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What's All the Hype About HPV?

One of the most frequently asked questions in my practice is, "Should I get the new HPV vaccine? The FDA has recently approved a vaccine to immunize young women who have never been exposed to sexually transmitted Human Papillomavirus which will help prevent cervical cancer in their 40s or 50s. Because the potential to reduce cervical cancer is so desirable, most women want to take advantage of this option. But a lot of misinformation exists about the vaccine and who will benefit from it.

What is HPV?
The human papillomavirus is a sexually transmitted infection often not clinically detectable. Venereal warts of the female labia vagina, cervix, and periana area are the most common visible clues, but women can be infected and never develop warts. In fact, most of my patients discover they have been infected only after an abnormal pap smear and biopsy reveal the diagnosis, well before cervical cancer evolves. If a woman is exposed to the virus, she will develop antibodies to it and "clear it" in about a year. Younger women, 24 years of age and under, tend to clear the virus faster than those 30 years old and older. But there are over 100 different HPV viruses, about 40 of which can be found in the female genital area. The development of cervical cancer is restricted to a subset of viruses called "high risk" of which HPV16 and HPV18 together account for about two-thirds of all cervical cancer cases. Low-risk HPVs rarely lead to cancer, and then, other factors are usually necessary to allow that to happen, such as smoking, DES exposure in her mother's womb, immune deficiency from an illness or immunosuppressant drugs, multiple male partners, and age. Cervical cancer does not usually occur until a woman's 40s or 50s, and with regular pap smears, will be detected early enough in its pre-cancerous stage to provide appropriate treatment.

How do I know if I have it?
Routine pap smears are the best way to discover if you have been exposed to the virus and have not developed genital warts. If a pap smear comes back "abnormal cells", viral typing of the cells will determine if high-risk HPV strains are present, or a colposcopy with biopsy will be recommended. A special microscope allows the provider to see areas of abnormal tissue on the cervix, and pin-head sized biopsies are sent to the laboratory were a pathologist can determine the type and extent of the infection. If a woman is over 30, and has a normal pap smear, often we'll do viral testing to determine if the virus is active in her body, and if so, will repeat pap smears every 6 months to 1 year to stay on top of any progression of disease.

If I don't have it, how can I protect myself?
The most effective way to prevent HPV is to abstain from all sexual conduct. Mutually monogamous relationships are the next most effective prevention strategy. Before engaging in a sexual relationship, it is important to ask if a potential partner has ever had warts, or had sex with a partner who did have the virus. Since men don't experience any cancer outcome, the negative aspects are limited to the cosmetics of any visible warts. If a partner has warts, they can be removed, but shedding can occur until the virus is cleared from the body. Condoms offer only theoretical protection, since infections can occur in places not covered by a condom, such as the scrotum and perianal area. Condom use may reduce the risk of exposure, however, and should routinely be used.

If I have the virus, how did I get it?
Anyone who is sexually active can get HPV except those in a mutually monogamous relationship who have not had other partners. At least 75%of all sexually active women will have HPV in their lifetime. Direct skin-to-skin contact with someone who has HPV will spread the infection, including vaginal, anal, and oral sex. The virus will stay in the area of contact and not move to other parts of the body. The virus can be dormant and not cause warts, so many women have no clue how they acquired it.

How is it treated?
The actual warts can be removed in the gyn office, or a solution can be prescribed for you to apply before bed Monday, Wednesday, and Friday, for up to 4 weeks, to be washed off in the morning. The cervix is treated for dysplasia by a procedure called a LEEP, Loop Electrosurgical Excision Procedure, performed in the gynecologist's office under local anesthesia. With the abnormal tissue excised, and good immune support, pap smears done every 6 months until 3 are normal are usually what result. Then annual pap smears are resumed. Good immune support includes a diet high in whole non-processed foods rich in vegetables and protein and low in sugar and simple carbohydrates, adequate sleep, stress management, and regular exercise.

If I'm treated for HPV, can my partner re-infect me?
As long as you both remain mutually monogamous and do not introduce new strains into the relationship, you will maintain immunity to the types you've previously encountered.

What about pregnancy and genital warts?
During pregnancy, genital warts may become more severe, because of transient immune suppression. Treatment is usually delayed until after delivery, to evaluate the degree of spontaneous regression. Most babies born to a mother with genital warts have no complications, and Caesarian delivery is not necessary.

Should I get the vaccine?
The vaccine for HPV16 has been FDA approved for females 10 to 26 years of age, since they are the most likely to benefit from it. It is indicated for those who have not previously been exposed to HPV, and are likely to encounter it. It will confer protection from cervical cancer which won't appear till their 40s or 50s, so benefit from this vaccine won't be seen for many years. The vaccine is a series of 3 injections at 0, 2, and 6months, with one booster if necessary, and costs about $320.00. Insurance will pay for those for whom it is indicated, if the particular plan includes prevention. Future vaccines are in development for the other high-risk vaccines such as HPV6, 11, and 18, but it is predicted that the vaccine against HPV16 will prevent up to 50% of cervical cancer cases in the future.

In conclusion, routine use of condoms, limiting sexual exposure to mutually monogamous relationships, and annual pap smears unless not at risk for HPV are the way to prevent cervical cancer Be sure to address this issue with your gyn provider at your next annual visit, or sooner if you are concerned about it.

New England WomenCenter is a woman-centered health care practice founded in 1997. At NEWC we provide gynecological care for women of all ages with a caring, respectful approach.

 

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