Genital Human Papillomavirus
Human papillomavirus (HPV) is a group of more than 150 related viruses. Some types of HPV are considered high risk because they can cause cancer. HPV testing detects the genetic material (DNA or messenger RNA) of high-risk HPV (hrHPV), primarily to screen for cervical cancer or to determine whether you may be at risk of cervical cancer.
Some types of HPV can cause skin warts, while other types can cause genital warts (also called condylomata). Genital HPV infection is one of the most common sexually transmitted diseases (i.e., spread through oral, anal, or genital sex). According to the U.S. Centers for Disease Control and Prevention, about 79 million Americans are infected with HPV and over 14 million become newly infected each year.
Low-risk HPV?some HPV strains cause genital warts but rarely cause cancer. HPV 6 and HPV 11 cause 90% of all genital warts but are considered ?low risk? because they rarely lead to cancer. These low-risk types can be diagnosed through visual inspection and, therefore, do not require testing. High-risk HPV?there are 14 high-risk types of HPV that can lead to cancer (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68). Two HPV types,16 and 18, cause 80% of all cervical cancers. These high-risk types can be detected with an HPV test.
Many HPV infections resolve without treatment?the body is able to clear the infection. However, infections with high-risk HPV types that do not go away can lead to cervical cancer. Almost all cervical cancers are caused by persistent infections with high-risk HPV. Each year, nearly 12,000 women in the U.S. develop cervical cancer and about 4,000 are expected to die from it.
In addition, some studies have also shown that persistent oral infections with high-risk types of HPV are strongly associated with oral cancers, including cancer of the mouth and throat (oropharyngeal cancer). Anal cancer has also been linked to HPV types 16 and 18. These types are also linked to other cancers, such as those of the vagina and penis.
It is typically recommended that you refrain from having sex, douching, or using vaginal products such as creams, deodorants, or medications for 24 hours before the test. Follow any instructions you are given. Reschedule the test if you are having your period (menstruating). You may be asked to empty your bladder before the examination. The American Cancer Society has details about how to prepare for the test when it is done at the same time as a Pap smear
A combination Pap-HPV test is performed in your doctor's office and takes only a few minutes. You may be asked to undress completely or only from the waist down. You'll lie on your back on an exam table with your knees bent. Your heels rest in supports called stirrups.
Your doctor will gently insert an instrument called a speculum into your vagina. The speculum holds the vaginal walls apart so that your doctor can easily see your cervix. Inserting the speculum may cause a sensation of pressure in your pelvic area. Sometimes the speculum feels cold when it's first inserted.
Your doctor will then take samples of your cervical cells using a soft brush and a flat scraping device called a spatula. This doesn't hurt, and you may not even feel the sample being taken.
After your test, you can go about your normal daily activities without any restrictions. Ask your doctor about when you can expect to receive your test results
Results from your HPV test will come back as either positive or negative.
Positive HPV test. A positive test result means that you have a type of high-risk HPV that?s linked to cervical cancer. It doesn?t mean that you have cervical cancer now, but it?s a warning sign that cervical cancer could develop in the future. Your doctor will probably recommend a follow-up test in a year to see if the infection has cleared or to check for signs of cervical cancer. Negative HPV test. A negative test result means that you don?t have any of the types of HPV that cause cervical cancer. Depending on your test results, your doctor may recommend one of the following as a next step:
Normal monitoring. If you?re older than age 30, and your HPV test is negative and your Pap test is normal, you?ll follow the generally recommended schedule for repeating both tests in five years. Colposcopy. In this follow-up procedure, which is recommended if your Pap test is abnormal, your doctor uses a special magnifying lens (colposcope) to more closely examine your cervix. Biopsy. In this procedure, usually done at the same time as colposcopy, your doctor takes a sample of cervical cells (biopsy) to be examined more closely under a microscope. Removal of abnormal cervical cells. To prevent abnormal cells from developing into cancerous cells, your doctor may suggest a procedure to remove the areas of tissue that contain the abnormal cells. Seeing a specialist. If your Pap test or HPV test results are abnormal, your doctor will probably refer you to a gynecologist for a colposcopic exam. If test results show that you might have cancer, you may be referred to a doctor who specializes in treating cancers of the female genital tract (gynecologic oncologist) for treatment
The HPV test is primarily used to screen for cervical cancer and/or determine whether you may be at increased risk of cervical cancer if you are a woman between the ages of 30 and 65. The test determines whether your cervical cells are infected with a high-risk type of human papillomavirus (hrHPV). Such an infection, if long-lasting, can cause changes in cervical cells that could lead to cervical cancer.
Because HPV infections are relatively common in women younger than 25 and often go away without treatment or complications, HPV screening is not recommended in this age group. However, HPV testing may be used as a follow-up test in women between the ages of 21 and 29 years who have abnormal results on a Pap smear known as ?atypical squamous cells of undetermined significance? (AS-CUS). Results may be used to determine the need for colposcopy, a procedure that allows a healthcare practitioner to visually inspect the vagina and cervix under magnification for any abnormal areas and to collect samples for a biopsy and/or treat as necessary.
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