In France, smears or HPV tests (sampling of superficial cells from the vagina and cervix) are started from the age of 25. These aim to detect contamination with certain viruses such as HPV (papillomavirus), which can cause lesions. These are of great concern when detected in women. However, they are very frequent and, regularly screened via smears, they do not put health at risk. Especially since in general, the immune system fights them naturally.
Patrick Cerf, gyecologist in Paris, answers all questions about lesions due to papillomavirus.
What is an HPV infection?
Patrick Cerf: The Human Papilloma Viruses are a family of viruses with more than 150 varieties. Many do not cause any pathology, others can cause warts, condylomas, and about fifteen of which 2 especially (the 16 and the 18) can cause lesions which are likely to evolve after many years until the stage of Cancer.
What are the signs?
There is no sign of contamination. Small warts, papillomas or condylomas can develop, most of the time on the genitals and / or anal parts of men or women. It can also develop invisible lesions in the mucous membranes of the vulva, vagina, cervix, anus, penis, urethra and oropharynx. These lesions remain symptom-free for many years to develop.
Is this virus common? How is it transmitted?
By sexual intercourse exclusively and in an extremely frequent manner. About 80% of people get HPV during their first sexual intercourse with a partner who has previously had sexual activity. In the vast majority of cases, the body reacts and immunity eliminates this virus which then persists in very few people.
Should a smear show an HPV infection?
The discovery of an HPV in screening is not worrying in itself but requires the realization of an assessment because several scenarios are possible: one can harbor the virus without having cell damage, and have more or less advanced lesions.
The lesions progress over many years and there is never an emergency or risk of rapid progression to serious short-term lesions. It must be repeated, discovering an HPV is not synonymous with present or future cancer but requires an assessment and monitoring.
What support is offered?
In the event of associated cellular lesions, suspected by the smear, it is necessary to do a colposcopy, examination with a kind of large magnifying glass, which will make it possible, if necessary, to take one or more biopsies to determine the evolutionary stage of these lesions. Depending on whether they are from low grade to high grade, called CIN 1, 2 or 3, the action to be taken will be simple monitoring (because the lesions often disappear naturally), destruction by laser or excision, or even conization. The decision depends on the stage of the lesions as well as the age and the history and plans for the pregnancy.
Is regular screening enough to prevent cervical cancer?
The surveillance established in France makes it possible to never have cervical cancer because the stages preceding the cancer of several years will be discovered and will lead to an adapted care. The current vaccine has clearly demonstrated its efficacy and safety. It concerns 9 HPVs among the most likely to give lesions that can become serious. If the vaccine alone protects only about 80%, mass immunity when a large number of people are vaccinated will eradicate not only cancers but also many pathologies, examinations and treatments induced by these viruses.
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