Testing for cervical HPV

The NHS has been considering HPV testing as part of the cervical cancer screening programme. It is not yet routinely available on the NHS. A trial called ARTISTIC is looking at whether testing for HPV as well as cervical screening works better than cervical screening alone. The researchers in Manchester have finished the trial and are looking at the results. They hope to have these by the end of 2008.

What should a person do if exposed to someone with genital warts?

Both people with HPV infection and their partners need to be counseled about the risk of spreading HPV and the appearance of the lesions. They should understand that the absence of lesions does not exclude the possibility of transmission and that condoms are not completely effective in preventing the spread of the infection. It is important to note that it is not known whether treatment decreases infectivity.

Finally, female partners of men with genital warts should be reminded of the importance of regular Pap smears to screen for cervical cancer and precancerous changes in the cervix, since precancerous changes can be treated and reduce a woman's risk of developing cervical cancer. Similarly, men should be informed of the potential risk of anal cancers, although it is not yet been determined how to optimally screen for or manage early anal cancer.

How are genital warts diagnosed?

Genital warts are fairly common; approximately 500,000 new cases of genital warts are diagnosed each year in the U.S. A typical appearance of a genital wart may prompt the physician to treat without further testing, especially in someone who has had prior outbreaks of genital warts. Genital warts usually appear as small, fleshy, raised bumps, but they sometimes can be extensive and have a cauliflower-like appearance. They may occur on any sexually-exposed area. Over 90% of genital warts are caused by HPV-6 and HPV-11, the so-called "low risk" HPV types.

What are the symptoms of genital warts?

In many cases genital warts do not cause any symptoms, but they are sometimes associated with itching, burning, or tenderness. They may result in localized irritation, depending upon their anatomic location. Women who have genital warts inside the vagina may experience bleeding following sexual intercourse or an abnormal vaginal discharge. Rarely, bleeding or urinary obstruction may occur if the wart involves the urethral opening.

Concern about getting infected again

Many women worry about becoming infected again after they have had treatment for an abnormal smear. Viruses are difficult to treat and your body gets rid of them by developing immunity to them. This may take from a few months to a few years.Some women worry about whether their partner has the virus and could reinfect them. Men aren’t routinely tested for HPV because the only way for a man to find out if he has the virus is to have several biopsies. Even then, a negative result only means that HPV wasn’t found on those biopsies and not necessarily that he doesn’t have HPV at all. Because our bodies clear the virus, even if a man has the virus when he has the test, his immune system may get rid of it before the test result comes back.As there more than 100 types of HPV, it is possible to be immune to one type but not another. So it may seem that you have been reinfected but in fact you may just have a different type of HPV.

How is HPV infection diagnosed?

HPV sometimes can be suspected by changes that appear on a pap smear, since pap smears identify infected abnormal cells that may be precursors to cancer. While HPV infection can lead to precancerous changes in the cervix that are recognized on the pap smear, the pap smear itself cannot definitely establish the diagnosis of HPV infection, unless special testing for the DNA of HPV is carried out on the material obtained from the pap smear. When there is an abnormal pap smear, the doctor often will do advanced testing on the material to determine if, and which kind, of HPV may be present. HPV also can be detected if a biopsy (for example, from a genital wart or from the uterine cervix) is sent to the laboratory for analysis.

HPV Symptoms and Tests

Genital HPV infection is very common. At least half of people who have had sex will contract the HPV virus (human papillomovirus) at some point in their lives. Yet many will not know it because they will not have any HPVsymptoms.
Whether HPV symptoms occur or not can depend on the HPV type involved in the infection. There are more than 100 types of HPV. Some HPV types are associated with genital warts, although the warts are not always visible.

Some types of HPV are associated with cervical and other cancers, and no warts occur, and no other symptoms may be noticed. Some HPV types also cause common warts that you can find on other areas of the body such as your hands or feet.
Many people who get genital HPV will clear it without treatment and without symptoms, and no health problems will occur. The longer the virus is in the body, however, the higher your risk of developing health problems such as cervical cancer or anal cancer.

Here's what you need to know about genital HPV infection, HPV symptoms, and the HPV test:

HPV Symptoms

The HPV virus lives in mucous membranes, such as those in the genital area, or on the skin. If genital warts show up, it's an indication of HPV infection. Genital warts take on many different appearances. They can be raised, flat, pink, or flesh-colored. They can even be shaped like cauliflower. Sometimes there is a single wart; other times multiple warts appear. They can be small or large. They can be on the anus, cervix, scrotum, groin, thigh, anus, or the penis.
Genital warts can show up weeks or even months after sexual contact with a person infected with HPV virus. That person may not know he or she is infected and is responsible for HPV transmission.

Some types of genital HPV infection are associated with cancer, including cervical cancer and cancer of the vulva, anus, or penis. If infection occurs with one of these virus types, precancerous changes can occur in cells in the tissue without causing any symptoms.

How Is HPV Infection Diagnosed?

The appearance of genital warts is one way HPV infection is diagnosed. A doctor simply does a visual inspection. The HPV types associated with warts, however, are not generally the types associated with cancer.
Women infected with the type of HPV that can cause cancer may first be told their Pap test results are abnormal. Pap tests are the main way doctors find cervical cancer or precancerous changes in the cervix.
To find out for sure if the changes are related to HPV, a doctor may decide to perform a DNA test on the virus in women who have an abnormal Pap smear. This tells you and your doctor whether the HPV virus you have can cause cancer. Only certain strains of HPV cause cancer. Indeed, HPV 16 and 18 account for 70% of all cervical cancers. This DNA test is often given to women who have mild Pap test abnormalities. It may also be given as part of a routine Pap test to women over age 30.

In the HPV test, a doctor takes a swab of cells from the cervix, just as for the Pap test. The cells are then analyzed in the laboratory. The test can identify 13 of the high-risk HPV types associated with cervical cancer.

This test is rarely given routinely to women under 30 because so many younger women are exposed to HPV and their bodies typically clear the infection without treatment. The DNA test could cause unnecessary worry and concern. Some experts also believe that in younger women the cervix is more susceptible to the HPV virus and that as women get older the cervix may become less susceptible.
In men, as in women, genital warts reflect HPV infection. But no specific test for the strains of HPV that cause cancer is available at this time for men.

When Is the Best Time to Test?

Combining the Pap test with the HPV test is appropriate for women aged 30 and over, according to the American College of Obstetricians and Gynecologists.
This test helps women and their doctors learn if a woman is at high risk or low risk for developing cervical cancer. If the HPV test is positive, the doctor can then decide if more testing is needed. One test that may be ordered next is a colposcopy, in which a special magnifying device is used to examine the cervix, vagina, and vulva.
If a woman is trying to get pregnant, there's no need to have the HPV test unless her doctor orders it based on an abnormal Pap test. During the first prenatal visit, a Pap smear is taken, and if the results are suspicious of HPVinfection, the doctor can order the HPV test then.