HPV: It’s so “in” you didn’t even know you had it.

If you read last week’s blog, you now have a new appreciation for your annual gyne visit.  You know the difference between a pelvic exam and a Pap exam. You know that a pelvic exam can include a Pap, but realize that a Pap test only screens for cervical cancer.

Human Papilloma Virus(HPV) is the cause of cervical cancer.

It occurs in high risk as well as low risk strains.  Low risk strains can cause genital warts and high risk strains cause cervical cancer.  However, just because you have been infected with HPV does not mean you will develop cervical cancer.
HPV is the MOST common sexually transmitted virus in the U.S. and around 3 out 4 women who are sexually active have been infected with the virus by their early 20’s.
According to the U.S Department of Health and Human Services 20 million Americans  between the ages of 15-49 currently have HPV.
We now have more knowledge on the natural progression of cervical cancer–which is slow to develop, and the connection with the high risk HPV strains (16 and 18) that cause cervical cancer.
When we test for HPV we are only concerned with the high risk strains that can lead to cervical cancer.
If you had a positive HPV test recently, it could be from an infection you contracted years ago, or it could also be a new infection.  This is especially true if you are having unprotected intercourse with a new partner.
The point is, we have no way of knowing when you got it–just that you have it.  
Most of the time a women’s immune system will clear the HPV virus on it’s own, but in a small percentage of women it will not.  This persistent HPV can stay dormant in a woman’s body and later infect the cells of the cervix to cause pre-cancerous lesions called “dysplasia”.  These abnormal cells can overtime, if left untreated, develop into cervical cancer.  However, if a women receives routine Pap testing, a pre-cancerous lesions can be treated before it develops into cervical cancer.
The two most important ways to protect yourself against the HPV virus is using condoms and getting vaccinated with the HPV vaccine. 
The vaccine protects against 2 low risk strains 6 & 11 and 2 high risk strains 16 & 18.  It is administered to girls between the ages of 9-26.
Smoking increases the amount of HPV in your body and increases your chances of developing cervical cancer 2-3 times more than someone who doesn’t smoke.  
An excellent reason to stop smoking…..especially if you were recently diagnosed with HPV.

Back to the Pap….

–  A Pap test is a sampling of the cervical cells to detect any early changes that may indicate pre-cancerous cells
–  Cervical cancer is a slow growing cancer and very rare in young women before the age of 30.
–  Younger women will be infected more often with HPV but also tend to clear the HPV virus quicker than older women.
Because of these facts we are able to reduce the number of Pap tests women get over their lifetime so that we can minimize the harms of over testing while still getting the benefits of cervical cancer screening.  


What does this mean, really?  We know that younger women (under the age of 24) tend to be infected more with HPV.  If we routinely screen these women with Pap exams, we will start picking up more and more positive HPV tests.
These positive tests will lead to more cervical biopsies and cervical excisional procedures–this is where a part of your cervix containing the pre-cancerous lesion is cored out.
Most young women will clear mild pre-cancerous lesions on their own without the need for any harmful intervention. ( Note the emphasis on mild, a severe lesion is a different story and requires further testing.)
It is very important to follow up if you do have an abnormal Pap to assure that the lesion is resolving and that your Pap reverts back to normal.
Women over the age of 24 will need to get further testing and likely a biopsy for any abnormal Pap since our immune system is slower or less likely to clear the HPV virus at this point.
So, no need to get a Pap test before the age of 21 and thereafter only every 3 or 5 years depending on your age and only if your last Pap was normal.
Here is an abbreviated version of the recommended guidelines for cervical cancer screening:
– under the age of 21: No Pap testing regardless of sexual activity
– between 21-29 years of age: Pap only every 3 years
– between 30-65 years of age: co-testing high risk HPV and Pap test every 5 years
There are exceptions and adjustments to these guidelines based on specific circumstances.
Because not all patient populations have a reliable follow up and some patients are high risk, the guidelines are just that….Your doctor will use her own clinical judgment based on your individual history and risk factors and will treat you accordingly.
Please continue the conversation and let me know individual questions or cases you may have so we can be sure to address them in the more detailed HPV and cervical cancer blog to come.
Post your questions below.
As always:
get educated about your body, become engaged in your choices, and empower yourself to make changes in your lifestyle…and eventually in the world around you!