I Those who are positive for high-risk HPV types but negative on cytology HPVDNA is measured in two ways. One is a qualitative (i.e., definitive) test for HPV, which tells which HPV type is infected. The other is a quantitative test that tells the extent of infection with 13 high-risk HPV types, usually expressed as a numerical value, but does not indicate which high-risk type is infected. This latter assay is now usually referred to as the HC2 assay. For those with a positive qualitative HPV test, we recommend a quantitative HPV test (HC2), which will give an idea of the extent of infection with the high-risk types and changes after treatment. For those with positive quantitative HPV test (HC2), we recommend a qualitative test for HPV16 or HPV18 infection, which are the most potent high-risk types for cancer. For cytology, TCT or LCT is the most commonly used test, and Pap smears are rarely used anymore. For Pap smear IIb and above, we recommend a TCT or LCT. For those who are purely HPV positive, the National Comprehensive Cancer Network (NCCN) in 2009 recommended the following management principles: for those over 30 years of age, it is possible to further define which high-risk type is infected and to proceed directly to long-focus colposcopy. Even if they are infected with HPV, they will most likely clear up on their own. According to guidelines published by the ASCCP in 2012, colposcopy is recommended for HPV line 16 or 18 infections, even if cytology is negative, because these are the most dangerous of the high-risk types. Treating HPV infections is often difficult. Low-risk HPV types usually cause genital warts, which can be removed with lasers and other physical methods. Those with high-risk types should primarily rule out possible intraepithelial cell carcinoma (precancerous lesions), especially to expel highly advanced lesions. Those who are positive for HPV high-risk types alone can be watched and waited. Some medications may help promote HPV clearance, such as vaginal interferon, or herbal medications such as povidone-based suppositories, although the effectiveness of these medications still needs further clinical validation. The duration of HPV clearance by the body itself usually lasts for 8-14 months. The clearance rate of the virus during this period is 70-80%. People with HPV infection should use condoms during observation or conservative treatment to prevent cross-contamination or reinfection. You should also adjust your immunity, including exercise, nutrition, regular lifestyle, adjust your mindset, reduce mental stress and burden, and have a healthy and hygienic sex life. For those who are older, such as older than 30 years old, and intend to have children in the near future, long-term observation is not recommended, but more aggressive treatment should be taken. TCT or LCT is recommended every six months for pure high-risk HPV infection, and colposcopy and multi-point cervical biopsy should be performed if abnormal TCT results are found. II High-risk HPV infection with intraepithelial lesions There is little effective treatment for HPV. However, HPV tends to stay in the cervical area with lesions. If the lesions are removed, the HPV may go with it, which is called “cure the disease is cure the virus”. However, HPV may also remain or integrate in cells without precancerous lesions, such as the squamous epithelium of the vagina or the columnar epithelium of the cervix. So although cervical lesions are removed, there is no guarantee that HPV is completely removed. In HPV-infected patients with cervical erosion, although TCT is normal, if the lesions can be removed with physical therapy, HPV may also be cleared with it. In patients with CIN I combined with HPV infection, if colposcopy is satisfactory, i.e., if the cervical lesion area is on the surface of the cervix, HPV may be cleared by physiotherapy. If colposcopy is unsatisfactory, i.e. the lesion is within the cervical canal, physiotherapy is less desirable. For CIN II and HPV infection, LEEP (loop cervical electrodesiccation) is a good option. For CIN III with HPV infection, HPV often decreases significantly after conization. The best treatment is prevention. Two HPV vaccines have been approved by the FDA, one is GlaxoSmithKline’s product, Cervarix, which targets HPV types 16 and 18 for prevention. The other is Mercer’s product Gardasil, a quadrivalent vaccine for HPV types 6, 11, 16, and 18. These vaccines are usually given in three doses over six months and are used for uninfected people aged 9 to 26 years. The total price for the three shots is $2,000-$2,700. The vaccine is not officially available in this country.