IPVS Consensus Statement on The Natural History of Cervical Human Papillomavirus Infection

Abstract Background Changes in cervical type-specific human papillomavirus (HPV) detection may reflect both natural variation in detectability and recent infection or clearance. Methods The Policy Committee of the International Papillomavirus Society (IPVS) convened a multidisciplinary working group to review scientific evidence and terminology related to the natural history of cervical type-specific HPV infections. Results The group proposes an updated model that distinguishes 3 cervical states: no HPV infection, undetectable HPV infection, and detectable HPV infection. An undetectable HPV infection refers to either a state of low viral genome load below the cutoff of the assay used or to a particular state of viral latency. These 2 states are virtually indistinguishable, and viral latency remains a topic of ongoing research and debate. The transition from HPV not detected to HPV detected is consistent with several possible events, including (i) acquisition from a partner, (ii) autoinoculation, (iii) transition from undetected to detected HPV infection, and (iv) transient deposition of viral material. Conversely, the transition from HPV detected to HPV not detected is consistent with (i) viral clearance, (ii) transition from detected to undetected HPV infection, and (iii) inadequate sampling. The likelihood of each possible explanation depends on context, including screening history, exposure, age, and immune status. Conclusions By distinguishing true cervical states from observed test results, the updated model acknowledges uncertainties that complicate the interpretation of HPV test result patterns in research and practice. Adopting this model may improve clarity and ensure consistency in scientific and clinical communication about cervical HPV infections.