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HPV and Females

HPV explained

Human papillomavirus, or HPV, is a common virus that affects both females and males. There are more than 100 types of the virus. In fact, certain types of HPV cause common warts on the hands and feet. Most types of HPV are harmless, do not cause any symptoms, and go away on their own.

About 40 types of HPV are known as genital HPV as they affect the genital area. Up to 80% of females and males will be infected with at least one type of genital HPV at some time.

Genital HPV types may be "high-risk" types (such as HPV types 16 and 18) that can cause cervical pre-cancer and cancer, or "low-risk" types (such as HPV types 6 and 11) that can cause genital warts and usually benign (abnormal but non-cancerous) changes in the cervix. Both the "high-risk" and "low-risk" types of HPV can cause abnormal Pap smears.

HPV is easily spread through direct skin to skin contact. Anyone who has any kind of sexual activity involving genital contact could get genital HPV. That means it's possible to get the virus without having intercourse. And, because many people who have HPV may not show any signs or symptoms, they can transmit the virus without even knowing it. A person can be infected with more than one type of HPV.

It is estimated that many people get their first type of HPV infection within their first few years of becoming sexually active.

Genital HPV infection is not something to feel embarrassed or ashamed about. It is very common and for the majority of people who have HPV, the body's defences are enough to clear the virus. Up to 90% of infections are “cleared” within the first 36 months. It could almost be considered a normal part of being sexually active.

How will I know if I have HPV infection?

Because HPV infection does not usually show any signs or symptoms, you probably won't know you have it. Most people can therefore get HPV and pass it on without even knowing it.

Most women are diagnosed with HPV disease as a result of an abnormal Pap smear. A Pap smear is part of a gynaecological examination that aims to detect abnormal cells (pre-cancers) in the lining of the cervix before they have the chance to become cervical cancer. That's why it's important to follow your healthcare professional's recommendation about regular Pap smears.

What is cervical cancer?

Cervical cancer is cancer of the cervix. The cervix is the lower part of the uterus, or womb, and is situated at the top of the vagina. Cervical cancer develops when abnormal cells in the lining of the cervix begin to multiply out of control and form pre-cancerous abnormalities. If undetected, these abnormalities can develop into tumours and spread into the surrounding tissue.

While factors such as the oral contraceptive pill, smoking, a woman's immune system and the presence of other infections seem to play a part, a woman has to have been infected with certain "high-risk" HPV types before cervical cancer can develop. "High-risk" types 16 & 18 are responsible for ~70% of all cervical cancers.

Does everyone with HPV get cervical cancer?

Fortunately, no. For the majority of people who have HPV, the body's defences are enough to clear the virus. Up to 90% of infections are "cleared" within 36 months.

However, for women who don't clear certain "low-risk" types of the virus, benign (abnormal but non-cancerous) changes in the cervix can develop.

And for women who don't clear certain "high-risk" types of the virus, abnormal changes can occur in the cells lining the cervix that can lead to pre-cancers and even develop into cervical cancer later in life. Most often, the development of pre-cancer to cervical cancer can take a number of years, although in rare cases it can happen more quickly. That's why early detection is so important. Talk to your healthcare professional about regular Pap smears, which help detect suspicious cell changes in the cervix.

How common is cervical cancer?

Each year in Australia approximately 600 new cases of cervical cancer are diagnosed and approximately 130 women die from this disease. Globally, cervical cancer is the second most common women's cancer, which is why many countries, including Australia, have implemented regular cervical screening (i.e. Pap smears) programs to detect cervical abnormalities.

The incidence of invasive cervical cancer has fallen dramatically in the last decade due to the formation of the National Cervical Screening Program, which takes the form of 2-yearly Pap smears for women.

Reference: Australian Institute of Health and Welfare. Cervical Screening in Australia 2009-2010. April 2012 AIHW cat no CAN 67.

What is a Pap smear?

The Pap smear or 'Pap test' is a test that can detect abnormal cells in the cervix that may lead to cervical cancer. When detected early, changes to the cervix are easy to treat. That is why having a Pap smear every 2 years is so important.

A Pap smear requires the use of a vaginal speculum but it only takes a minute or two. It is performed by a doctor or nurse, who will take a sample of cervical cells by touching the cervix with a small brush and spatula. The cells are then smeared onto a glass slide, which is sent to a pathology laboratory to be examined under a microscope.

Pap smears are usually performed every 2 years, unless your GP or nurse has asked you to have them more frequently. Regular Pap smears are a very good way of picking up abnormal cells before they progress into cervical cancer. If you are, or have ever been, sexually active (with either male or female partners) you should be having 2-yearly Pap smears, starting when you are 18 to 20 years old, and continuing through until age 70.

A Pap smear only tests for abnormal cells of the cervix. It does not screen for ovarian cancer or any other gynaecological cancers.

What are abnormal cervical cells?

These are cells from the lining of the cervix that look abnormal when a scientist examines a Pap smear (also called "Pap test") under a microscope. While most Pap smears contain normal cells, some Pap smears show mild cell changes (low grade cervical abnormalities), others show more significant changes (high grade cervical abnormalities).

Each year in Australia approximately 22,000 women are diagnosed with high grade cervical abnormalities requiring surgical treatment. In addition, approximately 14,000 women are diagnosed with low grade cervical abnormalities requiring further investigation and/or screening.

Reference: Australian Institute of Health and Welfare. Cervical Screening in Australia 2009-2010. April 2012 AIHW cat no CAN 67.

How is cervical cancer detected?

Cervical cancer can be detected in two ways. A woman may present to her healthcare professional with symptoms due to the cancer, or the cancer may be detected in its early stages with a Pap smear, before the woman has any symptoms. If a woman's Pap smear shows cancerous cells, she will be referred to a specialist doctor to confirm the diagnosis and plan appropriate treatment.

Consequences of HPV infection

In females, HPV has been shown to cause cervical cancer, some vaginal, vulval and anal cancers and genital warts.

In males, HPV has been shown to cause genital warts and some anal cancers.

About vaginal, vulval and anal cancers

Although relatively rare, in 2005, there were 340 cases of vulval and vaginal cancer in Australian women. Anal cancer affects both females and males and, although relatively rare, in 2005 there were 176 cases in females and 149 cases in males.

Infection with certain "high-risk" HPV types (such as HPV types 16 and 18) is a risk factor for vaginal, vulval and anal cancers as are other risk factors including cigarette smoking, immunodeficiency syndromes and a previous history of genital cancer.

How are anal cancers diagnosed?

Anal cancer sometimes has no symptoms at first. Common symptoms can include bleeding and discomfort in the area. Other symptoms can include pain, itching, straining during a bowel movement, change in bowel habits, change in the diameter of the stool, discharge from the anus and swollen lymph nodes in the anal or groin area.

A doctor may diagnose anal cancer using a number of tests such as a physical exam and history, a digital rectal examination (DRE), an anoscopy, a protoscopy, a biopsy or an ultrasound.

What are genital warts?

Genital warts are benign, flesh-coloured growths that are most often caused by certain "low-risk" types of HPV. Genital warts most commonly appear on the external genitals or near the anus of females and males. Less commonly, genital warts can also appear inside the vagina and on the cervix. Genital warts may cause symptoms such as burning, itching and pain. Up to 90% of genital warts cases are due to infection with "low-risk" HPV types 6 and 11. These are different to the "high-risk" types that can cause cervical cancer.

Genital warts are quite common. Approximately 1% of young sexually active people have them at any one time. After sexual contact with an infected person, genital warts may appear within weeks, months, or not at all.

How are genital warts diagnosed?

A healthcare professional can usually recognise genital warts just by seeing them. Because a person can be infected with more than one type of HPV, a healthcare professional may also examine women with genital warts for abnormal cervical cells caused by "high" or "low-risk" types of HPV.


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