What Is HPV?

“Cervical cancer is caused by a sexually transmitted infection?!” my patients often shout during our pap smear discussions with a look of disbelief.

Yep—believe it or not, cancer of the cervix is caused by the Human Papillomavirus (HPV), which is essentially a sexually transmitted virus.  In fact, HPV is THE most common sexually transmitted infection in women. 

What is HPV?

HPV is a virus contracted during sexual intercourse and is transmitted when you come into contact with someone who is carrying the virus.  It’s important to realize that you can become infected with just skin to skin contact—so you can contract it even without having penetrative sex.

There are about 40 different viral strains of HPV and these strains attack both the female and male genital system.

• Women: In women, about 13 out of these 40 HPV strains can attack the cells of the cervix and turn them into “bad cells,” which can eventually turn into cancer cells if left untreated.  This process can actually take up to ten to twenty years to turn into cancer. 

• Women and men: In both women and men, about a handful of these forty HPV strains can attack the cells of the genital skin and lining and cause genital warts.  Genital warts are highly contagious and up to sixty-five percent of those who are exposed to a genital wart end up contracting the virus.  That is a great example of why a condom is truly crucial.  It typically takes somewhere between three weeks to eight months after exposure to the virus for someone to actually develop a genital wart themselves, if they develop one at all. 

It’s important to note that women can be infected with both strains at the same time—and in fact, that’s common.

Who Gets HPV?

All sexually active women are at risk for getting HPV.  However, there are certain risk factors that have been associated with contracting it more frequently:

• Age: Women in their early 20’s are at a higher risk

• Higher number of partners:  The more partners, the higher the risk

• History of STI’s:  Those with a history of other sexually transmitted infections have a higher risk

• Sex at an early age: The earlier people become sexually active, the higher the risk

• Cigarette smoking:  Those who smoke have not only a higher risk of HPV infections, but also a higher risk of cervical cancer.

• Unprotected sex:  Those who do not use condoms are at much higher risk of HPV due to exposed genital contact.  But because you can contract the virus with just skin to skin contact, it’s important to realize that condoms are only seventy percent effective in preventing the spread of HPV.

Besides abstinence, the condom is the only way to protect against sexually transmitted infections.  No other birth control methods can do that.  So if you are sexually active, please use a condom to prevent yourself from spreading and contracting HPV and other sexually transmitted infections.

What Are the Symptoms of HPV?

Most people with HPV don’t have any symptoms at all.  In fact, about eighty percent of sexually active women become infected with HPV at some point in their lifetime.  But the good news is that like other viruses, such as the cold and flu, your immune system fights it off and clears it from your system—at least in most women.  It can, however, take up to two years for your body to clear it out completely. 

Those women infected by the strains causing genital warts often typically have non-painful bumps in or around the genitals and anus.  These bumps can be flat or raised, single or many, and grouped or cauliflower-like.  They can vary in color from brown to purple to flesh-colored.
How to Test for HPV?

Unfortunately, there is no HPV testing available for men.  Men are diagnosed with HPV only when they present with a genital wart that is visible on examination. 

For women, however, HPV is tested using a special brush of the cervix during the routine pap smear examination.  This swab can detect those thirteen strains that can cause cervical changes only, and not necessarily the strains that can cause genital warts. 

Pap smears are performed every one to three years, depending on the individual’s risk factors.  It is not recommended to get tested for HPV at any other time aside from during the routine paps.  That is because the HPV swab is only interpretable when used along with the pap smear results.  The result of the HPV swab is not considered particularly worrisome as long as the pap smear result shows no cervical changes.  Again, this is because most women clear this virus without it causing any significant problems.  If there are cervical changes, however, the results of the HPV test are used to figure out what your next step in treatment would be.

Should You Get the HPV Vaccine?

In addition to practicing abstinence and using condoms, there is one other major way to prevent the HPV in women—the HPV vaccine.

The HPV vaccine is available to women between the ages of nine and twenty-six years old and it protects against the four nastiest strains of  HPV.  The vaccine is given in a series of three shots, administered throughout a span of six months.  Even though you may opt to get the vaccine, it doesn’t mean you can skip your paps!  Remember, this vaccine covers four of the nastiest types only, not all strains of HPV.

I personally offer this vaccine to all of my female patients younger than age 26, because I know the studies have shown that those who get vaccinated have a much lower risk of getting cervical cancer late on in life.  Unfortunately, all of us passed the age of 26 no longer meet the criteria for getting the vaccine. 

What’s the Treatment for HPV?

If you’re too old to qualify for the vaccine, the treatment of HPV will depend on your symptoms. If you have genital warts, they can be frozen off at the doctor’s office with a chemical called “liquid nitrogen,” or treated with a special topical liquid that can be prescribed for you to use at home to destroy the tissue.

If your pap smear is abnormal, your doctor will interpret the results along with the HPV test results and tell you what your next step will be.  It may be to just repeat the pap smear in one year, rather than three. Or,it may be to see a specialist who will perform a procedure called a colposcopy, in which a special liquid will be placed on the cervix and examined with a high-tech microscope.  If there are any abnormal cells, they will essentially “light up,” and a biopsy of those spots may be taken and sent to the lab.  If those cells are abnormal, those areas may be frozen off or surgically removed.

So, yes, cervical cancer is a sexually transmitted infection! But, you have the power to prevent the contraction and spread of this infection.  We have the knowledge and technology to prevent this cancer, and no woman should have to battle with cervical cancer in their lifetime.