By Kirsty Bennett and Laura Marlow

In England and other countries, a new way of looking at cervical screening samples called primary HPV testing is being introduced. Women attending cervical screening programmes where primary HPV testing is used will be told that they are either HPV positive or HPV negative. HPV (human papillomavirus) is a very common sexually transmitted infection (STI) that most men and women will be infected with at some point in their life. There is strong evidence that virtually all cervical cancers are caused by a persistent infection with a high-risk type of HPV, although usually the body’s immune system clears the infection and it doesn’t cause any problems. Primary HPV testing is being introduced because it is a more accurate way of identifying women at risk of cervical cancer than the previously used cytology test – where cells are examined under a microscope.

Previous research suggests that a key concern among individuals with other STIs, such as herpes and chlamydia, is telling a sexual partner. Unlike other STIs, there is no treatment for HPV, so it is not necessary to disclose HPV to current or previous sexual partners. However, a woman may still chose to do so, so it is important to understand information needs and concerns around disclosure.

In our recently published review in BMJ Sexual and Reproductive Health, we reviewed all previous research that has explored women’s concerns about disclosing HPV to a sexual partner. Thirteen studies met the inclusion criteria, most of these were qualitative studies and used individual interviews. Three main themes emerged:

1. Anticipated psychological impact of disclosure – Prior to disclosing an HPV infection, some women felt anxious and worried about telling their sexual partner. Women’s concerns about disclosing were partly because of the stigma associated with having an STI and worries that they might be seen as promiscuous. Women were also concerned about how their partner would respond and were worried that they would be rejected following disclosure.

2. When is disclosure necessary? – Because of a lack of clear, consistent information and the perceived lack of serious physical consequences of HPV for men, some women questioned whether it was necessary to disclosure their HPV infection to current and previous sexual partners.
3. Managing disclosure – Some women were uncertain about how and when to approach disclosure. Some chose not to disclose their HPV result to their partner, instead focusing on their abnormal cytology result or potential cervical cancer. This approach was described as a way of minimising anxiety and avoiding embarrassment.

We found only one quantitative study which explored women’s concerns about disclosing HPV to a sexual partner. Responding to a single item, 60% of HPV positive women agreed with the statement ‘Disclosing my HPV test result is risky’.

The findings of this review suggest that some women have questions and concerns about disclosing HPV to a sexual partner. Increasing knowledge of key aspects of HPV such as how common it is, and providing clear and consistent information about disclosing HPV to a sexual partner could minimise any unnecessary concern surrounding disclosure.