HPV – prevention is better than cure

What is HPV?

Human papillomavirus (HPV) is a sexually transmitted infection (STI) that consists of more than 150 related viruses. It is most generally spread during oral, vaginal, or anal sex or through intimate skin to skin contact. Therefore, to lower your chance of getting HPV, using a condom is mandatory when having any type of sex.

Those with HPV can experience physical changes, including the development of cervical, vulvar, anal, or testicular cancer. In some cases, genital warts may appear. Normally, HPV can go away on its own within 12 months after an infection. However, in some cases the infected person might show no symptoms until possibly 10-15 years later.

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How can HPV cause cervical cancer?

In Thailand, cervical cancer is the second most commonly found cancer in Thai females after breast cancer. In regard to HPV, there are 15 types of high-risk HPV for cervical cancer with HPV16 and HPV18 being the most dangerous. These two types alone are responsible for 70% of cervical cancer cases in the country.


How can I be tested for cervical cancer?

A Pap smear is used to find cell changes or abnormal cells in the cervix, which can indicate cervical cancer. Once a sample is collected, it is reviewed in a laboratory.

There are two types of Pap smears:

  1. Conventional Pap Smear

A physician will collect a cell specimen in the cervix with a wooden or plastic scraper. This specimen is then placed on a glass slide before having a fixative added. It is then examined under a microscope for any signs of abnormalities.

However, there are a number of issues with this type of test. Through a conventional Pap smear, only 20% of the specimen is placed on a glass slide. Along with this, there might be mucus included in the specimen. Thus, the chances of identifying abnormal cervical cells is diminished. Moreover, with delayed preservation of the sample, the cells can experience physical changes from air-drying, crowding, and obscuring. These issues, along with possible overlapping of the cells, can make it difficult to obtain accurate test results.

  1. ThinPrep Pap Test

The ThinPrep Pap Test is the only test method that is certified by the United States Food and Drug Administration (USFDA). As a result, the test can be used to replace the conventional option since it is more effective. To do the ThinPrep Pap Test, the specimen is collected in the cervix using a special device. Then, the specimen is kept in a preservative solution vial and sent to the laboratory. Upon receiving, the specimen is placed on a microscope slide in a way to ensure a uniform, monolayer of cells without any overlap. Due to this process, it is easier to identify abnormal cells and detect the possible presence of cervical cancer.

Overall, studies have found that the ThinPrep Pap Test is more effective for cancer detection than the conventional Pap smear in several ways:

  • It allows for shorter screening times for cervical cancer detection. Therefore, the cancer can be detected before it spreads.
  • It provides better specimen quality and sampling accuracy.

Can HPV be detected through the ThinPrep Pap Test?

HPV cannot be directly detected by taking a ThinPrep Pap Test. However, the cells prepared for the ThinPrep Pap Test can be used for a HPV test without requiring a new cell sample.

Is it necessary for women who have received the HPV vaccine to take the ThinPrep Pap Test?

Yes. It is still necessary for women who have received the HPV vaccine to take the ThinPrep Pap Test since the vaccination does not prevent all types of HPV that can cause cervical cancer.

Who should have the HPV test?

  • Women between ages 21 and 29 should have a pap test every 2-3 years to test for cervical cancer and pre-cancerous lesion. HPV testing may be used in this group after an abnormal pap test result.
  • Women over 30 have a high risk of cervical cancer. Thus, it is recommended for them to do both the HPV and the ThinPrep Pap Test, which is called Co-testing every 3-5 years. This program increases the efficiency of the screening for initial stages of cervical cancer, and is guaranteed as a result.
  • Sexually active LGBT people have a high risk of getting HPV during oral, vaginal, or anal sex.

Who should get a vaginal examination and cervical cancer screening?

Through early detection, it is possible to prevent the development of cervical cancer. Thus, it is important to have a regular medical checkup, including a vaginal examination and an effective cervical cancer screening. Those who should get such a checkup include:

  • Sexually active women
  • Menopausal women
  • Women who have never had sexual intercourse. After turning 30 years old, a regular vaginal examination and cervical cancer screening should be done.
  • Women who have not undergone the screening for some time.
  • Women who have abnormal leukorrhea, a thick whitish or yellowish discharge from the vagina or irregular bleeding from their vagina.

What are the symptoms of HPV?

Normally, most people who have HPV do not show any signs of infection. However, some may have the following symptoms:

  • Excessive amount of leukorrhea
  • Foul vaginal discharge
  • Due to inflammation or infection within the vagina or cervix, bleeding during sexual intercourse may happen
  • Secretions or blood may be discharged from the vagina

What are risk factors for cervical cancer?

  1. HPV infection: HPV type 16 and HPV type 18 carry a high risk of causing cervical cancer, and exposure to either can happen during sexual activity.
  2. Smoking: Smoking weakens the ability of the immune system to fight off things such as cancer.
  3. Human immunodeficiency virus (HIV): Similar to smoking, HIV weakens the immune system’s ability to prevent the development or spread of cancer and other harmful things. Therefore, a person with HIV is more likely to get HPV, which can increase their risk of developing cervical cancer. As HIV can be contracted through sexual activity, it is recommended that a person avoids having multiple sexual partners.
  4. Chlamydia: Chlamydia is a sexually transmitted disease (STD) that can be contracted through oral, vaginal, or anal sex. A current or previous infection of Chlamydia can increase the risk of developing cervical cancer.
  5. Long-term use of birth control pills: Those who have taken birth control pills for more than 4-5 years have an increased risk of developing cervical cancer.
  6. Frequent pregnancies: Those who have been pregnant more than 3 times have an increased risk of developing cervical cancer.
  7. Teenage pregnancy: Those who are younger than 17 years old and pregnant have a higher risk of developing cervical cancer compared to those who are older than 25 years old.

Can cervical cancer be treated?

If the abnormal cervical cells are initially detected before they develop into cancer, there is a higher chance of recovery. When detection occurs, medical experts can choose an appropriate treatment option such as cryosurgery or loop electrosurgical excision. Thus, it is important to be tested regularly.

HPV vaccine for cervical cancer prevention

Currently, there are two kinds of highly effective vaccines that protect against HPV infection:

  1. The vaccine that prevents four types* of HPV, which are HPV6, 11, 16, and 18.
  2. The vaccine that prevents two types of HPV, which are HPV16 and 18.

It is suggested that people who are at high risk of contracting cervical cancer should receive both types of vaccinations since they effectively prevent the types of HPV that lead to cervical cancer.

It is best for a person to receive the HPV vaccination before having HPV or before they first have sexual intercourse. Anyone older than 9 can be vaccinated, and the World Health Organization (WHO) indicates that children between 9 – 14 are in the most appropriate stage to be vaccinated. After receiving all three doses, the vaccine takes effect one month later.

* The vaccine that protects 4 types of HPV is able to prevent both cervical cancer and genital warts since HPV 6 and 11 are 90% likely to cause genital warts.

  • Schedule for HPV vaccination
Female Age Number of Doses Remarks
9 –14 2 –      Get the first vaccine as appointed by the doctor.
15 3 –      Get the first vaccine as appointed by the doctor.

–      Get the second within one to two months after the first.

–      Get the third six months after the first.

Side effects of HPV vaccine

Those who receive the HPV vaccine may develop pain, redness, and swelling in the arm where the shot is given. They can also have headaches, a fever, fatigue, nausea, or muscle and joint pain. These symptoms are common after a vaccination, and they usually go away within 3 days.

Cautions:

  1. For the safety of both the mother and the baby, pregnant women should not get the HPV vaccination. However, if pregnant women receive either the first or the second dose of the vaccine before their pregnancy, they can continue the next dose after the baby’s birth.
  2. Those who have an allergic reaction to substances within the vaccine, including yeast or adjuvants, after the first dose are recommended not to take the next one.

Precautions with the HPV vaccine

  1. Whether or not you’ve previously had sexual intercourse, the HPV vaccine can effectively prevent future HPV infections. However, for those who have had HPV in the past, the vaccine will be less effective.
  2. Individuals who get vaccinated for HPV can normally have sex after that. However, they should avoid having more than one sexual partner, and always use a condom for birth control.
  3. Individuals who get vaccinated should complete the three doses as required in the designated period of time.
  4. Those who receive the vaccine are still advised to undergo cervical cancer screenings from time to time.

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