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Genital HPV Infection **Human papilloma viruses

    There are over 100 HPV types.

About 30 of these types are sexually transmitted and cause genital HPV.

Genital HPV is spread through skin-to-skin contact, not through an exchange of bodily fluid.

Genital HPV cannot be entirely prevented by condom use.

This virus is often asymptomatic — people usually don’t know they have it.

About 5.5 million new genital HPV cases occur each year — this is about 1/3 of all new STD infections.

About 20 million people — men and women — are thought to have an active HPV infection at any given time.

Nearly three out of four Americans between the ages of 15 and 49 have been infected with genital HPV in their lifetime.

HPV can be contracted from one partner, remain dormant, and then later be unknowingly transmitted to another sexual partner, including a spouse.

Though usually harmless, some types cause cervical cancer if not detected in time.

About 14,000 cases of cervical cancer are diagnosed in the United States each year.

Over 5,000 women each year die of cervical cancer in the United States.

The best way to screen for cervical cancer is a Pap test, which may be done alone or in combination with an HPV DNA test.

The American College of Obstetricians and Gynecologists recommend that sexually active women and women age 21 and older should have an annual gynecologic exam in addition to Pap tests at regular intervals (the frequency of Pap tests can vary depending on a woman’s age and the type of Pap test being done).

What is cervical dysplasia?
When a female goes to a clinic or her health care provider for a Pap smear, they are screening the cells on her cervix to make sure that there are no abnormal or precancerous changes. If the Pap test results show these cell changes, this is usually called cervical dysplasia. Other common terms the health care provider may use include:

Abnormal cell changes
Precancerous cells changes
CIN (cervical intraepithelial neoplasia)
SIL (squamous intraepithelial lesions)
“Warts” on the cervix
All of these terms mean similar things – it simply means that abnormalities were found. Most of the time, these cell changes are due to HPV. There are many types of HPV that can cause cervical dysplasia. Most of these types are considered “high-risk” types, which means that they have been linked with cervical cancer.

Just because a female has cervical dysplasia, it does not mean she will get cervical cancer. It means that her health care provider will want to closely monitor her cervix every so often – and possibly do treatment – to prevent further cell changes that could become cancerous over time if left unchecked.
HPV is a very common virus, and most females with HPV do not develop cervical cancer.
Cervical cancer is a slow-growing condition that usually takes years to progress. This is why getting screened on a regular basis is important; screening can catch any potential problems before they progress.

How can a person get the types of HPV that cause cell changes?

Any person who is sexually active can be exposed and get the cell-changing types of HPV.
Most people are exposed to the cell-changing types of HPV at some point, but not everyone (especially males) will actually have abnormal cell changes (dysplasia).
The types of HPV that cause abnormal cell changes are usually spread by direct skin-to-skin contact during vaginal, anal, or possibly through oral sex, with someone who has this infection.
Many experts think the cell-changing types of HPV are most likely to be given to a partner when dysplasia is actually present.
Transmission to sex partners with subclinical (invisible) HPV is not well understoond. Some experts think it may be less contagious than when the cell changes are not present.
The types of HPV that cause abnormal cell changes do not typically cause symptoms on other body parts such as the hands.
Recent research studies have shown a relationship between a cell-changing type of HPV and some rare head and neck cancers, but there is not much evidence that oral sex definitely transmits these types of HPV.

When and how do I screen for cervical cancer?
According to the American Cancer Society, a female should get her first screening by age 21, or within three years of becoming sexually active – which ever happens first.

Many women are used to getting screened once a year. However, newer research has found that it is not necessary to screen this often, especially if newer tests are being used. So now you and your health care provider have a few options available on screening methods.

If a conventional Pap smear is used (the cell sample taken is put on a glass slide) and the result is normal, then screening should be done once a year.
If a liquid-based Pap test is used (the cell sample taken is put in a container filled with liquid) and the result is normal, then screening should be done once every two years.
If a combination Pap-HPV DNA test is used (only approved for women over age 30) and the result is normal/negative, then screening should be done once every three years.
See the sections below for more information on these tests.

Even though screening for cervical cancer can occur less often, it is still important for you to see your health care provider annually for other female-related health care needs – ask your provider what they recommend.



How do I prepare for a Pap or HPV test?
Try to schedule the test on a day when you do not expect to be on your menstrual period. If your period begins unexpectedly and will be continuing on the day of your test, try to reschedule the appointment.

Avoid sexual intercourse 48 hours before the test.
Do not douche 48 hours before the test.
Do not use tampons, or vaginal creams, foams, films, or jellies (such as spermicides or medications inserted into the vagina) for 48 hours before the test



What about abnormal Pap test results?

The term “abnormal Pap” is broad and not very specific. There are many different systems that health care providers use to classify a Pap test. Within each system, there are different degrees of severity or abnormalities. The various classification systems and degrees of severity include:

Descriptive System
 Mild dysplasia, Moderate dysplasia, Severe dysplasia
CIN System
 CIN 1, CIN 2, CIN 3
 CIN stands for cervical intraepithelial neoplasia
Bethesda System (2001)
 ASC-US (Atypical Squamous Cells of Undetermined Significance)

ASC-H (Atypical Squamous Cells-can not exclude HSIL)

Low-Grade SIL (LSIL)

High-Grade SIL (HSIL)
 Means the results look borderline between “normal” and “abnormal” – often not HPV-related

Borderline results, but may really include High-Grade lesions

SIL stands for squamous intraepithelial lesion
Class System
 Class 1, Class 2, Class 3, Class 4
 This system is no longer widely used.

Women with abnormal Pap test results are usually examined further for cervical problems. This may involve coming back for a colposcopy and biopsy, or coming back in a few months for another Pap test. If the Pap result is “ASC-US,” then a HPV-DNA test may be done in the lab to see whether HPV is causing this borderline “normal-abnormal” Pap result.

What’s the difference between a Pap test, a biopsy and a HPV test?
A Pap test, or Pap smear, is a screening to find abnormal cell changes on the cervix (cervical dysplasia) before they ever have a chance to turn into cancer. During a pelvic exam, a small brush or cotton tipped applicator will be used to take a swab of cervical cells. These cells are then put either on a glass slide or in a container with liquid, and sent to the laboratory for evaluation. The most common commercially available liquid-based Pap test is called ThinPrep®, manufactured by Cytyc.

A biopsy is similar to a Pap test, but a larger cluster of cells is removed from the cervix to see if there are abnormal cell changes. It is a good way to confirm the earlier Pap smear result and to rule out cancer. If a biopsy is done, it will be performed at the same time as the colposcopy.

An HPV test is different than a Pap test or biopsy. This test checks directly for the genetic material (DNA) of HPV within cells, and can detect the “high-risk” types connected with cervical cancer. The test is done in a laboratory, usually with the same cell sample taken during the Pap test. The only commercially available test for HPV is called Hybrid Capture II™, produced by Digene. It is most convenient if the HPV test is done in the laboratory from a cervical cell sample that was taken using a liquid-based Pap test.

When is a HPV test used?
Currently, the HPV test called Hybrid Capture II™, is approved by the U.S. Food and Drug Administration (FDA) for use in two different situations:

(1) As a follow-up test if the Pap result is borderline between “normal” and “abnormal.” This is usually called “atypical squamous cells” or “ASC-US.” The HPV test is then used in the lab to determine if women with the borderline result are more likely to have precancerous changes on their cervix, (HPV positive), and which are more likely to just have normal cells (HPV negative). Basically, the test helps to rule out whether HPV is causing the borderline abnormal cells.

(2) As a cervical cancer screening test in combination with a Pap test in women at or over age 30 (rather than just having the Pap test alone). Research shows that the combination test can increase the effectiveness of detecting any problems early on. A preliminary recommendation by the American Cancer Society state that if the combination Pap – HPV DNA test (Digene’s DNA with Pap™ test) result is normal/negative, then the next screening would not have to be for three years. However, if one of the tests in the DNA with Pap comes back abnormal/positive, then follow-up will be needed.

When is a HPV test NOT used?

If the Pap result shows dysplasia or precancerous changes. This is because these cell changes are almost always associated with HPV.
In women under age 30, unless they have had an ASC-US Pap test result.
The HPV test is not approved for use with males. It is only FDA approved to be used on the female’s cervix.
Can a male find out if he has the cell changing-types of HPV?
Research has shown that the HPV test may lead to inconsistent results with men. This is because it is difficult to get a good cell sample to test from the thick skin on the penis. Most people will not have visible symptoms if they are exposed to HPV. Therefore, for most, the virus is subclinical (invisible). This is especially true for males. If a male is exposed to the cell-changing types of HPV, he would be unlikely to have symptoms. If there are no symptoms for males, it is hard to test for it. Most of the time, men will not have any health risks such as cancer with the “high-risk” types of HPV. It is the female’s cervix that needs to be monitored.



Currently, there is no treatment to cure HPV; there is no cure for any virus at this point. However, there are several treatment options available for treating the abnormal cells.
Sometimes treatment may not even be necessary for mild cervical dysplasia. These cells can heal on their own and the health care provider will just want to monitor the cervix. HPV may then be in a latent (sleeping) state, but it is unknown if it totally gone or just not detectable.
The goal of any treatment will be to remove the abnormal cells. This may also end up removing most of the cells with the HPV in them.
If the abnormal cells are treated, or if they have healed on their own, it may possibly help reduce the risk of transmission to a partner who may have never been exposed to the cell-changing types of HPV.
When choosing what treatment to use, the health care provider will consider many things:
location of the abnormal cells
size of the lesions on the cervix
degree or severity of the Pap smear results
degree or severity of the colposcopy and biopsy results
HPV test results (if this test was needed)
age and pregnancy status
previous treatment history
patient and health care provider preferences
There are a variety of treatments for cervical dysplasia:

Cryotherapy (freezing the cells with liquid nitrogen).
LEEP (Loop Electrosurgical Exision Procedure)
Conization (also called cone biopsy)
Laser (not as widely used today due to high cost, lack of availability, and not all doctors are well-trained with using it. LEEP is more commonly used)
No treatment at all since even mild abnormal cell changes may resolve without treatment. The health care provider may just monitor the cervix by either doing a colposcopy, repeat Pap testing, or a test for HPV.

What about HPV and pregnancy?

For some pregnant women, cervical dysplasia may increase. This may be due to hormone changes during pregnancy, but this is not proven.
If a woman has an abnormal Pap smear during pregnancy, even if it’s severely abnormal, many health care providers will not do treatment. They will just monitor the cervix closely with a colposcope during the pregnancy.
Sometime (a few weeks) after delivery of the baby, the provider will look at the cervix again and do another Pap smear or another biopsy. Many times after pregnancy, the cell changes will have spontaneously resolved – and no treatment will be necessary.
The reason that many health care providers do not want to do treatment during pregnancy is because it may accidentally cause early labor.
The types of HPV that can cause cell changes on the cervix and genital skin have not been found to cause problems for babies.

What about HPV and other cancers?

Anal dysplasia and anal cancer:

Anal cancer is a rare occurrence that has been strongly linked to “high-risk” types of HPV.
Abnormal cell changes in the anal area (anal dysplasia or anal neoplasia) are more common among individuals who engage in receiving anal sex.
However, anal dysplasia has also been reported in some females who have a history of severe cervical dysplasia
Treatment is available for anal dysplasia and anal cancer
Penile Intraepithelial Neoplasia (PIN) and penile cancer:

Cancer of the penis is extremely rare in the United States, and HPV is not always the cause
There are some cases of cell changes (neoplasia) on the penis, which are caused by “high-risk” types of HPV.
Most males do not ever experience symptoms or health risks if they get one or more “high-risk” types of HPV.
Penile neoplasia can be treated.
There is not a cancer screening for the penis because cancer of the penis is extremely rare, and because it is difficult to get a good cell sample from the penis.
Vaginal Intraepithelial Neoplasia (VAIN) and vaginal cancer:

HPV has been linked with some, but not all, cases of cell changes in the vagina and with vaginal cancers.
Various treatment options are available for vaginal neoplasia, depending on how mild or severe the cell changes are in this area.
Vaginal cancers are rare.
Vulvar Intraepithelial Neoplasia (VIN) and vulvar cancer:

HPV has been linked with some, but not all, cases of cell changes on the vulva (outside female genital area) and with vulvar cancers.
Various treatment options are available for vulvar neoplasia, depending on how mild or severe the cell changes are in this area.
Vulvar cancers are rare.

Is it normal to feel upset about HPV?
Yes, it is normal. Some people feel very upset. They feel may ashamed, fearful, confused, less attractive or less interested in sex. They feel angry at their sex partner(s), even though it is usually not possible to know exactly when or from whom the virus was spread. Some people are afraid that they will get cancer, or that they will never be able to find a sexual partner again. It is normal to have all, some or none of these feelings. It may take some time, but it is important to know that it is still possible to have a normal, healthy life, even with HPV. Ways to help cope with HPV emotionally:
Talk to someone you can trust such as a friend or loved one
Go to an HPV support group
Get educated and learn the facts about HPV by ordering ASHA’s materials


Reduce your risk
Any one who is sexually active can come across this common virus. Ways to reduce the risk are:
Not having sex with anyone.
Having sex only with one partner who has sex only with you. People who have many sex partners are at higher risk of getting other STDs.
If someone currently has abnormal cell changes, he or she should not have sexual activity until after the cells have been treated or have self resolved. This may help to lower the risk of transmission.
Condoms (rubbers), used the right way from start to finish each time of having sex may help provide minimal protection – but only for the skin that is covered by the condom. Condoms do not cover all genital skin, so they don’t give 100% protection.
Spermicidal foams, creams, jellies (and condoms coated with spermicide) are not proven to be effective in preventing HPV and may cause microscopic abrasions that make it easier to contract STDs. Spermicides are not recommended for routine use.
If someone was exposed to the types of HPV that can cause abnormal cell changes, it would be unlikely that he or she will become re-infected with those same types since immunity will be set-up at some point.
Realize that most people are exposed to one or more HPV types in their lifetime, and most will never even know it because they will not have visible symptoms.
It is important for partners to understand the “entire picture” about HPV so that both people can make informed decisions based on facts, not fear or misconceptions


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