Did you know that over one million sexually transmitted infections (STIs) are acquired globally every day? The vast majority of which have no symptoms. Because of the absence of symptoms, STIs such as HPV infections can go undetected. A high risk HPV infection can lead to cervical cancer if left untreated. What is HPV you ask? Let’s start from the basics.  

What Is An HPV Infection? 

Human Papillomavirus is a common sexually transmitted infection. Research suggests that almost 80% of sexually active individuals get an HPV infection at some point in their life as this virus spreads via skin to skin contact1. Most people with an HPV infection are asymptomatic and do not even realize they have an infection. More than 90% of all new HPV infections go away on their own2. Some HPV types are persistent and if left undiagnosed or untreated may cause cervical cancer. Cervical cancer is the most common type of cancer caused by certain high-risk HPV strains 3.

What Are The Different HPV Types? 

HPV is a family of more than 200 viral genotypes. It can be transmitted through vaginal, anal, or oral sex. HPV Viral genotypes transmitted sexually are classified as low risk and high risk. Low-risk HPV infections rarely cause disease. Very few low-risk HPV genotypes, on the other hand, can cause warts on or near the genitals, anus, mouth, or throat. High-risk HPV types have been linked to a variety of cancers. There are 14 high-risk HPV types, including HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. The majority of HPV-related cervical cancers are caused by two of these viruses, HPV16 and HPV18 4

Based on whether they increase a person's risk of developing cancer, HPV types are also frequently referred to as "non-oncogenic" (causing warts) or "oncogenic" (causing cancer) 5.

High-risk HPV Types

Almost 77% of Cervical cancer in India is caused by high-risk HPV 16 and HPV 18 types6. The most common high-risk type is HPV-16 which causes 50% of cervical cancers globally7.  Infection with either of these types do not show any symptoms. These strains make the cells of the cervix abnormal and are also the cause of several other types of cancers8. Some common cancers include cervical cancer, vaginal cancer, vulvar cancer, penile cancer, anal cancer and oropharyngeal (throat) cancer. Other high-risk HPV types include 31, 33, 45, 52, 58. They are responsible for 15% of cervical cancers and 11% of all HPV-related cancers 9.

Low-risk HPV Types 

The most common low-risk HPV types are HPV 6 and HPV 11. These two types cause more than 90% of genital warts which usually do not develop into cancer9. The warts look like bumps and sometimes are cauliflower shaped. They appear in clusters. Some warts may be flat. The warts appear after an individual has been exposed to the virus after sexual contact. They usually appear on the vulva, cervix, vagina, penis, anus, mouth and throat. Low-risk HPVs do not cause any symptoms and clear on their own after the infected individual's body develops immunity against the virus. Some Low-risk HPV types can cause non-cancerous mild abnormal changes in the cells of the cervix 10

What Is Cervical Cancer?

When cancer develops in the cervix of a woman, it is called cervical cancer. The cervix is present at the lower part of the uterus or the womb. It connects the uterus to the vagina, which is the birth canal. Cervical cancer occurs when the cells of the cervix begin to multiply and grow uncontrollably11. It is the fourth most common cause of cancer among women all over the world12. In India, cervical cancer is the second most common cancer among women aged between 15 to 44 years13

Regular screening helps detection of an HPV infection which leads to timely treatment.

Tests For Diagnosing An HPV Infection

  • HPV test: The sample is checked for DNA high-risk HPV types that could cause cervical cancer and other types of cancers. With LifeCell’s HPV DNA test you can get yourself tested from the convenience of your home. This test detects 24 HPV High-risk genotypes (3 major high risk strains and 21 other high risk strains)  using  RT-PCR to give quick and accurate results.                                                            
  • PAP test: The sample taken from an individual is checked for abnormal precancerous or cancer cells. This test requires a doctor visit.
  • HPV/Pap co-test: A combination of both the tests. 
  • Acetic acid solution test: Flat lesions caused by an HPV infection can be identified by applying acetic acid solution to it. Acetic acid turns the affected areas white 14

In Conclusion 

An HPV infection is almost always asymptomatic. This is why WHO recommends that all women aged 30 and above should go for HPV DNA test as primary screening test for an HPV infection every 5-10 years. Whereas for HIV positive women, women aged 25 and above should go for HPV DNA test as primary screening test every 3-5 years of interval 15.  If you test positive for an HPV test make sure to get a cervical cancer screening done. The screening can identify changed cervical cells that take up to 3-7 years to develop into cancer 16. Early detection leads to early intervention, and women can have these cells removed in order to live a healthy and long life.

References

  1. https://www.nfid.org/infectious-diseases/hpv/#:~:text=About%2080%20percent%20of%20sexually,infected%2C%20can%20spread%20the%20virus 
  2. https://www.who.int/news-room/fact-sheets/detail/cervical-cancer 
  3. https://www.cdc.gov/cancer/hpv/basic_info/index.htm 
  4. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer#:~:text=There%20are%20about%2014%20high,for%20most%20HPV%2Drelated%20cancers
  5. https://www.cdc.gov/cancer/hpv/basic_info/index.htm 
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385284/ 
  7. https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/hpv.pdf 
  8. https://www.acog.org/womens-health/faqs/cervical-cancer-screening 
  9. https://www.cdc.gov/vaccines/pubs/pinkbook/hpv.html 
  10. https://nyulangone.org/conditions/human-papillomavirus-in-adults/types 
  11. https://www.cancer.org/cancer/cervical-cancer/about/what-is-cervical-cancer.html 
  12. https://www.ncbi.nlm.nih.gov/books/NBK431093/ 
  13. https://www.nhp.gov.in/disease/reproductive-system/female-gynaecological-diseases-/cervical-cancer 
  14. https://www.mayoclinic.org/diseases-conditions/hpv-infection/diagnosis-treatment/drc-20351602 
  15. https://www.who.int/news/item/06-07-2021-new-recommendations-for-screening-and-treatment-to-prevent-cervical-cancer 
  16. https://www.acog.org/womens-health/faqs/cervical-cancer-screening