The subject of HPV (human papilloma virus) comes up a lot in my work. I have HPV discussions with my patients on a regular basis, so I thought I’d share the main points of the discussion I usually have with women. It usually begins when a woman’s pap smear comes back abnormal because the presence of the virus has caused her cervical cells to begin to change.
HPV is a very common sexually transmitted disease (STD). An estimated 75-80% of people will get HPV by age 50. There are more than 120 types of HPV and more are being discovered. HPV is responsible for warts on our hands, feet, genitals, and for cervical cancer. Most types are harmless and invisible. Even the kinds of HPV that cause genital warts are not associated with cancers. There are a few types that, when they travel to the cervix, are known to cause changes to the cells that can turn into cancer. Those types are considered high risk.
If you have HPV, there is no way we can tell you who gave it to you, or how long you have had it. We can tell you that 80% of people get rid of the virus in a year, 90% in 2 years. So statistics are on your side. If you are smoking, quitting can give your immune system a boost to fight off the infection. If you have warts (low risk HPV) you can either allow your body’s defenses to fight off the infection and the warts, or you can get them treated. There are some treatments we can prescribe for your use at home, or you can come in to have warts frozen.
If you have high risk HPV and abnormal cells on your cervix, we will refer you for something called a colposcopy. This is examination of your cervix under magnification. The provider may take biopsies if she sees abnormal areas. Based on the results of your colposcopy and biopsies, you will receive a recommendation on the next step. If the cells are not very advanced in their changes, your cervix does not need any treatment and we will most likely do paps more frequently for a period of time. If the cells are more advanced, they will need to be removed from the cervix. Having high risk HPV does not mean that you will develop cervical cancer. Cervical cancer is a preventable disease IF you follow all recommended steps for evaluation and/or treatment.
One of the reasons HPV is so common is that it is very easy to pass to sex partners. All it takes to give HPV to a sex partner is skin-on-skin contact. While condoms certainly reduce the amount of skin that touches skin, they don’t eliminate it altogether. So the risk is always there to some degree. We do have vaccines that can help prevent HPV before you get it. We carry the vaccine that protects against 4 types of HPV: the 2 types that cause most warts, and the 2 types that cause most cervical cancers. Even if you already have some form of HPV, you may still benefit from getting the vaccine. Ask us about it.
Since HPV is an STD, people want to know what to tell their partners. It is an important discussion to have. Talk about ways to protect your partner from the virus as much as possible (using appropriate barriers, whether your partners are men or women), but also include the encouraging statistics that by 2 years 90% of us will have cleared the virus. It is possible to get HPV orally and anally, and it is associated with cancers in both of those sites. However, since men do not have a cervix, the high risk strains of HPV that may cause cervical cancer in us do not affect them in the same way.
When we talk about all the different kinds of HPV, and how common it is, a lot of people ask to get tested for it. But there is no such test. Depending on your age group and other factors, we may test for high risk HPV only with your pap. But there is no test to look for every kind of HPV in every person. Since there are so many types, and the majority of them are benign, knowing if a person has one of the harmless types does not help us in any way. Knowing about the presence of a high risk type however, is very important to help prevent the development of harmful disease.
This is a lot of information. If the clouds have parted and you have a whole new understanding of HPV, great! If you have more questions than ever, also great! I love questions, in person, by phone, or by email at firstname.lastname@example.org.
Susannah Herrmann, ARNP