February 3, 2017 Liza Colimon, MD The Human Papillomavirus, which is best known by its abbreviated name, HPV. It is one topic that stirs up much anxiety in my office. This is understandable as many of the signs you will see state “HPV causes cervical cancer” instead of “HPV may cause cervical cancer.” If you’ve been infected by the HPV virus don’t panic. This does not mean you have cervical cancer or you are going to get it. What it does mean is that we need to have more frequent Pap smear screening on a yearly basis until it goes away. Also, you will likely need a colposcopy procedure to take a closer look at your cervix. The diagnosis is super common. Bottom line is; if you are sexually active, you are at risk. Although this fact will not make you feel any better… I tell every woman the most important action one can take is to be informed, not afraid. And even more important, talk to your gynecologist and follow your recommended treatment plan. That means taking notes, and keeping track when repeat testing is due. Most women that are diagnosed with cervical cancer in the United States have not had a pap smear within a five year period, did not follow up after having an abnormal pap smear/biopsy, or are over the age of 65. The Centers for Disease Control and Prevention (CDC) estimated in 2016 that by the time a woman reaches the age of 50, four out five would have been infected with HPV during her lifetime. I’m not saying don’t take an HPV diagnosis lightly, but anxiety and worry will not change the steps you need to take to ensure you’re healthy, and often just creates fear. Here are a few things you should know: 1. HPV is a Virus. There is no cure, pill to treat it, and in most cases, there are no symptoms. Most HPV viral infections go away within 2-3 years. Over 100 types of HPV have been identified and affect only humans. It is typically spread skin-to-skin by contact during sex. Sexual intercourse, which would include vaginal sex, oral sex, anal sex, and any other interaction that would involve your genital area or hands is the most common setting in which HPV is spread from person to person. Touching doors, toilet seats or surfaces, will not infect you. Unfortunately, condoms do not completely protect you from the virus but they can help decrease your risk of transmission. This is because they cannot possibly cover all the parts of your body that are involved during sexual activity. To my knowledge, full body condoms are not on the market and they would defeat the purpose anyhow. HPV affects the skin. The virus can affect skin anywhere on your body but we will focus this discussion on the following common areas: Cervix, Vagina, Vulva Penis Anus Back of the Throat, Tonsils, Tongue (Oropharynx) HPV has ben linked to Cervical Cancer. It has also been linked to cervical, vaginal, and vulvar cancers. There are over 40 types of HPV, which have been shown to increase the risk of developing cervical cancer. Years of research have allowed health care professionals to identify the types most likely to cause cervical cancer. Each type has been identified with a number. If you are diagnosed with HPV this does not mean you have cervical cancer or will develop it. Types 16 and 18 have been found to cause about 70 in 100 cervical cancers that are diagnosed. We detect HPV in your body by performing a Papanicolaou, however most women are more familiar with the term Pap Smear. Women over the age of 30 are automatically screened for the types of HPV mostly commonly linked to causing cervical cancer. If your Pap Smear is abnormal or HPV is found we closely observe you by performing other Diagnostic tests, performing a Colposcopy to take a closer look at your cervix and may perform very small biopsies of your cervix. You will likely be advised to have your Pap Smear done more frequently for a specified time. There are Vaccines available for preventing HPV. The overall goal is to protect girls and women ages 9 to 26 against cervical, vaginal, vulvar, and anal cancers and genital warts caused by HPV. There are several vaccines approved by the US Food and Drug Administration. All vaccines protect against a unique set of types of the HPV virus. Gardisil-9 offers protection against 9 types of HPV: 6, 11, 18, 18, 31, 33, 45, 52, and 58. The CDC recommends vaccinating boys and girls at 11-12 years old. We offer the vaccine up to the age of 26. All vaccines usually involve three shots within a six-month period. However two shots six months apart is now offered for girls starting at age 11. Either Gardasil or Gardasil 9 is recommended for boys and men between 9 and 21 years of age. And in special circumstances up to age 26. HPV can cause genital warts. If you have genital warts you will notice them. They can grow in many areas such as your vagina, rectum, labia, and on the skin between your vagina and rectum. You may notice them on your partner’s testicles. They often look like small pieces of cauliflower. Genital warts can be removed by several different methods. Commonly, gynecologists use an acidic chemical or a cream to treat them. Some dermatologists use cryotherapy. Your doctor’s treatment approach will depend on the number of warts you have, where they are located, and how they have grown on your skin. It may seem obvious, but make sure you have seen your lover’s private areas before you indulge. If your partner only wants to have sex with the lights out, you should wonder why.