Abnormal Pap Test: Human Papilloma Virus!
As a doctor, I often have the undesirable task of delivering the news that the Human Papilloma Virus (HPV) has been detected on a routine pap smear. Usually, this leaves my patients surprised and bewildered, and there are several questions that are almost always asked following a brief period of shock. After which, I do my best to quell their fears and develop a plan of action.
HPV and the Pap Test
The primary purpose of a pap smear is to detect the pre stages of cervical cancer, which is caused exclusively by HPV. Depending on a woman's age and history, the pap specimen may be tested directly for HPV. Suffice it to say, however, that if pre-cancerous changes are detected on a pap, HPV is present and responsible.
Symptoms of HPV
There are two manifestations of HPV, depending upon the strain of the virus infecting. Of the over 40 strains, most cause warts. Certain strains cause abnormalities on the cells of the cervix and have the potential to cause cervical cancer. Testing identifies these high risk strains in the body. In early stages, infection with high risk strains of HPV cause no symptoms. Further, men not only carry no symptoms, but there is no testing available.
The Scope of HPV
HPV is spread during the direct physical contact that occurs during sexual relations. About half of all sexually active Americans will get HPV in their lifetime. Warts aside, the asymptomatic nature of the infection explains the prevalence of infection spread among unknowing sexual partners. HPV is spread from the intimate contact of sexual relations.
The Most Common Questions
When discussing with patients a new diagnosis of HPV found on a pap test, a few questions come up consistently:
- Did I get this from my current partner? This is difficult to call. If a woman gets routine pap testing and an HPV test was done prior, the infection has likely occurred in the interim. In regard to pre-cancerous changes, this can take months or years to manifest, leaving the answer unknown.
- Does my partner have HPV? Remember, men do not manifest symptoms. If sex with a condom is consistently practiced, there is a fair chance that a partner does not have the same HPV. If there has been unprotected sexual relations, there is a reasonable chance that the partner has the HPV.
- How do I get rid of this? The best medicine for a known HPV infection is time. Like other viruses, our bodies can fight it off. The duration of time needed to fight off the virus varies from person to person. The virus can progress, however, moving down the line of more serious changes on the cervix. I reassure women that we will not allow the possibility of cervical cancer. Routine monitoring will document if the virus has cleared or if the virus has progressed. With progression, measures are taken to halt the trend toward cervical cancer before the cancer occurs. This watchful waiting is the best measure simply because, in healthy, non-smoking women, the changes revert to normal in over 90% of cases. The hardest part of the whole issue is patience.
- Should I still get the vaccine? The answer to this question is yes, provided that a person is eligible. Between recommendations and insurance coverage, eligibility usually encompasses the population between the ages of 11 and 23. Though a person has a one strain of an HPV infection, there are several other potentially harmful strains that can still cause new infection.
The Bottom Line
HPV is common. I know this does not change the matter other than revealing that you are not alone. Maintain hope in the fact that you will, in all likelihood, clear the virus in a matter of months. Live healthy to increase these chances with proper diet, adequate sleep, exercise, and by not smoking. Open communication with your partner(s) is important to contain the spread of the virus. If you are eligible, get the vaccine to prevent any future infection with a different strain.