Time to test for HPV

Ever had any kind of sexual contact? You may be at risk of HPV, which can develop into cervical cancer. Here’s how to easily test at home.

What is HPV?

HPV is short for human papillomavirus, the name of a group of viruses that includes more than 150 different types that cause infection on the surface of the skin.

More than 40 HPV types infect the anogenital area and throat (pharynx and larynx) and the majority are sexually transmitted. HPV is thought to be the most common sexually transmitted infection (STI) in the world, and most people are infected with HPV at some time in their lives.

The virus can cause visible genital warts but can also be present as an infection of the skin that is not visible to the naked eye (subclinical infection). Therefore, many people with genital HPV do not know they have it.

Warts on other parts of the body are caused by different types of HPV. A person may be infected with more than one type at a time.

We do things daily to look after our bodies – we try to get enough sleep and water, and make a doctor’s appointment if we’re feeling ill. One appointment we might put off, though, is a pap smear.

It might not be an appointment you particularly look forward to, but cervical screening is vital in helping to detect early changes in the cervix, which, if left untreated, can develop into cancer over the course of many years. Previously, a pap smear test was the only way to perform this screening. The test involves a vaginal examination using a brush to sweep the cervix for cells, which are then examined under a microscope. This screening is scheduled every three years, starting at the age of 25.

HPV testing

However, there’s now a new way for this screening to be done. Last month, the primary test for cervical screening changed to a human papillomavirus (HPV) test, with the option of self-testing, for women and people with a cervix.

It’s estimated that one in five people are infected with HPV at any given time. For most, the infection will clear by itself within two years – especially for those under 30 – but there are many different types of HPV. Some are more likely to lead to cervical cancer than others, and sometimes it can become a persistent infection that may lead to further follow up and treatment.

Auckland-based gynaecologist and obstetrician Dr Amelia Ryan explains that the new HPV cervical test will see the required testing interval increase from three years to five years and can be performed in two ways: the conventional pap smear involving a speculum examination; or through a self-swab.

“The self-swab is inserted into the vagina by a couple of centimetres and rotated for 20-30 seconds,” says Dr Ryan. “Generally, this is more comfortable than the usual speculum examination we are used to, along with being a more private, culturally appropriate, and sensitive screening option. You can usually just do the self-swab in the bathroom of your local GP clinic.”

By being a more comfortable experience, it’s hoped that many more people will take up cervical screening for the first time or keep up to date with their screening in the long-term.

“In 2022, only 67 per cent of New Zealand women were up to date with their screening,” says Dr Ryan. “More screening will lead to many lives being saved, and also help to address inequity in screening rates in Māori and Pasifika women. HPV screening can also be performed while pregnant or during your period, so there are less excuses for putting it off!”

Improved results

The HPV test is also just simply a better test, says Dr Ryan. “The whole point of cervical screening is to detect abnormalities in the cervix that, over time, might develop into cancer. Most of these abnormalities are caused by the HPV virus. Pap tests screened for abnormal cells on the cervix, but HPV screening looks for the virus, often before the cervical changes have had the chance to develop. This leads to earlier detection and treatment.”

In simple terms, HPV testing is viewed as better at detecting a high-grade abnormality than a pap test, and a negative HPV test is more reassuring than a negative pap test, even with the five-year interval. If you have a pap smear that comes back as negative, there is about a five in 1,000 chance of developing a high-grade abnormality within three years. However, a negative HPV test means you will have a much lower chance of about two in 1,000, over five years.

With the HPV test having already been rolled out in at least 48 countries internationally – including Australia and the UK – New Zealand is lucky to have guidance as the HPV self-testing is rolled out here.

“It is thought the introducing of HPV screening will protect an additional 30 per cent of New Zealand women due to earlier detection. The extended time frame and the self-swab will hopefully encourage many people in New Zealand who are under-screened or who have never screened to get involved and stay up to date.

“Self-screening alone has been shown to improve rates, with 85.7 per cent of under-screened women in one study accepting a self-swab as a screening method.”

Symptoms and abnormal results

Despite the lessened chance of developing a high-grade abnormality if you have an HPV test that comes back as negative/normal, you should still always seek the advice of your healthcare professional if you experience any symptoms suggestive of cervical disease, such as abnormal discharge, bleeding between periods, bleeding with sex, bleeding after menopause, or pain with sex or periods.

And if a self-performed HPV test result comes back with concern? “Depending on the result, you may need to be referred to your local gynaecology clinic for a colposcopy, which is a very close examination of the cervix using binocular-like glasses and often involves a biopsy,” says Dr Ryan. “Alternatively, a second examination might be required at the GP.”

What to know:

  • Almost all cervical cancers are caused by HPV. The virus is very common and is spread by intimate skin-to-skin contact or any sexual activity.
  • Cervical screening is available to people with a cervix aged 25 to 69 who have engaged in any sexual activity, no matter their sexual orientation.
  • As of September, the primary test for cervical screening – previously called a smear test – changed to a human papillomavirus (HPV) test, with the option of self-testing.
  • If you prefer, the smear test is still available.
  • HPV results will usually come back within two weeks.
  • If the HPV test comes back as normal, most people will only need to be tested every five years (or three years if you are immune deficient).
  • Get in contact with your local GP clinic to ask about the costs involved.

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