AN UPDATED UNDERSTANDING OF THE NATURAL HISTORY OF CERVICAL HUMAN PAPILLOMAVIRUS INFECTION - CLINICAL IMPLICATIONS

Recently, the International Papillomavirus Society (IPVS) convened a working group on cervical HPV latency, which resulted in an updated understanding of the HPV natural history. While the previous HPV natural history model considered HPV detection a result of HPV acquisition or possibly re-infection, and loss of HPV detection a result of viral clearance, the updated understanding of the HPV natural history is more nuanced. Thus, HPV detection may occur as a result of autoinoculation, deposition from a recent sex act, or as a redetection of a previously acquired infection. Similarly, loss of HPV detection likely reflects immune control rather than complete viral clearance. As it is practically impossible to identify the "true" source of a new HPV detection or determine why HPV is no longer detectable, we propose that health care providers and researchers use the terminology HPV detected vs HPV not detected. Moreover, we describe the updated understanding in a clinical context. Specifically, we discuss the potential implications of the updated understanding on clinical counseling in screening, and recommendations on cervical screening and HPV vaccination. We also suggest key phrases health care providers may use when counseling women attending routine HPV-based cervical screening.