• HPV is transmitted by sexual contact. Condoms do not always protect against HPV exposure.
• The infection is very common in young people. It is usually asymptomatic. 70% of women have been exposed to HPV at least once. Of every 5 women exposed to high-risk HPV, it will be persistent in just 1 and 80% of them will eliminate the virus spontaneously (clearance) in a period of one to two years, depending on their immune system.
• HPV is less frequent in women over 30 years of age compared with younger women.
• On average, 10% of women over the age of 30 are positive for HPVHR.(high risk)
• The majority of HPVHR+ subjects do not develop dysplasia (CIN) or cancer.
• A negative HPV test is more precise than the smear in determining the absence of disease.
• In developed countries where women are screened and there is regular early detection, the presence of HPVHR is not a risk factor for cervical cancer, but an indicator of existing or future benign lesions (CIN). The absence of screening is the most important risk factor for developing cervical cancer. The HPV test provides assurance that the negative results of the smear are correct. In developing countries where women do not have screening and do not know whether they are carrying the virus and the consequences of it, HPVHR is a powerful risk factor for cervical cancer. In this situation, cervical cancer can develop, on average twenty years after exposure in 20% of cases.
• Women who are persistently HPVHR-positive are at risk of developing pre-cancerous lesions even in the absence of cytological abnormalities.
• The presence of HPV is not a marker of sexual behaviour or infidelity, and the moment when the infection was contracted cannot be determined.
Seven key points for health professionals about the use of the HPV test
• Understand the natural history of HPV infection and be able to provide clear advice to patients before the test is used.
• Reassure HPV-positive patients that it is not possible to state precisely when they were infected.
• The presence of high-risk HPV does not mean there is a CIN lesion or cancer.
• Test only for high-risk HPV.
• Genotyping will allow viral persistence beyond 12 to 18 months to be evaluated.
• Do not use the HPV test as a primary screening measure in women under the age of 30, or after an HSIL, AGC or ASCH smear or cancer.
• No treatment should be carried out where the presence of HPVHR is the sole criterion.