Examining the psychosexual impact of human papillomavirus testing in routine cervical screening

The NHS Cervical Screening Programme aims to prevent cancer by detecting and treating abnormalities of the cervix. Cytology is currently used to detect cervical abnormalities with testing for human papillomavirus (HPV) if cytology results show borderline or low-grade abnormal cell changes. HPV is a highly prevalent sexually transmitted infection and nearly all cases of cervical cancer can be attributed to HPV infection. Research suggests that using HPV testing as the primary test in cervical is more sensitive for detecting high grade precancerous disease. The NHS Cervical Screening Programme is now using HPV testing as the primary test in six sites in England with the intention of rolling this out across the whole of England by 2019.

Previous research evaluating the impact of HPV testing in cervical screening suggests that an HPV positive result has an adverse psychosocial impact beyond that experienced by those receiving an abnormal cytology result alone (1). In addition to anxiety and concern there may be other psychological consequences of testing positive for HPV which relate to the sexually transmitted nature of the virus. Previous research suggests that women feel stigmatized, concerned about disclosing their result to others and concerned about their sexual relationships following a HPV positive result (2). The psychosexual impact of a HPV positive result has not been explored in the context of primary HPV testing but it is important that it is evaluated to determine the information needs and support required for women and to reduce the psychosexual burden of an HPV positive result, particularly as there will be far greater numbers of women receiving a HPV positive result than at present.

This PhD will explore the psychosexual impact of HPV primary testing in routine cervical screening. The first study will involve using data from the Psychological Effects of Abnormal Pap Smears Questionnaire short form (PEAPS-Q-5), a measure of psychosexual functioning, collected as part of the Psychological Impact of Primary Screening for HPV study (PIPS), collected shortly after women receive their screening result. Differences in psychosexual functioning will be assessed between six groups of women with different combinations of HPV and cytology results: those who test negative for HPV, those who are HPV positive with normal cytology, those who are HPV positive with abnormal cytology, those who tested positive for HPV previously and are attending their 12-month follow up appointment who have persistent HPV and those who tested negative at the 12-month follow up appointment, and a control group who have been screened using cytology only. The second study will be a repeat of the first study but will assess psychosexual functioning 6 and 12 months post screening result. The results of the first two studies will inform further qualitative and quantitative research for the remainder of the PhD.

1. Maissi E, Marteau TM, Hankins M, Moss S, Legood R, Gray A. Psychological impact of human papillomavirus testing in women with borderline or mildly dyskaryotic cervical smear test results: cross sectional questionnaire study. BMJ. 2004;328(7451):1293.
2. McCaffery K, Waller J, Nazroo J, Wardle J. Social and psychological impact of HPV testing in cervical screening: a qualitative study. Sexually Transmitted Infections. 2006;82(2):169-74.