FDA warns about using morcellation to remove uterine fibroids

The FDA on April 17, 2014 took a rate step of advising doctors to not remove uterine fibroids by a technique known as open power morcellation. This technique had become very popular as a tool used during minimally invasive gynecologic surgery as tumors can be removed during small abdominal incisions, reducing the pain of surgery and decreasing the time needed for the patient’s recovery. It is estimated that in the U.S. approximately 55,000 to 70,000 women have morcellation-aided hysterectomies every year. Gynecologists knew from the beginning that morcellators can drop bits of tissue. It was also suspected that in rare cases that a fibroid tumor can contain a hidden cancer. A study from South Korea in 2011 raised interest in this issue by showing how morcellating these tumors was more likely to spread cancer and worsen survival rates. The issue got even more attention in December when a 41 year old anesthesiologist at Boston’s Brigham and Women’s Hospital, Dr. Amy Reed, had inadvertent morcellation of a malignant tumor that resulted in a worse prognosis.Dr. Amy Reed

The FDA’s statement says it “discourages the use of laparoscopic power morcellation for the removal of the uterus (hysterectomy) or uterine fibroids (myomectomy) in women … because it poses a risk of spreading unsuspected cancerous tissue.”
“Based on currently available data, approximately 1 in 350 women who are undergoing hysterectomy or myomectomy for fibroids have an unsuspected type of uterine cancer called uterine sarcoma. … A number of additional treatment options are available for women with symptomatic uterine fibroids, including traditional surgical hysterectomy (performed either vaginally or abdominally) and myomectomy … performed without morcellation.“

The morcellation debate has sparked a big change: several hospitals including Brigham, Temple and Massachusetts General now say they require doctors for the first time to advise women about the cancer-spreading risk. What women do with that information is up to them. But, compared with a few months ago, they have a better chance to weigh the consequences as well as the benefits of less invasive surgery.

Hereditary Cancer Risk

The field of medicine is changing rapidly through the advances made by genomic technology. We are on the verge of an exciting era where we will be able to have personalized medical care and treat each person based on his or her individual risks. For example, every woman fits into one of three risk categories for breast cancer. A person may face only a sporadic risk with the same risk as the general population, or their risk may be increased due to a positive family history, or increased even more if they are discovered to have an inherited genetic risk.  Focusing on a person’s family history gives us the opportunity to detect those people who face a significantly increased danger of developing cancer and then use proven successful strategies to reduce that risk.Geneticsmutations

Cancer screening depends on risk. Women who face only the sporadic risk of breast cancer do not need additional screening beyond that for the general population: regular mammography starting at age 40. Those who have an increased risk due to family history or who have dense breasts would benefit from more frequent screening with mammography, breast ultrasound or breast magnetic resonance imaging starting at least 10 years prior to the age of cancer diagnosed in their youngest affected relative. A small number of women carry the highest risk for gynecologic cancer due to having a defective gene. BRCA gene carriers, for example, should have testing started 15 years earlier than average, and usually benefit from oral contraceptives to decrease the risk of ovarian cancer. They also benefit from surgery to reduce their risk such as preventative removal of the ovaries, as otherwise the risk of ovarian cancer can be as high as 44% by age 70.

There are about 1 million people in the United States carrying genes for the most common hereditary gynecologic cancers: BRCA and Lynch syndrome. Hereditary Breast and Ovarian Cancer syndrome (HBOC) is seen in approximately 10% of breast and ovarian cancer patients. This autosomal dominant genetic disorder is caused by mutations in tumor suppressor genes BRCA1 and BRCA2. Red flags for HBOC syndrome include a three generation family history positive for breast cancer prior to age 50, bilateral, triple negative or male breast cancer, ovarian cancer at any age, prostate, pancreatic or melanoma cancer under age 50, Ashkenazi Jewish population, or a known BRCA mutation in the family.

About 20% of colon and endometrial cancers are associated with a strong family history of cancer. 5% occur in autosomal dominant genetically defined high-risk syndromes such as Lynch syndrome. Risk factors for Lynch syndrome include colorectal or endometrial cancer before age 50, colorectal cancer in 2 generations on the same side of the family, ovarian or gastric cancer at any age, and 2 or more individuals with colon, endometrial, ovarian, gastric, brain, biliary, pancreatic, or small bowel cancers.Geneticsreduce

Cancer risk assessment is one of the key parts of the annual well woman exam. Standard pap testing has been successful in reducing cervical cancer, and so too can screening for hereditary cancers result in cancer prevention and early detection. Knowing one’s cancer risk can guide lifestyle choices and the choice of medications that can safely decrease cancer risk. 10% of people carry increased cancer risk, and approximately 6% of people have increased genetic family risk that makes them eligible for testing to determine if their risk is greatly higher than was previously thought. If positive, this result can have a positive impact on not only the patient, but also their relatives and their descendants.

With our understanding of cancer genetics progressing rapidly, knowing one’s detailed family history and then determining who is at increased cancer risk can be of great value in having a safer, healthier life.

Cell free DNA for Prenatal Genetic Testing

HarmonyPrenatal detection of chromosome abnormalities has been available for over 40 years. Amniocentesis started in the early 1970s and then chorionic villus sampling (CVS) in the 1980s. Given that increasing maternal age is associated with a higher risk of genetic abnormalities such as trisomy, the main use for testing used to be for testing offered to pregnant women 35 and older. But, according to the American Congress of Obstetricians and Gynecologists, all pregnant women should be offered prenatal testing for chromosome abnormalities.

What is a trisomy? Humans have 23 pairs of chromosomes, which are strands of DNA and proteins that carry genetic information. A trisomy is a chromosomal condition that occurs when there are 3 copies of a particular chromosome instead of the expected 2.

Trisomy 21 is due to an extra copy of chromosome 21 and is the most common trisomy at the time of birth. It causes Down syndrome, which is associated with mild to moderate intellectual disabilities and may lead to digestive issues and congenital heart defects. Down syndrome is present in 1 out of every 740 newborns.

Trisomy 18 is due to an extra copy of chromosome 18. Trisomy 18 causes Edwards syndrome and is associated with a high rate of miscarriage. Infants born with Edwards syndrome may have multiple medical problems and a shortened life. It affects 1 out of every 5000 newborns.

Trisomy 13 is due to an extra copy of chromosome 13 and causes Patau syndrome, which is associated with a high rate of miscarriage. Infants born with it have congenital heart defects and rarely live more than a year.

Sex chromosome conditions involve the X and Y-chromosomes, which make us male or female. Testing can determine the presence of an extra copy of one of the sex chromosomes (Klinefelter syndrome) or the absence of one copy (Turner syndrome).

Although young women have a low risk of conceiving a child with Down syndrome (trisomy 21), the majority of pregnant women are in their teens, twenties and early thirties. For these women having an invasive test (amniocentesis and CVS) is not a good option as the risk of complications from the procedure is greater than the chance of finding a genetic abnormality.

For this reason, a number of non-invasive prenatal tests (NIPT) have been developed, including first trimester genetic screening (NT test), maternal blood testing (AFP test) and ultrasound evaluation at 18-22 weeks. All of these tests have limitations in their accuracy and their need for follow-up confirmation by additional testing.

For years scientists have been looking for a more powerful test, safe, accurate and specific. It appears it may now have been discovered in the test called cell-free DNA.  Direct analysis of fetal cells in maternal circulation is limited by their scarcity; only about 1 in a million cells in maternal circulation are fetal in origin. But the fetal DNA has been found in much greater amount. There are now many confirmed reports of the successful analysis of cell-free DNA for non-invasive prenatal testing for chromosomal abnormalities such as Down syndrome.Chromosome

Fetal DNA accounts for 3-13% of the total cell free maternal DNA. The test can be performed as early as 10 weeks gestation. The sensitivity for trisomy 21 (Down Syndrome) is high, about 99% with a low false positive rate, less than 1%.

Cell Free DNA is a screening test with the advantages of early detection, high sensitivity and low false positive rates. The disadvantages of it include that it does not test for other abnormalities such as Neural tube defects and only screens for trisomy 13, 18, 21 and sex chromosomes. There is only limited experience with the analysis of twin pregnancies and in very overweight women. The main disadvantage is that it can cost between $795 and $2762.

Currently cell free DNA testing is recommended for women of advanced maternal age (35 or older), women who had a prior child with trisomy, and those with abnormal prenatal screening results. In the future, as the test gathers more experience and if the cost becomes less, cell free DNA may be offered for genetic screening of all pregnant women.

 

Morning Sickness of Pregnancy

Charlotte Bronte 1854Some of my patients have nausea and vomiting of pregnancy to such an extent that they have the severe symptoms of persistent vomiting, acute starvation (with ketones in the urine) and weight loss more than 5 per cent of their usual pre-pregnancy weight. We call this hyperemesis gravidarum but most people call it pregnancy morning sickness.

50% of pregnant women have nausea/vomiting in early pregnancy. It usually peaks at 9 weeks of gestation and in most cases will resolve by the end of the first trimester. It is associated with a decreased risk of spontaneous miscarriage.

Queen Victoria

Queen Victoria

A number of famous English women have suffered from it. Charlotte Bronte, the novelist and poet who wrote Jane Eyre, died at age 38 in the 4th month of her pregnancy of severe nausea and vomiting.  Queen Victoria had 9 children, hated being pregnant, viewed breast-feeding with disgust and thought babies were ugly. She used marijuana to treat her morning sickness and also for childbirth pain. Kate Middleton, Duchess of Cambridge was hospitalized due to acute morning sickness. Her hospital stay was marred by invasion of privacy and suicide of one of her nurses.

Kate Middleton

Kate Middleton

In the 1950s and 1960s the most widely prescribed drug for treatment was Bendectin, a combination of Vitamin B6 and doxylamine, an antihistamine. It was a safe and effective treatment. The manufacturer, Merrill Dow Pharmaceuticals was bombarded with lawsuits that claimed it caused birth defects. Despite clear scientific evidence that Bendectin did not cause birth defects, lawyers prevailed over science and in 1982 the drug was withdrawn from the U.S. market to avoid further litigation expenses. A similar medication, Diclectin continued to be prescribed in Canada and its’ increased use there was found to result in a decrease in hospitalizations for this condition.

There are many theories on the cause of nausea and vomiting in pregnancy. It is thought to be an evolutionary protective response against eating foods that could be harmful to pregnancy. Some believe that it is due to increased levels of the pregnancy hormone HCG as it is more often found in twin and molar pregnancies that usually have increased HCG levels.

Treatment of morning sickness starts with the proper diet: small frequent meals with avoidance of spicy, fatty or odorous foods. Meals and snacks should be eaten slowly and in small amounts every 1 to 2 hours to avoid a full stomach. Women who feel nauseous should eat as soon as they feel hungry to avoid an empty stomach. A snack before getting out of bed in the morning can help. Pretzels, nuts, crackers, cereal and toast are often tolerated well. Cold, clear, carbonated or sour fluids in small amounts can help. Ginger ale, lemonade, and popsicles are good. Fluids are sometimes better if taken in with a straw.

Avoidance of triggers is useful. Some triggers include stuffy rooms, strong odors, heat, humidity, noise, visual and physical motion. Brushing teeth after a meal can be helpful. Supplements containing iron should be avoided as they can cause gastric upset. Taking prenatal vitamins before bed with a snack is better than taking them in the morning on an empty stomach.

Treatment of morning sickness may sometimes require medications. The FDA has recently approved a new formulation Diclegis for treatment of pregnant women experiencing nausea and vomiting. The medication is similar to Bendectin but has the advantage of a delayed-release tablet that works overnight. The usual dose is 2 tablets taken at bedtime. It’s two ingredients are both rated Category A for pregnancy, the safest FDA rating. Another medication that is widely used is Zofran (Ondansetron). It is rated Category B, also considered safe, and may have minor side effects of constipation, diarrhea, and fatigue.

In some patients these medications are not successful and hospitalization may be needed to give i.v. fluid therapy and improved nutrition through gastric tube feeding. There can be severe complications of nausea/vomiting of pregnancy including maternal depression, damage to the esophagus, and kidney damage. The fetus has an increased risk of low birth weight, but actually a decreased risk of miscarriage.

Morning Sickness of pregnancy is a common condition that interferes with normal daily life and can cause serious consequences. Having the optimal diet, avoiding triggers, and taking medications when needed usually results in the symptoms improving over time and a healthy baby at the end.

 

Vaccinations for Pregnant Women

vaccine-imageMany people don’t understand the need for immunization because they have not personally been exposed to the devastating effects of infection or disease. But the danger is there: according to a report from Trust for America’s Health, approximately 50,000 Americans die every year from vaccine-preventable diseases or their complications, during the influenza season 5-20% of the U.S. population becomes infected with seasonal influenza virus, and by age 50 years 80% of women become infected with human papillomavirus (HPV). The American Cancer Society estimates there are 12,000 new cases of cervical cancer and 4,000 deaths from it each year. Rates of hepatitis B are highest among adults, with 45,000 new cases per year.

The need for immunization may be more closely associated with infants and toddlers, but vaccines like influenza and pneumococcal pneumonia have long been recommended for adults. More recently, new vaccines such as HPV, shingles, and tetanus, diphtheria and pertussis (Tdap) have become available and are recommended for adults.

Pregnant women who are vaccinated can transfer some of their protection to their newborns for the first 2 months of life. For example, the overwhelming majority of illness from pertussis (whooping cough) infection occurs in infants who are less than 3 months of age. Since infants do not begin their vaccinations until age 2 months, there is a time of vulnerability for newborns when they can become ill with this serious disease. Since 2006 the Centers for Disease Control and Prevention (CDC) has focused on decreasing pertussis in newborns. The current recommendation is to immunize during pregnancy at any time, but optimally just prior to expected delivery, during 27 to 36 weeks of gestation. However, there may be compelling reasons to vaccinate earlier in pregnancy. There is no evidence of adverse fetal effects from vaccinating pregnant women with an inactivated virus or toxoid, and increasing data shows more and more vaccine safety. If Tdap vaccine was not administered during pregnancy it can be given in the postpartum period to reduce risks to the newborn, and additionally other family members and direct caregivers can receive the vaccine to enhance protection “cocooning.”

Vaccination is one of the most important things you can do for yourself and for your baby. It can protect against diseases that can make both of you seriously ill. Vaccination is safe for both of you. For example, flu vaccine has been given safely to millions of pregnant women for more than 50 years.

Thimerisol, a type of mercury, is an ingredient in some vaccines. It has not been shown to be harmful to pregnant women or unborn babies, and it does not cause autism.  The benefits of preventing life-threatening illnesses far outweigh any potential risks of the vaccine.

The American College of Obstetricians and Gynecologists strongly recommends vaccine administration. The benefits of nonlive vaccines outweigh any potential unproven concern. The following is a table on vaccination during pregnancy and more information can be found at ACOG’s immunization web site, http://www.immunizationforwomen.org.

Vaccination-HeadlineVaccination-table

Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is thought to be one of the most common endocrine abnormalities in women, affecting between 6.5-8% of all women. Clinical features include menstrual dysfunction, hyperandrogenism (increased amount of male hormones), polycystic ovaries, metabolic problems, and an increased cancer risk.

Diagnosis:

  • Menstrual dysfunction shows itself as infrequent or absent ovulation. This can result in infertility and need for ovulation treatment for those wanting to conceive. The menstrual pattern is typically fewer than 9 periods a year (oligoamenorrhea) or no periods for three months or more (amenorrhea).
  • Hyperandrogenism is characterized as acne, hirsutism and male-pattern hair loss. Depending on which androgens are measured, 50 to 90 % of women have elevated androgen levels such as total testosterone, free testosterone and DHEAS.
  • Polycystic ovaries are seen by ultrasound and usually show 8 to 10 small follicles in the periphery of the ovary revealing a “string of pearls” appearance.string of pearls
  • Metabolic issues can include resistance to the effects of insulin, greater insulin levels, obesity, and a greater risk of Type 2 Diabetes. If the condition is not treated over a long period of time the result of too much estrogen can cause an increased risk of endometrial hyperplasia, which can lead to uterine cancer.

PCOS treatments are very helpful at reducing the symptoms and risks of this condition. The right treatment can lead to a normal outcome.

Treatment:

  • Birth control pills are the most commonly used treatment for regulating periods in those women who are not ready for pregnancy yet, and also pills are effective at reducing extra hair growth.
  • Weight loss is very effective in restoring normal ovarian function. Many overweight women with PCOS who lose 5 to 10 % of their weight will notice their periods become more regular.
  • Metformin is a medication that improves the effectiveness of insulin produced by the body. It is a treatment for Type 2 Diabetes but can also improve menstrual function.
  • Clomid is the most effective medication for achieving pregnancy. It stimulates the ovaries to release eggs in a regular monthly cycle.

With proper diagnosis and the right treatment we can achieve excellent results in minimizing the problems of this condition and leading to a normal life with regular menstrual cycles, good birth control and fertility when it is desired.

 

What Qualities do Women Want in an OBGYN?

I recently read an insightful article that gave a good summary of the qualities women are obgyn picseeking in an OBGYN. Recent reports show that many young women prefer female physicians compared to their male colleagues. Assuming that physicians are knowledgeable and skilled, is it communication skills that give female OBGYNs the edge?

To better understand the softer side of feminine communication, here’s a list of techniques for improving your communication skills during the patient-doctor visit. Being caring and compassionate is a good place to start. Beyond that, in your patient encounter:

  • Introduce yourself with a warm greeting or handshake, showing politeness, respect and approachability.
  • If possible, be sitting down to show that you have time to listen to all the reasons for the visit.
  • Repeat back to the patient your understanding of her concerns to show that she has been heard.
  • Try to warn in advance about any parts of the exam that might be uncomfortable. If you cause pain such as by drawing blood, or palpating a tender spot, say you are sorry for causing the discomfort but that it has to be done as part of the exam.
  • Give good instructions about medication use and show you are interested in her understanding what she needs to do.
  • Offer resources for more information to facilitate doing individual research about the topics that were discussed.
  • Give a good send off at the end of the visit by saying “Thanks for coming in” or “See you again next year” to show you appreciate her coming in for a visit. Sometimes the most important concern will be expressed as the patient gets up, walks to the door and stops, just before leaving.
  • Be a hero with the patient by following up on tests, returning calls or emails and being available to address concerns.

Being approachable, making time for the patient, helping her to be at ease during an exam,  listening to and caring about her concerns, and giving a good explanation about plans for treatment makes the OBGYN a physician whom patients look forward to see.

 

Gestational Diabetes now has a new test.

Diagnosing GDMGestational Diabetes mellitus (GDM) is carbohydrate intolerance that begins or is first recognized during pregnancy. It is associated with increased maternal, fetal and neonatal risks. The prevalence of it is increasing in the U.S. probably due to the increasing rates of overweight and obesity. Testing for GDM may be about to be going through some changes.

The American College and Obstetricians and Gynecologists recommends a two step test, with a screening test being given between 24-28 weeks of pregnancy. If the test is not passed then a 3 hour glucose tolerance test is done to diagnose GDM. If the first and second tests are both positive, then the person has gestational diabetes mellitus, and the pregnancy is managed differently to minimize the additional risk.

In 2013 the American Diabetes Association decided that new guidelines for diabetes are to be promoted. The new standards of care are intended to provide clinicians and patients with the components of diabetes care, treatment goals, and tools to evaluate quality of care. Targets that are desirable for patients are provided.

Diabetes will now be classified as Type 1 where there may be absolute insulin deficiency, Type 2, a progressive lack of insulin secretion on the background of insulin resistance, and Gestational diabetes mellitus, diabetes diagnosed during pregnancy that is not clearly overt.

The diagnosis of diabetes used to be based on glucose measurement, either fasting or the 2 hour value during a glucose tolerance test. Recently an expert international panel has recommended that diabetes can also be diagnosed by a different test called hemoglobin A1C. The A1C test has advantages, including greater convenience, since fasting is not required, and greater analytical testing stability. The older established criteria of fasting blood glucose and 2 hour oral glucose test still remain valid.

These new criteria are: a A1C test over 6.5, or a fasting glucose over 126, or a 2 hour plasma glucose over 200 during an oral glucose tolerance test using 75 gm of glucose.

To accommodate this change, we will be starting to check the hemoglobin A1C level during the initial obstetric evaluation. I expect this will yield better diagnosis of gestational diabetes, with the benefit of better control. This should result in a decreased risk of having babies that are too large, lower chance of having a cesarean, less risk of having diabetes in the future and fewer problems with babies having breathing problems, low glucose levels, and jaundice.

Reference: doi: 10.2337/dc13-S011

Diabetes Care January 2013 vol. 36 no. Supplement 1 S11-S66

Should Doctors and Patients be Facebook Friends?

SM iconsOne of the groups I’m involved with is the Physicians’ Electronic Health Record Coalition, or the PEHRC (pehrc.wordpress.com). Recently we were honored to have as our guest Dr. Humayan Chaudhry who is the CEO and President of the Federation of State and Medical Boards (FSMB). His organization is responsible for coordinating physician activity in the United States to help maximize patient safety. One of the subjects he discussed at our meeting is the huge increase in the use of social media by patients and by physicians, and how this practice is changing the way we practice medicine.

According to a recent survey, 87% of physicians use a social media website for personal use and 67% for professional use.  Also 35% of physicians have received Facebook friend requests from a patient and 16% have visited an online profile of a patient. Of the physicians who have received friend requests from a patient, 58% said they always rejected them. Some physicians feel that “friending” a patient through a personal Facebook page crosses the line between a professional and a personal relationship.

Dr Chaudhry’s group, the FSMB, has published guidelines for the appropriate use of social media in medical practice. Physicians are discouraged from interacting with patients on personal social networking sites like Facebook and physicians should never discuss treatment with patients on a personal social networking site. Information that could identify patients should never be provided. Patient privacy and confidentiality must be protected at all times. Physicians are encouraged to use separate personal and professional social media networking sites.

I think these guidelines make good sense. Social media have confused the distinctions between personal and professional identities. Some healthy separation is in order. So, if you are a patient, please don’t send me a request to be your Facebook friend. I’m honored to be your doctor, but I can’t cross the line between professional and personal by being your Facebook friend as well.

 

All about HPV

HPv imageThere’s a lot of misunderstanding about HPV. If you get a phone call that your pap test is not normal, people tend to jump to the worst possible conclusion and believe that they now have cancer. In the great majority of cases there is no cancer at all, and what we are dealing with is a condition that might lead to cancer in the distant future if it is not properly treated.

HPV is a virus spread through vaginal, oral or anal sex through direct skin to skin contact. Sexual intercourse is not required to get it. It’s very common, and research suggests between 50 to 75% of all people who have sex will get it at some time during their lives. In most cases HPV exhibits no symptoms and in 90% of cases the immune system clears it within 2 years.

There are more than 100 types of HPV. About 12 types of HPV can cause genital warts. These types are called “low-risk” because they have very low cancer potential. About 15 types of HPV can cause cancer of the anus, cervix, vulva, vagina and penis, as well as cancer of the head and neck. These types are called “high-risk.” Just 2 types – 16 and 18, cause most cases of cervical cancer.

HPV harms the cervix by infecting cells, which may become abnormal and begin to grow differently. These changes may lead to cancer. They are known as dysplasia and are classified as mild, moderate, or severe. Both low risk and high risk HPV can cause abnormal cells to grow, but only the high-risk types increase the risk of cancer.

HPV infections that are not cleared by you body’s immune system are called persistent. Young women get rid of the virus quicker than older women. Also, women who smoke are more likely to have the virus persist. The longer the virus persists, and the older the woman, the greater the chance of developing pre-cancer of the cervix. When HPV is present, smoking doubles the risk of progression to severe dysplasia.

Men and women can pass HPV to each other. Since HPV usually does not cause any symptoms, if you have more than one partner over time it’s not possible to know who passed it to you, even if you are currently monogamous. In many cases an abnormal pap test result is from an exposure that happened years ago.

The pap test is the main screening test for early signs of abnormal growth in the cervix. Regular use of pap tests has greatly reduced the number of cases of cervical cancer in the U.S. An HPV test is also available and can identify 15 different high risk types. Currently, there are NO approved tests to detect HPV in men! While cervical cancer is the most common type of cancer associated with HPV, the virus can also lead to oral and anal cancers in men and women. It’s possible that in the future with the successful detection and treatment of cervical pre-cancer, the oral and anal cancers may become more common than cervical ones.

Abnormal pap results are usually evaluated by an office procedure called colposcopy. This looks at the cervix with magnification and a biopsy is taken to provide a more definite diagnosis. In many cases no treatment is needed. If a biopsy shows an abnormal finding, the type of treatment is determined by the woman’s age, the type of abnormal result (mild, moderate or severe) and how long the abnormal cells have been present. The LEEP procedure is one of the more common treatments used to remove pre-cancer. It’s effective and has a high rate of cure.

Prevention of HPV is best as there is currently no medication or treatment that completely destroys the virus. Limiting your number of sexual partners and using condoms will help protect you against HPV, herpes and other STDs. Condoms won’t protect you against virus transmitted through oral sex.

Vaccines are available to help protect against the worst types of HPV. The vaccines increase your immune response to fight the viruses. The vaccines are given in 3 doses over six months. The vaccines work best if they are given before the person has had sex. They can still be given if you are already infected with one type of HPV and will protect you against the other HPV types the vaccine prevents. The vaccines are not recommended for pregnant women but can be given during breastfeeding.

Getting vaccinated, limiting your exposure, and getting screening for cervical cancer and any follow-up tests that are recommended are the best ways to prevent the worst complication of HPV, cervical cancer.