According to Doctor Kieu Le Bien of the Obstetrics and Gynecology Center at Tam Anh General Hospital in Ho Chi Minh City, about 80% of women are infected with HPV at least once in their lives. This group has a four times higher risk of reinfection with the same or different strains. Typically, the body can clear the virus within 1-2 years with a healthy immune system. However, persistent HPV infections increase the risk of pre-cancerous or cancerous cervical lesions.

"Ngat had been vaccinated but hadn't completed all three doses. The HPV infection likely occurred because she hadn't developed sufficient antibodies, as she hadn't finished the full vaccination schedule," Dr. Bien said. Antibody levels, or the concentration of specific antibodies in the blood, correlate directly with the body's ability to fight off the virus: the higher the levels, the stronger the defense.

Ngat's pap smear and biopsy revealed high-grade squamous intraepithelial lesions extending into the cervical canal. This indicates that abnormal squamous cells had spread deep into the cervix, increasing the risk of progression to carcinoma in situ and invasive cancer if left untreated due to the difficulty in controlling the depth of the lesion.

Dr. Bien assessed Ngat's condition as CIN 3 pre-cervical cancer. With timely treatment, there is a high chance of full recovery. As Ngat hadn't had children yet, Dr. Bien performed a cone biopsy to remove the lesion while preserving the uterus and her ability to have children. Following the procedure, she will need regular check-ups to monitor for recurrence and ensure prompt intervention if necessary. During future pregnancies, she will be assessed for cervical insufficiency and a short cervix, and a cerclage may be considered to prevent premature birth if indicated.

Dr. Bien (center) and her team perform a cone biopsy. Photo: Ngoc Chau

Pre-cancerous and early-stage cervical cancer often have no symptoms. Some women experience abnormal vaginal bleeding after intercourse, between periods, or after menopause, unusual vaginal discharge, pain during intercourse, pelvic pain, or swelling in the lower extremities. By the time these symptoms appear, the lesion is often significant and may have already spread.

HPV is the human papillomavirus, with about 40 strains that can cause genital diseases. High-risk strains linked to cervical cancer include 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59. The virus often presents no noticeable symptoms, persisting and progressing silently. HPV is typically transmitted through skin-to-skin or skin-to-mucosa contact with HPV-containing fluids, such as during sexual activity. The progression from a high-risk HPV infection to invasive cancer usually takes 10-15 years, but can be as short as 1-2 years in some cases, according to Dr. Bien.

Currently, cervical cancer screening for sexually active women aged 21 and older includes pap smears, HPV tests, and visual examination of the cervix with acetic acid. If screening results are abnormal, a colposcopy is performed. A biopsy of the suspicious area is taken for pathological analysis to confirm the diagnosis. In cases of invasive cancer, an MRI may be used for staging.

To prevent HPV infection, Dr. Bien recommends using condoms, practicing safe sex, and getting the HPV vaccine according to the recommended schedule. Women over 21 who are sexually active should undergo regular cervical cancer screenings.

Ngoc Chau

*The patient's name has been changed.