HPV and Cervical Cancer
Human papillomavirus, or HPV, refers to a viral infection that affects the skin and mucous membranes of both men and women. There are over 100 different strains of HPV, of which 40 are known to infect the anogenital tract [1, 3]. HPV is the most common sexually transmitted disease and it is estimated that approximately 60% of all sexually active women and men in South Africa contract the virus at some point in their lives [2, 4].
The risk factors for HPV acquisition include unsafe sexual behaviors, early sexual debut, multiple sex partners, early pregnancy, hormonal contraception use as well as co-infection with HIV or other sexually transmitted infections [3, 8].
It is important to emphasize that HPV can also occur in those in a monogamous (one-partner) relationship so the risk isn’t limited to those having multiple partners.
The majority of HPV infections are asymptomatic (no symptoms) and can be cleared by the immune system. However, persistence of particular strains of the virus is associated with the development of benign genital warts as well as certain cancers. The most common cancer associated with HPV infection is cervical cancer [1, 5, 6, 13]. Worldwide, it is estimated that 99% of cervical cancers are caused by HPV. Furthermore, in South Africa, cervical cancer ranks as the leading cause of female cancer deaths in women aged 15-44 years [3, 8].
Of important note, cervical cancer due to HPV is a preventable disease. Regular screening leading to early detection and treatment is at the forefront of managing the heavy burden of cervical cancer that is placed on the developing world [3, 12, 13].
MDS offers such screening tests.
HPV strains and risk of cervical cancer
There are approximately 40 strains of HPV that infect the genital mucosa. These genital HPV strains are classified into low or high risk by their susceptibility to cause cervical cancer [1, 3]. There are 14 high risk strains of HPV that are associated with cervical cancer. Of the high risk types, the most notable strains are HPV16 and HPV18. Together, HPV16 and HPV 18 account for 70% of all cervical cancers [1, 3, 5, 8].
The HPV DNA test performed at MDS specifically differentiates the presence of HPV 16 and 18. Furthermore, the test detects the presence of the additional 12 high risk strains which include HPV 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68.
HPV screening guidelines
The South African guidelines for HPV screening recommend that all women should initiate HPV screening from the earliest age of 25 years old or at the time of a positive diagnosis of HIV. In the case of a negative result, HPV screening should occur at 5 yearly intervals or 3 yearly intervals for HIV positive cases if undergoing an HPV DNA test .
The gold standard for cervical cancer identification has been the Pap test. However, as the role that HPV plays in contributing to cervical cancer has been better understood, screening for the presence of the HPV virus has started to rival that of the Pap test. Recent studies have shown that screening for HPV is more accurate in determining cervical cancer risk than that of the Pap test. Additionally, women with a negative HPV test had half the risk of developing cancer over three years as women who had a negative Pap test .
This principal can be further explained by understanding the difference between the HPV test and the Pap test and what the end result aims to identify. For both the HPV test and the Pap test, a health care provider will scrape cells from the surface of the cervix. During the Pap test, the cells collected are analyzed under a microscope for abnormalities . Changes to the morphology of the cells are known as cervical intraepithelial neoplasia (CIN) and can be classified as CIN 1 (low grade lesion) to CIN 3 (high grade lesion) which indicates the stages of infection and persistence that lead to the development cervical cancer [5, 12].
On the other, the HPV test detects the presence of HPV DNA in cells. This allows for earlier detection at a much higher sensitivity before any changes to cervical cells can be visualized morphologically. As a result, health care practitioners are enabled to provide earlier treatment options and less invasive management protocols to their patients, ultimately preventing the progression of the infection to a cancerous state .
An HPV DNA negative result indicates that you do not have an HPV strain that is linked to the development of cervical cancer. As a result, the overall risk for cervical cancer is low and no additional testing is required for 5 years (unless factors such as changes in sexual partners occur within this time frame or one is infected with HIV etc) .
An HPV DNA positive result indicates that you do have an HPV strain that is linked to the development of cervical cancer. Further testing is required to determine the level of advancement of the infection. Result management guidelines will differ according to the resources available to the health practitioner. However, the South African HPV advisory board recommends the following procedures :
- Women who test positive for HPV 16 and 18 should undergo a colposcopy and/or biopsy. A colposcopy is an examination procedure that magnifies the cervix so physicians can take a better look at abnormal cells and take biopsies if needed.
- Women who test positive for other high risk strains of HPV should have a Pap test as a follow-up to determine the morphological state of their cells and identify any precancerous lesions.
Ordering an HPV test
Clients can email/phone MDS (firstname.lastname@example.org or 031 2677000) to arrange an appointment with the nurse at MDS so that their sample can be taken and tested.
Clients can also email / phone us to request a request form and take this to their GP/Gynaecologist to request that an LBC (liquid based cytology) sample be taken and be delivered/couriered to MDS.
MDS uses the latest technology to test the sample and provides a result to the Client / Doctor within 24 hrs. The result will inform the client of her HPV Status. All HPV High Risk Positive results will include a recommendation by MDS that the client consult a Doctor for further testing and / or treatment.
MDS offers various women’s health panels e.g. for Candida that can also be requested. Please refer to the Women’s Health request form for further details.
Should you have any further questions or wish to request an HPV test, please do not hesitate to contact us.
- Roden R and Wu TC. How will HPV vaccines affect cervical cancer? Nat Rev Cancer 2006; 6(10):753-763.
- Mbulawa ZZA; Van Schalkwyk C; Hu NC; Meiring TL; Barnabas S; Dabee S; Jaspan H; Kriek JM; Jaumdally SZ; Muller E; Bekker LG; Lewis DA; Dietrich J; Gray G; Passmore JAS; Williamson AL. High human papillomavirus (HPV) prevalence in South African adolescents and young women encourages expanded HPV vaccination campaigns. PloS ONE 2018; 13(1): 1-15.
- Ebrahim S; Mndende XK; Kharsany ABM; Mbulawa ZZA; Naranbhai V; Frohlich J; Werner L; Samsunder N; Karim QA; Williamson AL. High Burden of Human Papillomavirus (HPV) Infection among Young Women in KwaZulu-Natal,South Africa. PLoS ONE 2016; 11(1): 1-10.
- Mbulawa ZZA; Coetzee D; Williamson AL. Human papillomavirus prevalence in South African women and men according to age and human immunodeficiency virus status. Infectious disease 2015; 15(459): 1-11.
- Schiffman M; Castle PE; Jeronimo J; Rodriguez AC; Wacholder S. Human papillomavirus and cervical cancer. Lancet 2007; 370:890-907.
- Bruni L, Albero G, Serrano B, Mena M, Gómez D, Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in South Africa. Summary Report 17 June 2019.
- Botha MH and Dreyer G. Guidelines for cervical cancer screening in South Africa. South Afr J Gynaecol Oncol 2017; 9(1):8-12.
- Munoz N; Castellsague X; Berrington de Gonzalez A; Gissmann L. Chapter 1: HPV in the etiology of human cancer. Vaccine 24S3 2006; S3/1-S3/10.
- Dillner J; Arbyn M; Unger E; Dillner L. Monitoring of human papillomavirus vaccination. Clinical and Experimental Immunology 2010; 163:17-25.
- Miranda PM; Silva NNT; Pitol BCV; Silva DCG; Lima-Filho JL; Carvalho RF; Stocco RC; Becak W; Lima AA. Persistence or Clearance of Human Papillomavirus Infections in Women in Ouro Preto, Brazil. Biomed Research International 2013; 57826:1-6.
- Ramanakumar AV; Goncalves O; Richardson H; Tellier P; Ferenczy A; Coutlee F; Franco EL. Human papillomavirus (HPV) types 16, 18, 31, 45 DNA loads and HPV-16 integration in persistent and transient infections in young women. BMC Infectious Diseases 2010; 10:326-338.
- Sachan PL; Singh M; Patel ML; Sachan R. A study on cervical cancer screening using pap smear test and clinical correlation. Asia-Pacific Journal of Oncology Nursing 2018; 5(3):337-341.
- Paavonen J. Human papillomavirus infection and the development of cervical cancer and related genital neoplasias. International Journal of Infectious Diseases 2007; 11(2):3-9.
- Gage JC; Schifman M; Katki HA; Castle PE; Fetterman B; Wentzensen N; Poitras NE; Lorey T; Cheung LC; Kinney WK. Reassurance Against Future Risk of Precancer and Cancer Conferred by a Negative Human Papillomavirus Test. Brief Communication 2014; 106(8):1-4.