Cervical abnormalities: CIN3 and CGIN

Human papilloma virus (HPV)

Human papilloma virus (HPV) is a large family of viruses that affect the skin and mucous membranes that line the mouth and genital area. HPV is a very common virus with over 100 different strains. HPV infection causes changes to the cells of the cervix creating abnormalities such as CIN and CGIN. Because of this HPV is thought to cause 99.7% of cervical cancers*1

The types of HPV that can cause warts, genital warts and verrucas are known as ‘low risk’ strains and do not usually cause cell changes or develop into cancer. Some types of HPV can cause changes in the cells of the cervix or the lining of the mouth and throat. They are known as high risk HPVs. The changed cells have an increased risk of becoming cancerous. It is thought that 13 strains of high-risk HPV’s are responsible for causing cervical cancers*2 and of those strains those known as types 16 and 18, which are the most common, are thought to cause over 70% of cervical cancers*3

Nearly all sexually-active men and women get HPV at some point in their lives -80% (four out of five) of the world’s population will contract some type of the virus once.*4 HPV is transmitted primarily by genital-to-genital sexual contact, anal sex and, occasionally, oral sex. It can also be transmitted from same-sex partner to same-sex partner. Infection with HPV does not imply either infidelity or promiscuity as even people who have had sex with only one person in their lifetime can get it.

The body’s immune system will usually clear HPV up, without the need for treatment. Since there are no symptoms for HPV, most people don’t even know they have contracted the virus. The virus can remain suppressed in some people for long periods of time.

Because HPV can be carried for a number of years without symptoms, lesbian/gay women who have previously had sex with a man, or whose partner or previous partner(s) have had sex with a man, remain at risk. Lesbian/gay and bisexual women are therefore encouraged to come for routine screening appointments.

Most women who have HPV do not develop cervical cancer. However, a small number of women do develop abnormal cells that may become cancerous. This is why cervical screening and HPV vaccination is important in helping to prevent cancer. 

Most women we spoke with had never heard of HPV or CIN/ CGIN. Many read more about it after their diagnosis because they wondered how and why they’d got CIN/ CGIN. They would have liked more information about it and other possible causes. They felt it was important that there was more awareness and more information about HPV and how it causes CIN.

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Many of the women we talked to said that they hadn’t realised that CIN was a condition that was sexually transmitted. Some were wary of telling other people they’d had it because of this and because it affected a private part of their body. Many felt there was a stigma attached to having HPV and this made it difficult to talk openly about having CIN/ CGIN. Some said that other people often related it to promiscuity, but stressed that women diagnosed with CIN should not feel embarrassed or ashamed because HPV is such a common virus.

Most of the women we interviewed told close family that they’d been diagnosed with CIN3 / CGIN. Some also told friends and colleagues (see ‘Telling other people’). Because of its link with HPV, several women said they found it difficult telling their parents and a few were surprised at their negative reaction. Other women said they didn’t tell many people because they felt embarrassed or that other people would judge them.

Some women we talked to said that, at first, they were concerned about how to tell their partner because HPV is sexually transmitted.

Many of the women we interviewed said they didn’t know how they’d got HPV, several stressing that they’d had very few relationships and sexual partners. Pam wondered if she’d got CIN3 because her ex-boyfriend, who’d cheated on her, had had many partners. 

Lynne said that, after her marriage of 28 years broke up, she ‘went off the rails’ and had several short-term relationships. With hindsight, she wondered if these had caused her HPV or whether emotional stress could also play a part.

Some of the single women we talked to said they were now more concerned about having a sexual relationship and would be particularly wary of having sex without a condom. While latex condoms offer protection against sexually transmitted infections (STI’s) spread by bodily fluids, such as Chlamydia and HIV, they are much less effective against infections that can be spread by genital-to-genital contact such as HPV. However, doctors recommend using a condom because it may reduce the risk of HPV and is very effective against other STI’s.

Some factors, like age of first sexual intercourse and having more sexual partners, can increase the chances of catching HPV. But many women who have their first sexual intercourse later in life, or who have had few sexual partners, have HPV and may go on to develop CIN. Other risk factors include smoking, and some studies suggest long term use of the contraceptive pill (over ten years) can slightly increase the risk. Some women said that, after reading more about the causes of CIN or cervical cancer, they decided to make changes to their diet or lifestyle. This included eating healthier, exercising, drinking less alcohol and stopping smoking. One woman said she’d also started meditation to help her relax more.

A few women said that, especially when they’d just been diagnosed, they did not want to know how they got CIN / CGIN but just wanted to be treated. Others said that, after treatment, they wanted to resume life as normal and did not read much about the causes.

Some of the women we spoke to asked to be tested for HPV. Others were concerned about the HPV vaccine.

The HPV vaccine provides protection against two high risk types of HPV (types 16 and 18) that cause 70% of all cervical cancers (NHS Choices September 2014). Women need to be vaccinated before they come into contact with the virus. The virus is transmitted by skin-to-skin contact, usually by sexual activity. Studies have already shown that the vaccine protects against HPV infection for around 10 years, although experts expect protection to be for much longer. (NHS Choices September 2014).

Different countries have different policies. The HPV vaccination 'Catch Up Programme' started in the UK in September 2008 with all 12 to 13 year olds and 17 to 18 year old girls being offered the vaccine. This programme continued until autumn 2011 to ensure all girls under 18 years of age were offered the HPV vaccine.

As there is currently no medical treatment for HPV, being vaccinated against it and practising safe sex by using condoms is the best way to reduce the chance of infection.

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Some of the women we talked to said they didn’t know who was eligible for the HPV vaccine or when it had to be given. A few said they would have liked more information about it and felt strongly that that their daughters should be vaccinated. All of the women we spoke with advocated the HPV vaccine apart from one. Some wished it had been available when they were younger.

Since April 2011, the NHS Cervical Screening Programme has been introducing a testing system called the ‘HPV triage’ so if a woman has a screening result that shows abnormal cell changes the sample is automatically tested for the HPV virus.

“If you have an HPV infection, you will be offered another test (called a colposcopy) to check your cervix more closely.” (NHS Cervical Screening leaflet, ‘Helping you decide’, May 2017)

“In the next couple of years, primary HPV testing will be rolled out across England and Wales. This means that they will test the sample of cells for HPV first. If HPV is found, they will then test for cell changes.” Cancer Research UK June 2017

For more information on colposcopies see our topic on ‘The colposcopy examination’.

If the test comes back and it does not show any HPV virus (negative result) the woman will be asked to return to normal regular screening every 3-5 years depending on their age. ‘HPV triage’ programme is currently operating in England and Northern Ireland but not in Scotland or Wales.

In England, Northern Ireland and Wales all women between the ages of 25 and 49 are eligible for a free cervical screening test every three years. Women aged 50-64 are eligible for a free cervical screening test every five years. Women living in Scotland between the ages of 20 and 60 are invited for a test every three years.

The NHS Cervical Screening Programme has also introduced a ‘HPV test of cure’ programme which means if you have had treatment (such as a colposcopy, LLETZ or cone biopsy) for cervical abnormalities/CIN, you will be asked to go back after six months for more screening. The sample taken at this screening will be tested for abnormal cell changes (CIN) and it will also be tested for the HPV virus. If the screening result shows either the HPV virus or abnormal cell changes the woman will be again referred to colposcopy for further investigation.

‘HPV test of cure’ is available in England, Wales, Northern Ireland and Scotland.


*1(Walboomers JMM et al. (1999) Human papilloma virus is a necessary cause of invasive cancer worldwide. Journal of Pathology, 189 (1), 12–19).

*2 Li N et al., 2011. Human papillomavirus type distribution in 30,848 invasive cervical cancers worldwide: variation by geographical region, histological type and year of publication. International Journal of Cancer 128, 927–935. 

*3 Bosch FX et al., 2008. Epidemiology and natural history of human papillomavirus infections and type-specific implications in cervical neoplasia. Vaccine 26 (10), K1-16. 

*4 Koutsky L. 1997. Epidemiology of genital human papillomavirus infection. The American Journal of Medicine, 102 (5A), 3-8 

 
Last reviewed July 2017.
Last updated July 2017.

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