In my practice, I spend a lot of time talking to girls and women about HPV (human papillomavirus), a sexually transmitted infection. HPV is incredibly common; research in college health centers identified HPV in about 50 percent of female students. Condoms are somewhat protective, but with this kind of prevalence you can be exposed without realizing you were at risk. HPV can lead to genital warts, abnormal pap tests, cervical, vaginal, and vulvar dysplasia (pre-cancer), and cervical, vaginal, and vulvar cancer. Most people infected with this virus are not aware that they have it.
Different types (strains) of the virus cause different sorts of problems: types 6 and 11 are most likely to lead to genital warts and mild changes on the cervix; "high risk" types 16 and 18 account for 70 percent of cervical cancer, and for most of the severe pre-cancerous changes that require treatment. Sometimes tests are done to identify the viral type, to assess the level of risk.
We used to think that once you had HPV you were infected forever, but it turns out that most people with HPV fight it off over a few years, with no harm done. But some people develop warts or pre-cancerous changes that require evaluation and treatment. Cigarette smoke (firsthand or secondhand) and problems with your immune system make long-term complications of HPV more likely. Quitting smoking can help prevent cervical cancer.
Routine Pap testing and appropriate follow-up prevent most cases of cervical cancer. Pap testing can usually detect cellular changes (dysplasia) before cancer develops. If the Pap is abnormal, typically the next step is colposcopy, in which the cervix and lower genital tract are visualized with the colposcope, which looks like binoculars mounted on a stand. Abnormal-appearing areas are biopsied, by taking a pinch of tissue. Some women find this painful, while others find it similar to a day at the dentist. Significant pre-cancerous lesions identified at colposcopy can be treated with excision, freezing, or laser before they have a chance to turn into cancer.
You may have heard about Gardasil, the new vaccine that protects people from catching four strains of this troublesome infection. In my next blog, you can read about the new HPV vaccine, to see if it might benefit you or someone you know.
