With the advent and widespread availability of HPV testing, as a Gynecologist, I encounter women every day who are worried after receiving a positive test result (for Human Papilloma Virus).
HPV infection is extremely common—it’s estimated that about 80% of sexually active people contract it at least once in their lifetime—but, thanks to prevention, we now have all the tools to prevent it from becoming a serious problem.
Prevention of this infection is based on three fundamental pillars:
Vaccination: Our Primary Shield
The vaccine is the most powerful weapon we have: it’s not just a vaccine against a virus, but a true vaccine against cancer (particularly cervical cancer, but also vulvar, vaginal, anal, and oropharyngeal cancer).
- When to do it: It is most effective if administered before the onset of sexual activity (around 11-12 years of age), but it is also strongly recommended and useful in adulthood.
- The vaccine isn’t just for the very young: Even if you’ve already had sexual intercourse or tested positive for one strain in the past, the vaccine can protect you from the other strains contained in the preparation (the nonavalent vaccine protects against 9 types of virus).
Pap smear and HPV test: the screening
Secondary prevention helps detect the virus or small lesions before they can develop into something dangerous. It’s based on two simple tests.
| Test | What it looks for? | How often? |
| HPV-test | Presence of the virus’s DNA | Generalyy every 5 years (above 30-35 years of age) |
| Pap-test | Cellular alterations caused by the virus | Every 3 years (under 30-35 years of age or as a in depth-analysis |
A positive test doesn’t mean you have cancer. It just means we need to monitor you more closely to give your immune system time to eliminate the virus or to intervene promptly if necessary.
Lifestyle and Barriers
Although HPV can also be transmitted through skin-to-skin contact in the genital area (making condoms effective but not 100% protective), a healthy lifestyle plays a crucial role:
- Use condoms: significantly reduces the viral load and the risk of transmission.
- Quit smoking: cigarette smoke is a major contributing factor. Toxic substances concentrate in cervical mucus, weakening local defenses and making it much more difficult for the body to “expel” the virus.
- Take care of your immune system: a balanced diet and good stress management help your body do what it does best: neutralize the infection spontaneously (which happens in 90% of cases).
HPV isn’t a curse, but a visitor to watch out for. The combination of vaccination and regular screening almost completely eliminates the risk of serious complications. If you missed your last checkup, now is the right time to schedule one.
What if the test is positive?
HPV infection can lead to cellular changes in the cervix, resulting in a Pap smear report with a “non-negative” result.
This can cause anxiety, but it’s important to understand that this result is an early warning sign, not a diagnosis of a serious disease. In the vast majority of cases, it indicates the presence of mild cellular changes that only need to be monitored or easily treated.
Here’s how to typically proceed to investigate the situation:
Let’s begin by interpreting the acronym on the report (according to the Bethesda system). The most common are:
- ASC-US: Atypical squamous cells of undetermined significance. This is the most common finding: the cells are “strange,” but it is unclear whether the cause is HPV, inflammation, or severe dryness.
- L-SIL: Low-grade squamous intraepithelial lesion. This almost certainly indicates an HPV infection causing subtle cellular changes. It often regresses spontaneously.
- H-SIL: High-grade lesion. These changes are more pronounced and require greater attention, often requiring intervention to prevent their progression over the years.
The next step is almost always a colposcopy, which is the key in-depth examination.
How the exam is performed:
- Colposcopy is a checkup similar to a gynecological exam: the gynecologist uses an instrument called a colposcope, which illuminates the cervix and magnifies it.
- Liquids (acetic acid and iodine solution) are applied to the cervix. If any “abnormal” areas are present, they change color and are easily identified.
- If a suspicious area is identified, a biopsy is performed, removing a very small tissue sample (a “pinch” of a few millimeters) for histological analysis.
Possible scenarios after the tests
Depending on the findings of the colposcopy and biopsy, there are three options:
- Follow-Up (Wait and See): If the lesion is mild (CIN1), the doctor waits 6-12 months for a further follow-up test. The immune system often eliminates the virus, and the cells return to normal on their own.
- Conservative treatment:If the lesion is moderate or severe (CIN2 or CIN3), the small abnormal area is removed. The most common technique is LEEP (or conization performed with a diathermic loop or laser), a quick outpatient procedure that preserves the integrity of the uterus and fertility.
- Local therapy:In some cases of nonspecific inflammation, suppositories or gels are simply prescribed to restore the vaginal ecosystem before repeating the test.
What happens if HPV lesions are left untreated?
- Most lesions heal spontaneously, but some, if left untreated, can progress and become cancerous. This, however, is very rare and generally takes many years.
- Scientific research still doesn’t allow us to determine which lesions will heal and which won’t.
- Therefore, it’s important to monitor all lesions and treat only those above a certain severity that are at risk of progressing.
The Doctor’s advice
A positive HPV test or an abnormal Pap test means that screening has worked: we’ve found something microscopic long before it could become a problem.
Prevention serves precisely this purpose: giving us time to act calmly.
The important thing is not to forget the problem or pretend it doesn’t exist.
Alessandro Lauri
Gynecologist
