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I recently attended a conference in Wellington on Abnormal smears, colposcopy, and the HPV VIRUS. As this was the most up to date information available I thought it would be prudent to share this with the readers of my website.

Firstly the HPV virus. It stands for HUMAN PAPILLOMA VIRUS (the wart virus).There are 100 known types with 20 infecting the anogenital region. Only 2 of these cause genital warts.  I have termed them the ‘Virus of intimacy’ It is the common cold of sexual activity. We give them to each other when we have sex with each other. The HPV virus is the only known virus that directly causes cancer of the cervix, anus, penis, vulva, oropharynx, some skin cancers and some cancers of the oral cavity. The virus is further divided into high risk (Hr) and low risk (Lr) which one we get is a jackpot. We may get a single one or multiple both Hr and LR.The jackpot goes further. If it is Hr it can be 16 or 18 or others. The most dangerous is 16 followed by 18.The numbers represent the DNA classification.

Some interesting statistics. The risk of getting HPV with a first unprotected sexual event is 40%. With a second partner it’s about 60% and 3 or more partners it goes to almost 100%. Women at highest risk of severe abnormalities are in the 25-34 year age group. There can be a long latent phase between infection and the abnormal smear as the body can contain the virus. However, that’s not always the case.

When we grade abnormal smears we use the term ‘Cervical Intraepithelial neoplasia’ (CIN). We use CIN1 as a mild change and CIN2 and CIN3 as a severe pre-cancer change. The classification is based on the depth of the abnormal cells from the surface inwards. If left untreated 50% of CIN 1 will regress in 9 to 15 months, and 35% of the higher grades will regress. However and this is fundamental to the screening programme, 10% of CIN3 will progress to cervical cancer.

Another important thing to understand is that there are two types of cervical cancer.

  1. Squamous  cancer involving the ‘Skin of the cervix’
  2. Adeno cancer involving the glands.

Both of these are HPV related. Most of them are 16 and 18.

So, what does this all mean?

Firstly all women should take cervical screening very seriously and make sure they have regular screening. Most women who present with cervical cancer have not had a smear in at least 5 years.

If you have had a hysterectomy for an abnormal smear or have had abnormal smears in the past you need to continue screening. If you have had a hysterectomy and changed your partner then have a smear.

If the smear comes back as low grade you may be advised to repeat it in 6 to 12 months as at least 50% will revert to normal. Remember cervical cancer usually takes a very long time to develop. If the smear comes back as high grade, persistent low grade or uncertain (ASCUS) then you will be asked to have a colposcopy.

Colposcopy is looking at the cervix with a microscope and taking tiny pieces called biopsies. I am a certified Colposcopist and it is one of my main areas of interest.

One of the most important warning signs of a possible problem is bleeding after or during intercourse as well as intermenstrual bleeding. If you have any of these please see your doctor as soon as possible.Please note that most women with abnormal cells have no symptoms at all.

Immunization for the virus is now available. It is offered to all school girls and boys. Older women and boys can still get the vaccine but they will need to pay for it. The product is called Gardasil and it protects against 9 viruses included 16 and 18 as well as the two viruses that cause genital warts namely 6 and 11.

I have endeavored to briefly discuss HPV and its relationship to abnormal cells and cervical cancer. The cell undergoes a cellular reaction to the virus and this is what we try and pick up on smear testing.


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