Human Papillomavirus (HPV)- October 2007
What is Human Papillomavirus (HPV)?
Human Papillomavirus (HPV) is one of the most common sexually transmitted infections affecting both male and females in the the United States. Some strains of HPV are responsible for warts on the hands and feet, and other strains are responsible for warts on the penis, scrotum, vulva, vagina, anus, rectum, urethra, cervix and mouth. HPV is spread through skin - to - skin contact during sexual activity.
Research has shown that 99.7% of cervical cancers are caused by the HPV infection. There are 120 different types of HPV of which 35 are linked to infection of the genital tract. Genital HPV types are divided into low-risk and high-risk types based on their potential to cause cervical and other genital tract cancers.
It is estimated that 20 million people in the United States are currently infected with HPV and over 6 million new HPV infections are diagnosed each year. Based on these national estimates, over 50% of sexually active men and women will acquire HPV infection at some point in their lives.
Most genital HPV infections are transient, asymptomatic, and clinically unrecognizable. The majority of infections will clear without medical intervention within two years of infection . Recurrence or reinfection with the same or a different subtype of HPV can occur, consequently sex partners of infected patients should be evaluated for the HPV infection.
How is HPV transmitted?
HPV is a contagious sexually transmitted virus and can be transmitted through sexual activity that does not necessarily involve intercourse, but only skin - to - skin and mucous membrane contact. HPV is difficult to identify and avoid in people who are sexually active because it is often not possible to see lesions.
How do I know if I have HPV?
Because HPV may not show any signs or symptoms, you probably won't know you have it. Most women are diagnosed with HPV as a result of abnormal Pap tests. A Pap test (also known as a Pap smear) is part of a gynecological exam and helps detect abnormal cells in the lining of the cervix before they have a chance to become precancers or cervical cancer.
Many cervical precancers (changes that could lead to cancer) are related to HPV and can be treated successfully if detected early. That's why early detection is so important.
What happens if I get HPV?
In most people , the body's defenses are enough to clear HPV. If not cleared by the body, some HPV types cause genital warts. Other types cause abnormal changes in the cells lining the cervix that can lead to precancers and even turn into cervical cancer later in life. If the abnormalities are mild, the health care professional may choose to closely monitor them. If the abnormalities are more severe, removing these cells can almost always prevent cervical cancer from developing in the future.
Methods commonly used to treat abnormal cervical cells include freezing, removing them using an electrical instrument, and conventional surgery. The treatment may have to be repeated if the abnormal cells reappear.
How can HPV infection be prevented?
There are two ways in which HPV can be prevented.
1) Abstinence -- HPV can be spread during sexual activity with skin to skin contact other than vaginal, rectal, or intercourse.
2) Monogamy -- People who have never had sexual activity with anyone else.
What about the HPV vaccine?
The FDA has approved a vaccine that will prevent 7 out of 10 cases of cervical cancer and 9 out of 10 cases of genital warts. In addition, this vaccine also will significantly reduce the number of false positive Pap tests, and thus reduce the number of costly and potentially unnecessary diagnostic procedures performed on women.
Who should receive the HPV vaccine?
The Center of Disease Control (CDC) has recommended that females between the ages of 11 and 26 receive the HPV vaccination, whether they are sexually active or not. The best time to receive the vaccine is before becoming sexually active. But the CDC recommends that women under the age of 26, who are already sexually active still get the vaccine because they will still benefit from some protection.
How is the vaccine given?
Merck, one of the manufactures of the HPV vaccine, Gardasil, recommends three doses of the vaccine over a six month time period; an initial dose followed by doses at 2 months and then again at 6 months.
Where can someone get the vaccine?
Discuss this with your health care provider to see if they have the HPV vaccine. If you are uninsured, or unable to afford the costs of the vaccine, contact your local health department or a community health center in your area to see if they are offering the vaccine at a low or no cost.
Are there any side effects of the vaccine?
The vaccine is very safe and has been tested on thousands of women from all over the world. Through these clinical trails, there have not been any serious adverse side effects shown. Participants in the studies complained of minor skin irritation and pain at the site of infection. There were found to be occasional headaches for a few days after injection. These symptoms are self limiting and subside on their own without additional treatment.
Do Women need to continue to get Pap tests after the vaccination?
Yes. Gardasil only protects against the two types of HPV that cause 7 out of 10 cases of cervical cancer. Additionally, it is currently unknown how long the vaccine will protect against HPV, so it is important to see your health care professional for continue Pap screening.
The American Cancer Society recommends:
- All women should begin cervical cancer screening about three years after they begin having vaginal intercourse, but no later than when they are 21 years old. Screening should be done every year with the regular Pap test or every two years using the newer liquid-based Pap test.
- Beginning at age 30, women who have had three normal Pap test results in a row may get screened every two to three years with either the regular or newer liquid based Pap test. Women who have certain risk factors such as diethylstilbestrol (DES) exposure before birth, HIV infection, or a weakened immune system due to organ transplant, chemotherapy, or chronic steroid use should continue to be screened annually.