What your ob/gyn wants you to know about HPV

When I was trying to decide what topic I should cover in my blog, I tried to think about what medical problems concern and confuse my patients the most. One diagnosis I commonly encounter that seems to terrify patients is HPV and abnormal pap tests. Hopefully, after reading this you will have a better understanding and less fear if you have been diagnosed with HPV. There have been entire books written about HPV. I will not be able to cover every issue with HPV but hopefully will answer a few important questions you may have.

First, let me explain a little about HPV. HPV (Human Papillomavirus) is not just 1 virus. There are over 100 types of HPV. Some strains of the virus are more important medically than others. There are only about 30 types that have been associated with diseases in humans. From a medical standpoint, we focus on 4 types. Types 16 and 18 are more commonly associated with abnormal pap (cervical dysplasia) and cervical cancer. Types 6 and 11 are more commonly associated with genital warts (condyloma). Because HPV is a virus, there are no antibiotics to treat the infection. Fortunately, our body’s immune system usually fights off the virus and it never causes any long-term problems. The method of transmission of HPV is direct skin-to-skin contact - primarily intercourse. OK, lets tackle a few important points to remember.

• HPV is a common virus. Estimates suggest that about half of adults have had HPV. Most people never know they have had it because their immune system clears it before symptoms show up. This is important because I tell patients they should not be embarrassed with this diagnosis.
• It is very difficult to determine when someone acquired the virus. Because the virus is mostly asymptomatic, patients can acquire HPV years before a test is performed. In fact, it is recommended not to routinely test patients for HPV. This is especially true in younger patients. Most physicians only test for HPV if the Pap test shows Atypical Cells. I assure patients that a diagnosis of HPV does not mean their partner has been unfaithful.
• Most HPV infection will clear. Estimates are 60-80% of HPV infections will clear in 2-3 years. This is why patients with low-grade pap smears will usually return to normal pap tests with observation only.
• HPV does not affect fertility or pregnancy. Patients should have no problems getting pregnant or having a normal pregnancy. One situation of concern is if a patient has had a treatment to remove abnormal cells from her cervix. These procedures are called LEEP or cones. The risk of these procedures causing preterm delivery is less than 1%. Most patients who have had a problem have had multiple procedures.
• Vaccines are effective at preventing HPV. There are currently 2 vaccines approved for HPV prevention. These are not treatments for people with HPV. Studies have shown about a 90% reduction in HPV in vaccinated females. The vaccines appear to be more effective if given before sexual activity begins. Females can be vaccinated from age 11-26.

I realized having an abnormal pap test and a diagnosis of HPV is extremely concerning. I hope this blog has answered a few questions. I also hope I have been able to ease some anxiety with this diagnosis. Please let us know if you have other questions.