Many women are used to getting screened once a year. However, newer research has found that it is not necessary to screen this often, especially if newer tests are being used. So, now you and your health care provider may have a few options available on screening methods.

A biopsy is similar to a Pap test, but a larger cluster of cells is removed from the cervix to see if there are abnormal cell changes. It is a good way to confirm the earlier Pap smear result and to rule out cancer. If a biopsy is done, it will be performed at the same time as the colposcopy.

An HPV test is different than a Pap test or biopsy. This test checks directly for the genetic material (DNA) of HPV within cells, and can detect the types connected with cervical cancer. The test is done in a laboratory, usually with the same cell sample taken during the Pap test. The only commercially available test for HPV is called Hybrid Capture II™, produced by Digene. It is most convenient if the HPV test is done in the laboratory from a cervical cell sample that was taken using a liquid-based Pap test.

When is a HPV test used?

Currently, the HPV test called Hybrid Capture II™, is approved by the U.S. Food and Drug Administration (FDA) for use in two different situations:

(1) As a follow-up test if the Pap result is borderline between "normal" and "abnormal." This is usually called "atypical squamous cells" or "ASC-US." The HPV test is then used in the lab to determine if women with the borderline result are more likely to have precancerous changes on their cervix, (HPV positive), and which are more likely to just have normal cells (HPV negative). Basically, the test helps to rule out whether HPV is causing the borderline abnormal cells.

(2) As a cervical cancer screening test in combination with a Pap test in women at or over age 30 (rather than just having the Pap test alone). Research shows that the combination test can increase the effectiveness of detecting any problems early on. A preliminary recommendation by the American Cancer Society state that if the combination Pap - HPV DNA test (Digene’s DNA with Pap™ test) result is normal/negative, then the next screening would not have to be for three years. However, if one of the tests in the DNA with Pap comes back abnormal/positive, then follow-up will be needed.

When is a HPV test NOT used?

• If the Pap result shows dysplasia or precancerous changes. This is because it is automatically assumed that the HPV is the cause.
• In women under age 30, unless they have had an ASC-US Pap test result.
• The HPV test cannot be used on males. It is only FDA approved to be used on the female's cervix.

Can a male find out if he has the cell changing-types of HPV?

Research has shown that the HPV test usually shows false negative results in men. This is because it is difficult to get a good cell sample to test from the thick skin on the penis.

Most people will not have visible symptoms if they are exposed to HPV. Therefore, for most, the virus is subclinical (invisible). This is especially true for males. If a male is exposed to the cell-changing types of HPV, he would be unlikely to have symptoms. If there are no symptoms for males, it is hard to test for it.

Most of the time, men will not have any health risks such as cancer with the "high-risk" types of HPV. It is the female's cervix that needs to be monitored.

How can a person get the types of HPV that cause cell changes?

• Any person who is sexually active can be exposed and get the cell-changing types of HPV.
• Most people are exposed to the cell-changing types of HPV at some point, but not everyone (especially males) will actually have abnormal cell changes (dysplasia).
• The types of HPV that cause abnormal cell changes are usually spread by direct skin-to-skin contact during vaginal, anal, or possibly through oral sex, with someone who has this infection.
• The cell-changing types of HPV are most likely to be given to a partner when dysplasia is actually present.
• Very little is known about passing subclinical (invisible) HPV to sex partners. Some experts think it may be less contagious than when the cell changes are present.
• The types of HPV that cause abnormal cell changes do not typically cause symptoms on other body parts such as the hands.
• Recent research studies have shown a relationship between a cell-changing type of HPV and some rare head and neck cancers, but there is not much evidence that oral sex definitely transmits these types of HPV.

How can someone reduce the risk of getting HPV?

Any one who is sexually active can come across this common virus. Ways to reduce the risk are:

• Not having sex with anyone.
• Having sex only with one partner who has sex only with you. People who have many sex partners are at higher risk of getting other STDs.
• If someone currently has abnormal cell changes, he or she should not have sexual activity until after the cells have been treated or have self resolved. This may help to lower the risk of transmission.
• Condoms (rubbers), used the right way from start to finish each time of having sex may help provide minimal protection - but only for the skin that is covered by the condom. Condoms do not cover all genital skin, so they don't give 100% protection.
• Spermicidal foams, creams and jellies are not proven to act against HPV, but they work against some other STDs. These are best used along with condoms, not in place of condoms.
• If someone was exposed to the types of HPV that can cause abnormal cell changes, it would be unlikely that he or she will become re-infected with those same types since immunity will be set-up at some point.
• Realize that most people are exposed to one or more HPV types in their lifetime, and most will never even know it because they will not have visible symptoms.
• It is important for partners to understand the "entire picture" about HPV so that both people can make informed decisions based on facts, not fear or misconceptions.

How are abnormal cells treated?

• Currently, there is no treatment to cure HPV; there is no cure for any virus at this point. However, there are several treatment options available for treating the abnormal cells.
• Sometimes treatment may not even be necessary for mild cervical dysplasia . These cells can heal on their own and the health care provider will just want to monitor the cervix. HPV may then be in a latent (sleeping) state, but it is unknown if it totally gone or just not detectable.
• The goal of any treatment will be to get remove the abnormal cells. This may also end up removing most of the cells with the HPV in them.
• If the abnormal cells are treated, or if they have healed on their own, it may possibly help reduce the risk of transmission to a partner who may have never been exposed to the cell-changing types of HPV.
• When choosing what treatment to use, the health care provider will consider many things:
  · location of the abnormal cells
  · size of the lesions on the cervix
  · degree or severity of the Pap smear results
  · degree or severity of the colposcopy and biopsy results
  · HPV test results (if this test was needed)
  · age and pregnancy status
  · previous treatment history
  · patient and health care provider preferences

What about pregnancy, HPV, and cervical dysplasia?

• For some pregnant women, cervical dysplasia may increase. This may be due to hormone changes during pregnancy, but this is not proven.
• If a woman has an abnormal Pap smear during pregnancy, even if it's severely abnormal, many health care providers will not do treatment. They will just monitor the cervix closely with a colposcope during the pregnancy.
• Sometime (a few weeks) after delivery of the baby, the provider will look at the cervix again and do another Pap smear or another biopsy. Many times after pregnancy, the cell changes will have spontaneously resolved - and no treatment will be necessary.
• The reason that many health care providers do not want to do treatment during pregnancy is because it may accidentally cause early labor.
• The types of HPV that can cause cell changes on the cervix and genital skin have not been found to cause problems for babies.

What about HPV and other cancers?

• Anal cancer is a rare occurrence that has been strongly linked to "high-risk" types of HPV.
• Abnormal cell changes in the anal area (anal dysplasia or anal neoplasia) are more common among individuals who engage in receiving anal sex.
• However, anal dysplasia has also been reported in some females who have a history of severe cervical dysplasia
• Treatment is available for anal dysplasia and anal cancer

Penile Intraepithelial Neoplasia (PIN) and penile cancer:

• Cancer of the penis is extremely rare in the United States, and HPV is not always the cause
• There are some cases of cell changes (neoplasia) on the penis, which are caused by "high-risk" types of HPV.
• Most males do not ever experience symptoms or health risks if they get one or more "high-risk" types of HPV.
• Penile neoplasia can be treated.
• There is not a cancer screening for the penis because cancer of the penis is extremely rare, and because it is difficult to get a good cell sample from the penis.

Vaginal Intraepithelial Neoplasia (VAIN) and vaginal cancer:

• HPV has been linked with some, but not all, cases of cell changes in the vagina and with vaginal cancers.
• Various treatment options are available for vaginal neoplasia, depending on how mild or severe the cell changes are in this area.

Vulvar Intraepithelial Neoplasia (VIN) and vulvar cancer:

• HPV has been linked with some, but not all, cases of cell changes on the vulva (outside female genital area) and with vulvar cancers.
• Various treatment options are available for vulvar neoplasia, depending on how mild or severe the cell changes are in this area.

Is it normal to feel upset about HPV?

Yes, it is normal. Some people feel very upset. They feel ashamed, fearful, confused, less attractive or less interested in sex. They feel angry at their sex partner(s), even though it is usually not possible to know exactly when or from whom the virus was spread.

Some people are afraid that they will get cancer, or that they will never be able to find a sexual partner again. It is normal to have all, some or none of these feelings. It may take some time, but it is important to know that it is still possible to have a normal, healthy life, even with HPV.

More Information on HPV and other STD's

For additional questions about this or any other STD's and other diseases, CDC (Centers for Disease Control) provides several toll-free hotlines for public use. The hotlines provide referrals and more answers to your questions. Be sure to request free printed information when you call the hotlines.

• CDC National STD and AIDS Hotlines:
  1-800-342-2437 or 1-800-227-8922. The hotlines are open 24 hours a day, seven days a week. For Spanish call 1-800-344-7432, 8:00 a.m. to 2:00 a.m. Eastern Time, seven days a week. For the Deaf and Hard-of-Hearing call 1-800-243-7889, 10:00 a.m. to 10:00 p.m. Eastern Time, Monday through Friday.
• CDC National Immunization Information Hotline:
  English 1-800-232-2522 Spanish 1-800-232-0233 8 a.m. to 11 p.m. Eastern Time. For the Deaf and Hard-of-Hearing call 1-800-243-7889. Monday through Friday 10 a.m. to 10 p.m. Eastern Time.
• CDC Public Response Hotline (CPR):
  English 1-888-246-2675 span 1-888-246-2857 Monday through Friday 8 a.m. to 11 p.m. Eastern Time 10 a.m. to 8 p.m. Saturday and Sunday. For the Deaf and Hard-of-Hearing 1-866-874-2646 10 a.m. to 1 p.m. Eastern Time Monday through Friday.