What You Need To Know Now About HPV

WHAT IS HPV?

HPV, which stands for human papillomavirus, is the most common sexually transmitted infection in the United States. There are lots of strains of HPV, but you can put those strains into two major categories: low-risk HPV and high-risk HPV. Exposure to low risk strains of HPV can lead to genital warts. Exposure to high risk strains of HPV can lead to some types of cancers, such as cancers of the cervix (the lower part of the uterus that connects to the vagina), mouth/ throat, penis, vulva, vagina, or anus.

HOW IS HPV TRANSMITTED?

You can get HPV by having vaginal, anal, or oral sex with someone who has the virus. It is most commonly spread during vaginal or anal sex. HPV can be passed even when an infected person has no signs or symptoms.

HOW IS IT DIAGNOSED??

We routinely look for HPV and/ or HPV related cellular changes during pap smears. Otherwise, HPV screening is not routinely performed. Here is more information:

Cancers

Men- Screening that checks for HPV or HPV-related disease before there are signs or symptom of anal, penile, or throat cancers is typically not recommended by the CDC for men in the United States. However, for men who may have an increased risk for anal cancer, including men with HIV or men who receive anal sex, some healthcare providers do offer anal Pap tests to check for anal cancer. If you ever have symptoms or you are concerned about cancer, please see a healthcare provider.

Women- For women, a diagnosis of HPV often starts with abnormal results from a routine pap smear. During a Pap smear, the doctor will take a sample of cells from your cervix. The sample is sent to a lab and looked at under a microscope.

If abnormal cells are seen, your doctor will sometimes request an HPV test (if that test is needed). The HPV test can identify many of the types of HPV that can lead to genital cancer (i.e.- cancer of the cervix, vagina, or vulva). If you have an abnormal Pap smear, you might need a colposcopy; during this in-office procedure, your doctor looks at your cervix, vagina, and/ or vulva with a large microscope. If any tissue looks abnormal, your doctor will take a small biopsy to check for signs of cancer or pre-cancer.

In most instances, women are not routinely screened (i.e. at your annual visit) for vaginal, vulvar, anal and throat cancers and pre-cancers, but there are often tests available if you are concerned. See your physician if you are concerned about any abnormal growths on your anus, vagina, vulva or throat.

Genital Warts Some men and women find out they have HPV when they get genital warts, but we do not routinely screen people for HPV strains that might lead to genital warts.

WHAT ARE THE SYMPTOMS?

HPV usually causes no symptoms. Therefore, men and women can get HPV— and pass it on—without realizing it. It is true that most people will clear their HPV and they will not have any health issues from the virus. But remember, even if you don’t develop health problems from HPV, the person you give it to might not be as lucky.

For those who do develop health problems due to HPV, they may include (but are not limited to) the following:

1.Warts: Warts can appear as small, flesh-colored or gray swellings in your genital area or on your thighs. There can be just one, or they can appear in groups. If you have several warts close together, they can take on a cauliflower-like shape. Genital warts can cause itching or discomfort in your genital area; they can also result in bleeding with intercourse. Sometimes, warts may appear weeks, months, or even years after the initial infection.

2.Cervical Cancer: Women with early cervical cancers and pre-cancers usually have no symptoms. Symptoms frequently don’t start until the cancer becomes advanced. When symptoms do develop, a female might notice the following: abnormal vaginal bleeding (ex- bleeding after sex or irregular periods), vaginal discharge that is not normal for them, pelvic pain, or pain during intercourse.

3.Vulvar Cancer: Vulvar cancer commonly forms as a lump or sore on the vulva that often causes itching that doesn’t go away. Additionally, look out for bleeding that isn’t from menstruation and skin changes such as color changes or thickening.

4.Vaginal Cancer: Early vaginal cancer may not cause any signs and symptoms. As it progresses, you might notice unusual vaginal bleeding (for example, after intercourse or after menopause), watery vaginal discharge, a lump or mass in your vagina, painful urination, frequent urination, constipation, or pelvic pain.

5.Anal Cancer: Sometimes anal cancer causes no symptoms at all, but bleeding is often the first sign of the disease. Frequently, the anal bleeding is minor. Additional symptoms include rectal itching, pain or a feeling of fullness in the anal area, a lump or mass at the anal opening, narrowing of stool or other changes in bowel movements, swollen lymph nodes in the anal or groin areas, or abnormal discharge from the anus.

6.Penile Cancer: The first sign of penile cancer is most often a change in the skin of the penis. For instance, you might notice an area of skin becoming thicker, changes in the skin color, a lump, an ulcer (sore) that might bleed, penile discharge, or bleeding under the foreskin.

7.Throat Cancer: You might notice a sore throat or ear pain that doesn’t go away, constant coughing, a persistent voice change, a throat mass, and pain or trouble swallowing or breathing.

Cervical cancer is the most common HPV-associated cancer among women, and throat cancers are the most common among men.

Of note, the symptoms listed above don’t always mean that you have warts or cancer. In fact, many of the symptoms are more likely to be caused by other conditions. Still, if you notice them let your doctor know so that your condition can be treated appropriately.

HOW IS HPV PREVENTED?

Because HPV is such a common virus, it is hard to avoid it completely. However, here are some steps you can take to prevent it:

Get vaccinated. Ideally, The Centers for Disease Control and Prevention (CDC) recommends that all boys and girls be vaccinated at age 11 or 12, before any likely exposure to sexually transmitted strains of HPV. According to the CDC, the HPV vaccination can prevent over 90% of HPV cancers.
Be in a mutually monogamous relationship and avoid sex with people who have had numerous sexual partners.
Use condoms correctly and consistently. (But, remember that the virus isn’t in secretions—it’s in the skin—so it can affect the parts of someone’s genitals that aren’t covered by a condom. Therefore, condoms may not fully protect you from HPV.) Also, use dental dams as needed during oral sex.

DO YOU RECOMMEND THE HPV VACCINE FOR YOUTH WHO ARE NOT SEXUALLY ACTIVE?

Yes. It is best to be vaccinated prior to becoming sexually active. Studies of the HPV vaccine indicate that younger adolescents respond better to the vaccine than older adolescents and young adults. Additionally, numerous research studies have shown that getting the HPV vaccine does not make kids more likely to be sexually active or start having sex at a younger age. The HPV vaccine is recommended for females and males regardless of their sexual orientation.

IS HPV CURABLE?

There is no medication to cure the HPV virus, but it is possible for a person’s body to suppress the virus. According to the CDC, More than 90% of new HPV infections, including those caused by high-risk HPV types, clear or become undetectable within 2 years, and clearance usually occurs in the first 6 months after infection.

If your body does not suppress the virus, there are treatments for the health problems that HPV can cause.

WHAT ARE THE TREATMENT OPTIONS?

It depends on your specific scenario. For example:

Genital Warts: If your warts are not causing discomfort, you may not need treatment. If your symptoms include itching, burning and pain, or if visible warts are causing emotional distress, your healthcare provider can help you clear an outbreak with medications or surgery. Some medications include Imiquimod, Trichloroacetic acid, Sinecatechins, Podophyllin and podofilox.

For larger warts, warts that do not respond to medication, or if you are pregnant and your doctor thinks that treatment is needed, surgery might be recommended. Surgical options include freezing with liquid nitrogen (cryotherapy), electrocautery, laser treatment, or surgical excision.

Cervical Pre-cancers: Your doctor might recommend cryotherapy (damages cells by freezing them), laser treatment (uses a tiny beam of light to vaporize abnormal cells), or a cervical excision procedure (removes the abnormal area of the cervix).

Cancers: Depending upon the specific type and stage of the cancer, treatment options might include surgery, radiation therapy, chemotherapy, targeted therapy (This type of treatment uses drugs or other substances to identify and attack specific cancer cells without harming normal cells), or immunotherapy (Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. Basically, this treatment uses the patient’s immune system to fight cancer).

IF A PERSON IS BEING TREATED FOR HPV, IS IT STILL POSSIBLE TO PASS IT TO YOUR PARTNER?
Yes

IS THERE AN AGE LIMIT ON WHEN TO BE VACCINATED?
The vaccine is approved for girls, boys, women, and men ages 9 to 45. (Ask your doctor if your insurance will cover the vaccine cost for you.)

WHO’S MORE AT RISK OF GETTING AND OR TRANSMITTING HPV MEN OR WOMEN?

Men and women should be equally cautious. According to the Center for Disease Control and Prevention, “Almost every person who is sexually active will get HPV at some time in their life without HPV vaccination.”

Dr. Nita answers your questions on the next page.

Why are head and neck cancer patients checked for HPV? What’s the correlation ?
HPV can infect the mouth and throat and cause cancers of the oropharynx (back of the throat, including the base of the tongue and tonsils). This is known as oropharyngeal cancer. According to the Centers for Disease Control and Prevention, HPV is thought to cause approximately 70% of oropharyngeal cancers in the United States.

What are the side effects of the HPV vaccination?
Some people have no side effects at all, but these are some common side effects of the HPV vaccine:
-Pain, redness or swelling in the arm where the shot was given
-Fever
-Dizziness or fainting
-Headache or feeling tired
-Nausea
-Muscle or joint pain

According to the Centers for Disease Control and Prevention, “Over 100 million doses of the HPV vaccine have been distributed since the vaccine was licensed, and data continue to show the vaccine is safe and effective.”

The CDC and the FDA continue to monitor the vaccines for unusual or severe problems.

Your doctor will make sure you don’t have any contraindications to the vaccine (ex- pregnancy or a history of an allergic reaction to the HPV vaccine.

How do you remove warts from the vagina?
If your warts are not causing discomfort, you may not need treatment. If your symptoms include itching, burning and pain, or if visible warts are causing emotional distress, your healthcare provider can help you clear an outbreak with medications or surgery. Some medications include Imiquimod, Trichloroacetic acid, Sinecatechins, Podophyllin and podofilox.

If males have a low risk of genital cancer, caused by HPV virus, what is the rational for vaccinating boys with Gardasil?
In males, exposure to the HPV virus can lead to genital warts, penile cancer, anal cancer, or cancers of the back of the throat (oropharyngeal cancer). Every year in the United States, over 13,000 men get cancers caused by human papillomavirus (HPV).

The HPV vaccination could prevent most of these cancers from ever developing. The HPV vaccine also helps to protect males from genital warts.

Additionally, if a male doesn’t get HPV because they got the vaccine, then they won’t pass the virus to another person. That will help decrease the overall prevalence of HPV.

I was recently diagnosed with HPV when I went in for a Pap smear. My PCP stated my Pap smear was normal, it came back positive for HPV, but negative for genotype 16 and 18. My PCP stated it may go away. Should I be overly concerned?
According to the CDC, More than 90% of new HPV infections clear or become undetectable within 2 years, and clearance usually occurs in the first 6 months after infection.

Therefore, in most cases your body’s immune system defeats an HPV infection before it has an opportunity to cause pre-cancer or cancer of the cervix.
For the most part, women who get cervical cancer in the U.S. now either have not ever been screened, haven’t had a screening in the previous five years, or had an abnormal result on a screening test that was not followed up on.

So, follow up as instructed. Your doctor is waiting to see if your body will successfully defeat the virus. If your immune system does not suppress the virus, following up appropriately will increase the probability that your healthcare provider will catch an abnormality at an early (very treatable) stage.

Is HPV most commonly passed from men to women, since they can have it and not know it? especially if they have multiple partners?
Men and women should be equally cautious about getting/ giving HPV. While it is true that men usually don’t know that they have HPV, many women don’t know they have the virus either. Additionally, women who find out they have HPV during a routine pap smear typically don’t abstain from sex.

Even if a woman knows about her HPV and she uses condoms to help protect her partner(s), remember that the virus isn’t in secretions—it’s in the skin—so it can affect the parts of someone’s genitals that aren’t covered by a condom. Therefore, condoms may not fully protect you from HPV

According to the Centers for Disease Control and Prevention, “Almost every person who is sexually active will get HPV at some time in their life without HPV vaccination.”

You are correct: Whether you are a man or a woman, the more sexual partners you have, the more likely you are to contract a genital HPV infection. Having sex with a partner who has had multiple sex partners also increases your risk.

As a male if you have HPV at age 37 can your body fight the virus and it no longer in your body or once you get HPV it’s in you for life?
Some research suggests that some people truly clear the virus, but in other people the virus can hide deep in the affected mucosa or skin for several years, below detectable levels (these are called “latent” infections).

At this time, it is unknown what proportion of HPV is truly cleared by the body vs. what proportion goes latent. If your virus is latent, the HPV might “reappear” and cause health issues several years after the initial infection.

The good news is (whether your body clears it or whether your body is only able to suppress it), most people will not develop health problems from HPV.

PHOTO: Courtesy

Dr. Nita Landry, known as “Dr. Nita,” is a co-host on the Emmy Award-winning talk show The Doctors and a board- certified OB/GYN.

After obtaining her Medical Doctorate (M.D.) and completing her OB/GYN residency, Dr. Nita became a locum tenens physician (traveling doctor). In addition to practicing medicine and co-hosting The Doctors TV show, Dr. Nita is a published author who has served as a medical expert on television programs such as Good Morning America, The Today Show, Dr. Phil, Iyanla Fix my Life, CBS National News, and Black Entertainment Television.

She and frequently speaks to teenagers and college students about sexual well-being, and she is regularly quoted in publications such as Self Magazine, Women’s Health Magazine, Shape Magazine, Cosmopolitan, and The Atlantic.