A positive HPV test: what happens next
What a positive HPV result means, why most infections clear on their own, when colposcopy is needed and how cervical screening follow-up is planned.
As HPV testing has become part of routine cervical screening, many women now meet the words HPV positive — and understandably worry. First, take a breath: a positive HPV result does not mean you have cancer. It means you are carrying the virus and that your cervical health needs a more careful period of follow-up.
What HPV is and how it spreads
HPV — human papillomavirus — is a very common family of viruses affecting the skin and the mucous membranes (the linings of the mouth, the genital area and so on). It usually spreads sexually, through direct contact between skin and an area carrying the virus. It is so common that the great majority of sexually active women and men encounter it at some point in their lives.
How many types there are, and what they cause
More than 200 HPV types have been described. About 40 of them affect the genital area, and they fall into two groups according to their relationship with cancer:
- Low-risk types (particularly 6 and 11): these do not cause cancer. They cause the warts known as condyloma in the genital area. Genital warts are not dangerous but can be uncomfortable and do need treating.
- High-risk types (particularly 16 and 18): these can cause cellular changes (dysplasia) in the cervix, vagina and vulva and, if left untreated, carry the potential to lead to cancer over years. Types 16 and 18 are responsible for around 70% of cervical cancers.
What happens when the test is positive
The most important fact to hold on to is this: a healthy immune system clears the great majority of HPV infections — around 90% — on its own within 1 to 2 years.
If the virus cannot be cleared and becomes persistent, it can cause structural changes in the cells of the cervix. The purpose of follow-up is to detect those changes early and stop them before they progress.
When colposcopy is needed
Colposcopy is the main method used to see what state the cells of the cervix are in. It is a detailed examination of the cervix, vagina and vulva using a special illuminated magnifier. It is usually well tolerated and resembles a standard gynaecological examination.
Guidelines do not call for colposcopy after every positive HPV result. It is needed when:
- the test has found HPV type 16 or 18, the types carrying the highest risk;
- the HPV test is positive and the smear taken at the same time shows cellular abnormalities (ASCUS, LSIL, HSIL and so on);
- lower-risk types are present but the virus has not cleared over years of follow-up (persistent infection).
If a suspicious area is seen during colposcopy, a biopsy about the size of a lentil is taken from it and sent for pathology. In this way, if there is a cellular change (CIN), it is found at an early stage and can be treated completely with small, simple measures before it turns into cancer.
What helps
- Vaccination. The vaccines developed against the most dangerous HPV types are the strongest form of protection, and prevent a large proportion of cervical cancers and genital warts. Protection is highest when vaccination comes before any encounter with the virus, but it can still offer benefit to women who are already sexually active.
- Supporting the immune system. Clearing HPV is above all the work of the immune system. Stopping smoking matters (smoking makes it easier for the virus to persist), as do eating well, keeping stress down and sleeping regularly.
- Regular screening. Condoms reduce the risk of transmission but, because the virus can pass through skin-to-skin contact, they do not give complete protection. Keeping to your gynaecological examinations and your smear and HPV screening is the most important step of all.
Early detection and regular follow-up are what keep this manageable. See also smear and HPV testing.