Objective: Genotyping of human papillomavirus (HPV) 16/18 is an effective method for the classification of high-risk (hr) HPV-positive women in the primary detection of HPV for cervical cancer. The present study aimed to evaluate whether coinfection with other types of hrHPV will affect the risk of cervical carcinogenesis in women positive for HPV16 / 18.
Methods: A total of 313,704 women aged ≥30 years in China were examined. Among them, 4,933 HPV16 / 18-positive participants underwent colposcopy-directed biopsy. HPV genotypes were identified using the Cobas HPV genotyping system. Multinomial logistic regression was used to model different HPV16 / 18 infection patterns.
Results: The general prevalence rates of hrHPV and HPV16 / 18 were 7.85% (24,456 / 311,382) and 1.95% (6,086 / 311,382) respectively. Among people positive for HPV16 / 18, 33.24% (2,023 / 6,086) were coinfections with multiple types. Of the 4,933 women who underwent colposcopy, their HPV16 / 18 infection patterns were as follows: 52.38% (2,584 / 4,933) HPV16 only, 23.54% (1,161 / 4,933) HPV16 + other hr HPV, 14.98% (739 / 4,933) HPV18 only, 6.83% (337 / 4,933) HPV18 + other HPVh, 1.13% (56/4933) HPV16 + 18, 1.13% (56 / 4,933) HPV16 + 18 + other HPVh.
After adjusting for cofactors, compared with a single HPV16 infection, the risk of developing cervical intraepithelial neoplasia (CIN) grade 3 or higher (CIN3 +) was significantly lower in the HPV16 + other rhHPV group (odds ratio [OR ] = 0.637, 95% confidence interval [CI] = 0.493-0.822).
Conclusion: Coinfection by HPV16 / 18 with other HPV is a common phenomenon. Different patterns of HPV16 / 18 infection can influence the risk of cervical carcinogenesis. HPV16 coinfected with other rHPV appears to have a lower associated risk of CIN3 + in women ≥30 years of age.
Keywords: CIN3; Cervical cancer; HPV coinfections; HPV16; Primary HPV test.
The human papillomavirus (HPV) is a sexually transmitted infection (STI), also known as a sexually transmitted disease (STD). HPV is the most common trusted source of STIs in the United States. Nearly 80 million Americans of reliable origin currently have HPV. Approximately 14 million trusted sources contract the virus each year.
There are more than 100 types of HPV. Because some are likely to cause more complications than others, the types are classified as low-risk and high-risk HPV. Low-risk types cannot cause cervical cancer and are treatable. High-risk types can cause abnormal cells to form on the cervix, which can turn into cancer if left untreated.
Common types of HPV
If you’ve contracted HPV, identifying the type you have helps your doctor determine the next steps. Some types of HPV go away without intervention. Other types can cause cancer. Your doctor will monitor your condition so that if cancer cells develop, they can be found early.
1. HPV 6 and HPV 11
HPV 6 and HPV 11 are low-risk types of HPV. They are linked to about a 90 per cent reliable source of genital warts. HPV 11 can also cause changes in the cervix. Genital warts look like cauliflower-shaped bumps on your genitals. They usually appear a few weeks to months after exposure to a sexual partner who has HPV. Getting the HPV vaccine can help prevent HPV 6. The vaccine also offers some protection against HPV 11.
For the Gardasil 9 HPV vaccine, clinical trials showed up to 89 to 99 per cent effectiveness in protecting against HPV types 6 and 11. This significant reduction against contraction of these types was observed in people aged 9 to 26 years. The recommendation is to receive the vaccines before becoming sexually active since the vaccine cannot protect against a strain of HPV to which a person has already been exposed.
If you contract HPV 6 or HPV 11, your doctor may prescribe medications such as imiquimod (Aldara, Zyclara) or podofilox (Condylox). These are topical medications that destroy genital wart tissue. This local destruction of wart tissue helps improve your immune system’s ability to fight the STI virus. You can apply these medications directly to your genital warts.
2. HPV 16 and HPV 18
HPV 16 is the most common high-risk HPV type and usually does not cause any noticeable symptoms, although it can cause changes in the cervix. It causes 50 per cent of cervical cancers worldwide. HPV 18 is another high-risk type of HPV. Like HPV 16, it does not usually cause symptoms, but it can lead to cervical cancer. HPV 16 and HPV 18 together are responsible for approximately 70 per cent of the reliable source of all cervical cancers worldwide. The Gardasil 9 HPV vaccine can protect against several types of HPV, including HPV 16 and HPV 18.
The HPV test can be done in women with a Pap test (commonly known as a Pap test), which is a cervical cancer screening test. The HPV test is only available to women and can determine if HPV is present. If present, the test can determine if HPV is a low- or high-risk type. The HPV test is not recommended as a routine screening for women under the age of 30. This is because many women will have some strain of HPV at that age. Most of these will disappear spontaneously without intervention.
However, if a person’s Pap test showed abnormal cells, the HPV test would be done to assess the risk of more serious conditions, including cervical cancer. If her test shows that she has HPV, it does not mean that she will develop cervical cancer. It means that she could develop cervical cancer in the future, especially if she has a high-risk type of HPV. Your doctor will review your results with you and discuss treatment or monitoring options.
As mentioned above, 80 million Americans have HPV right now and 14 million new diagnoses are expected each year. This means that almost anyone who is sexually active will get at least one type of HPV during their lifetime. It is estimated that HPV will go away without treatment in 80 to 90 per cent of people who get STI. HPV infection is less common in women over the age of 30, but it is more likely to cause cervical cancer. This is one of the reasons why it is important to see your gynaecologist regularly.
Get the HPV Vaccine
- The HPV vaccine includes two shots, 6 to 12 months apart, for ages 9 to 14 years.
- For people over the age of 15, three injections are given over six months.
- People ages 27 to 45 who have not previously been vaccinated against HPV are now eligible for Gardasil 9.
Ask your doctor what vaccine they are giving you
The types of HPV that different vaccines protect against vary:
- The bivalent HPV vaccine (Cervarix) will only protect against HPV 16 and 18.
- The quadrivalent HPV vaccine (Gardasil) will protect against HPV types 6, 11, 16, and 18.
- The recombinant, 9-valent HPV vaccine (Gardasil 9) can prevent HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58.
Since Gardasil 9 protects against a much broader spectrum of HPV strains without a noticeable increase in side effects or adverse reactions, this option offers more protection against HPV. Common side effects of the Gardasil 9 vaccine are irritation at the injection site, including pain, swelling, or redness. Some people may have a headache after the injection.
- Avoid sexual contact with your partner if there are genital warts.
- Use latex condoms every time you have sex. But keep in mind that HPV is spread through skin-to-skin contact, not through the exchange of bodily fluids. This means that while condoms may not always prevent the spread of HPV, they may reduce your risk.
- If you are a woman, make an appointment with your gynaecologist for a cervical cancer screening. You should start screening at age 21 and continue until age 65.
How does HPV develop?
Warts are the most common symptom of HPV infections. For some people, this can mean genital warts. These can appear as flat lesions, small stem-like lumps, or as small cauliflower-shaped lumps. Although they may itch, they generally do not cause pain or discomfort.
Genital warts in women usually appear on the vulva, but they can also appear inside the vagina or on the cervix. In men, they appear on the penis and scrotum. Both men and women can get genital warts around the anus. Although genital warts may be the first type of wart that comes to mind, this is not always the case. You can also experience:
- Common warts. These rough, raised bumps appear on the hands, fingers, or elbows. They can cause pain and are sometimes prone to bleeding.
- Flat warts. These dark, slightly raised lesions can occur anywhere on the body.
- Plantar warts. These hard, grainy lumps can cause discomfort. They usually occur on the ball or heel of the foot.
- Oropharyngeal warts These are lesions of various shapes and sizes that can occur on the tongue, cheek, or other oral surfaces. They are generally not painful.
In most cases, HPV infections will show no symptoms and will go away on their own. But two strains, HPV-16 and HPV-18 can cause precancerous lesions and cervical cancer. Depending on the state of your immune system, this can take 5 to 20 years to develop. Cervical cancer is generally asymptomatic until it reaches a later stage. Advanced symptoms of cervical cancer include:
- irregular bleeding, bleeding between periods, or abnormal vaginal bleeding after sex
- pain in the leg, back, or pelvis
- vaginal pain
- foul-smelling discharge
- loss of appetite
- a single swollen leg
HPV can also cause cancers that affect the following areas of the body: