Women’s Health

HPV

Human papillomavirus (HPV) is the most common sexually transmitted disease in the United States. With more than 6 million new cases reported each year it occurs more frequently than trichomoniasis, chlamydia, gonorrhea, syphilis, genital herpes, HIV and hepatitis B combined!

images-Human-Papilloma-Virus-363x265The major implications of this virus for women are two-fold: first, it can cause venereal warts and second it has the capacity to cause cellular changes of the cervix that can lead to Pap smear abnormalities (usually transient and reversible) and, in rare instances, this virus can cause cervical cancer. Despite well-funded advertising campaigns that would have you believe otherwise, HPV is common while invasive cervical cancer is classified by the National Cancer Institute (NCI) as a rare disease.

It is estimated that at any one time there are 20-40 million cases of HPV infections in the U.S. (prevalence) and that over 6 million new cases occur annually (incidence). It is estimated that 75-80% of sexually active adults will acquire a genital tract HPV infection before the age of 50. The prevalence of cervical HPV infection decreases sharply in women after the age of 30. Those with persistent infection are at the highest risk for the development of high-grade precancerous lesions or invasive cervical cancer.

Human papillomaviruses are a group of viruses called “double-stranded DNA viruses”. There are over 100 types of human papillomaviruses (HPV) that can divided into two groups—those that infect the skin (such as plantar warts) and those that infect mucous membranes (such as the tissues in the vagina, vulva, the cervix and the tissue around the anus. Flat warts of the skin are most often caused by HPV types 3 and 10. Plantar warts, very common in children and adults, are most often associated with HPV types 1, 2 and 4. HPV types 16 and 18 are most commonly associated with pre-cancerous changes of the cervix. However, HPV types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68 and 69 are also associated with these pre-malignant changes. Genital warts, also called, condylomata accuminata, are frequently caused by HPV types 6, 11, 42, 43 and 44.

How do women get genital HPV infections?

Genital HPV is passed by skin-to-skin and genital contact, primarily during vaginal and anal intercourse. However, actual vaginal or anal penetration isn’t necessary to acquire this virus. Skin to skin contact with genital contact or “outercourse” can also transmit this disease. It might also be possible to pass it during oral sex—though this is probably rare in the absence of visible lesions.

How do I know if I have an HPV infection?

Most women who have HPV infections never know it! Pap tests are excellent tools for detecting HPV-related abnormalities. Your health care provider may also send an HPV test along with your pap smear to see if you are carrying a high-risk viral type. Another way you might know if you have an HPV infection is the presence of genital warts. These warts can grow inside the vagina, on the vulva or around the anus.

Who gave me HPV?

It isn’t always possible to answer this question. You may have acquired it from your current partner or from one of your past sexual partners.

Is my partner unfaithful?

Not necessarily! Your partner may have acquired HPV from a previous partner and unknowingly became an asymptomatic carrier (a carrier with lesions so small that he never noticed). In fact, you may have harbored the virus in an asymptomatic form and then developed an infection.

Is HPV forever?

About 90% of HPV infections are transient and clear within 3 years without a woman ever realizing that she had the virus. The younger the person is when she gets infected the more quickly it clears. Sixty to eighty percent of new HPV infections clear within 1 year. This is true of women who have skin or mucous membrane lesions as well as women with mild Pap smear abnormalities, such as mild dysplasia (click here). Approximately 90% of young women with mild dysplasia will spontaneously revert to normal within 1 year.

Do condoms protect against HPV?

The answer is “not completely” and perhaps not at all. Condoms do not cover the base of the penis, the scrotum, anus etc. The HPV virus is easily spread during foreplay without penile penetration. Condom use is only one “piece of the puzzle” in reducing the risk of STDs and not as important as lifestyle choices. Simply put, the greater your exposure to different sexual partners the greater your risk.

Should my partner use condoms?

Given the fact that HPV is very easily transmitted from one partner to the next it’s important to understand that condoms are of limited usefulness and then only partially helpful, even if used consistently.

What about the new HPV vaccine?

In 2006 Merck released its new HPV vaccine. This is a “quadrivalent” vaccine, meaning that it offers protection against 4 different HPV types (6, 11, 16 and 18). Remember that there over 100 various types of HPV and, therefore, receiving this vaccine provides only partial protection against genital warts and pre-cancerous changes of the cervix. The vaccine is best administered in children before they become sexually active. Since the vaccine has only been available in the U.S. for a relatively short period of time it has yet to be determined what its long term effect will be on reducing pre-cancerous changes of the cervix, cervical cancer and genital warts. It’s also unknown if the vaccine will require a “booster” 5 or more years later. And like any new drug that is released by the FDA it will take many years before it’s long term effects can be determined. For additional information on the new quadrivalent HPV vaccine.

Is HPV related to promiscuity?

Not necessarily. HPV has a very high prevalence rate in the population. Simply stated—it’s out there! HPV is the most common of all sexually-transmissible agents. Additionally, HPV has a much higher risk of transmission than herpes or HIV during a single sexual act.

When should I get my first Pap smear and how often should I get one?

The American Cancer Society recommends that you get your first pap smear at age 21 or within 3 years of becoming sexually active—whichever comes first. Since the Pap smear has been adopted over 50 years ago, this country has seen a sharp decline in the number of women suffering from invasive cancer of the cervix. Pap smears should be performed annually. Modern pap smears are both painless and accurate. The cells that are obtained can be tested to see if they are abnormal in appearance and even for the presence of cancer-causing viruses.

If my Pap smear is negative can I be assured that I don’t have HPV?

No. You can have HPV and still have a negative Pap test. And remember than most HPV types do not cause Pap smear abnormalities.

How are genital warts treated?

Genital warts cover an entire spectrum from being virtually undetectable to large masses with multiple lesions. Most warts, fortunately, are small measuring only millimeters in size. Some can be treated at home with a prescription medication called Podofilox. This agent is applied by the patient on an every other day basis for about 3 weeks. Other methods can be used in an office setting and include Podophyllin and trichloracetic acid, which is a caustic agent commonly used in the treatment of small genital warts.

For larger warts or warts that cover a larger surface area surgery may be recommended. Warts are easily removed by a variety of methods including, simple excision, cryosurgery (freezing), electrosurgery and laser surgery.