Women's Health: Care for life and stay away from HPV

Cervical cancer is the fourth most common female cancer in the world. Almost all cases of cervical cancer are caused by persistent infection with the HPV virus, and only a very small number of cervical cancers are not related to HPV.

"What is HPV?" "HPV positive means cervical cancer?" "Is it safe after HPV vaccination?"

What is HPV?

HPV, the full name of which is human papillomavirus, is a non-enveloped double-stranded DNA virus that is widely present in nature and has humans as its only host. There are currently about 200 known HPV subtypes, of which about 40 are related to reproductive tract infections, which is the focus of our discussion today.

What are the dangers of being infected with HPV?

According to the carcinogenic potential, HPV is divided into low-risk and high-risk types. Low-risk HPV mainly causes benign proliferative lesions such as genital warts, and rarely malignant changes, such as types 6 and 11; while high-risk HPV has carcinogenic potential, such as the most common types 16 and 18. Contemporary science has clarified the relationship between HPV and cervical cancer. Almost all cervical precancerous lesions and cervical cancer, 40-50% of vaginal cancer and vulvar cancer, and 90% of anal cancer are caused by HPV infection.

Will women get cervical cancer if their reproductive tract is infected with HPV?

This is a very one-sided idea. You should know that among healthy or asymptomatic women, 5-27% of women can be tested positive for HPV. A study showed that the high-risk HPV infection rate among Chinese women is 16.8%, and 80% of women have been infected with HPV virus in their lifetime, but the actual incidence of cervical cancer in the population is not that high. Because more than 90% of high-risk HPV infected people can use their own immune system to eliminate the virus, only a few women, under the influence of some synergistic factors such as simultaneous infection of other bacteria and viruses in the reproductive tract, early sexual life, multiple sexual partners, smoking, long-term oral contraceptives, malnutrition, lack of health awareness, unwillingness to actively accept cervical cancer screening, etc., lead to persistent infection of HPV virus, and eventually cause cervical precancerous lesions and cervical cancer. Therefore, cervical cancer is currently the only malignant tumor with a clear cause. It is precisely because the cause is clear that early prevention becomes possible.

How long does it usually take for the human body to clear the HPV virus?

About 80% of HPV infections take 6 to 24 months to be completely cleared, especially for young people with good resistance, who can clear the virus more easily. About 90% of the population can clear the virus within 3 years. Therefore, only about 10% of the population may continue to be infected or develop low-grade squamous intraepithelial lesions, and only about 10% of the persistently infected population will eventually progress to precancerous lesions or cervical cancer. So, with this calculation, only about 1% of HPV infections develop into precancerous lesions and cancer, so there is no need to panic.

Was my HPV transmitted to me by my significant other?

This problem is also a concern for most female friends, and sometimes it can even easily cause family conflicts. This involves the transmission route of HPV. Of course, the main transmission route of HPV is still sexual transmission. The more active the sex life or the more sexual partners a person has, the higher the HPV infection rate is, but this is not the only route. Indirect contact transmission and mother-to-child vertical transmission are secondary transmission routes. Contact with contaminated towels, underwear, toilets and other items may also cause infection with the HPV virus. Therefore, once you find that you are infected with HPV, it is recommended to wear a condom during sex to avoid cross-infection, and pay attention to the disinfection and independence of bathing utensils and underwear.

How do I know if I am infected with HPV?

Generally, you need to go to the hospital, where the doctor will use a special small brush to take samples from the cervix or vaginal wall, and then test the HPV nucleic acid to determine whether there is HPV infection. Typical genital warts can be determined to be infected with low-risk HPV just by naked eye observation.

What are the symptoms of HPV infection?

Most HPV infections are actually asymptomatic. If you are infected with low-risk HPV, when your body's resistance is reduced, cauliflower-like warts often grow in your reproductive tract, which is a common reason for women to seek medical attention. High-risk HPV infections are often asymptomatic, so regular cervical cancer screening is particularly important. Of course, some women may experience irregular vaginal bleeding, abnormal secretions, bleeding during intercourse, etc., which require special attention and should be treated in a timely manner.

Is it serious if the test result is positive for HPV66 subtype?

Everyone should know that even if they are all high-risk HPV infections, the dangers are still different. The "Guidelines for Screening and Treatment of Cervical Precancer Lesions" released by WHO in 2021 propose that high-risk HPV testing should include at least the following 14 subtypes: HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. The morbidity of each type is still divided into different echelons. The first echelon is HPV16 and HPV18, which cause almost 70% of cervical cancer and are the most carcinogenic. This is also the reason why colposcopy must be evaluated once a positive result is detected. In the second echelon are types 31.33.45.52.58, which are the culprits of 20% of cervical cancer, and the rest belong to the third echelon, which are relatively weak in carcinogenicity. But it does not mean that the carcinogenicity is weak and can be ignored. Doctors generally combine the results of cytology tests to assess the risk and decide whether further examination is needed.

How to screen for cervical cancer?

The screening of cervical cancer follows the three-step principle. The first step is to perform cervical cytology (TCT) and HPV testing on cervical exfoliated cells. TCT has high specificity but low sensitivity (this is the screening method currently used by most physical examination institutions and censuses), while HPV testing has high sensitivity but low specificity, so the characteristics of the two are complementary. The doctor will decide whether to conduct a joint screening or a separate screening based on the specific situation of each person. The second step is colposcopy. For those who have abnormalities in the first stage of screening, the doctor will decide whether to conduct a colposcopy based on the specific situation. The colposcopy is to observe the vulva, vagina, and cervix through the use of magnifying equipment combined with acetic acid, Lugol's iodine, etc., to perform biopsies on suspicious areas, and then send the tissue to pathology. The third stage is histopathological examination: the pathologist will carefully observe the tissue obtained under the colposcopy under a microscope to draw the final diagnosis conclusion.

For example, a patient with positive HPV16 but normal TCT will have a typical high-level image after colposcopy, and a biopsy will confirm the presence of precancerous lesions. This shows that TCT examination is not sensitive and is prone to missed diagnosis, so it must be considered in conjunction with HPV. Using HPV testing to replace TCT screening, and adding TCT to the same tube if there is an abnormality, the missed diagnosis rate is expected to drop significantly.

At what age should cervical cancer screening generally begin? When can it be stopped?

According to the current age characteristics of cervical cancer incidence in my country, it is recommended that the starting age for screening for women at general risk be 25-30 years old. For population screening, considering cost-effectiveness, it is recommended to start screening at the age of 35, and the age at which women with high-risk factors start screening should be earlier. Women over 65 years old in my country can stop screening if there are no abnormalities in cytology examinations every 3 years in the past 10 years, or 2 consecutive negative HPV tests or combined screenings every 5 years, and no history of cervical precancerous lesions or cervical cancer. So it does not mean that you don’t need to check when you are over 65 years old. There are prerequisites.

The biopsy pathology is a low-grade lesion. Is this a precancerous lesion of the cervix? What should I do?

Cervical precancerous lesions include high-grade cervical squamous intraepithelial lesions and adenocarcinoma in situ. The full name of the low-grade lesions that everyone talks about is low-grade cervical squamous intraepithelial lesions. It does not belong to the category of precancerous lesions. Only a small part will progress to cervical precancerous lesions. The probability of progression to cervical cancer is very low, and most of these low-grade lesions will reverse after HPV is cleared. There is no need to panic. Just do regular follow-up as required by the doctor. Only a few low-grade lesions require further diagnosis and treatment, which can be left to the doctor to evaluate.

How to Effectively Reduce the Risk of HPV Infection

HPV (Human Papillomavirus) is a significant public health concern, but with proactive prevention and early intervention, the risks can be greatly minimized. Here are six key strategies:

1. Get Vaccinated Against HPV

Timing: HPV vaccines are most effective when administered during adolescence, before exposure to the virus. Vaccination can significantly lower the risk of infection by targeting high-risk HPV strains.

Types of Vaccines: Options include the nine-valent and quadrivalent vaccines. Consult a healthcare professional to choose the vaccine that best suits your needs.

2. Practice Safe Sexual Habits

Use Condoms: While condoms don’t fully eliminate the risk of HPV transmission, they can greatly reduce it.

Limit Sexual Partners: Reducing the number of partners and maintaining a mutually monogamous relationship can lower the risk of infection.

3. Schedule Regular Gynecological Exams

Cervical Screening: Tests like Pap smears and HPV DNA tests can detect infections or abnormalities early, enabling timely intervention.

Monitor Your Health: Even without symptoms, regular check-ups help track your HPV status and ensure early action if needed.

4. Strengthen Your Immune System

Healthy Diet: Eat a balanced diet rich in vitamins C and E, focusing on fruits and vegetables to boost immunity.

Regular Exercise: Engage in moderate activities like walking, swimming, or yoga to improve physical fitness and immune function.

Adequate Sleep: Ensure sufficient rest and avoid sleep deprivation to maintain optimal immune health.

5. Adopt Healthy Lifestyle Habits

Avoid Smoking and Excessive Alcohol: Both can weaken the immune system and increase the risk of infection.

Use Medications Wisely: Follow your doctor’s guidance and avoid drug misuse, which can impair immune function.

6. Take Extra Precautions During Pregnancy

Prenatal Check-ups: Regularly monitor your health and HPV status during pregnancy to address any risks promptly.

Consult Your Doctor: If HPV is detected during pregnancy, seek professional advice to protect both mother and baby.

Conclusion

Preventing HPV infection starts with education and proactive measures. Vaccination, safe sexual practices, regular health screenings, and a strong immune system are essential in reducing risks. Should symptoms arise or concerns develop, consult a healthcare provider promptly for appropriate care and treatment. By staying informed and taking preventive steps, women can better safeguard their reproductive health.