Colposcopy

Human papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). According to statistics in different countries, between 50% to 80% of people are carriers of some kind of HPV virus. Only in the USA, it is estimated that 6 million people become newly infected every year. HPV is different to herpes (HSV) or HIV (the virus that causes AIDS).

There are many HPV types that can infect the genital areas of males and females, as well as the mouth, throat and anus. The majority of those infected with HPV do not know they have it, as they may never develop any symptoms. On the other hand, they can still transmit the virus to other people. There are very sensitive specific (PCR) tests that can prove whether an individual carries a HPV virus and also which type.

Many people develop signs (warts or abnormal cells on Papanikolaou smear test or even cancer of the cervix of the uterus, in case of women) many years after they were first exposed to the virus. Some HPV types can also cause other, less common but serious cancers, including cancer of the vulva, anus and head and neck types of cancer (tongue, tonsils and throat).

HPV is passed on through all kind of genital contact, during vaginal and anal sex, during oral sex, between straight or same-sex partners. The use of condoms reduce, but does not eliminate the risk of transmission. It is also possible to get more than one type of HPV.

Very rarely, a pregnant woman with genital HPV can pass HPV to her baby during vaginal delivery. In these cases, the child can develop Juvenile-Onset Recurrent Respiratory Papillomatosis (JORRP).

Genital warts are most commonly caused by HPV types 6 and 11 and usually appear as small cauliflower bump or groups of bumps in the genital area. If left untreated, they might go away, remain unchanged, or increase in size or number. They almost never turn into cancer.

Cervical cancer is most commonly caused by HPV types 16 and 18. Women affected by these viruses do not have symptoms. Fortunately, there are pre-cancer changes on the cervix of the uterus that can be detected through the Papanikolaou smear test and colposcopy.

Colposcopy is a type of test/examination that can be performed in an outpatient clinic and needs no anesthetic to be performed. Using a speculum to visualise the cervix, 5% acetic acid solution is applied on the cervix. HPV areas turn very bright white areas (called aceto-white areas). Biopsies can be taken at the same from these areas, in order to diagnose the severity of the disease. These can be Low Grade (LGSIL) or High grade (HGSIL). The severity of the condition, the age and parity as well as other individual parameters will help the clinician and patient decided whether treatment needs to be considered. It is important to know that the patient’s own immune system can cure these abnormal areas, which can occasionally disappear without treatment!

It is therefore important for women to be regularly screened for cervical cancer in order to detect these early abnormal changes of the cells. The vast majority of women treated at the pre-cancer stage of the disease will never develop cancer.

Prevention of infection is now available through vaccines that protect males and females against some of the most common types of HPV (these are types 6, 11, 16, 18). These vaccines are given in three shots and the recommended age of vaccination is different in each country based on the average age of onset of sexual intercourse in each country. The vaccines are most effective when given before a person's first sexual contact.

In Greece, the recommended age is between 12 and 16 years of age and it is given in girls only. Even after that age though, and at least up to the age of 26, the vaccine may be offered, depending on the needs of each woman. It is important to get all three doses. Two vaccines (Cervarix and Gardasil) are available worlwide.

External genital warts can be treated by the patients themselves with medications that are in the form of cream or solution. They can also be treated by a health care provider with Laser or other means.

Cervical cancer is one of the commonest types of cancer in women, but can be treated if diagnosed early. We all need to remember though: Prevention (in terms of regular smear test check-up) is always better than treatment.

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