Tuesday, July 28, 2009

HPV: To be or not to be tested

What is HPV?
In the United States, the most commonly diagnosed sexually transmitted infection is human papillomavirus (HPV). An estimated 80 percent of sexually active adults in the U.S. will acquire HPV infection prior to the age of 50 (Reichman, 2009). The source of transmission is usually without symptoms and is unaware that he/she has been infected. There are many different types of HPV. Certain types can cause genital warts, and others can lead to cervical cancer.

Risk factors
The following predisposes one to infection with HPV: early onset of intercourse, multiple sex partners over time, and having sexual partners who have had multiple partners (Sirovich, B., Feldman, S., & Goodman, A., 2009). Cigarette smoking and immunosuppression increases the risk of cervical cancer (Sirovich et al, 2009).

The Pap smear is a screening test that can identify changes in your cervical cells that are caused by HPV infection. It is estimated that more than half of women who develop cervical cancer either have never had a pap smear, have been screened on an irregular basis, or have not been screened within the previous five years (Sirovich et al, 2009). The current recommendation is for women to initiate annual pap smears beginning three years after the onset of intercourse or at the age of 21, whichever comes first. “The effectiveness of Pap smear screening also hinges on adequate follow-up and treatment for abnormal results” (Sirovich et al, 2009, p. 11).

What can you do to prevent HPV?
A vaccine has been approved for girls, age 9-26. This vaccine protects against four different types of HPV, two of which put a woman at increased risk for cervical cancer and two that cause genital warts.
The only way to prevent HPV is to abstain from intercourse. Utilization of condoms with intercourse, if used all of the time and in the correct manner, may lower the risk of developing HPV.
Limit the number of sex partners.
Cervical cancer can be prevented with routine screening (pap smears) and prompt follow-up of abnormal results.
Avoid cigarette smoking.
Lead a healthy lifestyle w/ diet rich in fruits, vegetables, lean meats and exercise.

Should I tell my partner?
Talking to your sexual partner about HPV is a personal decision. If you do, recall that:
-By the time your infection with HPV was found, your partner was already exposed.
-Once a particular virus has been shared through sexual contact, the risk of passing the infection back and forth is gone.
-It is nearly impossible to determine who gave you HPV or when you were first infected. -The HPV infection could have been from your current partner or any of your past partners.
-If your partner is male, at this time there is no approved testing for HPV in men.

Should I be tested for HPV?
I am sure you have seen plenty of ads for HPV vaccine and HPV testing. You must be wondering if your doctor is testing you or not. At this time there are two options in the American College of Obstetricians and Gynecologists guidelines for women over the age of 30;
1-Continue annual pap smears and perform HPV only if pap smear shows ASCUS which means it is hard to determine if there is definitely an abnormality present or not.
2-Perform HPV with every pap smear. If they are both normal you don't need a pap smear for 3 years(even though you need a pelvic exam every year). If pap smear is normal but high risk HPV is positive you need anther pap smear in 1 year.
Are you confused?!
As you can see there are different ways of making sure we reduce the risk of developing cervical cancer. You and your physician should collaborate and make sure that you are being followed by one of these approved guidelines.

Eden Takhsh M.D.
Elizabeth Torres APN
Kimberly Alton APN