HPV (human papillomavirus) is a group of viruses that specialize in infecting human skin and mucous membranes. According to the relationship between HPV and the development of cancer, HPV can be classified into high-risk types (HPV16/18, etc.) and low-risk types (HPV6/11, etc.). The development of cervical cancer and its precancerous lesions (high-grade cervical intraepithelial neoplasia and adenocarcinoma in situ) is inextricably linked to the persistent infection of high-risk types of HPV, and the development of almost all cervical cancers is associated with the persistent infection of high-risk types of HPV. Studies have shown that if a woman is infected with high-risk HPV, her relative risk of developing cervical cancer is 250 times higher than if she is not infected. Thus, high-risk HPV infection is the most important risk factor for cervical cancer, and cervical cancer is the only cancer with a clear cause to date. Cervical cancer almost never occurs in women who do not have high-risk HPV infection. However, does infection with high-risk HPV necessarily lead to cervical cancer? HPV Positive: Not the Same as Cervical Cancer Most women panic when they learn that they are infected with HPV, thinking that HPV infection (HPV positive) is a pre-cancerous lesion of cervical cancer, which is sure to develop into cervical cancer in the future, and they want to be treated as soon as possible. Although HPV infection is indispensable for the development of cervical cancer and its precancerous lesions, the vast majority of high-risk HPV infections do not cause clinical lesions, and the infection can be cleared spontaneously by the body’s immune function within 2 years. Studies have shown that 50% to 80% of women will develop HPV infection at some point in their lives, and only a very small percentage of women will develop persistent infection, which will progress from low-grade lesions (Cervical Intraepithelial Neoplasia Grade I, CIN1) to high-grade lesions (Cervical Intraepithelial Neoplasia Grade II/III, and Adenocarcinoma in situ) and then to cervical cancer. During this process, 70% to 90% of low-grade lesions will spontaneously regress, while the probability of cervical intraepithelial neoplasia grade II and III lesions progressing to invasive carcinoma is 57% and 70%, respectively. Therefore, high-risk HPV positivity is not equal to cervical cancer, and there is no need to panic or be anxious, but it should be given enough attention. Abnormal cytology: active diagnosis and treatment Currently, cytology is still the most important method of cervical cancer screening, and HPV testing is an effective complement to cytology. HPV testing is not recommended for women younger than 30 years of age because of the high rate of HPV infection in young women and the fact that most of the infections are transient. In women in whom cytology is not definitive for the presence or absence of cervical lesions, cervical high-risk HPV testing may be performed to further clarify the need for colposcopy and to determine the frequency of cervical cytology screening. If the cytology is not clear and the high-risk HPV test is positive, the HPV test and cervical cytology should be repeated within 12 months, and colposcopy should be performed if there is still an abnormality. Currently, the most widely used HPV test in clinical practice is called HPV test for HC2CIN2-3, which targets 13 high-risk HPV types and has high sensitivity although it cannot distinguish between specific HPV subtypes. To date, there is no effective treatment for HPV infection, therefore, it is currently believed that only high-grade lesions, i.e. cervical intraepithelial neoplasia grade II/III, are considered to be true pre-cancerous cervical cancer lesions and need to be aggressively treated with surgery, laser, etc. While low-grade lesions, e.g. cervical intraepithelial neoplasia grade I, most of them will spontaneously regress, and close observation is generally recommended with no special treatment. The latest cervical screening guidelines in western countries recommend that cytologic screening should start at age 21 or 3 years after the beginning of sexual life; women between 21 and 65 years old with normal cytology should receive cervical cytology every 3 years; women between 30 and 65 years old with normal cervical cytology and HPV testing can extend the screening period to 5 years. Women with pre-existing cervical lesions may opt for closer monitoring as recommended by their doctor. Prevention of infection: HPV vaccination Although the vast majority of HPV infections are spontaneously cleared by the body and immunity to the same type of HPV virus is acquired, the duration of immunity in an individual is not known, and therefore women are always exposed to the possibility of being re-infected or infected with other types of high-risk HPV throughout their lives. Therefore, even after follow-up HPV conversion, regular cervical screening is still needed to prevent cervical cancer. Currently, the mainstay of prevention of HPV infection is HPV vaccination, a prophylactic vaccine against HPV 16/18 that has been shown to be effective in preventing HPV 16/18 infection and the resulting precancerous lesions and cervical cancer. The two commercially available vaccines have been approved for use in more than 100 countries and regions, but are still in the clinical trial stage in China. At present, the HPV preventive vaccine mainly vaccinates children aged 11 to 12 and some women who have never had sex, while it has no preventive protective effect on those who have been infected with HPV. Moreover, the current vaccine has no significant preventive effect on high-risk HPV infections other than HPV types 16/18. It should be pointed out that since the virus particles of HPV are so small that they can even pass through the tiny gaps in condoms, the current condoms, although they can prevent most of the sexually transmitted diseases, such as gonorrhea, syphilis, and AIDS, have a poor preventive effect on HPV, and they can not yet be used as the main method of preventing HPV infection. In conclusion, only persistent HPV infection will develop into precancerous cervical cancer, and it usually takes about 10 years to develop from precancerous cervical cancer to cervical cancer. Therefore, HPV-positive people should not be too anxious, as cervical lesions can be detected at an early stage with regular checkups. However, it should be reminded that once a person who tests positive for high-risk HPV infection has an abnormal cervical cytology, he/she should be actively treated and shorten the interval of cervical screening, so as to stay away from the threat of cervical cancer and to maintain his/her health. Cherish life and stay away from unclean sex! Studies have shown that early sexual intercourse, multiple sexual partners, history of sexually transmitted diseases, smoking, oral contraceptive pills, immunosuppressive disorders such as organ transplantation, and HIV infection are all associated with HPV infection and the development of cervical cancer and precancerous lesions. Male sexual partners play an important role in the transmission of HPV infection, and evidence suggests that the incidence of cervical cancer is significantly higher in men with partners who have squamous penile cancer. Therefore, we should clean ourselves and stay away from unclean sex, as well as actively treat chronic inflammation and maintain the immune status of the body.