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You got your Pap test result: “HPV”. What do you do? What most of us do: you google it! You go from one site to the other, from forum to forum … and you get really confused: I have what?!? How did I catch it? Will I have cancer? Is my partner cheating on me? A lot is being said and written about HPV, a great part of it being contradictory! The truth is, many things about HPV are still a mystery, even for physicians… Let’s try to get things straighten out and answer the most common questions regarding HPV….

• Getting to know HPV

HPV stands for human papillomavirus. It’s a virus and is transmitted from person to person through skin-to-skin contact. HPV is in fact a very large family, comprising more than 120 subtypes; of those, only 30 infect the genital area.

• How common is HPV infection?

Very common! It is estimated that 80% of women will contract the virus at some point in their lives. Most of the times, the immune system will be able to get rid of the virus, but a small percentage will keep it for life. It seems that many women will catch it and fight it several times in their lifetimes…

• How did I get HPV? Who gave it to me?

The primary source of transmission is sexual contact, including vaginal, oral or anal. Actually, sexual intercourse is not required to get infected, as HPV can be spread by skin-to-skin contact. Although some research suggests that HPV could be transmitted through items such as towels or underwear, this is not yet clear. On this subject, the opinions are divided between experts, and many (including myself) feel that it is extremely unlikely, if not impossible, to catch the virus this way. Α pregnant woman, in rare instances, may transmit HPV to her baby, but the transmission route (vaginal the moment of delivery, or through the placenta during pregnancy) is not yet clear.

• Is there any way of knowing how long I’ve had HPV?

Once you get infected with HPV, it may either show itself (usually 1 to 3 months after), or lay dormant and undetectable. Then the virus may be later cleared completely by the immune system, or remain present in the cervical cells for years. Because it can last long in your body before any cell changes occur, it is difficult to know who transmitted HPV to you or how long you’ve had it. So the answer to this question is: NO.

• I got HPV! What will happen to me now?

-Most of the times, absolutely nothing. The majority of HPV infections will be cleared by your immune system without you even noticing it.

-Of the over 100 types of HPV, about 12 subtypes (mostly subtypes 6 and 11) may cause genital warts (also known as condylomas). These are growths that may appear on the external genitalia, but also around the anus, inside the vagina or on the uterine cervix. Genital warts are very common: 1 out of 10 persons will have condylomas at some point in their lives (the frequency varies according to different countries between 0,3 and 12 %). It is important to remember that genital warts are benign and do NOT evolve to cancer.

-Approximately 15 types of HPV (most commonly types 16 and 18) are related to cancer. All these types are known as “high risk types”. While cervical cancer is the most common cancer related to HPV, and HPV seems to be almost the exclusive cause of cervical cancer, this virus can also cause other, less frequent cancers: vulvar, vaginal, anal and oropharyngeal (means throat and tongue). Because a lot has been said lately about the possibility of getting cancer of the throat with oral sex, it is important to clarify that: Yes, HPV is related to throat cancer, BUT this is a not a very common cancer and only half of all throat cancers are caused by HPV!

-Low-risk types can also cause a rare condition called recurrent respiratory papillomatosis, in which warts grow in the throat.

• What about men?

Things are less clear for men, as HPV is more difficult to test than in women. It is accepted that men are carriers of the virus and contribute to its widespread presence, so it can be assumed that HPV infection is as frequent in men as in women. What is sure is that men are much more rarely affected by the virus, with the exception of genital warts (same as women). Although rare, men may develop HPV-related anal or oropharyngeal cancer. HPV may be also related to penile cancer, but this type of cancer is extremely unusual.

• I got infected with a high risk-type HPV. Will I have cancer?

When we get infected with a high risk-type virus, it may enter the cells and damage their DNA, causing then to grow abnormally. These cellular changes may progress to what is called dysplasia or cervical intraepithelial neoplasia (CIN). Most of the times, the immune system will destroy the abnormal cells before they become cancer. But sometimes they are not cleared by our body’s defense, allowing them to evolve, first to a mild lesion, then to a moderate, then to a severe lesion, which in turn, after several years may result in cancer. The transformation of these cells into cancer has to do with a balance between the aggressiveness of the virus and how strong our immune system is: the stronger will prevail…

• Can we stop the virus before going into cancer?

Yes! Thanks to a Greek scientist, Dr. Georges Papanicolaou, we learnt that cervical cancer can be found before becoming cancer, that is, at its precancerous state. The Pap test (named after him) can detect early signs of abnormal cell changes of the cervix, allowing early treatment so they do not become cancer. There are other, more sophisticated tests, such as HPV testing and colposcopy that can be used as complementary exams t to the Pap test.

• How can I avoid HPV infection?

That’s a difficult question. A sexually active person will never be 100% protected against HPV. We can though take some measures to reduce the chances of infection:

-Limit the number of sexual partners: although you may get HPV even if you had only one sexual partner in your lifetime, the more partners you have, the more the changes of getting infected.

-Use condoms. Condoms offer only partial protection against HPV infection as the virus can also be passed by touching infected areas not covered by a condom. The protection of condoms is estimated to be around 60%, that’s something, though ! and in fact is the only mean we have to be protected. Condoms should be used for vaginal, anal or even oral sex.

-Get vaccinated. Two vaccines are available to protect against certain types of HPV. This topic deserves further analysis in a future post…

• What can I do to fight HPV?

There is no treatment for HPV itself, only for the problems that the virus can cause. These are some measures you can take to help your body get rid of the virus or at least prevent it from evolving into more severe lesions:

-Boost your immune system. The virus takes profit of a low defense system to progress. To help your immune system eat healthy, sleep well, avoid stress (if that is possible…), exercise, do activities that make you feel relaxed…Read more here.

-Quit smoking. Some chemical contained in cigarette will help the virus to progress into cancer.

-Get off the pill. Although the pill protects against uterine and ovarian cancer, it doubles the risk of cervical cancer…

In conclusion, if you got HPV:

First of all: don’t panic!

Second: get always good quality information on the subject. Don’t rely on rumors or on “what someone told you”. Knowledge is power!

Last, but not least, visit regularly your gynecologist. It takes 5 minutes to have a Pap test done. These 5 minutes can save your life!

References

http://www.cdc.gov/std/hpv/stdfact-hpv.htm

http://www.acog.org/~/media/For%20Patients/faq073.pdf?dmc=1&ts=20140707T0129049372

http://www.biomedcentral.com/1471-2334/13/39