Human papillomavirus (HPV for its acronym in English) is one of the main causes of cervical cancer. Therefore, regular HPV-DNA testing, especially for high-risk HPV infection, is important to predict the risk of developing cervical cancer. Current methods of cervical cancer prevention screening include HPV-DNA testing, traditional Pap smear, thin-layer liquid-based cytology smear, and colposcopy. This technique allows sophisticated testing for HPV to determine if it is a high-risk type of infection, allowing more patients to effectively prevent cervical cancer from occurring.
HPV infection has a wide range of routes
HPV infection can be contracted through direct contact, in addition to sexual intercourse as the main transmission route. In other words, if your hands touch something with HPV in your daily life, you will inadvertently bring the virus into your genital organs when you go to the toilet or take a shower, or your genital organs come into direct contact with bath towels, bathtubs, toilets and other items with HPV, you can be infected with HPV, so the chances of being infected with HPV are very high.
After HPV infection, most infections will naturally subside after a certain period of time and do not cause changes in cervical cells and cause disease. Even if there is persistent HPV infection, cervical cancer can be avoided if treatment is given in time at an early stage.
Women over the age of 35 who have persistent HPV infection are in the high-risk group and have a relatively higher risk of developing cervical cancer.
What is human papillomavirus (HPV) and how does it affect pregnancy?
Human papillomavirus (HPV for short) is an epitheliophilic virus with a high degree of specificity. HPV has long been known to cause benign human tumors and warts, such as cervical cancer, condyloma acuminatum, and papillomas growing on mucous membranes.
I. Classification of HPV
Clinically, HPV can be classified into two categories: low-risk and high-risk, depending on the pathogenicity or cancer risk of HPV.
1. Low-risk HPV: Generally speaking, it can be eliminated by its own immune system.
2. High-risk HPV: It can cause external genital cancer, cervical cancer and highly cervical intraepithelial neoplasia, and there are more than 100 types of HPV, the most dangerous ones clinically are HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, etc.
Second, can patients with high-risk HPV infection get pregnant?
HPV infection in women’s cervix is a relatively common disease that can cause cervicitis, condyloma acuminata, endothelioma-like changes in the cervix, and even cervical cancer. Persistent high-risk HPV infection has been shown to be strongly associated with the development of cervical cancer. Therefore, high-risk HPV infection is still worthy of high attention.
Whether high-risk HPV patients can get pregnant is a concern for many people. According to relevant reports, it is possible to get pregnant with high-risk HPV infection, but only if it does not cause other pathologies, such as condyloma acuminata, malignant lesions of the cervix, etc.
Therefore, firstly, early detection and complete treatment of high-risk HPV infection should be given, followed by curing the cervical lesions before preparing for pregnancy. However, to completely cure HPV infection, advanced testing methods are needed, and only accurate test results can make the treatment and prognosis of HPV infection better.
What are the common HPV testing methods?
Commonly used HPV testing methods include the following.
1, nucleic acid blotting in situ hybridization: suitable for HPV typing and HPV-DNA molecular weight identification, high sensitivity, but the operation is complex, requiring fresh tissue specimens, not convenient for clinical promotion.
2, spot blotting: its sensitivity and specificity are lower than nucleic acid blotting in situ hybridization method, economic and practical, but there is radioactive contamination during the experiment.
3, in situ hybridization: detection of paraffin tissue by non-radioactive probes, and can do localization detection, low false positive rate, but the sensitivity is not high.
4.Hybrid capture method (i.e. HC2-HPV-DNA test): detects the typing of HPV and the degree of harm caused to the cervix, which makes up for the deficiency of cytological examination, thus providing a clinical treatment basis for the treatment of HPV, in order to achieve early detection and early treatment, to keep away from cervical diseases and to achieve a healthy pregnancy.
How often should HPV testing be performed?
1.First HPV test: If you are over 30 years old (special groups should be earlier) and have never been tested for HPV, you should perform an HPV test at the same time as cytology examination.
2. If you are between 20 and 30 years old, HPV testing is required only if the cytology results are critical, i.e., atypical cell change (referred to as “ASC-US”).
3, HPV review: If you are over 30 years old, the frequency of HPV testing depends on the results of the previous test. If the results of both cytology and HPV testing show normal, a repeat test can be performed every 3 years.
HPV: It takes several years to progress to cancer
Regardless of how much earlier the average age of onset of cervical cancer and precancerous lesions is, there is still plenty of time left to detect the disease.
It takes years or a decade for HPV infection to progress to cancer, so most of it can be prevented if women are aware of self-care and have regular checkups.
Cervical cancer has a relatively long precancerous period, and it takes an average of 10 years to develop from cervical precancerous lesion to cervical invasive cancer. Timely detection and proper treatment during this period can completely stop the development of cancer.
Prevention: Regular gynecological examination is most important
According to the report of the World Health Organization, the incidence of cervical cancer in developed countries has dropped significantly, largely due to the effective prevention and early diagnosis and treatment of cervical cancer. According to Zhao Xianlan, to prevent cervical cancer, the key lies in regular cervical cancer preventive checkups.
The prevention of cervical cancer is a systematic project that should be paid attention to by all women. The survey found that one fourth of cervical cancer patients have never had cervical cancer prevention checkups. Nationwide, less than 1% of women aged 20 to 69 years old receive routine cervical cancer prevention checkups every two years; women over 50 years old almost never have cervical cancer prevention checkups, and these women have a high chance of developing invasive cervical cancer.
Treatment: Maintain physiological functions as much as possible
The incidence of cervical cancer is gradually getting younger and many patients are still in their reproductive age, which puts forward higher requirements for treatment, including preservation of endocrine, reproductive and sexual functions.
For young patients with cervical carcinoma in situ, local excision of the cervix is sufficient, which can preserve reproductive functions and the cure rate can reach 97%. For middle-aged and older women, total hysterectomy is advocated.
Patients with early stage of invasive cancer and no fertility do not need to have a large-scale radical surgery, but a larger local excision of the cervix can be done with close follow-up.
If a young patient with invasive cancer strongly requests to preserve fertility, and the cancer is small and has not metastasized to the lymph nodes, the uterus can be preserved. However, patients should be informed of the possible consequences of this procedure before surgery, such as infertility, miscarriage, preterm delivery, and especially cancer recurrence. The current choice of treatment for cervical cancer emphasizes the human-centered principle of thorough treatment while maintaining physiological functions as much as possible.
All women aged 18-70 should be aware of cancer prevention
Women who have sex should have cytological examination from the age of 18-20, or have cervical cancer prevention examination every two years starting within one or two years after their first sexual intercourse.
Women over 70 years old can stop the screening if the two cervical cancer tests in the last 5 years are normal.
People with early first sexual intercourse, multiple sexual partners, smoking, and high-risk type of HPV infection have high risk of cervical cancer and should increase the number of cervical cancer preventive examinations appropriately.
Cervical cancer preventive screening should be done for women who have hysterectomies. The same applies to women who are on hormone replacement therapy, which does not increase the risk of developing cervical cancer. Cytology screening for pregnant women during pregnancy will not have any effect on pregnancy.
HPV cervical cancer vaccine
The cervical cancer vaccine has limited effectiveness and the best time to get vaccinated is before puberty, but it is not a one-off.
Vaccination is not a substitute for cervical cancer screening
There are currently two types of HPV vaccines approved by the U.S. Food and Drug Administration (FDA): the quadrivalent vaccine (for HPV types 6, 11 (which mainly cause genital warts), 16, and 18 (which mainly cause cervical and vaginal tumors)) and the bivalent vaccine (for HPV types 16 and 18). The former is indicated for women aged 9 to 26 years and the latter for women aged 10 to 25 years. Although both vaccines immunize vaccinees against HPV types 16 and 18, which are responsible for 70% of cervical cancers, other subtypes of HPV can still cause cervical cancer in vaccinees; therefore, vaccination is not a substitute for cervical cancer screening, and vaccinees are still screened in the same way as unvaccinated individuals.
The vaccine is best administered before puberty
The cervical cancer vaccine is not cheap and requires three doses of several thousand dollars each. As a result, most of the women who currently travel outside of the country for vaccination are high-income earners, most of whom are already sexually active. Once they have had sexual experience, they may have been exposed to the HPV virus or even infected. If you get the vaccine again, the protection will not be as good. The best time to get the cervical cancer vaccine is before a woman has her first sexual intercourse, and it is best to have the universal vaccination when a woman is young, like the hepatitis B vaccine. It is understood that a significant percentage of the population abroad who receive the HPV vaccine are girls who are about to enter puberty or are in their prime.
Despite these limitations, the vaccine is still a positive preventive tool to reduce the risk of infection. However, from the perspective of cervical cancer prevention, “mature girls” do not necessarily need to hug the vaccine as a “tree” to prevent cervical cancer. “After HPV infection, the virus can be latent in the cells for several years, and once the body’s immunity is reduced, the latent virus can resume its activity.”