There are some HPV strains which may cause the development of abnormal cells. When this happens, it is called dysplasia.
A common area for dysplasia is the cervix. There are fewer common places where dysplasia can happen such as the vulva, anus, and vagina. This is not a type of cancer, but if it is not treated, it can develop into cancer. It is because of this that dysplasia cells are often called pre-cancerous cells.
Screening for cancer and dysplasia is vital to find and treat any pre-cancerous change and to prevent cervical cancer. Often times the Pap Smear or Test, will be done. This test will take a small brush and collect cells to look for changes. Now, there are more effective and common liquid-based systems that are able to screen the samples which are better for finding abnormal cells.
Because the Pap Smear will need a lab, and people who can read the tests, there are resource limited areas that have different tests that can screen for cancer and dysplasia. VIA which is a visual exam using vinegar can be used. The vinegar is placed on areas of your cervix and looked at to see if any areas react. Those areas would need treatment. Some areas will collect samples of your cervix and look for the DNA of any HPV strains.
Cervical cancer can take a long time to be developed fully, but there are no symptoms until the cancer is in an advanced stage. It is because of this that you should have cervical screenings regularly. Screening is able to catch any potential problems before it ends up being worse. It is really important for women who have HIV to get cervical screenings each year. This is due to HIV positive women are highly likely to have abnormal screenings.
Any form of cervical cancer is dangerous. This is one of the conditions that is considered AIDS defined that happens to women only. Luckily, cervical cancer is able to be prevented especially with an early diagnosis followed with treatment.
Most women will never have symptoms. However, in the more advanced stages a woman can have bleeding between periods, bleeding after sex, vaginal discharge, and abdominal pain.
Women who have HIV need to have a gynecological exam which includes a cervical screening test as well as getting pelvic exams after they are diagnosed, followed by a 6 month follow up. If both of the tests come back as being normal, then cervical screenings will have to be done every year.
Women who have HIV, who have dysplasia need to have a cervical test every 6 months.
Pregnant HIV positive women need to have cervical screenings whenever they go for prenatal care.
Women who were perinatally infected or born with HIV will be at risk for having high risk HPV. Cervical screenings will need to begin before the age of 21, if they are sexually active.
Abnormal screening tests can mean cancer, dysplasia, infection or inflammation.
If you get abnormal results from your cervical screening, you will need to have a colposcopy which is an exam which uses a type of magnifier to examine your cervical tissue along with a biopsy which is where a tiny amount of tissue is taken and then examined under a microscope for any signs of cancer.
HIV positive women need to be screened for cervical cancer every year.
Any VIA or HPV test that has abnormal results, you are going to need to have treatments. Your screenings as well as treatment will be based on the area where you live.
Most areas will have specific screening guidelines along with guidelines for diagnosis which are different from the WHO. You will need to look to see what your care standard is based on your country or region.
If you have been diagnosed with dysplasia, then you will need to discuss your treatment options with your doctor. Many treatments will often focus on the removal of abnormal cells which prevent them from turning into cancer.
Cryotherapy: the cells are frozen with liquid nitrogen
Loop Electrosurgical Excision Procedure or LEEP: This will use a thin wire look that is electrified to cut the cells out.
Biopsy: Cells are cut off of the area during a surgery.
Laser Therapy: This uses intense light to destroy the cells.
There are some forms of dysplasia that are mild. In these cases, a doctor may monitor you and then consistently screen you for abnormal cells.
Cervical dysplasia is common for women who have HIV, who have low CD4 cell counts, or have advanced HIV. This is often difficult and serious to treat in those who have HIV.
It is better to treat cervical cancer when it is first diagnosed and done early enough. This means that regular exams are very vital for your health. Treatment will often depend on the cancer type and if it has spread. Often times, multiple treatments are used at once. These treatments include:
Radiation: High energy rays are sent and used to kill off the cancer cells.
Chemotherapy: Medications like intravenous and/or pill medications are used to kill or shrink the cancer.
Written by Mark Riegel, MD
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