- MEDICINE ATHENS MED4WOMAN ATHENS
- MEDICINE VOLOS MED4WOMAN VOLOS
- 2103390838
- 2421022988
Obstetrician Gynaecologist
Doctor of Medicine, University of Athens Medical School
Panagiotis Polyzos, Gynaecologist Obstetrician, is active at the Institute of Life - IVF Unit of Iaso Maternity Hospital.
Το Pap test is a routine examination, that all women should undergo starting from the onset of their sexual activity and thereafter on an annual basis. It is one of the standard routine and screening tests for cervical cancer (just as mammography is for breast cancer) that are currently performed to detect potentially pathological or abnormal cells on the cervix. At the same time, it serves as the first line of detection for the HPV virus , which has increasingly taken on epidemic proportions, affecting more than 40–45% of the female population.
In addition to identifying any pathological or abnormal cells on the cervix and within the endocervical canal, the Pap test can also detect mild cervicitis, vaginitis, or possible fungal infections. However, what has dominated medical interest in recent years—and remains a significant scientific concern for both physicians and patients—is the HPV virus.
The HPV (Human Papillomavirus), which is usually detected (in women) through a Pap test—mainly because it does not present clinical symptoms—is sexually transmitted. It is transmitted from a sexual partner to the woman, unfortunately, often without the man showing any clinical symptoms. Like any other virus that enters the body, HPV can remain in a woman’s body. It is important to emphasize that it cannot be eliminated.The available treatments from that point onward—whether simple monitoring, loop electrosurgical excision procedure (LEEP), cauterization, or vaccination—aim to suppress or manage its manifestations, but they do not remove the virus from the body. This virus can remain in the body for life, much like a herpes virus. It may become active or manifest during different phases of life, often in association with other factors such as fatigue, stress, and similar conditions.
If the Pap test shows the presence of HPV, the immediate next step is what we call a colposcopy. Colposcopy is a gynecological examination that takes slightly longer and is more detailed. During the procedure, the gynecologist uses a special microscope—called a colposcope—to examine the cervix more closely. Through a specific process, the doctor can observe the lesions caused by the virus on the cervix and within the endocervical canal in greater detail. In the particular area where the so-called columnar epithelium transitions into squamous epithelium—known as the transformation zone—certain changes or lesions caused by the virus may occur. Based on the size, type, and grade of these lesions, a decision will be made regarding whether treatment is necessary. If the lesions are suggestive of possible dysplasia—either low-grade (CIN I) or high-grade (CIN II, CIN III) —or are categorized as LG-SIL or HG-SIL, treatment options may include loop electrosurgical excision (LEEP), cone biopsy (conization), simple cauterization, or biopsy.
At this point, it is important to emphasize that many types of genital warts are also caused by HPV. Although there is no definitive cure for the virus itself, there are effective ways to treat these warts. Treatment may be pharmaceutical (topical medication) or may involve diathermy and cauterization. Similar energy-based methods, such as laser therapy or loop excision, may also be used. Furthermore, because certain HPV types (notably 16 and 18) are directly associated with cervical cancer—typically after many years—HPV is considered a risk factor that may predispose to cervical cancer under specific conditions.
Regular Pap tests play a crucial role in the prevention of cervical cancer. The cells of the cervix can undergo changes and progress silently, without causing any symptoms or pain. Even minor cellular abnormalities may gradually develop into cancer if they are not identified and treated promptly.
Moreover, the Pap test can provide useful information regarding hormonal function and can help monitor the administration and effects of hormonal treatments. Finally, it enables the detection of inflammation of the vagina or the cervix (vaginitis, cervicitis), as well as the identification of their underlying causes, such as bacteria, fungi, trichomonads, viruses, and other infectious agents.
During a Pap test, the doctor gently scrapes cells from the cervix using a small spatula and a brush. The collected cells are then spread onto a glass slide, which is sent to the laboratory for microscopic examination.
You will likely be advised to undergo Pap tests more frequently (every 3–6 months). In addition, through specialized DNA testing—known as HPV typing—we can identify the specific viral strains. This allows us to determine which types carry a higher predisposition and stronger association with the potential development of cervical cancer, typically over a long period of 20–25 years. Another important fact about HPV is that it is transmitted sexually.
However, it can also be transmitted through skin-to-skin contact in the genital and perigenital area. As a result, under certain circumstances, condoms may not provide complete protection, since the infection can be present in areas not covered by a condom. Nevertheless, condoms remain the most important and only effective form of protection we have against this virus. It is important to remember that HPV is now extremely common. As previously mentioned, nearly 40–45% of the female population are carriers. Many sexually active individuals have been infected. The virus does not produce clinical symptoms in men, which makes transmission easier. Unfortunately, it can remain in the body without causing any noticeable symptoms.
Smoking is also considered a contributing factor to the development of cervical cancer and represents an additional risk factor that predisposes individuals to this condition.
In recent years, one of the most important areas of research has been the development of a vaccine designed to prevent infection with the HPV virus, since HPV is one of the primary risk factors for cervical cancer.
Approximately two thousand women each year in the United Kingdom are diagnosed with this type of cancer. There are more than 100 types of HPV. The second phase of these studies, conducted in May 2005, showed the first indications that an HPV vaccine could, under certain conditions,reduce HPV infection. The study known as FUTURE II released its first results in October 2005.This 3rd phase of the study included more than 12,000 women aged 16–26 years and demonstrated the following:
The women participating in the study did not have HPV at the start and were divided into two groups.
The first group received the vaccine called Gardasil, while the second group received a placebo injection—that is, a substance with no active pharmaceutical effect. These two groups of 12,000 women were monitored over the following two years while maintaining a normal sexual life. Researchers evaluated whether they would develop HPV infection, any form of dysplasia, or any other precancerous condition of the cervix. The vaccinated group did not develop any such symptoms. In contrast, among the 5,258 women who received the placebo injection, 21 developed some form of cervical pathology over the two years—corresponding to a rate of 0.4%. The initial results also indicated approximately a 1% reduction in new HPV infections and suggested potential protection against HPV types 6, 11, 16, and 18. At the same time, additional studies have been conducted on a second vaccine, likely to be introduced to the market, called Cervarix. This particular study involves 18,000 women and is known as the PATRICIA study (PAPILOMA TRIAL TO PREVENT CERVICAL CANCER IN YOUNG ADULTS), which focuses on the prevention of cervical cancer in young adult women.
