Human Papillomavirus (HPV)
Human papillomavirus or HPV is a small DNA virus that infects the deepest layer
of the skin or genital surfaces (epithelium). There are over 100 types of HPV, of
which about 40 infect the genital area. The virus is ubiquitous and HPV infections
are very common. The majority of all HPV infections resolve on their own and cause
no clinical problems. Approximately 70% clear within a year and 90% within two years.
However, persistent infection with some HPV types can cause cervical cancer, genital
warts, other rarer anogenital cancers and cancers of the head and neck
HPVs are classified as either:
'high-risk' or oncogenic types which can cause cervical cancer and the early changes
in the cervix associated with cervical cancer, or
'low-risk' types, which lead to the development of benign genital warts.
Infection by a high-risk type of HPV is necessary for the development of cervical
cancer. Over 99% of cervical cancers are caused by HPV infection. Persistent infection
with a high-risk HPV type can cause abnormalities of the cervix, which, if left
undetected and untreated, can progress to cervical cancer. The time span between
being infected by a high-risk HPV and the development of cervical cancer is, in
most cases, many years.
While infection by genital HPV is most common among young adults (aged 18-28), cases
of cervical cancer peak in women in their late 30s. Two high-risk types, HPV 16
and HPV 18, are responsible for over 70% of all cervical cancers in Europe. Other
high-risk HPVs that cause cervical cancer include HPV types 31, 33, 35, 39, 45,
51, 52, 56, 58, 59 and 66.
In the western world cancers of the anus, penis, vagina and vulva (here forth described as non-cervical genital cancers) are increasing in incidence. The increase in non-cervical genital cancers may be associated with a concomitant rise in high-risk oncogenic HPV infections, with HPV-16 and -18 estimated to contribute between 74 and 93% of these cancers (Olsen et al., 2012)
National Human Papilloma Virus (HPV) Immunisation Programme
In October 2007, a new immunisation programme against HPV was introduced in Scotland.
The HPV immunisation programme aims to help protect girls against developing cervical
cancer later in life. The vaccine protects against the two High Risk HPV types HPV-16
and HPV-18 that cause over 70% of cases of cervical cancer.
The Scottish HPV immunisation programme started in September 2008, and vaccination is now routinely offered to all girls during their second year of secondary school (aged 12 to 13). At the start of the programme, all 13 to 17-year-old girls in Scotland were also offered HPV vaccine through a time-limited catch-up campaign. This catch-up programme finished on the 31 August 2011. In September 2012, the vaccine was changed from Cervarix to Gardasil. Gardasil also protects against HPV 16 and 18 but also offers protection against HPV 6 and 11, the two viruses which cause 90% of genital warts.
Cervical Cancer Screening Programme
Cervical screening aims to detect and treat abnormal changes in a woman's cervix (the neck of the womb) which, if left untreated, may develop into invasive cervical cancer. The test is designed to pick up any changes so that they can be simply and effectively monitored or treated. Cervical screening saves around 5,000 lives in the UK every year and prevents 8 out of 10 cervical cancers from developing.
The Scottish Cervical Screening Programme has been in place since 1989. All eligible women in Scotland between the ages of 25 and 49 are routinely invited for a cervical smear test every three years. From 50, they are then invited every 5 years (until age of 64).
Women who have been vaccinated with HPV vaccine, will still need to attend for cervical screening when they reach screening age for the best protection against cervical cancer.
HPV Patient Group Direction
Information about the immunisation programme and vaccine uptake statistics
Information about the cervical screening programme, screening uptake and cervical
- Olsen J, Jørgensen TR, Kofoed K, Larsen HK. Incidence and cost of anal, penile, vaginal and vulvar cancer in Denmark. BMC Public Health 12, 1082 (2012).