A woman’s lifetime chance of contracting HPV is >80%. Human papillomavirus (HPV) is very common, with over 80% of sexually experienced women being infected with HPV, and there are no medications available today to remove the infected virus. So, what exactly is HPV testing?
I. Meaning
HPV test is to see if you are carrying the HPV virus, which is generally known to cause cervical cancer.
II. Examination
1.Histopathological changes: The epidermis is papillomatous hyperplasia with thickened spiny layer. There is mild hyperkeratosis and incomplete keratinization on the surface. Vacuolated cells can be seen in the spiny cells and granular layer. The cell cytosol is large, with a round deep-stained nucleus, perinuclear vacuolation, light staining, and filaments connected between the nuclear membrane and plasma membrane, making the cells catarrhal. The vacuolated cells are characteristic of acanthosis and are more pronounced in the middle and upper layers of the acanthocytes. The superficial dermis is surrounded by moderately dense infiltration of blood vessels, predominantly lymphocytes, and plasma cell infiltration is also seen. The dermal papillae are vasodilated and the papillae are widened and extended.
2, vinegar white test to 3% to 5% acetic acid solution soaked gauze wrapped or applied to the suspected skin or mucous membrane surface, 3 to 5 minutes after removal, the typical condyloma damage will show white papules or warts superfluous material, while subclinical infection is manifested as white patches or spots. The vinegar white test is a simple and easy way to identify early condyloma damage and subclinical infections. It is a very useful tool for detecting subclinical infections that have not yet developed visible changes. The vinegar white test is simple and easy to perform and should be used as a routine test for patients with condyloma acuminatum to help determine the extent of the lesion and guide treatment.
Colposcopy is a special magnifying glass that is mainly used for the observation of the mucous membrane of the cervico-vaginal area and can be used for the examination of the vulva and vaginal epithelium. Colposcopy magnifies the cervical manifestations 20 to 40 times and is very helpful in the early detection of subclinical infections of the cervical epithelium, precancerous lesions, and early diagnosis. Patients should avoid vaginal douching and sexual intercourse for 24 hours prior to the examination. Colposcopy with gauze soaked in 3% to 5% acetic acid solution on the cervix for 3 minutes will help to detect subclinical infection of HPV. For well-defined white patches or spots, further material should be taken for histopathological examination. Cervical intraepithelial neoplasia (CIN) can be classified as grade 3.
4. Cytological examination is mainly used to check whether a woman has HPV infection in the vagina or cervical epithelium. Cells are scraped from the examined area and coated on a slide, fixed with 95% alcohol; Pap staining is commonly used and the microscopic findings are divided into five grades; grade I is normal; grade II is inflammation; grade III is suspicious cancer; grade IV is highly suspicious cancer; and grade V is cancer. Grade Ⅱ is divided into Ⅱa and Ⅱb. Ⅱa is inflammatory cells; Ⅱb smear contains a few mild nuclear heterogeneous cells in addition to inflammatory cells. Cases with smears showing IIb should be followed up and examined regularly. To determine whether there is HPV infection, specific anti-HPV antibodies, histochemical staining or in situ hybridization techniques should be used.
5. Polymerase chain reaction (PCR) is used to take a sample of the lesion or suspicious area, extract DNA, and amplify the target DNA using specific primers. The primers can be HPV universal primers or specific primers for a particular type. The method is highly sensitive and specific, but it should be performed in a laboratory accredited or certified by the relevant institution.
III. Classification
HPV includes HPV types 6, 11, 42, 43, 44, etc., which often cause benign lesions such as external genital warts including cervical intraepithelial low grade lesions (CINI), and high risk HPV types including HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, etc., which are associated with cervical cancer and cervical intraepithelial high grade lesions ( CINII/III) are associated with the development of HPV, especially HPV types 16 and 18. Those that do not fall into this range are considered normal.
IV. Clinical significance
1. Abnormal results: After women are infected with HPV, about 30%-50% of them develop mild lesions of cervical epithelial cells, but most of them will turn normal within 3-4 months time after the clearance of the virus, so if HPV and cytology are checked at the same time during this period, there will be negative HPV but abnormal cytology.
2, people who need to be checked: during vaginal examination, superficial erosion is visible, with contact bleeding, etc.; in the middle stage, there is often increased leucorrhea, fishy odor, irregular vaginal bleeding, persistent pain in the sacral tail, buttocks and thighs, and urination and defecation disorders may appear when the bladder and rectum are invaded.
Five, hpv virus is how the infection
1.Sexual transmission route;
2, close contact;
3, indirect contact: through contact with the infected person’s clothing, household items, utensils, etc.;
4, medical source of infection: medical personnel in the treatment and care of poor protection, resulting in their own infection or through medical personnel to patients;
5.Mother-to-child transmission: close contact by infants through the birth canal of pregnant women.