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
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:
- ASC-US (Atypical squamous cells of undetermined significance):
This means your pap smear is borderline, and you may or may not have
- ASC-H (Atypical squamous cells, cannot exclude HSIL):
The results are still borderline, but you may very well have HSIL (high-grade
- LSIL (Low-grade squamous intraepithelial lesions)
: Low-grade abnormal cells, or low/moderate dysplasia.
- 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:
- 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.
* 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.