VitalPath

HPV: The Virus Nearly Everyone Gets

Human papillomavirus (HPV) is the most common sexually transmitted infection — approximately 80% of sexually active people will contract at least one strain. There are over 200 HPV types, with about 14 being “high-risk” for cervical cancer (types 16 and 18 cause ~70% of cases).

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The vast majority of HPV infections clear on their own within 1-2 years without causing any health problems. Persistent infection with high-risk types is what can lead to precancerous changes and, over many years (typically 10-15), cervical cancer.

The HPV Vaccine: A Cancer Prevention Revolution

• Australia (80%+ vaccination coverage): cervical abnormalities in women under 20 dropped by ~50%. On track to eliminate cervical cancer by 2035.
• Scotland: In women vaccinated at age 12-13, zero cases of invasive cervical cancer have been detected.
• The current vaccine (Gardasil 9) protects against 9 HPV types, covering ~90% of cervical cancers.
• The HPV vaccine is recommended for all genders ages 9-26, with shared decision-making for ages 27-45. It also prevents anal, penile, vaginal, vulvar, and oropharyngeal cancers.

Updated Screening Guidelines

• Ages 21-29: Pap smear every 3 years.
• Ages 30-65: HPV test alone every 5 years (preferred), OR Pap every 3 years, OR co-testing every 5 years.
• Over 65: Screening can stop with history of normal results.
• After hysterectomy: Screening can stop if cervix removed and no cancer/precancer history.

Understanding Abnormal Results

An abnormal Pap smear is NOT a cancer diagnosis.

• ASC-US: The most common abnormal result. Often transient. HPV testing helps determine next steps.
• LSIL: Mild changes, often transient. Usually monitored rather than treated in young women.
• HSIL: More significant changes. Requires colposcopy and possible biopsy. Treatment (LEEP or cone biopsy) is highly effective.

The most important takeaway: cervical cancer is almost entirely preventable through vaccination and regular screening.

References: ASCCP 2019 Guidelines; Australian Cervical Screening Program; Palmer et al. (2019), BMJ.

📋 Keep a Daily Health Journal to track screening dates and results.