Human Papilloma Virus (HPV) and women's health

Ojita Konjengbam *

Cervical cancer is one of the most common cancers in women worldwide and is the most common cancer in women from the low-income countries, which account for more than 80% of the total cases. Despite the fact that the cancer of the cervix is one of the most preventable forms of cancer, it continues to kill women in low-income countries at very young age when they still raising families.

Human papilloma virus (HPV) is considered the main cause behind the malignant transformation of cervical cells, with certain high-risk HPV types now labelled as the first-ever identified, indisputable, solely infectious cause of cervical cancer.

HPV is one of the most common sexually-transmitted infections.Theability to identify and type the exact HPV present, whether it is a high-risk or a low-risk type, allows a healthcare provider to significantly improve patient management and reduce the patient's anxiety when an abnormality is detected.

Low-risk and high-risk HPV types: Low-risk HPV types are associated with benign genital warts and benign cervical lesions with no serious oncogenic potential. The low-risk types have been identified as HPV 6 and 11.

On the other hand, certain HPV types, most notably, 16, 18, 31 and 45 are considered the high-risk types for the development of cervical cancer and its precursor lesions. There are other types considered medium-to-high-risk but their occurrence are limited as compared to the mentioned genotypes. Among these again, the HPV types 16 and 18 are regarded as the genotypes most closely associated with progression to cervical cancer.

How common are HPV infections?: HPV infections are so common that nearly all men and women will get at least one type of HPV at some point in their lives. Most people do not know that they have been infected and may give HPV to a partner without knowing it.

How do people get HPV infection?: HPV is transmitted through the sexual route. A person may get HPV even if the partner does not have any symptoms of HPV infection. In fact, most people do not realise that they have been infected. They also do not know that they could pass HPV to their partners. One person may have more than one type of HPV.

What problems do HPV infection cause?: It is a fact that most people with HPV do not develop symptoms or other health complications. Further, most HPV infections go away by themselves within two years. When HPV infections last longer, the virus could cause certain cancers and other diseases like:
o Cancers of the cervix and vagina.
o Cancers of penis in men, and
o Cancers of the anus and back of the throat.

Why is HPV testing done?: The HPV test is primarily done to screen for cervical cancer and/or identify women who may be at increased risk for cervical cancer. The test determines whether a woman's cervical cells are infected with a high-risk type of human papilloma virus. HPV testing has now become an essential part of women's health screening in many countries.

The HPV testing is used:
o As a part of a Pap/HPV co-test in women 30 years and older.
o When a Pap test is unclear, to see if HPV is present.

How serious is HPV infection?: In most people, the HPV virus is harmless and causes no symptoms and will not develop into warts, pre-cancer or cancer. In a few people, HPV causes genital warts, which is not a serious infection, has treatment options, and usually disappears on its own. However, some types of HPV (mentioned earlier) can cause cervical, vaginal, anal, head, throat and penile cancers

HPV test by Polymerase Chain Reaction (PCR) – the advantages: HPV PCR test allows detection of presence of any individual high-risk HPV. The PCR technique detects one or more of the oncogenic genotypes as well as other so-called low-risk types.

The test is more sensitive than other tests like hybrid capture assay which does not have an amplification step. A unique aspect of this method is the near-elimination of false-negative results. The advantage of a PCR-based assay, unlike other conventional assays is that it is able to report the actual genotype detected, rather than issue a general report that says "a risk type detected".

Preparation for the test: Before an HPV test, the client is asked to refrain from using tampons, sprays or vaginal medications for at least 48 hours before the test. The client is also asked to empty the bladder just before the test to lessen the slight discomfort one may feel during the procedure.

What affects the test?: Reasons why the client may not be able to take the test or why the results may not be helpful include:
o Use of douches, tampons, and vaginal creams or medications within 48 hours before the test.
o A cervical cell sample that is too small.

Conclusion: HPV test results and Pap test results go hand-in-hand when determining a woman's risk for cervical cancer. Co-testing with an HPV test and Pap smear can determine whether cervical cells are infected with a high-risk type of HPV and identify abnormal changes in cervical cells.