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.

About Mark Seigel, MD

I'm an ObGyn with offices in Rockville and Germantown, Maryland. Our modern practice includes electronic medical records, advanced ultrasound, and in-office procedures. We offer gynecologic services, as well as normal and high risk obstetrics. I have three great partners, Drs Emily Gottlieb, Jennifer Jagoe and Supriya Mishra. We are part of George Washington University Medical Faculty Associates. I enjoy reading, swimming, and blogging.
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