HPV (Human Papiloma Virus)

HPV (Human Papiloma Virus)

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If your doctor, nurse or health worker has told you that your abnormal Pap smear result may be due to an infection with HPV, you be may wondering what it is, how you got it and what it means for your health.

HPV is a very common virus, with four out of five people having it at some stage of their lives. In some cases, it can increase a woman’s risk of cervical cancer. However, most women with HPV do not develop cervical cancer.

About HPV

There are over 100 different types of HPV, including some that affect the genitals. Genital HPV is similar to the virus which causes warts on other parts of the body.

Genital HPV is so common that it could be considered a normal part of being a sexually active person. Most people will have HPV at some time in their lives and never know it. You may become aware of HPV if you have an abnormal Pap smear result, or if genital warts appear.

HPV infection is very common and in most people, it clears up naturally in about 8-14 months.

What does HPV have to do with cervical cancer?

A few of the many types of HPV have been linked to causing abnormalities of the cervix and in some cases the development of cancer of the cervix.

It is important to remember that most women who have HPV clear the virus naturally and do not go on to develop cervical cancer. In a small number of women, the HPV stays in the cells of the cervix. When the infection is not cleared, there is an increased risk of developing abnormalities. In very rare cases, these abnormalities of the cervix can progress to cancer. When cervical cancer develops, HPV is found in almost all cases. Having regular Pap smears is the best way to ensure that any changes are monitored and managed to protect your health.

If you have early cell changes due to HPV, there is a strong likelihood that these changes will clear up naturally in 8 to 14 months. Because of this, and the fact that cancer of the cervix takes around 10 years to develop, your doctor may recommend simply having another Pap smear in 12 months time.

How did I get HPV?

Genital HPV is spread through genital skin contact during sexual activity. As viruses are microscopic, HPV can pass through tiny breaks in the skin. HPV is not spread in blood or other body fluids. While condoms are an important barrier to many sexually transmitted infections, they offer limited protection against HPV as they do not cover all of the genital skin.

Because the virus can be hidden in a person’s cells for months or years, having a diagnosis of HPV does not necessarily mean that you or your partner has been unfaithful. For most people it is probably impossible to determine when and from whom HPV was contracted.

Can HPV be cured or treated?

There is no cure or treatment for HPV. It will, in most cases, be cleared up by your immune system. However, the effects of the virus, such as any warts that appear, or changes to the cells of the cervix, can be treated.

Consult your doctor or health practitioner if you are concerned about genital warts because of their appearance, or if they are causing you discomfort. There are a range of treatment options for warts.

If your Pap smear indicates that cells have been affected by HPV, you should have more frequent Pap smears until these cells return to normal. If the changes continue, further tests and treatment may be needed.

Should I have a special test for HPV?

There is an HPV test available which can identify strains of HPV. This is not a test for cancer. HPV tests are available in Australia but are only subsidised by the government in a limited number of cases. Because most HPV infections usually resolve naturally, and there is no cure, there is little reason to have an HPV test.

Experts now recommend that HPV testing be used for women who have been treated for a high grade abnormality. The HPV test is done to make sure the virus has gone from your body. An HPV test done for this reason will be subsidised through a Medicare rebate. Your GP can advise you if the test would be useful in your particular case.

While a Pap smear cannot identify which type of HPV is present, regular Pap smears will make sure any changes that occur are identified early and managed effectively.

What about a vaccine for HPV?

Cervical cancer is one of the leading causes of cancer morbidity and mortality in women throughout the world. Persistent infection with oncogenic Human Papilloma Virus (HPV) is associated with the development of cervical cancer. Infection with oncogenic HPV types is also implicated in the development of other cancers, including neoplasms of the vulva, vagina, anus and penis. Of the oncogenic HPVs, types 16 and 18 account for some 70% of cervical cancers. Non-oncogenic HPV types cause genital warts. HPV infection is common with an estimated 70% of sexually active women becoming infected.

Vaccination to prevent infection with oncogenic HPV types has the potential to reduce the incidence of precursor lesions and cervical cancer.

Two products for vaccinations are available in Australia, Gardasil and Cervarix.

Recommendations:

  • The HPV vaccine is routinely recommended for 11 and 12 year-old girls. The vaccine series can be started at 9 years of age. Catch-up vaccination is recommended for 13 through 26 year-old females who have not yet received or completed the vaccine series.
  • Ideally, females should be vaccinated before onset of sexual activity, when they may be exposed to HPV. However, sexually active females may also benefit from vaccination since few young women are infected with all four HPV types targeted by the vaccine (6, 11, 16, and 18). Females who already have been infected with one or more HPV types would still get protection from the vaccine types they have not acquired. Currently, there is no test available to determine whether a female has had any or all of the four HPV types targeted by the vaccine.

The HPV vaccine can be given to females who:

  • Are lactating.
  • Have minor acute illnesses (diarrhea or mild upper respiratory tract infections, with or without fever)
  • Have an equivocal or abnormal Pap test
  • Are immunocompromised, either from disease or medication. However, vaccine efficacy might be less

The HPV vaccine should not be given to females who:

  • Are pregnant (category B2)
  • There is no evidence to suggest that administration of HPV vaccine adversely affects pregnancy or infant outcomes
  • Have hypersensitivity to yeast
  • Have moderate or severe acute illnesses

Vaccination is Not Treatment

The HPV vaccine is not therapeutic and is not intended to treat patients with cervical cytologic abnormalities or genital warts.

Vaccination of Women Older Than 26 Years

Although the peak incidence of genital HPV infection is within the first five years after commencement of sexual activity, new HPV infections do occur throughout a woman’s life, particularly in the context of new sexual partners and changing sexual behaviour.

It should be emphasised to them that vaccination is about prevention of future HPV infections, whilst continuation of cervical screening is vital to detect pre-cancerous changes related to past infections.

Available Vaccines

Two prophylactic HPV vaccines are currently available in Australia

  • Gardasil – licensed for use in females aged 9 to 45 years of age for the prevention of cervical cancer and its precursor lesions due to HPV types 16 and 18 and HPV types 6 and 11, the latter two which cause 90% of genital warts. To be given in a three dose schedule at 0, 2 and 6 months Gardasil® is also approved for use in males aged 9 to 15 years for the prevention of HPV infections.
  • Cervarix – licensed for use in females from 10 to 45 years of age for the prevention of cervical cancer and its precursor lesions due to HPV types 16 and 18. It is given at 0, 1 and 6 months.

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