HPV: Could It Happen To You?

This article was originally published by The Cornell Daily Sun on February 14, 2014. Some changes have been made to this version.

A 25 year-old woman comes to clinic for her routine Papanicolau (Pap) smear during my ob-gyn rotation. A few days later she receives a phone call from the gynecology resident. “Your Pap smear results were abnormal,” the doctor told her, “and we would like to take a biopsy of your cervix, which we do under an exam called a colposcopy.” She is told that this abnormality was caused by a strain of the human papillomavirus (HPV), the same virus family that causes common warts.

“HPV?” she asks, “isn’t that a sexually transmitted infection?”

“It is, in fact it is the most common STI in the US.”

“I didn’t think that I was at risk for HPV… I have not had many partners… and we almost always use protection… and I think maybe I was vaccinated… Does this mean I’m going to get cancer?”

The patient expressed a flurry of questions. She was quite surprised and distressed. She did not know that she could be among the 20 million Americans, male and female, aged 15-49 currently infected with HPV. Seventy-four percent of those infections occur in the 15-24 age group.

Nearly all sexually active people will become infected with one of the many strains of HPV at some point in their lives; half become infected within three years of becoming sexually active. Some strains are high-risk, or potentially cancer-causing, and some are low-risk, or wart-causing. Most HPV infections will not cause symptoms or problems, and they will become undetectable within 6-24 months. Among women with high-risk HPV infection of the cervix, the infection will be persistent in 10%, putting the patient at risk of developing dysplasia, or precancer, that, if left untreated, could progress to cancer. Cervical cancer is currently the third most common cancer in women, and 99.7% of cervical cancer is caused by HPV. Both males and females, regardless of sexual orientation, are susceptible to developing dysplasias and cancers of the anogenital region. HPV has also been associated with head and neck cancers and some skin cancers. Looking at cancer as a whole, approximately 5% of all cancers in men and 10% of all cancers in women are caused by HPV.

There is no cure for HPV infection. The best strategies are prevention and early detection. Vaccination with Gardasil or Cervarix can prevent infection with HPV types 16 and 18, which are responsible for 70% of cervical cancer. Gardasil also provides protection against HPV types 6 and 11 which cause anogenital warts. Gardasil has been approved for use in both females and males ages 9 to 26, and is ideally given before the start of sexual activity (i.e. before exposure to HPV), so it is commonly administered prepubertally (eg. age 11-12). Even if you are already sexually active, vaccination is recommended. On the other hand, even if you plan to abstain and become monogamous for life, if your partner has ever had another sexual partner, you could still be at risk for acquiring HPV. Furthermore, HPV can be transmitted by genital contact besides intercourse. Vaccination should be a consideration for all young people, because everyone who will eventually become sexually active will most likely be exposed to at least one strain of this ubiquitous virus.

Because vaccination does not cover all strains of HPV, regular Pap smears are recommended in women aged 21 and over regardless of vaccination status. With a Pap smear your doctor can collect a sample of cells from the cervix and upper vagina to analyze under the microscope. This test can detect precancerous cells, prompting further intervention in order to diagnose dysplasia and prevent the progression to cancer.

So, what are some ways to protect yourself against HPV?

1. Get vaccinated if you are under 26, regardless of gender, sexual orientation, and sexual activity. Then,

2. Get Pap smears regularly if you are a female, starting at age 21. Your doctor will let you know how frequently you should be screened. Currently most women with a negative Pap smear at age 21 only need screening once every three years.

3. Use condoms consistently. Condom use reduces the risk of HPV infection and disease progression. Condoms are not, however, a perfect protection against HPV. Condom use is important to prevent against other STIs including HIV and chlamydia, two infections that have serious consequences in their own right, and that make HPV more likely to remain persistent.

4. Consider your number of partners: HPV prevalence increases nearly linearly with increasing number of lifetime partners, despite condom use. Furthermore, infection with multiple high-risk HPV types increases the risk of high-grade precancerous lesions.

5. Don’t smoke: Smoking is a risk factor for persistent infections.

If, after taking appropriate precautions, you find yourself with an HPV-related concern as the patient described did, remember that:

1) You are not alone. The volume of patients seeking care for HPV-related concerns, particularly cervical dysplasia, is quite large. On my ob-gyn rotation, four afternoons per week were dedicated to cervical dysplasia: one to Pap smears and three to colposcopy. I have also seen patients presenting to dermatology for genital warts and for HPV-related skin cancers and precancers of the penis.

2) About 90% of infections become undetectable without further intervention. Therefore, your infection will most likely not remain persistent, and you will most likely not develop an HPV-related cancer. Make healthy choices for your body and mind, and live your life.

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