Objective To examine the psychosocial impact of testing positive for high risk human papillomavirus (HPV) among women attending primary cervical screening. Design Cross sectional survey. Measures were taken at baseline and one week after the receipt of HPV and cytology screening results. Setting Well women's clinic in London, UK.Population or Sample Four hundred and twenty-eight women aged 20 -64 years.Methods Postal questionnaire survey. ConclusionThe findings suggest that testing positive for HPV may have an adverse psychosocial impact, with increased anxiety, distress and concern about sexual relationships. Psychosocial outcomes of HPV testing need further investigation and must be considered alongside clinical and economic decisions to include HPV testing in routine cervical screening.

This study examined attitudes to human papillomavirus (HPV) testing among a purposively selected sample of women from four ethnic groups: white British, African Caribbean, Pakistani and Indian. The design was qualitative, using focus group discussion to elicit women's attitudes towards HPV testing in the context of cervical cancer prevention. The findings indicate that although some women welcomed the possible introduction of HPV testing, they were not fully aware of the sexually transmitted nature of cervical cancer and expressed anxiety, confusion and stigma about HPV as a sexually transmitted infection. The term 'wart virus', often used by medical professionals to describe high-risk HPV to women, appeared to exacerbate stigma and confusion. Testing positive for HPV raised concerns about women's sexual relationships in terms of trust, fidelity, blame and protection, particularly for women in longterm monogamous relationships. Participation in HPV testing also had the potential to communicate messages of distrust, infidelity and promiscuity to women's partners, family and community. Concern about the current lack of available information about HPV was clearly expressed and public education about HPV was seen as necessary for the whole community, not only women. The management of HPV within cervical screening raises important questions about informed participation. Our findings suggest that HPV testing has the potential to cause psychosocial harm to women and their partners and families.

Objectives:To assess the level and accuracy of public understanding of human papillomavirus (HPV) in the United Kingdom. Methods: Women attending a well woman clinic were asked to complete a questionnaire assessing HPV awareness and specific knowledge about the virus. Results: Questionnaires were completed by 1032 women, of whom 30% had heard of HPV. Older women, non-smokers, and those with a history of candida, genital warts, or an abnormal smear result were more likely to have heard of HPV. Even among those who had heard of HPV, knowledge was generally poor, and fewer than half were aware of the link with cervical cancer. There was also confusion about whether condoms or oral contraceptives could protect against HPV infection. Conclusions: In this relatively well educated sample, awareness and knowledge of HPV were poor. Public education is urgently needed so that women participating in cervical cancer screening are fully informed about the meaning of their results, especially if HPV testing is soon to be introduced. H uman papillomavirus (HPV) is widely acknowledged to be the most prevalent sexually transmitted infection (STI) in the United States 1 and elsewhere. High risk types of HPV are a necessary though not sufficient cause of the vast majority of cervical cancers. 2 In the United States, HPV testing is recommended for the triage of women with borderline smear results.3 A similar system is being considered in the United Kingdom, and HPV testing in primary screening has also been suggested. 4 Studies in the United States have found low awareness of HPV among women in university and healthcare settings. [5][6][7][8][9] In the United Kingdom, 70% of female university employees surveyed had never heard of the virus 10 and in a representative population sample, fewer than 1% recalled HPV as a risk factor for cervical cancer (unpublished data).It is critical that women participating in cervical screening are aware of HPV and its causal role in cervical intraepithelial neoplasia (CIN) and cancer. Information about HPV has been found to cause confusion among women with no prior knowledge of the virus or its link with cervical cancer 11 and smear results which mention "wart virus" are poorly understood. 12We assessed HPV knowledge among women attending a well woman clinic to gain an understanding of the level and accuracy of public awareness. METHODS ParticipantsParticipants were women attending the Margaret Pyke Centre, an NHS well woman clinic in central London. Speaking English was the only inclusion criterion. Participants' reasons for attending the centre are shown in table 1 and are broadly representative of the clinic as a whole. MeasuresKnowledge of HPV was measured using a series of questions similar to those used in other studies.6-10 Women who reported having heard of HPV were asked how they had heard about it. They also responded to six statements about HPV with "true," "false," or "don't know" (see table 2).Demographic characteristics and STI and cervical screening history were also assessed with si...