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HPV Test

What is HPV testing? Human papillomavirus (HPV) testing has been introduced in some parts of the UK as part of the National Cervical Screening Programme. The HPV test is carried out using the same sample of cells taken during a cervical screening test. In the laboratory the cells are analysed for current HPV infection. The HPV test is important because it identifies women with a high risk type of HPV. If a woman contracts high risk HPV and this becomes a persistent infection then she has a higher possibility of developing abnormal cells and thus should be monitored more closely to reduce her risk of developing cervical abnormalities and cervical cancer.

What is HPV?
HPV is an extremely common virus. There are over 100 different types of HPV. Some HPVs cause non-cancerous skin warts that commonly appear on the hands and feet.

Around 40 types of HPV affect the genital area and these are divided into those which have no risk for cervical cancer (called low risk) and those which can cause cancer (cervical, anal, vulval and some head and neck cancers) and called high risk types. Low risk types, such as HPV 6 and 11 cause non-cancerous genital warts. High risk types - the types most likely to cause cervical cancer - include HPV 16 and 18.

How do you get HPV?
Anybody who has ever been sexually active is at risk of contracting HPV. Genital HPV is transmitted primarily by genital-to-genital contact, anal intercourse and occasionally oral sex. HPV is the most widespread sexually transmitted infection; 80% (four out of five) of the world's population will get some type of the virus at least once i. If you catch HPV, in the majority of cases the body's immune system will clear or get rid of the virus without the need for treatment. In fact you would not even know that you had contracted the virus.

The time from exposure to the virus to the development of warts or cervical disease is highly variable and the virus can remain dormant in some people for long periods of time, this can be months and sometimes years. Usually it is not possible to determine exactly when or from whom the infection originated.

HPV testing
The HPV test is carried out using the same sample of cells taken during a cervical screening test. The results of the HPV test combined with cervical screening cytology (examination of the cells under a microscope) enable faster investigation of those at higher risk of developing cervical cancer, and reassurance of those at very low risk. The test can also reduce the number of unnecessary screening appointments and colposcopies among women with borderline/mild cervical screening cytology results or who have been treated for abnormal cells. In the laboratory, the sample of cells is analysed for high risk HPV infection. If the cells have been infected with HPV testing is not yet available throughout the whole of the UK as each country has their own policy (see HPV testing in the UK for your country's testing policy). In the UK, HPV testing will be offered to women in the following ways:

HPV Triage - used when a woman has a cervical screening result of borderline or mild dyskaryosis (see our Factsheet on Cervical Screening for more information on cervical screening cytology results). The same sample of cells used during the cervical screening analysis will be tested for high risk HPV infection. If the test is HPV positive the woman will be referred for colposcopy. If the test is HPV negative the woman will be returned to routine screening every three or five years depending on her age and the country she lives in.

The HPV test is important because it allows earlier identification of women who need treatment. Women with either borderline or mild dyskaryosis have only around a 15-20% chance of having a significant abnormality that requires treatment ii. If a woman does not have HPV even though her screening result showed slightly abnormal cells, the risk of cancer being present is negligible, thus, the woman can return to normal routine screening iii.

Test of cure - uses HPV testing to identify if a woman has been successfully cured after treatment for abnormal cervical cells. The HPV test will be given to women who have undergone treatment for cervical abnormalities. The test is carried out at the first appointment after treatment in combination with cervical screening by cytology. This usually takes place about six months after treatment.

If HPV is not found and the screening test comes back negative, then the woman has been successfully treated by removing the abnormal cells and will return to regular screening schedules. She does not need to have another cervical screening test for three years. The HPV test helps to confirm that the woman no longer has a higher than average risk of developing further cervical abnormalities.

If HPV infection is found (HPV positive) or the screening test shows an abnormality the woman will be again referred to colposcopy for further investigation.

Results of HPV testing
Results of HPV testing will be sent in the post. This may be sent to you either by your doctor, or by a local health care agency. The letter will include the results of cervical screening cytology and the HPV test. The letter will tell you what action you need to take, if any. If you have not received a result letter within 2-3 weeks, you should contact your sample taker. Women who are HPV negative will not require further investigation and will return to normal screening intervals.

Receiving an HPV positive result
Cervical cancer is caused by infection with high risk types of HPV but it is important to remember that the vast majority of women with an HPV infection will not have any problems at all. The term "high risk" refers to the virus. It does not mean that the woman is at high risk of getting cervical cancer - in fact the overall risk is still low, but higher than for women without infection with high risk types of HPV. That is why the HPV test is so essential because it allows women who have high risk type HPV and mild cervical abnormalities to be monitored more closely.

Remember, most women are infected with HPV at some point in their lives, but never know they have been infected. HPV is usually cleared (without treatment) by the body's immune system, like other viral infections such as a cold.

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