1. High-risk HPV positive but cytology negative There are two types of HPV DNA assays, one is a qualitative (i.e., definitive) HPV test that tells which high-risk HPV type is infected, and 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. Cytology, most commonly used today, is TCT or LCT; Pap smears are now used sparingly. For those with a positive qualitative HPV test, we recommend a quantitative HPV test (HC2), which will give an idea of the extent of the high-risk type of infection and the changes after treatment. For those with Pap smear IIb or higher, we recommend a TCT or LCT. For those who are only HPV positive, the National Comprehensive Cancer Network (NCCN) in 2009 suggested management principles: for those over 30 years of age, further clarification of which high-risk type of infection is present can be done by direct long-focus colposcopy. the NCCN does not recommend HPV testing for those under 21 years of age because women in this age group Even if they are infected with HPV, it will most likely clear up on its own. Those who are positive for HPV high-risk types alone can be watched and waited for. Certain medications may help promote HPV clearance, such as vaginal interferon or herbal medicines. Although the effectiveness of these drugs still needs further clinical validation. The body’s own clearance of HPV usually lasts for 8 to 14 months. The clearance rate of the virus during this period is 70% to 80%. Treatment of HPV infection is often difficult. Low-risk HPV usually causes genital warts, which can be treated with laser or other physical methods. Those with high-risk types should primarily rule out possible intraepithelial cell carcinoma (precancerous lesions). People with HPV infection should use condoms during observation or conservative treatment to prevent cross-contamination or reinfection. During the observation period for people with simple HPV infection, they should adjust their immunity, including exercise, nutrition, regular life, adjustment of mind, reduction of mental stress and burden, and healthy and hygienic sex life. For those who are older, e.g., 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. It is advisable to check TCT or LCT every six months for pure high-risk HPV infection. if abnormal TCT results are found, colposcopy and multi-point cervical biopsy should be done. 2. High-risk HPV infection with intraepithelial lesions There is almost no 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 for disease is cure for 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. For those with simple cervical erosion, although TCT is normal, if the lesions can be removed with physical therapy, HPV may also be cleared with it. For CIN I with HPV infection, if colposcopy is satisfactory, i.e., if the cervical lesion 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 electrosurgery of the cervix) is a good option. For those with CIN III combined with HPV infection, HPV often declines 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 to $2,700. The vaccine is not officially available in this country.