I get more questions about HPV — the human papilloma virus — from my patients in this quarter of their lives than any other age category. It is often a difficult conversation to let a patient know that they have been diagnosed with HPV and then discuss what happens next. Cervical HPV is most often the biggest concern for my patients, although HPV can cause other diseases as well. Many patients feel completely overwhelmed by this information, and then hit me with a litany of questions: “How did I get this? What is going to happen to me? Do I have cancer? How is this treated? Can I have children?” There are many myths out there about this virus, which can be very scary for women who are at risk for it or already know that they have it. I want to help clarify some of this information for the many women with HPV facing these questions.
What is it? HPV is a common family of viruses that are typically passed through skin contact. Certain strains are passed through sexual contact , for example, with oral, vaginal or anal sex.
Who gets it? It is estimated that more than 50% of sexually active people will get it during their lifetime, according to the Center for Disease Control.
How did I get it? It is typically transmitted with intercourse, although there is no way to know when the virus was transmitted to you. The virus can go undetected for years without causing any other health problems.
What does it cause? HPV can cause warts (especially in the genital area) and cancers (especially cervical cancer) depending on the type of HPV that a person has. It can also cause vulvar, vaginal and anal cancer. According to the World Health organization, “Virtually all cervical cancer cases (99%) are linked to genital infection with HPV, which is the most common viral infection of the reproductive tract.” There are more than 40 different subtypes of this virus. There are four types in particular that are of concern for women. These are called “high risk” types. Types 6 and 11 cause 90% of genital warts. Types 16 and 18 cause 70% of cervical cancer.
How do I prevent it? Regular condom use prevents the transmission of HPV. There are currently two vaccines on the market for HPV prevention. Both are recommended for ages 9-27 and prevent the most high risk types of HPV, but not all types. It is recommended for both males and females in this age range.
Is it curable or treatable? There is no cure for HPV, however, there are treatments for the diseases that it causes. If HPV persists and causes genital warts, there are topical treatments that can eliminate these warts (but won’t prevent them from returning). If an abnormal pap is a result of HPV infection, there are a couple of options. Your doctor may choose watchful waiting, in which a series of paps are done close together during a time period to see if your immune system combats the virus on its own. The other option involves colposcopy, which is an office procedure where a biopsy from the cervix is completed and sent to a lab for further evaluation. Further surgical procedures may be needed if cervical cancer is found.
How do I test for it? HPV is not a standard part of sexually transmitted disease testing. If you are under the age of 30 and have an abnormal pap smear, it will then be tested for HPV. Normal pap smears in this age group are not tested for HPV. This is because the immune systems of women in this age group often combat the virus and eliminate it on their own. All pap smears on women 30 and older are automatically checked for HPV, as women in this age group are more likely to have the virus persist if they are infected with it.
Does HPV cause cancer? HPV can invade the cells of the cervix and increase the chance that these cells can become abnormal, which could lead to cervical cancer over time. An abnormal pap smear on its own does NOT mean that a patient has cancer, just that there are cell changes.
Does this affect having children? Rarely. In cases where HPV causes cervical cancer requiring extensive cervical surgery, a patient may have difficulty carrying a pregnancy due to a shorter or less adequate cervix after the surgery. There are procedures to help with this, such as cerclage.
This can be a scary diagnosis for many patients, but the good news is that research is making progress in this area. The vaccines against HPV have been a huge medical advance and are the first vaccines that are known to prevent cancer. Regular condom use can help the prevention of contracting HPV and is always encouraged. If you have concerns about the virus, call your doctor for more information.
Dr. Sarah J. Wistreich is a staff physician at the Center for Women’s Health at Capital Health located in Hamilton, NJ. You can follow her on Twitter: @DrWistreich
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Please note: This information was current as of its post date. But medical information is always changing, and some information given here may be out of date. Please see your physician for the most up to date information.