HPV Vaccination And Testing

Question 1

How many HPV subtypes are sexually transmitted?

Answer 1

Approximately 40 subtypes.

Question 2

List 5 high risk types of HPV.

Answer 2

Type 16, 18, 31, 33, 45. These types can all cause precursor lesions of cervical cancer.

Question 3

List some low risk subtypes of HPV.

Answer 3

Types 6,11,42,43,44

Question 4

What do low risk types of HPV generally cause?

Answer 4

Genital warts and low grade lesions (CIN1).

Question 5

What will usually happen to infections caused by both high risk and low risk HPV subtypes within 6-18 months?

Answer 5

Most HPV infections both high risk and low risk are transient and resolve within 6-18 months.

Question 6

What is the usual time between infection and disease in patients with high risk HPV infection?

Answer 6

Approximately 20 years. The longest period is between the precursor lesion and invasion.

Question 7

Why are we interested in preventing high risk HPV infections?

Answer 7

Because preventing high risk HPV infections could prevent cervical cancer.

Question 8

When was the HPV vaccination programme introduced in the UK?

Answer 8

2008

Question 9

At what age are females given the HPV vaccination?

Answer 9

At age 13 (catch up programme to age 18).

Question 10

Where can girls get their HPV vaccination?

Answer 10

Via school vaccination programmes or at their GP.

Question 11

What was the uptake rate of HPV vaccination by 2011?

Answer 11

Approximately 80%

Question 12

What is the aim of mass HPV vaccination?

Answer 12

Mass vaccination programmes will reduce the global burden of cervical cancer and CIN.

Question 13

What types of HPV does the HPV vaccine protect from?

Answer 13

The vaccine protects against HPV types 16 and 18, which are found in 70% of squamous cancer of the cervix (i.e. offers 70% protection against cancer).

Question 14

What are the names of the 2 types of HPV vaccines currently available?

Answer 14

1) . Cervarix

2) . Gardasil

Question 15

What do the HPV vaccines contain?

Answer 15

They contain harmless proteins of certain viral types, not the actual potentially carcinogenic viral DNA.

The vaccines stimulate the immune response to destroy virus before it is able to infect the cervical epithelium.

Question 16

Describe the Cervarix vaccine.

Answer 16

GSK,
Bivalent (HR types 16 and 18),
Used in the UK since 2008

Question 17

Describe the Gardasil vaccine.

Answer 17

Merck,
Quadrivalent (HR 16 and 18, LR 6 and 11),
Used in the NHS since 2012

Question 18

What HPV subtypes doe Cervarix protect against?

Answer 18

High Risk types 16 and 18.

Question 19

What HPV subtypes does Gardasil protect against?

Answer 19

High risk subtypes 16 and 18,

Low risk subtypes 6 and 11

Question 20

Why is the HPV vaccine given to females at a relatively young age?

Answer 20

Because the vaccine is most effective when given before natural infection occurs (i.e. before the onset of sexual activity). Recommended that girls get vaccinated around the age of 13.

Question 21

Do vaccinated women still need to be screened?

Answer 21

Neither vaccine protects against all types of HPV and therefore vaccination is not guaranteed to prevent cervical cancer. Hence cervical cancer screening must continue for the foreseeable future for women 25-64 years.

Question 22

Why wouldn’t HPV primary screening currently be effective?

Answer 22

HPV infections are widespread in women under 35 so primary screening for HPV would be oversensitive and costly.

Question 23

What did the Mavaric study prove?

Answer 23

The Mavaric study proved HPV testing to be effective in the triage setting.

Question 24

When was HPV triage testing and TOC implemented in the NHS?

Answer 24

April 2012.

Question 25

Explain the HPV triage process for women with low grade cytological abnormality.

Answer 25

Women with borderline or mild cervical tests are tested for high risk HPV. Negative women will be referred to normal recall whereas positive women will be referred to colposcopy.

Question 26

Explain the procedure for using HPV for test of cure (TOC).

Answer 26

Women who have been treated for CIN are HPV tested. Negative women are then returned to normal recall whereas positive women will be re-referred to colposcopy.

Question 27

What are the overall aims of HPV testing in the cyto lab?

Answer 27

To ensure that HPV high risk (HR) positive women are referred to colposcopy without the need for repeat cytology tests avoiding delays in diagnosis.

It means that HR negative women do not need to have repeat screening as they are at very low risk of cervical cancer.

It means faster return to normal recall for treated women who are HR negative, no need for 10 years of annual follow up cytology tests.

HR positive treated women are referred back to colposcopy.

Question 28

What samples is HPV testing carried out on?

Answer 28

HPV testing is carried out on LBC cyto samples used for cervical screening. The residual sample left over after cervical screening is tested for viral DNA.

HPV test results are included in the cytology report along with appropriate management recommendations.

Question 29

What 5 different platforms have been approved by the NHSCSP for HPV testing?

Answer 29

1) . Roche
2) . Abbott
3) . GenProbe
4) . Hologic
5) . Qiagen

Question 30

How many HPV subtypes have been identified?

Answer 30

Approximately 100.