By Robert Thompson, M.D., OB/GYN

161 N. Binkley St., Ste 201, Soldotna, AK

907-260-6914

Knowing the facts is important when it comes to understanding the current information regarding HPV infection. This sexually transmitted infection is the first viral infection to conclusively be determined to cause changes to the cells of the vagina, cervix, penis, and rectum leading in some cases to cancer. While there are over 70 known types of HPV virus that have been identified, each having different characteristics, it is known for example that types 1, 3, and 5 can cause warts on the hands and feet, types 6 and 11 can cause cauliflower like warts on the genitals of men and women, and other types such as types 16, 18, 31, 33, 35, 45, 51, 52, 56, and 58 have been shown to cause over 90% of cancers of the cervix, and also cause cancers of the vagina, rectum, and penis. Types 16, 18, 31, 45 appear to account for the majority of these cancers.

Cervical cancer is the second most common cancer in women after breast cancer and is considered preventable with routine screening and early onset adequate treatment. Current standards of care, dictate the use of Pap smears using the “Thin Prep” technology with or without HPV DNA screening to detect the presence of the virus. Studies have indicated that over 70% of sexually active adults have acquired HPV infection at some point in their lives making this the most prevalent of all sexually transmitted diseases. For each new partner, the risk of contacting the virus increases over 10 times. Condoms will not prevent the spread of this virus. Any abnormal Pap smears with pre-cancerous changes or atypical cells is almost certainly associated with HPV infection of the cervix and/or vagina. Additionally, over 70% of the male partners of these women are also infected with the virus and are very often transmitting the HPV virus to their partner(s). Unfortunately, routine screening and treatment of male partners is not commonly practiced or completed adequately by a skilled examiner familiar with the atypical appearance of the virus in the skin of the penis, which is only able to be visualized with specialized techniques and magnification.

Exciting new technologies and research have advanced our ability to detect the virus making screening, diagnosis, treatment, and follow up more effective. However, these technologies remain largely unknown and underutilized in many health care settings. Coupled with the lack of clarity in treatment and follow up issues, the emotional discomfort surrounding the issues related to sexually transmitted infections, and the limited provider time for counseling and patient education, it is no wonder that many patients are puzzled, angry, and frightened when confronted with what seems to be inadequate and inconsistent information and advice concerning this potentially life threatening condition. These issues are further complicated in that this infection may appear within several weeks after exposure to someone who has the virus (most commonly), or it may take several months or years to appear, or they may never appear.

It is important to understand that the Pap smear is only a screening test. Repeat Pap smears should be performed to facilitate early diagnosis and treatment of HPV and/or cervical pre-cancerous conditions (called dyspasia), especially if one has a new or different partner, an aggressive viral type detected previously, or a weakened resistance to viral infections. Accurate diagnosis requires a colposcopic exam and if indicated a biopsy of the cervix and/or the vagina using special light and magnification. The treatment alternatives may then be directed by the specific biopsy findings. Unfortunately, too often the male partner is never screened, and various forms of follow up treatment of the female to eradicate the virus are not considered in the treatment regimens. Naturally, this makes recurrences more likely, thereby increasing the cost of adequate treatment, the amount of cumulative discomfort, and the fear of the disease persisting and/or being transmitted to an unsuspecting partner, and/or progressing to a more serious form of the illness or cancer. Nevertheless, follow up Pap smears remain more critical.

Please remember to keep your Pap smear current and be certain that your health care practitioner is fully informed regarding this illness. For more information regarding this or any other OB/GYN concerns, please feel free to contact my office for an appointment or consultation. (907-260-6914)