HPV is a common sexually transmitted infection and the primary cause of cervical cancer. A hysterectomy is a surgical procedure that removes the uterus, sometimes including the cervix. Many individuals mistakenly believe this surgery eliminates the viral infection entirely. While a hysterectomy can remove tissue damaged by the virus, the procedure does not clear the HPV infection itself.
Understanding HPV Persistence and Location
A hysterectomy does not clear the infection due to the specific biology of HPV. HPV is a localized infection, unlike viruses that circulate in the bloodstream. It establishes a reservoir within the basal layer of squamous epithelial cells, the deepest part of the skin and mucosal lining. The virus persists here by maintaining its genetic material in these long-lived cells.
Since the virus is widely distributed across the lower genital tract (vagina, vulva, and anus), removing only the cervix does not remove every cell harboring the virus. HPV can remain dormant or persist in the epithelial cells of the vaginal walls or vulva even after surgery. This persistence allows HPV to potentially cause new lesions in different areas of the genital tract.
The Impact of Surgical Scope
The specific type of hysterectomy performed affects the immediate risk for future disease. A total hysterectomy removes both the uterus and the cervix, eliminating the possibility of developing new cervical dysplasia or cancer. However, this procedure does not guarantee the HPV infection is eliminated, as the virus may still reside in surrounding vaginal or vulvar tissues.
In contrast, a supracervical or partial hysterectomy removes only the main body of the uterus, leaving the cervix intact. If high-risk HPV was present before surgery, the remaining cervical tissue is still susceptible to developing precancerous changes or cancer. Individuals who undergo a supracervical hysterectomy must continue routine cervical cancer screening, including Pap tests and HPV testing.
Post-Operative Surveillance and Future Risk
Continued surveillance is necessary even after a total hysterectomy, especially if the surgery was performed due to pre-existing HPV-related disease like cervical intraepithelial neoplasia (CIN). The primary concern following cervix removal is the potential development of vaginal intraepithelial neoplasia (VAIN), which are precancerous lesions in the vaginal walls. This risk is higher in patients with a history of high-grade CIN.
Ongoing monitoring protocols are recommended for at least 20 years for individuals who underwent hysterectomy due to high-risk HPV or cervical cancer. Surveillance involves collecting a vaginal vault smear, often called a vaginal Pap test, combined with high-risk HPV testing. This co-testing strategy is more sensitive for detecting precancerous changes in the vaginal tissues. This long-term follow-up is necessary to detect any persistence of the virus that may lead to new lesions.