Dr. Price’s Medical Note of the Month-March 2009–HPV

Today’s number is 15.

in the past are still at risk of being affected.

HPV, or Human Papillomavirus, is a controversial virus both because of its climbing rate of occurrence and because of a new vaccine available to prevent it called Gardasil. HPV causes genital warts and abnormal cervical cells, which sometimes can lead to cervical cancer. It is the one sexually transmitted virus that we know that leads to cancer in women and some homosexual men. Because abnormal pap smears are the way we find HPV on the cervix, that makes it that much more important for women to stay up-to-date with their annual gynecologic exams.

Another reason HPV is controversial is because of the many different varieties that it comes in. The explanation I give to my patients is the lower number varieties (“low-risk” types 6, 11, 42-44) are usually the ones that cause common genital warts. Genital warts are flesh-colored outpouchings of the skin that can come and go. They can be removed with the use of liquid nitrogen freezing, acids and prescription creams used at home. They are contagious through sexual contact with infected individuals. Although these lesions can be annoying and somewhat uncomfortable, they are otherwise benign and do not lead to cancer.

The higher numbers (“high-risk” types 16, 18, 31, 33, 35, 45 and higher) are more associated with abnormal pap smears and cervical cancers. Does that mean if you have an abnormal pap, you have HPV? To this, I say no. If you have HPV, does that mean you have cervical cancer? No.

The following advice and recommendations come from national standards called USPSTF, or the Task Force, which I follow when counseling female patients about their maintenance. As women, we should all begin having annual exams, including pap smears, approximately two years after the first sexual encounter or at age 21, whichever comes first. Pap smears should then continue yearly or every other year until age 65 or until a woman has a hysterectomy for benign reasons (meaning without a previous history of cancer or abnormal pap smears prior to her surgery). However, if you’ve had significantly abnormal pap smears or cancer before you had a hysterectomy, you should continue having pap smears until 65. Yes it becomes confusing, but that’s why doctors exist.

Not all pap smears are tested for HPV. This is usually left to the clinician’s discretion based on a patient’s clinical history. When it is reasonable to do so, labs check for HPV presence on a pap smear. The results are then checked for whether the HPV is in the low- or high-risk category. If the pap smear itself is also abnormal, showing cells that may lead to cancer, patients are usually set up to have further investigation such as colposcopies or biopsies.

The last thing to note is that similar to herpes, HPV never completely goes away. The good news is low-risk types never turn into high-risk types, and Gardasil is here. Gardasil is a vaccine, split into three doses over six months, available for females from age 9-26 years. The idea is to start at a young age, before any sexual contact, to protect from both low-risk and high-risk types of HPV. Since it is fairly new, the jury is still out on what the true benefits will be. But based on the research, it’s a promising invention for a devastating disease that affects women, and I’ve recommended it for the large majority of my female population. One point of clarification is it does not treat those who have already been exposed to HPV but can prevent picking up another type.

As I mentioned above, the topic is a confusing one. We should all have our annual check-ups and regular follow-ups with our medical professionals to discuss all matters such as this.

  1. Nicole Price, MD, works for the Durham Family Practice in Durham. Contact her at 220-9800.

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