Case 1 Wang, a 33-year-old female, was married and not pregnant. She was seen on 2015-9-11. She was found to be positive for HPV type 16 and negative for TCT in January 2014. In January 2015, she was rechecked for HPV 16 and TCT showed atypical cells of undetermined significance (ASCUS). Colposcopic biopsy showed CIN I. The doctor recommended cervical physiotherapy. I was reluctant to do the treatment because I was not yet pregnant, so I continued to observe the treatment, intermittently using interferon vaginally and exercising to improve my immune system. Because I was planning to get pregnant, I had a repeat examination in September this year: TCT still showed ASCUS, HPV type 16 was still positive, four point biopsies were done again under colposcopy, 6 and 12 points showed CIN 2, and the local doctor recommended cervical LEEP surgery. The purpose of my visit is to ask if I can get pregnant without surgery and have a baby before surgery. Is there any other way to remove HPV quickly? Case 2 Ms. Li, 53 years old, had a negative TCT test for HPV 16 infection at the end of 2013 due to irregular menstruation (menopausal transition). She was given interferon vaginally for 3 months as prescribed by her local doctor for observation, and was retested after one year. Since then, the irregular menstruation disappeared (one and a half years after menopause), so I didn’t review it regularly. In August 2015, at the urging of my daughter, I had a repeat TCT with low grade lesions, HPV 16 was still positive, and a colposcopic biopsy showed CIN 2/3 at 3, 6, and 9, and CIN 1 at 12. The purpose of the visit was to find out what to do next. Comment: HPV type 16 is one of the high-risk viruses, and like HPV type 18, it is the most carcinogenic of the dozen high-risk types. Therefore, the internationally accepted ASCCP guidelines for cervical colposcopy recommend colposcopy and, if necessary, multi-point cervical biopsy for HPV types 6 and 18 infections, despite negative TCT, in order to exclude high-grade cervical lesions. For other high-risk types of infection, the patient can be observed for one year and then rechecked for TCT and HPV. The clearance of HPV infection depends mainly on the infected person’s own immunity, and after about 8-14 months, HPV can disappear on its own in 80% of people. In the other 20% of patients, HPV may persist. Those who have been infected for more than one year are called “persistent HPV infections”. People with persistent infection have an increased chance of developing cervical precancerous lesions. Cervical precancerous lesions can be artificially divided into 3 stages, CIN1, CIN2, and CIN3, and at the stage of CIN3, if the lesion continues to progress, it may become true cervical cancer. Cervical precancerous lesions take an average of about 3-5 years to progress through each stage. However, studies have shown that cervical HPV type 16 is highly carcinogenic, has less chance of natural regression, and once it leads to the development of precancerous lesions, its progression is more rapid. In both cases, the patients chose to observe the HPV infection after it was discovered, and the effect of interferon was very small. Both patients progressed from simple HPV type 16 infection to high grade lesions (CIN 2 and CIN 3 are high grade lesions) over a period of almost 2 years. When high cervical precancerous lesions occur, they have very little chance of resolving spontaneously (except in those younger than 24 years of age) and should be treated with appropriate excisional therapy (Excision) to remove the precancerous tissue and possibly eliminate the HPV virus by excision of the lesion, i.e., “cure the disease”. In the first case, the patient delayed treatment because she wanted to have children and did not want to treat the disease even though it had progressed to CIN 2, which was a lack of awareness of the disease and irresponsible for her life. In early 2015, when she was found to have CIN 1, she should have been treated with cervical surface physiotherapy (Ablation), i.e., cervical laser or electrocautery, which can effectively remove the lesion and virus with a cure rate of about 85% and does not affect her fertility. She can go to the hospital for this procedure 3-7 days after her menstruation, without having intercourse. This is a minor treatment that does not require hospitalization and does not affect fertility. Now that CIN 2 has developed, she should undergo a hysterectomy, i.e., cervical LEEP or a small cone to remove part of the cervix, which can achieve an 80-90% cure and does not affect pregnancy. She can go to the hospital for this procedure 3-7 days after her menstrual period, without having intercourse. Cervical LEEP is also a minor outpatient procedure and she can try to conceive if she has a negative TCT and HPV test 3 months afterwards! Conversely if she still does not take aggressive treatment to remove the CIN2 lesion, in a year or two, she may develop CIN3, or even develop cancer, at which point, major surgery will be required and it will be difficult to preserve reproductive function. If she were to become pregnant with a CIN2 lesion, the lesion could progress during the 10 months of pregnancy, posing an unavoidable risk to life. In the second case, after HPV6 infection is detected, TCT and HPV should be reviewed regularly and a multi-point colposcopic biopsy should be done if necessary. It should never be neglected. Fortunately, her daughter was concerned enough to force her to go for a review and the highly lesion was detected in time without delaying the appearance of cancer. She just needs to be hospitalized for a conization and the lesion is usually cured. The cut specimen should be carefully taken at multiple points to see if the possibility of cancer was overlooked and if the cut margin was clean. If the pathology shows no cancer and the margins are clean, her disease can be cured by conization. If the pathology shows cancer, or if there is a high degree of lesion at the margin suggesting residual, she needs further surgery. In conclusion, for HPV 16 infection, due to the strong cancer-causing ability of the virus and the fact that the virus does not easily go away naturally, we should not take it lightly and should not treat it like other types of virus, but should observe or treat it more actively.