Saturday, October 13, 2012

Human Papillomavirus (HPV)

I have HPV. Is my life over?

No, your life is not over. It will be OK.
Human Papillomavirus (HPV) is an extremely common sexually transmitted infection. There are dozens of forms of HPV, but not all of them cause disease. Some forms of HPV cause cervical cancer, and some forms cause genital warts. Other forms seem to cause no disease at all.

Why is HPV important?
HPV causes almost 100% of cervical cancer. If we can prevent HPV, we can prevent cervical cancer.

How did I get diagnosed with HPV?
Most likely, the diagnosis occurred during a Pap smear.

For years, we have known that cervical cancer is almost entirely preventable. When a woman has HPV, it takes years to cause problems, and if caught before becoming actual cancer, it can be treated. That's why we do Pap smears regularly. Pap smears are a light scraping of the cervix that gently brushes off some of the cells. Those cells are examined by a pathologist to determine if they are abnormal or normal. If normal, the woman can continue her regular screening. If abnormal, they must be investigated further.

How do I know if my cervix has abnormal cells?
The abnormal readings that predict cervical cancer are called cervical dysplasia, meaning that the cells of the cervix have been altered by the presence of HPV. These readings can be either LGSIL (low-grade squamous intraepithelial lesions) or HGSIL (high-grade squamous intraepithelial lesions). The higher the grade, the more abnormal the cells, and the closer to cancer it is. However, these LGSIL and HGSIL do not mean that cancer is present, only that abnormalities are present that may lead to cancer. When a pap test shows LGSIL or HGSIL, this means that HPV is definitely present, so there is no need to do a specific HPV test. (More on abnormal Pap testing in a later blog post).

HPV --> LGSIL (low grade) --> HGSIL (high grade) --> Cancer

A third abnormal finding that may occur is called ASCUS (atypical squamous cells of undetermined significance). This means that the cells looked a little abnormal, but not quite LGSIL or HGSIL, and it was hard to tell whether their appearance indicated dysplasia or not. Until HPV testing, it was very hard to know what to do with ASCUS pap readings. Nowadays, we can test for HPV in the settings of ASCUS. If HPV is positive, then we know that there may be precancerous changes, and so we should treat that as an abnormal pap. If HPV is negative, then the woman cannot have dysplasia, and we can treat that as a normal pap.

Sometimes HPV testing can be done even when the Pap smear is negative. This is one possible method of screening available to women who are 30 years of age and older. You can talk to your doctor about what screening method is right for you.

Do I have an STD for life now?
Not necessarily. In some people, the HPV sticks around for years, and that's how it creates abnormal cells. However, many people, especially young people, acquire and eliminate HPV rapidly before it causes any damage. That's why HPV testing is not as useful in women under 30 - because they can acquire and eliminate HPV so quickly that a positive test doesn't mean much. However, in all women, including women under 30, cervical dysplasia does not disappear quickly, and does need to be followed up. That's why Pap smears are done in even young women.

Can I prevent HPV?
Yes. HPV is sexually transmitted, so the only thing that puts you at risk is having sex. The best protection is abstinence, but if you are sexually active, using condoms is the best way to prevent HPV. HPV is not usually acquired outside of sexual intercourse, so you can't get it from a toilet seat (which people often wonder).
Since men are not tested for HPV, routine STD testing will not identify whether your male partner has HPV. Therefore, it's important to always get pap smears, even if you are monogamous and/or have only had 1 partner.
There is also a vaccine against HPV. It is only partially effective, which means that you still need pap smears, but your risk of having an abnormal Pap smear is much lower, and that's great. Women aged 26 and younger are eligible for the HPV vaccine. (There's a good reason for that. I'll address it in a future post).