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HPV 101 - Genital Warts and Cervical Cancer

What You Need To Know

 

If you're like most people, you probably looked at your doctor blankly and said "Huh?" when he told you that you had HPV. And although he may have tried to explain the virus to you, you most likely left his office a lot more confused than you entered it. Chances are that even now, after you've tried frantically searching the internet for an explanation of what is going on with your body, you still have a lot of questions. So the purpose of this article is to clarify the basics of HPV - what it is, how to understand your individual type, and what this means for you.



HPV, very simply, is the virus that causes warts. And by warts, I mean any wart - the wart on your hand, the wart on your nose, the plantar's wart on your foot. There are some 110 strains of it, though, and around 23 of them are sexually transmitted. Note that the other 50-some are not. This means that if you have warts on your hands and feet - most commonly caused by HPV types 1 and 2 - then you will not transmit them to your genitals, because types 1 and 2 do not infect the genitals. Likewise, the types that do infect the genitals will not infect other parts of the body such as the hands and feet. The reason for this is that the virus is very picky about the type of skin it likes to infect. Now the types of HPV that are sexually transmitted cause one of two things: either genital warts or dysplasia.

Warts and Dysplasia

Genital warts may or may not be "warts" in the conventional sense of the word. They are most commonly caused by HPV types 6 and 11 (less commonly by types 42, 43, and 44) and usually start out as small, raised bumps that can be either white or flesh-colored and will grow if left untreated. Although they are quite a nuisance, genital warts are basically harmless and will not cause cancer. However, they are very easily transmitted: you can spread them through sex, with or without a condom (since they can grow on areas that a condom doesn't cover), through touching yourself and then your partner " down there " (since you can get the virus on your hands by touching infected areas), and there is also a slight possibility of transmitting the virus through oral sex, though this is much less common. It is rare or unheard of to transmit the virus through toilet seats, public swimming pools, hot tubs etc. or any other everyday contact.

Dysplasia is a fancy term for abnormal (pre-cancerous) cells on the cervix, identified by an abnormal pap smear. The types of HPV that cause dysplasia are usually 16 and 18 (less commonly 31, 33, 35, 39, 45, 51, 52, 56, and 58). In fact, types 16, 18, 31, and 45 alone are responsible for 80% of all cervical cancer. This is not to say that having an abnormal pap smear means that you have, or will get, cancer. Thanks to pap smears, only about 2% of the women with dysplasia ever do develop cancer. All this means is that if your pap smear was abnormal, you have cells on your cervix that could turn into cancer if they were left untreated. It usually takes at least several years without any treatment for the cells to actually become cancerous, although this process can be faster if the immune system is compromised through immunosuppressant drugs or illness, such as AIDS. (It is especially important for HIV-positive women to get regular pap smears and monitor any cellular changes.) There are varying degrees of dysplasia, from the very mild, which doctors usually don't even treat because it goes away on its own, to the severe, which requires immediate surgery. Doctors use several classification systems to categorize them. These classification systems are a special favorite of mine, because they're so confusing (and if your doctor just told you that you have some sixteen-letter word on your cervix, you're probably confused too!). There is the Descriptive System, the CIN system, the Bethesda System, and the Class System.

The Descriptive System is very simple: you have mild dysplasia, moderate dysplasia, or severe dysplasia. Mild, as mentioned earlier, does not usually require any treatment, but may be monitored because it could progress, and further tests may be done. Moderate will definitely lead to some kind of further testing, such as a biopsy/colposcopy (a procedure where they insert a camera to look at the cervix and take a bigger sample of tissue). It may also require surgery, depending on the situation. Severe dysplasia certainly requires surgery, such as a LEEP procedure (where they take a wire loop and scrape the cells off).

The CIN system is still pretty simple: it uses CIN1, 2, 3, and 4. This is where CIN stands for "cervical intraepithelial neoplasia," or bad cells on the cervix, and 1 is mild, while 4 is severe.

The Bethesda system is not as easy to understand, but it's used most commonly and contains a word that keeps haunting our vocabulary: squamous intraepithelial lesion. "Squamous intraepithelial lesion," now what is that?! Do doctors do this just to prove that we don't know anything about the medical profession? In terms that the rest of us can understand, it means a patch of cells that have become abnormal. So now you know. There are four categories within the CIN system:

  1. ASC-US (Atypical squamous cells of undetermined significance): This means your pap smear is borderline, and you may or may not have HPV.

  2. ASC-H (Atypical squamous cells, cannot exclude HSIL): The results are still borderline, but you may very well have HSIL (high-grade lesions).

  3. LSIL (Low-grade squamous intraepithelial lesions) : Low-grade abnormal cells, or low/moderate dysplasia.

  4. HSIL (High-grade squamous intraepithelial lesions) : High-grade abnormal cells, or severe dysplasia.

The Class System just has Class 1 through 4. It is no longer widely used.

Testing for HPV

If you are a woman over 30 (and therefore at higher risk for dysplasia) or your pap smear shows ASC-US, the doctor will probably perform an HPV DNA test in addition to your pap smear. Other than that, however, doctors do not "test" for HPV. The reason for this is that HPV, being a skin disease, can infect an undetermined amount of skin in places that are difficult or impossible to test. So if they took a sample from one spot on you and it came up negative, who's to say you don't have HPV in a spot that wasn't tested? HPV doesn't show up in the blood, so there's no sure way to tell you you're positive or negative for it unless there are symptoms present.

Prevalence of HPV, incubation period, and triggers

HPV hardly ever causes symptoms. Some experts believe that only 1-2% of the people who are infected with wart-causing HPV, and 3-5% of people infected with dysplasia-causing HPV ever show symptoms. This is why so many people have HPV and don't know it! In fact, HPV is so very normal at this point that if you are sexually active, you have a 75-90% chance of contracting it sometime in your life! So relax, this is not the end of the world. You've merely found out that you're sharing a virus everyone else has, too - they just don't know it yet.

On the other hand, even though HPV is so widespread, hardly anyone knows about it, and that's bad. People just keep on spreading the virus because they are inadequately informed, or simply do not think it's a big enough problem to even tell their partners. For this reason, it is very important that you tell any future partners that you have HPV, and also anyone you could have gotten the virus from. Many times, however, it is very difficult to determine who has infected you because HPV has an indefinite incubation time. It can infect the skin and then stay there, dormant, until a change in the body gives it the chance to activate. I have received emails from people who were married for years, faithfully, and suddenly found themselves with HPV because of changes in their health. Some triggers of HPV are:

  • Stress
  • Hormonal changes due to birth control or pregnancy
  • Immunosuppressant drugs
  • Other illness
  • An HIV-positive diagnosis

Keeping tabs on HPV

As you can see, the nasty little virus is just waiting to come out. To keep tabs on it, try to adopt a healthier lifestyle. First of all, get all available STD tests, so you are sure that you only have HPV. Then, practice taking care of your body by eating less junk food, quitting smoking and drinking, and exercising more. It is also helpful to take vitamin supplements. I remember a study where they gave women with dysplasia vitamin C over a period of time, and it helped a lot. So take vitamin C often, and you may also want to try Echinacea. Finally, practice de-stressing yourself! Stress is a big factor in helping your immune system cope with anything, especially viruses. I know that's easy to say, and your stress level is doing anything but falling now that you've been diagnosed. But let me assure you that there are plenty of resources out there to help you deal with HPV, in book form and on the web. There are also a number of support groups on Yahoo, and of course, our very own HPV FAQ. In any case, if you need help and you reach out, there will certainly be someone available to get you through this.

Sources:
* The American Social Health Association
* The Association of Reproductive Health Professionals
* "What Your Doctor May NOT Tell You About HPV and Abnormal Pap Smears" by Joel Palefsky, MD.

 

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