HPV Test - HPV DNA Test

What it is and why it is done

The "HPV Test is a" molecular investigation aimed at identifying infections from Human Papilloma Virus, replacing or integrating, depending on the case, the classic cytological examinations (pap-test).

The Human Papilloma Virus (HPV) plays a crucial role in the development and progression of cervical cancer → the early detection of the anomaly by pap-test or HPV test allows to monitor the patient more carefully, in order to intervene before the virus leads to an overt tumor in cases where the anomaly does not resolve spontaneously

While the traditional pap smear is based on the microscopic examination of epithelial cells taken from the uterine cervix, the molecular diagnosis is based on the search for DNA, m-RNA or specific viral proteins directly in these cells. The search for viral DNA can also be carried out in humans on semen and urine samples.

• HPV testing offers a way to improve cervical cancer screening programs and reduce mortality for this type of cancer

• What it means to be positive on the test
• How to interpret a positive HPV test?
• When to undergo pap smears and HPV tests
• Exam execution and preparation

Positive Test - What does it mean?

A patient is considered positive for pap smear, therefore deserving of further diagnostic investigations (colposcopy and possibly targeted biopsy), when the microscopic examination detects cellular anomalies suggesting a possible HPV infection. During a molecular examination, however, the laboratory identifies directly infection by searching for and typing the genetic material of the virus; is therefore able, for example, to establish which HPV genotype has infected the patient's cervical cells → this is a very important aspect, since we know that some viral serotypes are more associated with cervical cancer, primarily HPV 16 and HPV 18, alone responsible for 70% of cervical cancers

• HPV genotypes with high oncogenic risk: HPV 13, HPV 16, HPV 18, HPV 31, HPV33, HPV 35, HPV 39, HPV 45, HPV 51, HPV 52, HPV 56, HPV 58, HPV 59, HPV 68, HPV 73 , HPV.
• HPV 26, 53 and 66 are categorized as "probable high risk genotype"
• The other HPV genotypes, in particular 6 and 11 (the most common), present a very low risk of tumor degeneration: these are, in fact, the genotypes involved in the formation of genital warts.

Not being able to test and identify all the more than 100 scientifically isolated papilloma virus serotypes, the HPV test focuses on finding the most common high-risk HPV genotypes (HR-HPV) among the population.

To sum up:

• Positive PAP test: the cells taken from the patient's neck of the uterus show microscopic anomalies attributable to the cytopathological effect of the virus → the patient has a greater risk of developing cervical cancer → need for further diagnostic investigations (HPV test, colposcopy, biopsy) to identify any tumor lesions, and to establish in case of positivity an adequate therapeutic or follow-up program
• Positive HPV test: in the cells taken from the patient's neck of the uterus, genetic material of the papilloma virus has been identified, suggesting an ongoing viral infection → the patient is considered at risk → need for cytological evaluation and any further diagnostic investigations

Pap test and HPV test

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How to interpret a positive HPV test

• The pap-test and the HPV test are screening tests that have the purpose of quickly identifying that slice of the population at risk that must be subjected to further tests; on the other hand, they have no diagnostic significance, which is why a patient with a positive Pap smear should not indulge in excessive anxieties and worries, considering it a simple invitation to carry out further tests. Conversely, women who test negative presumably do not present, nor will they soon have, cervical cancer lesions.
• Let's repeat it once again: the diagnosis of HPV infection is not necessarily related to an oncological pathology, it simply indicates a greater risk of developing it, hence the need to monitor the patient with greater constancy and attention → viral DNA is practically present in everyone cervical cancer, but only a very small percentage of cases of viral DNA positivity in cervical cells are associated or will be associated with cervical cancer → the possibility of developing a malignant cervical tumor, even in the event of a positive test, it is therefore minimal.
• Especially in young women, papilloma virus infection often tends to regress spontaneously without leaving a trace or consequence, therefore it has a benign and transient character, which however tends to be lost in older women → as the age advances the probability that the infection has been present for a long time and is now in a chronic form that is difficult to cure → only a "persistent infection leads to the integration of the viral genetic code with that of the infected cell, increasing the risk of malignant evolution of the cells of the cervix → this is why regular pap smears are so important from 18-21 years old)

To sum up:

• In young women there is the greatest number of cases of positive pap-test and HPV DNA test, however a large part of the population naturally passes the infection without consequences of any kind.
• The incidence of infection, therefore the positivity to the tests, decreases with age; however, over time the risk associated with a positive result increases significantly, especially in the case of persistent infection with high-risk oncogenic HPV strains ( to find out if the infection has recently been contracted, therefore with the possibility of regression, or has persisted for some time, periodic monitoring is essential) → further confirmation of the importance of undergoing these tests from 21/25 years of age

When to undergo the pap smear and the "HPV test"