Frequently asked questions on HPV Primary Screening

If I have been diagnosed with HPV should I get the vaccination?

The vaccine prevents infection by other types of HPV and prevents reinfection by the same type, but does not clear the infection. Therefore, if you have been diagnosed with HPV it could still be beneficial for you to get vaccinated, even though it will not help you clear that particular infection.

However, the HPV vaccine is currently only provided free of charge by the NHS for girls aged 11–17 in Scotland and 12–17 in the rest of the UK (up until their 18th birthday), and only girls aged 11–13 in Scotland and 12–13 in the rest of the UK will be routinely offered the vaccine.

If you are ineligible for the NHS vaccination programme you can pay to have the vaccine privately. The complete course of the vaccine requires three doses with each dose costing around £150.

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What is human papillomavirus (HPV)?

HPV is an extremely common virus. There are over 100 identified types of HPV. Some types of HPV, known as high-risk HPV types, can cause changes in the cells of the cervix, creating abnormalities. Once cervical abnormalities become severe they may develop into cancer.

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What is the difference between HPV triage and HPV primary screening?

HPV triage and HPV primary screening both involve testing the sample of cells collected during the cervical screening test for high-risk HPV as well as examining the cells under a microscope (cytology). The order in which the HPV testing and cytology is done is where they differ.

With HPV triage, cytology is done first. Then HPV testing is done on any samples that come back with a cytology result of borderline or low grade cell changes (dyskaryosis). If no high-risk HPV infection is found during this test, the risk of the abnormalities turning into cancer is very low so the women will be returned to normal screening routine.

With HPV primary screening, the high-risk HPV test is done first and only if a high-risk HPV infection is found will cytology be done. If the results of the cytology are abnormal, at that point the woman will be referred to colposcopy, if they are normal she will be retested in 12 months.

HPV triage is currently used in both England and Northern Ireland in addition to cytology as part of the NHS screening programme. HPV primary screening will now replace the current cervical screening test across England.

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What is the difference between HPV primary screening and current cervical screening?

In the current cervical screening the sample of cells that is collected from the cervix is first examined under a microscope (cytology) to look for any abnormalities. If you live in England or Northern Ireland and this cytology shows borderline or low grade squamous dyskaryosis, your sample may then be tested for a high-risk HPV infection. If an infection is found (high-risk HPV positive) then you will be sent to colposcopy. If not (high-risk HPV negative) you will be returned to the normal screening program.

With HPV primary screening the cervical screening sample is tested for the presences of high-risk HPV first. If the sample is high-risk HPV positive (high-risk HPV infection has been found) then cytology will be used to check for cervical abnormalities. If abnormalities are seen you will be sent to colposcopy for further examination. If you are HPV positive but no cervical abnormalities are found in cytology then you will be rescreened again in 12 months time. If you are high-risk HPV negative (no infection found) then you will be returned to the normal screening programme, because without the presence of high-risk HPV there is virtually no chance of going on to develop cervical cancer.

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Where is HPV primary screening being done?

Currently, the roll-out of HPV primary screening has been announced for both England and Wales. Both areas will go through an initial trial period and full roll out of the programme will happen in 2018/2019 in Wales, and 2019 in England. 

If you live in Northern Island or Scotland you will not be offered HPV primary screening and your cervical screening (smear) test will still be examined under a microscope (cytology) to look for cervical abnormalities directly. 

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How can I reduce the risk of becoming infected with HPV?

HPV infections are very common, with an estimated four out of five (80%) people worldwide contracting some type of the virus once in their life, and there are no symptoms associated with it. Therefore, it is very difficult to tell whether an individual is infected. HPV is transmitted primarily by skin-to-skin contact of the genital area, including genital-to-genital contact, vaginal and anal intercourse, and oral sex.

While it is not possible to fully protect yourself from high-risk HPV if you are or have ever been involved in any kind of sexual contact, there are some things you can do to help reduce your risk of getting high-risk HPV and developing a persistent infection:

  • Safe sex: practising safe sex through the regular use of condoms can help reduce the risk of being infected with HPV, but it will not completely eradicate the risk as HPV lives on the skin in and around the whole genital area [1]. Genital HPV in men affects the skin of the penis, scrotum, anus and rectum [2]. In women it affects the vulva (area outside the vagina), linings of the vagina, cervix and rectum. It can also affect the skin of both the mouth and throat of men and women
  • Leading a healthy lifestyle: keep your immune system – your body's natural defence against disease and infection – strong. A weakened immune system could mean that your risk of cervical cancer is higher than average.
  • Not smoking: smoking can weaken the immune system around the cells of the cervix, which makes it harder to both prevent and clear high-risk HPV infections. Thereby increasing your chance of developing cervical abnormalities and cervical cancer [3].

References

  1. Winter RL et al., 2003. Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students. American Journal of Epidemiology, 157 (3), 218-226.
  2. Giulano AR et al., 2008. Epidemiology of human papillomavirus infection in men, cancers other than cervical and benign conditions. Vaccine 26 (10), K17-K28.
  3. Cancer Research UK. Cervical cancer risk factors. http://www.cancerresearchuk.org/cancer-info/cancerstats/types/cervix/riskfactors/. Accessed: 06.07.2016.

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If I have high-risk HPV, will my body ever clear it?

Most people with a healthy immune system will eventually clear a high-risk HPV infection (test negative). Around four out of every ten people (40%) affected by a high-risk HPV infection will clear it within 12 months (one year) and this increases to around six out of every ten people (60%) within two years [1]. However, in a minority of people an infection can persist over many years and may result in recurrent abnormalities (though this is rare).

 

Reference

  1. Kitchener HC et al, 2009. ARTISTIC: a randomised trial of human papillomavirus (HPV) testing in primary cervical screening. Health Technology Assessment 13( 51).

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