HPV - Human Papillomavirus: What You Need to Know

I know many of you are worried when you are sent to me from your primary care doctor (or return after a pap I have done showing abnormal results) with dysplasia or Human papillomavirus - HPV. HPV is the name for a group of more than 100 types of viruses; more than 40 types of HPV can be passed through sexual contact.

We may feel like we are the only ones who have such a thing when we get it, but HPV is so easy to get and so common that over 70% of sexually active people will have HPV at some point in their lives. In fact, HPV is the most common STD in America, with well over 25 million cases and rising. Some people will never know they even have it because they never break out with warts or never have an abnormal pap test. HPV usually has no symptoms, but can have periods of flaring up and then hibernating. Most of the time there are no signs of infection or "flare ups" (such as abnormal discharge or itching) to alert us of a problem.

The pap test is designed to detect abnormalities of cervical cells and also HPV infections. The pap test will focus on High Risk abnormalities, as these types are known to cause cervical cancer. Low Risk types can cause genital warts - which are obvious when they are present and which can be removed. The HPV that causes cancer cannot be seen visibly when your doctor looks at your cervix or anal area. HPV is a flat warty virus that is invisible to the naked eye. The vaccine focuses on preventing only the top High Risk types of HPV.

If you have an abnormal pap test it is important to follow-up for further testing by your doctor to determine the reason for it. Sometimes yeast or bacterial infections, cervical irritation or hormone changes can be the cause. An abnormal pap does not always mean HPV infection or cervical cancer. A colposcopy is often done to help your doctor see the abnormal tissue on the cervix. It is a lot like getting a pap smear except a special magnifying scope can be used with a strong iodine solution or acetic acid solution that causes the HPV to show up white. This helps your doctor know where to do a biopsy to send a sample to pathology for further evaluation. Some colposcopies are being done with colpo biopsy brushes which are much faster and less painful.

If you do have HPV, there are different ways it can be treated right in your doctor's office. Using Cryosurgery, abnormal tissue is frozen off. The Loop Electrosurgical Excision procedure (LEEP) uses a hot wire loop to remove tissue. Laser treatment uses a beam of light to destroy abnormal tissue.

Cone biopsy, where a cone-shaped sample of abnormal tissue is removed from the cervix and looked at under the microscope, is done in the operating room and reserved for instances when biopsies show early signs of cancer. This biopsy also can serve as a treatment if all the abnormal tissue is removed.

If you have had the HPV vaccine, it does not mean you do not need to worry about HPV or about getting a pap test. HPV can lay dormant for years, and even undetected HPV can show up after the vaccine because the vaccine does not cure HPV. It simply prevents us from getting infected or reinfected.

Being in an exclusive relationship is the best way to prevent HPV infection or reinfection. Note, condoms don’t always protect you from HPV. But, they may reduce your risk of getting genital warts and other STDs.

Just remember, the best thing is to follow up with your doctor and get your annual pap smears, so you know you are healthy. Encourage your partner to visit the doctor as well.

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Is There Treatment For HPV?

 " I've been told I have HPV and I wanted to know if there is any treatment for it?"

HPV is a virus that is acquired through sexual contact. There are over a hundred types of HPV. Some can cause visible condyloma (a growth resembling a wart) and other types infect cells internally. When the cells are infected internally, the virus can take over the cell & start causing tissue changes consistent with early signs of cancer. These early changes are called dysplasia, and are not cancer, but if left untreated can eventually become cancer.

Condyloma are seen on the labia majora and labia minora, mons pubis, vaginal opening and around the anus.  These can be treated with prescription solutions that can be applied at home. Many women choose to have them removed surgically using a CO2 laser. This is much quicker, less painful and works better when there are multiple condyloma in different areas.

When the HPV infection shows up on your pap smear, the virus cannot be seen as a visible lesion or a wart.  In this case, it has infected the cervical cells internally. When this happens, your OB/Gyn will call you to notify you of the abnormal pap test and the high risk HPV status.

At this point, further testing will be ordered. If your pap test is otherwise normal, but is positive for high risk HPV, it is ok to return to your doctor for paps every six months. If your pap test is positive for dysplasia (mild, moderate, or severe) then it is usually best to have a colposcopy done with a biopsy.

If this test returns from the pathologist showing no underlying cancer cells, then the next step would be to remove the infected tissue. This can be done in two ways: 1) If the biopsy and pap show only mild dysplasia, the tissue can be frozen off (cryotherapy), and a follow up pap done is in three months to make sure it has cleared and healed; 2) The other option is to perform a LEEP procedure, which is done by numbing the cervix with lidocaine and shaving off the abnormal tissue with small instruments that have wire loops on the ends . The tissue can then be sent to pathology for evaluation. If no cancer is seen, the patient can return in 3 months for a repeat pap and continued close survellence.

When these procedures are done, HPV can be completely removed, however there is always a chance of reinfection from the male partner. Many women worry because they have a misconception that HPV is in the blood and can circulate throughout their bodies, but in reality HPV can only infect the areas it comes in contact with.

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What does HPV and Dysplasia mean, for me?

Dear KnowYourV,
I just got the results of my pap smear back and it showed 'high risk HPV with mild to moderate dysplasia'. I'm worried because someone told me HPV is an STD and that dysplasia is pre-cancerous."

Well, Vanessa let's back up a little bit. First of all, the reason you come in once a year for your pap is to screen for cervical cancer. And since so many more women do get tested yearly now, we rarely see advanced cases of cervical cancer like they saw years ago.

These days, if a woman has an abnormal pap, we do repeat paps or biopsies immediately to evaluate the cervical tissue. If necessary, any abnormal tissue with HPV can be removed so healthy tissue can grow in its place. This way, dysplasia or high risk HPV never have a chance to progress to a cancerous condition.

HPV (Human Papilloma Virus) is transferred through sexual contact and belongs to the wart family. It can show up as visible genital warts or flat 'invisible' kind that can cause cervical cancer. Men harbor it in their semen and women carry it in their cervical tissue and cervical/vaginal fluids.

There are two types of HPV: 'low risk’ and ‘high risk'. High risk is the one reported on pap smears and is responsible for cervical Cancer. It can also cause penile cancer, anal cancer, vulvar cancer and oral cancer. Therefore, it can be transferred though anal sex and oral sex as well.

It's possible to get HPV from your first sexual partner and not know you have it. There are no symptoms and it can lay dormant for years. Just like the herpes virus, it may erupt during times of stress or during pregnancy. When HPV begins to flare up, it causes cellular changes in the tissues. When your pap specimen is taken, the cells are looked at under a microscope and the clinician can see the HPV infection and any affects it is having upon your cervix.

Dysplasia is not cancer; it is not even pre-cancer. It is only a descriptive name given to tissue at a certain point in time so that it can be compared with another point in time to note changes. With dysplasia, the terms ‘mild’, ‘moderate’ and ‘severe’ are used, and then it may go to cancer. Most of these changes take several years to happen, and most women choose some form of treatment long before cancer would become an issue.

What about the men? That's what women worry about when they find out they have HPV - shouldn't the men be tested too? Unfortunately, it doesn't do much good, because HPV is in their semen, and there is no way to treat them. They are not at risk for cancer the same as we are.

Fortunately, the new HPV vaccine, which can be given starting at age 8 to boys and girls, should start making a huge impact in the future.

The most important thing is keep getting your pap smears on a regular basis. Over 75% of the U.S. population has HPV, and it is as high as 85% worldwide. So, you are definitely not alone in this. It is a battle we've been working hard to win, and the vaccine is one step along with regular pap tests.

As I've told you, one of the best things you can do daily to help yourself feel fresh and clean is use the new WaterWorks feminine cleansing system. This is so wonderful because it can be used when you shower, and does not require special formulas or chemicals - just plain tap water. And, it can be used more than once a day. Most women will use it right after sex to rinse out semen, which helps them feel clean and fresh right away. Plus this can also immediately rinse away any semen infected with HPV or other STDs. This is important, since a woman's body acts like a little incubator for bacteria or viruses. That is why so many women love using their WaterWorks - it gives them confidence and they feel they are working towards better health with better hygiene. Plus WaterWorks is FDA cleared for vaginal cleansing to remove unwanted odor with or without discharge.

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What should I know about HPV, human papilloma virus, and what are its signs and symptoms?

Dear KnowYourV,  

What should I know about HPV, human papilloma virus, and what are its signs and symptoms?" 

This has become one of the most commonly asked questions recently, since HPV is a sexually transmitted virus and the #1 cause of cervical cancer worldwide.

As women come in for their annual exams and pap smears, questions arise about HPV testing and detection. Infections by genital HPV are very common. In fact, over 70% of people who are sexually active will contract the virus at some point in their lives. Yet many will not know it because they will not have any symptoms.

Whether or not symptoms occur has to do with the type of HPV, and there are more than 100 types of this virus. Some types of HPV are associated with genital warts, either visible or flat and not visible. Other types of HPV are associated with cervical and other cancers, with no warts nor other noticeable symptoms. Still more common forms of HPV produce warts on other parts of your body like your hands and feet. Many people who get genital HPV will clear it spontaneously over time, however, the longer it stays in your body (and depending on which type of HPV you have), the higher the risk for cervical, anal or oral cancer.

Since HPV infections are contracted through sexual contact, many women have concerns about their current partner and how to find out when they contracted the virus. Women in monogamous relationships who have tested positive for HPV worry about re-infection from their partner, if their partner is positive, or protecting a negative partner.

For most women, it is an abnormal pap smear that first alerts them to a positive HPV test. Like most viruses, HPV has an incubation period, and it is possible to be infected with the virus even years earlier, only to have it lay dormant. During times of stress to the body, either emotional or physical, the HPV can re activate, just like we experience with cold sores or acne outbreaks.

As I've explained previously, the prevalence of HPV and its dormant period can make it impossible to know who the infection originated from – a current partner or a previous one. We can contract it during our first sexual experience and it may not be detected until years later on a pap smear.

Concerns about HPV are increasing, as they are now finding oral and throat cancer on the rise due to viral infections from oral sex . There has also been recent publicity about celebrities that have battled throat and anal cancer.

HPV has become the most important reason for women to come in for their annual exams and pap smears. Also, good dentists will screen for any suspicious or HPV-type oral lesions during your routine exams. Thankfully, most gynecologists now report that cervical cancer has been on the decline in America due to early detection of High Risk HPV.

Women tend to be at an increased risk as their bodies tend to function as incubators for such viruses when semen is deposited. So, it is best to get up after sex and rinse out that semen with the amazing WaterWorks System. It may look and act like a douche but works nothing like it. It is completely reuseable, and uses only natural tap water, no chemicals. The stainless steel nozzle coupled with the downward gentle sprinkling action of the water makes it unique. The stainless steel reacts with the water and vaginal wall to remove unwanted odor, and the gentle sprinkling action of the water cleans and rinses out any remaining semen. This has helped so many women feel cleaner, fresher and odor-free without the use of medication or douching, which can be harmful to the natural environment of the vagina.

So keep up the good work, stay healthy, eat right and get out there and move your muscles around. You will start to feel much better.

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