine smear test, it can then guide your doctor when checking for abnormal cells and determine whether you need to be monitored more closely. If your smear reveals you’re HPV positive, your sample will then be tested to see if there have been any cell changes. If abnormal cells are found, you’ll be invited to have a colposcopy – a small biopsy of your cervix may also be taken at this stage. If no abnormal cells are found, you’ll be invited for another cervical screening in a year’s time.
Your Smear Isn’t A Test For Cancer
Screening stops at the age of 64 as it takes ten to 20 years for HPV to develop into abnormal cells, and then into cervical cancer if the virus is persistently present, says Marielle. “This means that it’s unlikely those who have been regularly screened will go on to develop the disease. There are very rare types of cervical cancer that aren’t caused by high-risk HPV, though more than 95% of cases are.”
You May Not Know You Have It
“More often than not, there are no symptoms to see with HPV,” says Victoria Howell, menopause and women’s health nurse. “This is because the body usually fights off the virus before it has the chance to produce visual symptoms. However, it’s not uncommon to develop warts around the vulva with certain strains of HPV. These can be white, grey or pinkish. Get into the habit of checking your vulval skin monthly so you understand what’s normal for you.” It’s also worth noting it can take up to 18 months from getting infected for warts to show up, which means working out who gave it to you can be tricky.
Your Body Usually Clears It On Its Own
By the age of 50, at least 90% of women will have been infected with HPV but just 0.75% get cervical cancer, as your immune system has the capacity to deal with an infection. If it doesn’t, that’s when the abnormal cell changes that a smear test detects begin to manifest. These changes in your cells take around ten to 15 years to morph into cervical cancer, but within this time, you should have had a handful of smear tests, which would detect changes and prompt treatment if needed. It’s estimated that 70% of HPV infections clear spontaneously within one year and 90% clear within two years. “It can, however, take longer,” says Shree Datta, consultant obstetrician and gynaecologist. “Smoking, stress and other medical conditions can affect how quickly your body can clear HPV.” If you were looking for another reason to give up smoking, research also shows smoking can significantly increase your risk of cervical cancer in conjunction with a high-risk strain of HPV.
It Can Lie Dormant For Years
“One of the most common concerns women have is that by developing HPV, it means their partner has been unfaithful,” Marielle adds. “The truth is that HPV can lie undetected for years, and it’s not uncommon to suddenly test positive having been with the same partner for years. It’s also possible for couples to reinfect each other throughout their lives. Another misconception is that HPV can impact pregnancy, for example by increasing the risk of miscarriage or disrupting delivery, but there is no evidence to suggest this is the case.”
Treatment Is Available
While the thought of receiving an abnormal result can feel daunting, it needn’t be. In fact, around one in 100 women screened will have an abnormal result, but that doesn’t mean you have cancer. If you receive an abnormal result, it will say one of two things. You will either be found with HPV but no cell changes, meaning you have high-risk HPV but don’t have changes to your cervical cells, so there’s no cause for concern. As the majority of people clear the virus over time, you’ll be invited for another smear test within the next 12 months. If you have this result three times in a row, you’ll be invited for further tests. Your test may also flag you have HPV and that cell changes have been found. Most cell changes do not develop into cervical cancer, but you will be invited for further tests. Once cell changes are found and graded, specialists can monitor or treat them as needed. If you’re confused about cell changes and want more information on colposcopies and further treatment, Jo’s Trust is worth checking out.
Home Testing May Soon Be A Reality
For some women, the thought of going for a smear test is daunting, which is why research is being done into home testing. “For example, in certain areas of London, a trial called YouScreen is being offered,” adds Marielle. “This trial will offer a home test kit to 31,000 women who are overdue a cervical screening, and other similar trials are taking place elsewhere in the country. It’s hoped these at-home tests will boost the numbers of women getting checked for high-risk HPV.”
The Vaccine Doesn’t Mean You’re Immune
If you’ve had the HPV vaccination, you are protected against at least 70% of cancer-causing HRV, but you are not absolutely protected. Attending smear tests is just as important whether you have been vaccinated or not as screening can detect abnormalities caused by other types of HPV. As Shree confirms, “The HPV vaccine is a three-injection course, which you would ideally take before becoming sexually active. However, it doesn’t cover all of the high-risk types of HPV, meaning it’s vital that you still attend your smear tests.”
For more information visit RoyalMarsden.NHS.uk/Private, VictorianaHowell.com and HCAHealthcare.co.uk. Jo’s Cervical Cancer Trust also provides support, whether you’re looking for information on what to expect at a smear test, results, cervical cancer, and more – visit JosTrust.org.uk
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