What You Need to Know About Human Papillomavirus (HPV)

>> Wednesday, January 2, 2013

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Hello everyone. I hope your Holidays were safe and happy.

Human papillomavirus (HPV) seems to be one of those infections women get that has a lot of rumors and misinformation associated with it. Some patients come in saying, "I have HPV and my doctor told me I have pre-cancer." Others come in worried because you have an abnormal pap smear and HPV infection and have been told that you have cervical cancer. HPV can, indeed, cause cervical, anal and oral cancer. It is also the cause of genital warts, but just having an abnormal pap smear and an HPV infection does not mean you have cancer or that you will ever get cancer.

HPV is the most common sexually transmitted infection in the United States. An estimated 20 million people are currently infected, and an estimated 6.2 million new HPV infections occur annually. HPV infection is common among adolescents and young adults. Prevalence among adolescent girls is as high as 64%. Up to 75% of new infections occur among persons 15–24 years of age. It is estimated that more than 80% of sexually active women will have been infected by age 50.

About 11,070 new cases of cervical cancer will be diagnosed in the United States a year, and, of those, approximately 3,870 women will die as a result of cervical cancer. HPV is believed to be responsible for nearly all of these cases of cervical cancer. HPV types 16 and 18 are associated with 70% of these cancers.

HPV is classified as either high- or low-risk types. The low-risk types do not carry a risk of cancer, but can cause genital warts, and, for some women, an increase in discharge, negative culture results and no treatment. Low- and high-risk HPV infections can just come and go, and even spontaneously resolve. High-risk types, if persistent, are the ones tested for on pap smears and will cause cancer if they do not resolve. The high risk types are: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 69, 73 and 82.

In addition to cervical cancer, HPV is believed to be responsible for 90% of anal cancers, 40% of vulvar, vaginal, or penile cancers, and 12% of oral and pharyngeal cancers. Population-based estimates, primarily from clinics treating persons with sexually transmitted infections, indicate that about 1% of the sexually active adolescent and adult population in the United States have clinically apparent genital warts. More than 90% of cases of anogenital warts are associated with the low-risk HPV types 6 and 11.

HPV is transmitted by direct contact, usually sexual, with an infected person. Transmission occurs most frequently with sexual intercourse but can occur following nonpenetrative sexual activity. Studies of newly acquired HPV infection demonstrate that infection occurs soon after onset of sexual activity. HPV transmission can be reduced, but not eliminated, through the use of condoms and recent studies demonstrated a significant reduction in HPV infection among young women after initiation of sexual activity when their partners used condoms consistently and correctly. Abstaining from sexual activity is the surest way to prevent genital HPV infection. For those who choose to be sexually active, a monogamous relationship with an uninfected partner is the only sure way to ever prevent HPV infection.

The reason I bring this up is because there is so much conversation that HPV is only caused by risky behavior, when the truth is, if you are virgin and marry or have your first sexual experience with someone who has HPV you can get it that fast just like getting any other sexually transmitted disease.

We've heard it said that Risk factors for HPV infection are related to sexual behavior, including the number of sex partners, lifetime history of sex partners, and the partners’ sexual history. Most studies
suggest that young age (less than 25 years) is a risk factor for infection.
Most cases and deaths from cervical cancer can be prevented through regular Pap tests at your gynecologist.

I hope this will help you understand more about HPV. Have a wonderful New Year.

Dr. Susan Boyd, MD
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