The Doctor Is In
Gail Hacker, MD
Abnormal Pap Smear or What is HPV?
I have been terribly remiss about writing new material for "The Doctor is In." I have been very busy these days, having just returned from a medical trip to El Salvador. I plan to write a piece regarding this trip when I get the pictures from the photojournalist that accompanied us. For now, I will just say that we don't have a lot to grouse about here compared to the average Salvadoran.
This column will address abnormal pap smears. Men, you may think you don't need to read further, but you would be wrong. Since the vast majority of abnormal pap smears and cervical cancer are caused by the Human Papilloma Virus (HPV), which can also cause cancer of the penis, I would suggest all sexually active folks read on.
HPV is a very common virus. It causes warts. Common warts on the hands and feet, and not so common warts on the genitals of both men and women.
Warts on the genitals are not only unsightly, they can cause cancer. There have been over 140 types of HPV identified so far, but only about 40 cause problems on the genitals, and 15 of those are likely to cause cancer.
HPV is transmitted through direct skin to skin contact. Genital HPV is transmitted by sexual contact. The bad news is that over 80% of sexually active people will be infected with HPV at some point in their sexual lives. The more partners a person has, the greater the risk of getting HPV. The good news is that over 90% of people that become infected with HPV will clear the infection on their own in about 2 years. There is no specific treatment for the viral infection. Clearing the infection means a person's immune system does its job.
Women can be screened for early signs of cervical cancer and HPV via Pap smears. Pap smears are recommended for all women, beginning within 3 years of onset of sexual activity or by age 21, and every 1-3 years thereafter, depending on a woman's particular risk factors. If a woman has an abnormal result on her pap, a number of different recommendations may be made, depending upon her age, HPV status, number of abnormal paps, and what the exact abnormality is on her current pap.
The most common test used to follow up on an abnormal pap smear is called a colposcopy. During this test an instrument called a colposcope is used to look at and magnify the cervix and further determine where an abnormality may have come from. Biopsies are often taken to send to the lab for further diagnosis. The results of the colposcopy and biopsies, if taken, will determine if further treatment is needed or if a woman can be observed with more frequent pap smears.
Colposcopy is a fairly expensive test, but most insurance companies will cover the cost of the test and biopsies. And LCC is now able to offer women colposcopy on site in the Health Clinic! There is an extra fee for the procedure, but we feel that all women should be able to get the follow up necessary if they have an abnormal pap smear, and will work with you to make sure cost is not the reason you forego necessary treatment. The important take home message is to get screened and discuss the results with your health care provider.
The really good news is that there is now a way to prevent the infection in the first place. A new vaccine, Gardasil, has been on the market for about a year. It protects women from infection with the most common and most dangerous types of HPV. It does NOT clear up infection that is already there. That is your immune system's job. But if a woman receives the entire series of 3 shots she is over 90% protected against the worst HPV viruses. It is currently licensed for use in only women under the age of 26, not for men, and not for "older" women. We are able to offer the vaccination in the Health Clinic. It is expensive, $140/shot, but we may be able to assist some students with getting financial assistance for this important vaccination program. Please call to schedule an appointment with Nadine Wilkes, RN to discuss it further.
Supporting you in good health,
Gail Hacker, MD