Genital Warts, Cervical Precancer and Cancer
Human papilloma virus is very common. It can be spread in many ways, including sexually. There are more than 100 kinds of HPV. Most people will have an HPV infection of some kind at some point in their lifetime. HPV can be spread sexually by oral, vaginal or anal sex. About 40 types of HPV are known to infect the genital area of men and women. These infections can lead to genital warts, cervical dysplasia (precancer) and cervical cancer.
HPV can be carried without causing any symptoms at all for many many years. Your body can suppress it to non-detectable levels. It can show up again when your body is immune suppressed or under stress. It is unlikely you ever completely clear it once you have it, but you can suppress it to the point it does not spread to other people or cause damage to you.
Genital Warts
Most HPV does not cause symptoms. A few kinds, particularly HPV Type 6 and Type 11, can cause genital warts in some people who come in contact with this virus (not everyone who carries these viruses has genital warts however). Genital warts are mostly a cosmetic nuisance. Your body can clear them in a few years, but most people prefer to have them removed. This can be done with medication, freezing with liquid nitrogen or excising them with laser, radiofrequency or surgically. The often appear around the outside of the vagina and vulva, on the cervix or walls of the vagina, on the penis, or around the anus.
The kinds of HPV that cause genital warts typically do not cause cancer. You can decrease your risk of genital warts by limiting the number of sexual partners you have and using condoms.
HPV and Cancer
Some kinds of HPV are considered "high risk" in that they are capable of causing cancers and precancers, particularly of the cervix, but also of the vagina, anus, penis, and vagina. Such viruses typically do not cause any symptoms, they work silently inside the nucleus of the cell, mutating the DNA. This causes them to develop into a precancerous state, called dysplasia. Most of the time this is reversible when your body suppresses the HPV virus over a few years. Occasionally it can progress (slowly) into a cancer if left untreated. It can progress more quickly if you smoke, are immune suppressed (HIV, immune suppressant medications for organ transplants or autoimmune disease, or stress).
Tests
The PAP test is the best way to detect the results of a high risk HPV infection. If you PAP shows dysplasia (high grade, or low grade), we usually do not test for HPV, unless we are trying to determine what type of HPV you have for purposes of determining whether or not you would still benefit from the Gardasil vaccine. If your PAP returns as "ASCUS" ("atypical squamous cells of undetermined significance"), then an HPV test is helpful to determine whether or not dysplasia might be causing the changes.
If a PAP is abnormal, you usually need further testing (colposcopy and/or biopsy) to assess the extent, location and severity of the dysplasia.
HPV testing is probably a more reliable way to screen for cervical cancer than the PAP. It is recommended every 3 years as a screen, in women ages 30 and up, and is done as part of an annual exam.
Risk Factors for Cervical Cancer
- HPV
- Previous treatment for cervical precancer or cancer
- Immune suppression (HIV, immune suprressant medications, stress
- smoking
- in utero exposure to diethylstilbosterol
Treating HPV
There is no cure for HPV, although with good health and stress management, proper treatments where indicated, and not smoking (or quitting if you are), your body may be able to suppress it for many years to non-detectable levels.
Preventing HPV
HPV is best prevented in the first place:
- Limit your number of sexual partners
- Use condoms (they don't complete protect you, but they help)
- Have PAPs as often as your physician recommends
- HPV Vaccines: Given at a young enough age, these vaccines can prevent infection with 2 high risk strains (HPV 16 and 18) that cause 70% of cervical dysplasias. One of the available vaccines can also protect against Types 6 and 11 which cause most genital warts. The vaccine is recommended for boys and girls ages 11 to 12 (although it can be given as young as age 9). "Catch up vaccines" are recommended for ages 13 to 26. If you are under age 19, the vaccine is covered by the Dept of Health, but not usually by insurance. If you are over age 19, it is not covered by the state, but is often covered by your insurance company.
View the ACOG Brochure on HPV
View the ACOG Brochure on the HPV Vaccine
