HPV stands for “Human Papilloma Virus” and is the virus responsible for causing abnormal pap smears and cervical cancer. This virus is not “new”; it has been around as long as we have been…and most women have been exposed to it at some time in their life. It is sexually transmitted and most people (men especially) have no idea that they have ever been exposed to it and/or carry it. It actually is pretty much impossible to completely avoid exposure! What IS important is the understanding that this virus is extremely common and every woman should be aware that anyone could be or could have been exposed to it, at any time in her life, and needs to be screened appropriately. The virus also can become reactivated many years after the initial exposure; even over 20 years later! The other very important fact about HPV is that there are two types of HPV; “high risk” which is responsible for abnormal pap smears and “low-risk” which is responsible for genital warts…but rarely abnormal pap smears and never with cervical cancer.
The good news is that now we know what causes cervical cancer (HPV!!!) and we have a very reliable test for HPV viral activity that can be easily obtained at the time of the routine pap smear. It is not recommended however to test young women for HPV activity as >90% of young women exposed to HPV will NOT have any significant abnormalities EVER on their pap smears and will NEVER develop cervical cancer; however the high number of initial positives that would be obtained by screening everyone would cause significant anxiety to many young women who will never have cervical problems; not to mention potentially leading to addition testing, procedures, etc that are NOT necessary! The HPV vaccine is designed to protect women from the most aggressive HPV sub-types; as you can see, with HPV exposure being so common and difficult to prevent, the vaccine is definitely recommended before sexual activity has occurred.
What is recommended, however, is the testing of all women over the age of 30, who have had normal pap smears for 10 years, for the presence of HPV activity. This represents HPV that has become “re-activated” or “active” without the women being aware. The HPV that is tested for is “high risk HPV”; the types that cause abnormal pap smears and cervical cancer. The intent of screening for HPV activity is to identify women who may have had “false negative” pap smears so they may be followed more closely; also this testing is so strong in identifying women who are at minimal risk for cervical abnormalities that it only needs to done every three years! (as well as the pap smear). It is important to also understand that the overwhelming majority of women who test positive for HPV will never develop cervical cancer; it is just a marker to identify women who need close follow up (this actually for most women just means another pap smear in one year).
Dr. Anne Rainville, MD