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HUMAN PAPILLOMA VIRUS (HPV)

One of the most common sexually transmitted diseases, HPV, can cause either genital warts, abnormal pap smears, and even, in some cases, cervical or other genital cancers. There are several types of HPV, and you may be tested for them by a virapap test. Prevalence of HPV ranges from 20 - 46% in various countries.

If there is evidence of HPV on your pap smear, you may be asked to have a colposcopy test. This is a microscopic analysis of your cervix done in the office. If any abnormality is seen with the colposcope, a biopsy may be obtained for further analysis. If the virus has caused an advanced change in the cells (precancerous), treatment with laser, cautery (leep), or freezing (cryo) may be indicated. If the change is minimal, a wait and see period of 3-6 months is indicated. In 50% of cases, the abnormal cells will spontaneously disappear. However, we do not know if the virus completely disappears. You may be a carrier for life.

Patients often ask about their partners. We know that HPV is sexually transmitted. If you have it - you got it from a sexual partner. Since the virus can be carried and no abnormality detected for months to years, it may be impossible to blame any given partner. If you are sexually active, your current partner may want to be checked by a urologist. Most commonly, the male may carry the virus but have no external signs of it. In order to see small microscopic lesions, the urologist should view the penile and scrotal skin with a microscope of magnifying glass. Application of acetic acid (dilute vinegar solution), as is done for you during colposcopy, will help enhance the spots. They may need treatment also. In general, however, it is our experience that when HPV affects your pap smear only, and you do not have warts on your other genital areas, your partner won't either. In any event, it never hurts to be checked.

Medicine is often not black and white. HPV is a relatively new finding and not completely understood. Here are a few other facts we know:

  1. HPV acquisition increases the more sexual partners you have.
  2. Acquiring it at an early age (puberty) increases your chance of cervical cancer, but older women with persistent high risk HPV are also at high risk.
  3. Nicotine and HPV are both carcinogenic to the cervix. (cause cancer)
  4. Having your yearly exam with follow-up and treatment of HPV will make cervical cancer a very rare occurrence for you.
  5. If you do not yet have children, treatment of mild dysplasia and HPV should be very limited, yet still followed carefully.

For additional information please visit www.cdc.gov/std/hpv/hpv-factsheet-nov-2011.pdf

Ref: NEJM, Vol. 338, #7 - p. 423 Natural History of Cervicovaginal Papillomavirus Infection in Young Women





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