Having read the title you probably fall into one of 3 camps here…
1. “WTF is HPV?”
2. ”I’ve definitely never had HPV so I’m intrigued…”
3. “Finally someone is actually talking openly about HPV!”
So for all the people in the first camp, HPV aka Human Papillomavirus is the virus that causes abnormal cervical screening/smear tests and in a very small handful of people cervical cancer, as well as cancers of the anus, throat and penis. There are over 200 different types of HPV, but there are 15 types that the World Health Organization has identified as ‘high-risk subtypes’, which are most likely to cause cancers. All sounds pretty scary so far? So what if I told you that by the age of 50 years, 90-100% of women will have been infected? But in the UK, the lifetime risk of getting cervical cancer is 0.75%. If almost all women get HPV at some point, but only one in 135 get cervical cancer…something isn’t really adding up here is it? That’s because the immune system clears the infection in most women. In some people it’s cleared incredibly quickly – possibly within a few days, but can take weeks, months or even years. If it hangs about it starts to cause changes in the cells, because the virus is a bit needy and needs to make a comfy home in your ever so hospitable cervical cells to help it survive. It’s these cellular changes that we are looking for in a smear test; so you can think of it as a bit of a housing inspection. Are you sub-letting your cervix to HPV?
If HPV lingers for too long, it can, unfortunately, cause very severe abnormalities, which may eventually turn into cervical cancer. From getting the first infection however, this takes at least 10-15 years. If you’re in this very small minority of women, you will have been invited for between three to five cervical smears during which we would detect these abnormal cells and be able to treat you before they every turned into cancer. This means attending for your smear test is the single most effective way of preventing cervical cancer.
Most people think they’ve never had HPV because of the fact they have never had an abnormal smear test. HPV is all over the place. It is found in our environment and all over our skin. In fact, a study has even shown that high-risk HPV has been found on the hands of small children. So chances are, if you’ve ever been sexually active, you’ve probably had the virus, because that's how it gets to your cervix. You just don’t know about it because your body cleared the virus quickly, and you didn’t happen to have a smear during the time that HPV was setting up shop in your cervix.
To finish I’d like to quickly clear up a few common misconceptions about HPV that I commonly discuss with my patients
- HPV infection is not a true sexually trasnmitted infection and is not a sign of promiscuity – the virus is everywhere, and sex is what gets it to the right place (your cervix), and even just having one partner will put you at risk. Finding out you have HPV just means you have a very hospitable cervix which enabled the virus to get a bit too comfy and then your immune system wasn’t able to get rid of it very quickly.
- HPV is not a lifetime sentence – about 90% of infections detected as cervical smear abnormalities will be spontaneously cleared within 2 years. But you can get the same, or different type of HPV again, so you need to continue screening even if you had HPV and it went away.
- Using condoms all the time, or having a same-sex partner do not protect you – if the virus is on your skin, it can still get into your cervix, therefore, you still need to go for smears.
- There’s no medication for HPV – because it’s a virus that lives inside your cells it makes it very difficult to develop medicines that would kill the virus without destroying the cells of your cervix. In clinic we observe women with abnormal cells, and in the small number where HPV causes severe abnormalities because it doesn't go away, we remove those abnormal cells, thus removing the infection along with them.
- You still need to attend for smears if you’ve been vaccinated – the vaccine doesn’t protect against all types of HPV so there is still a risk of getting abnormal cells although it is MUCH lower than people who haven’t been vaccinated.
- You don’t need to disclose your HPV status to your partner – even if you got it from him, which you will never know because there's no test for men and chances are he doesn’t even have the infection anymore, even if you do…the honest reason is that penises are hostile places…HPV doesn’t like to stick around that long compared with the cervix!
On that note, I will leave you with my HPV mantra that I tell all my patients;
“everyone gets HPV no matter what you do, so trust in your immune system, eat your 5 (or 10) a day, don’t smoke and go for your smear test; that’s the way to cervical disease freedom”
I’m sure there are a lot more questions you may want to ask so feel free to leave your comments below and I’ll answer them in another post in the future.
Also my favourite HPV-related online resource is Jo's trust which is probably the most up to date and reliable information you will find online.