HPV

(Excerpted from Figure Magazine. Click here for the article as it originally appeared.)

 

The TRUTH about HPV

From its link to cervical cancer to a new vaccine, HPV is in the news. Our health expert sorts out fact from fiction for information every woman needs to know about this sexually transmitted infection.

 

Human papilloma virus (HPV) is a common sexually transmitted virus. In fact, it's the most common; there are 100 types, most of which are harmless. HPV is not new; evidence suggests ancient Greek and Roman couples suffered from problems related to HPV. However, it wasn't until the 1970s that researchers identified HPV and linked it to abnormal Pap smears, genital warts and cancer.

No matter a woman’s age, she is at risk for contracting HPV. In addition, some types of HPV cause genital warts, and about 10 high-risk strains can lead to cancer of the cervix, vulva or vagina. That, in turn, increases a woman’s risk of cervical cancer; persistent infection with a high-risk strain of HPV is the leading cause of cervical cancer.

How Do I Know If I Have It?

There is a reason doctors urge all sexually active women to get a yearly Pap smear. The test detects cervical changes that can lead to cancer, and many forms of the test can determine whether a woman is carrying HPV. Most women who develop invasive cervical cancer have not had regular screening, the Centers for Disease Control says.

Genital warts, a form of HPV that is not usually cancerous, can sometimes be linked to vulvar cancers. It is possible for some women to determine if their partner has genital warts by applying a washcloth soaked in vinegar to the genitals; most warts will turn white (yes, people really do this).

However, this cannot tell for certain whether there is an infection. Warts can be microscopic, flat or more obvious, but they also can hide in skin folds or mucous membranes. For women, this home test is even less reliable since warts can reside in hard-to-see areas, including the vagina. Some warts are irritating and itchy, but most cause no symptoms.

Genital warts often go away on their own, but some require weeks or months of topical medication. Some very large warts may need to be removed surgically.

What Does a Diagnosis Mean?

HPV is responsible for most cervical cancers. However, fewer than 1 percent of all women get cervical cancer.

In most cases, a healthy immune system is able to clear the virus so new non-infected cervical cells can replace abnormal ones. Certain persistent types of HPV require monitoring. It takes years for pre-cancerous cells to turn into cancerous ones. Regular Pap smears ensure that if pre-cancerous cells appear, they can be treated early.

One of my patients, Sophie, learned of an abnormal Pap smear and assumed she would get cervical cancer and need to have a hysterectomy. That’s highly unlikely. In fact, 99 percent of women will not need a hysterectomy after an abnormal Pap smear. If your doctor says you have HPV, don’t panic. But don’t avoid that annual exam, either.

Condoms help prevent the transmission of HPV, but they don’t guarantee protection. Transmission of some virus forms is possible through skin-to-skin contact (“outercourse”). Because most forms of the virus have no symptoms, many people do not know they are carrying it.

Another patient, Julia, trusted her new boyfriend when he said he was free of sexually transmitted infections, and she had unprotected sex with him. She was shocked when I told her the small bumps outside her vagina were genital warts. Because most of the time there are no symptoms, it is possible he didn't know he carried the virus.

There is no way to determine exactly when the virus was acquired. For example, when I told Audrey, a patient who had been happily married for 10 years, that she had HPV, she was horrified—until I told her a new diagnosis does not mean it’s a new infection. It’s not unusual for HPV to lie dormant for years.

The FDA recently approved Gardasil, a vaccine that immunizes girls and women ages 9–26 against the four most common types of HPV. Gardasil is administered in three injections over the course of a year. It is primarily intended for young women who have never been exposed to HPV, but women of any age who are not in a monogamous relationship can benefit from it. If you already have HPV, the vaccine will protect you against any of the four strains you do not have.

One of my patients declared she was going to get the new vaccine and would no longer need an annual Pap smear. It’s not true. The vaccine protects against just four strains of the virus, so while it greatly reduces the chance of infection, it doesn’t eliminate it.

The vaccination costs about $700. Many insurance plans cover the vaccine for girls and women ages 9–26.

Did You Know?

• Ninety-eight percent of the 200,000 worldwide annual deaths from HPV-related cervical cancer occur in underdeveloped countries where regular Pap smears are not performed.
• By 50 years of age, at least 75 percent of women will have acquired genital HPV infection.
• The greatest risk factor for acquiring HPV is the number of lifetime sexual partners; the fewer partners, the lower the risk.
• 90 percent of HPV infections are transient and will be cleared by the body’s immune system within three years without treatment.
• Since the majority of HPV infections occur between age 18 and 25, routine vaccination of adolescent girls who have never been exposed to the virus could theoretically reduce the rate of cervical cancer by 75 percent in the next generation.

Watch Dr. Streicher talk about HPV on NBC's In the Loop with iVillage.