HPV--CAN'T SEE IT, TOUCH IT OR SMELL IT BUT IT'S THERE!

With this month being National Sexually Transmitted Infection (STI) month this would be a great time to review 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.  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 a low risk strains.  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 little thing 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.  If you have been exposed you may need more careful screening in terms of repeating your pap in 1 year versus 3-5.  However depending on your individual risk factors you may or may nor 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 (usually 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.  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 dyplasia but this has not yet been extrapolated to humans and there are concerns about dosage and mode of delivery. But 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.

Now I'm not one for fear mongering but there have been adverse reports associated with the Gardasil vaccine. However the studies do not suggest that the rates of these events are any higher than the same rate of adverse events with other common vaccination series.  So what does that mean?  That means that when you look at humans and vaccinations there is always a certain small percentage that may have an unforeseeable adverse event but when you are considering overall public health the rate of that event is what determines if a therapy or treatment stays or goes. In these cases although the total number may seem high when you compare that against the millions in total population the real overall number is very, very small. That is essence means that it is a treatment that is judged worthy with an acceptable risks.  So in essence if you in principal just chose not to vaccinate against any disease at all it make s sense to not get the vaccine but if you have gotten all other routine vaccinations there isn't any reason to in particular exclude this one based on the information that we currently know.