HPV Questions Answered


HPV is by far the most confusing and anxiety-provoking topic for my patients. In the following article I hope to answer some of the typical questions I am asked, as well as alleviate the common worries I hear from patients.

What is HPV?  Human papillomavirus (HPV) is the most common sexually transmitted virus in the United States. It is estimated that 50% of sexually active people will have genital HPV at some time in their lives. Usually a genital HPV infection is asymptomatic and resolves on its own; in fact many people are not aware they are infected.

Why do we care about HPV?  There are over 150 types of HPV. Some low-risk types cause genital warts, while other types, called high-risk or oncogenic, cause cervical cancer. Virtually all cervical cancer is caused by these high-risk HPV types.  However, it is important to stress that not all women with high-risk HPV will develop cervical cancer. In fact, half of new HPV infections are undetectable in 6-12 months, and more than 90%of infections clear within a few years. 
The precursor to cervical cancer is called cervical dysplasia. The good news is that there is an excellent form of screening for cervical cancer, the Pap smear. Even better news is that progression from normal cervical tissue through the series of increasing grades of dysplasia into full-blown cancer is very slow, and usually takes 8 to 10 years. In the majority of patients, mild dysplasia spontaneously regresses and it turns back into normal cervical tissue.  If you get your Pap smear as recommended, we will almost always be able to catch dysplasia before it turns into cancer (with the exception of rare very aggressive cancers). 

How do you check for HPV? What if my Pap is abnormal? How often do I need a Pap? If you have genital warts, which are easily identified during an exam, you have low-risk HPV.  In most cases, if your Pap smear comes back abnormal you have high-risk HPV.  The current guidelines state that routine Pap smears should begin at age 21, with subsequent Pap smears every 2 years.  If the pap is abnormal, a procedure called a colposcopy is performed to get a more specific diagnosis. Once your Pap is abnormal, the Pap smears usually become more frequent, usually every 6-12 months.  HPV screening along with the Pap starts at age 30. We do not check HPV on everybody (nor do we start screening earlier than age 21) because most of HPV infections that occur in younger women soon after they become sexually active and resolve spontaneously.  

Wait, I’m confused, I don’t need a Pap every year? These are general guidelines, every particular patient is unique and the decision to perform a screening Pap should be individualized. Even if you do not need an annual Pap, you still need an annual breast and pelvic exam (as well as a yearly check-in with your physician to see what else might be needed). 

How and when did I get HPV?  HPV is transmitted through sexual contact. It is impossible to predict when a new infection started. Obviously if you see a wart on your partner, and then you get warts, you can assume you got it from that person; however, often it is not so easy.  Unfortunately condoms do not completely prevent against the transmission of HPV.

Does HPV ever go away? Current research does not have the answer to this interesting question. We know that HPV goes away in the cells that we test. Whether it truly goes away, or lies dormant in deeper cells (called the basal cell layer) has yet to be determined.

What about the vaccine I’ve heard about? Should I get it if I’ve tested positive for HPV?  There are two HPV vaccines on the market, one that covers the two most high-risk HPV types, and another that covers these two as well as two HPV types that are responsible for a majority of genital warts. The vaccine will have the best personal and public health impact if it is given prior to the onset of sexual activity, that is, before any HPV exposure has taken place.  The idea that cervical cancer (which kills 250,000 women a year worldwide) could be eradicated by a vaccine is a very exciting proposition.  Whether the vaccine is right for a particular patient is best determined by her and her health care provider. 

Does my partner need to be tested for HPV? Can we just trade it back and forth?  Currently there is no HPV test for men. Just as 90% of HPV is cleared in women over time, so it is thought to be the case in men. Therefore you would both eventually clear it and not re-infect each other.  There is also some evidence of immunity from re-infection with the same strain, but this is another area requiring more research.  In men, HPV is associated with penile and anal cancer, but these are very rare in men with healthy immune systems.

What can I do to help my body get rid of HPV?
  • If you are a smoker, stop smoking. Smoking depresses the immune system and interferes with your body’s ability to clear the virus.  
  • Scientific evidence suggests that a high dose of vitamin A prevents cervical cancer, as vitamin A modulates epithelial cell growth and differentiation.  It is important to note, however, that a high dose of vitamin A causes birth defects, so patients taking it need to be careful not to get pregnant.  
  • Indole-3-carbinol (I3C) is a compound present in cruciferous vegetables such as cabbage, broccoli, cauliflower, kale, and Brussels sprouts.  I3C alters the pathway of estrogen metabolism in a manner that decreases the risk of certain tumors, including cervical cancer.  Eat more cruciferous vegetables!
  • Folate deficiency has been linked to cervical dysplasia.  Folate deficiency impairs DNA synthesis and repair, and makes DNA more susceptible to attack by carcinogens and viruses. One could theorize that supplementing with folic acid (preferably in the form of 5-methyltetrahydrofolate) would help the body clear the virus, however more research is required. 

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There are certainly many questions that the scientific community has yet to answer regarding HPV. I would like to reiterate the following points:  HPV is extremely common, most HPV infections resolve on their own and do NOT turn in to cancer, and it is very important to keep all follow up pap appointments as directed by your physician.  
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