This post is to educate more about what arguably is one of the most important STI's of our time, HPV.
Often in practice I am faced with frantic questions about 1-2 weeks after the annual gynecologic exam and patients are rushing in, sending messages, and calling because they have screened positive for HPV. Often they get their results automatically so of course the next stop is Google and have you ever googled HPV? Trust me you don't want to especially not the images! Many women and men are unfamiliar with how common this virus is and according to the Centers for Disease Control it is actually the most commonly transmitted sexually transmitted infection. The problem is that when it's time to slip into the sheets it's not something that you can usually see, touch, or know it's there. So the key lies in education that the virus is out there and unlike make believe monsters it really does exist!
I refer to human papillomavirus infection like the "flu of sex". I mean we are talking over 75% of the reproductive age population is exposed to this virus so it's actually worse than the flu! And it's not just youngsters because older people can be less likely to use protection therefore more likely to get infected. Yes that means that even seasoned sexual partners are NOT immune! Like the flu there are many different strains and like the flu there are strains that will only cause a mild infection and others that can take you off this planet. The "bad strains" of HPV are referred to as the high risk strains and these are the ones that are commonly screened for during preventative care exams. Doctors can also test for low risk strains but as the disease is so common low risk testing is not typically recommended in the absence of a lesion like genital warts which can be caused by certain type of low risk strains-commonly types 6 and 11.
The reason why doctors care so much about whether or not you have been exposed to a high risk strain is because they are most associated with increased cancer risk, in particular types 16/18 which are associated with up to 50% of cervical cancers. The reason why doctors want to know if you have been exposed to the virus period is because it is so very common and because exposure can increase risk of cancer. But just because you have been exposed doesn't mean you automatically have cancer. You have to remember there is this protective powerhouse called your immune system which helps to fight off disease as well of a host of other influencing factors in the development of cancer. But what is does mean is that you are in a higher risk group so certain preventative services may be performed more often and if your pap smear becomes abnormal you are more likely to get a higher level investigation with an exam called a colposcopy (don't google that either---you don't want to know!).
So if you have already been diagnosed with HPV but your pap is normal don't fret. You will be able to talk to your doctor and they can advise you of whether or not it’s okay to just repeat your pap smear or if you will need to proceed with getting a colposcopy. If you are currently between doctors or just want a second opinion you can meet with our physician Dr. Kourtney virtually to discuss your concerns. If you have been exposed you may need more careful screening in terms of repeating your pap in 1 year versus 3-5. It is the total measure of your individual risk factors that determines if you may or may not need further investigation with examinations like a colposcopy. If your pap is abnormal and your HPV test is positive you most likely will be recommended to receive a colposcopy but this again depends on your age (sometimes can observe patients 24 years old and younger) and individual risk factors. Talking with a doctor in this scenario is very important.
A lot of patients want to know if there is anything that they can do to treat the virus but really you just have to allow time for your immune system to clear the virus which in some cases can take a prolonged period of time. Most women are able to clear the virus in about 2 years however everyone’s system is different and you may clear the virus in a shorter period of time. If you are persistent in testing positive 3+ years you may want to make sure that you are checked for HPV type 16 and 18 and also think about looking into a functional evaluation of your immune system. In some very small studies with mice the use of a naturally occurring substance called diindolylmethane or DIM has been shown to have beneficial effects in regards to dysplasia but this has not yet been extrapolated to humans and there are concerns about dosage and mode of delivery.
Otherwise if you haven't tested positive or you have tested positive and you know a female or male in your life between the ages of 9-26 you need to make sure that they know that this virus is out there. Even if you have tested positive you can still receive the vaccine if you are in the indicated vaccination age range. Although protected sex is ideal it doesn't always happen therefore the best thing is to protect against the virus. There is a vaccine that can be given in this age range that protects against types 16,18,6, and 11 and ideally should be given even before a person is sexually active which is why it can be given as young as 9. Think of it like sending a loved one out in a hailstorm without a hardhat. They are bound to get clobbered! It's the same with this virus.
Another common question that a lot of people have is if they can still be vaccinated for HPV after they have already tested positive and the answer to that question is yes! Just because you have been infected with one or two strains of HPV does not mean that you cannot get vaccinated against the remaining strains of HPV that are covered by the vaccines that are available. If you are interested in receiving the vaccine for HPV I would recommend reaching out to your local pediatrician, family practice or nurse practitioner clinic in your area to discuss scheduling an appointment for the vaccine.
Since there is no current medication to treat HPV one of the best things that you can do is to make sure that you are optimizing your body’s immune system by paying attention to lifestyle determinants of health. These would include things like nutrition, stress, sleep, gut and immune health. One way to get an idea of the status of your health when it comes to these systems is to get a Functional Lab Analysis and Care Assessment. This is a series of 2-3 visits where you complete a functional health assessment and complete traditional labs (that are typically covered by insurance*) and then our doctors will present you with a functional analysis that identifies what functional systems in your body need the most work.
To schedule an initial consultation as a new patient to start on your functional health journey please click here.
If you are already an established patient with our office as a traditional patient and you are ready to start on your functional health journey please click here to schedule and participate in your first 90 minute group visit.