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Could you have HPV? The answer might surprise you

Virus that affects as many as 8 in 10 women by age 50 often goes undiagnosed, even though some strains can be deadly Maggie Downs • The Desert Sun • September 6, 2009

Katie didn't show any signs of having an STD. She was healthy. She had annual exams with the gynecologist. She never had an abnormal Pap smear.

But during her most recent exam, the single, sexually active 28-year-old asked her doctor about testing for HPV, human papillomavirus, just in case.

In addition to being the most common sexually transmitted infection, HPV is almost always the cause of cervical cancer — a disease that strikes with 11,270 new cases in the U.S. each year and kills around 4,070 women annually, according to the American Cancer Society.

It was with this in mind that Katie asked for the test.

"I'm a worrier, and I don't like to leave any stone unturned," she said. "I wanted to be able to definitively say that I have a clean bill of health."

That wasn't the case.

Katie was soon notified that she tested positive for a high-risk type of HPV, the kind that could turn into cancer someday.

She immediately fired off questions for the nurse practitioner. "(The nurse) said I was very well informed and know more than most people — which is scary, because I didn't know much about HPV at all," she said.

Katie's situation isn't unique. Fifty percent of all sexually active adults already have some form of the virus. The Centers for Disease Control and Prevention also estimate that 80 percent of all women will contract HPV by age 50.

"If you're young and dating, there's basically a 1-in-2 chance that person has the HPV virus," said Dr. Lisa Lindley of the Rancho Mirage Women's Health Center.

"It really makes you stop and think."

There are more than 100 strains of HPV, which is passed through skin-to-skin contact. Of those, about 40 strains can infect the genitals, including the penis, vulva, anus, vagina, cervix and rectum.

But it is far more of a medical concern for women than for men, according to Dr. Lindley. "It is implicated in cancers of the penis and cancer of the larynx, but that's not nearly as common as cervical cancer," she said.

About 15 high-risk strains of HPV can lead to cervical cancer. Two of those have been shown to cause 70 percent of all cervical cancers.

Most people who become infected with HPV never know they have it. There are no symptoms, unless you have the kind that manifests itself in the form of genital warts.

"The irony is that if a woman has warts, that's what brings her into the office to see me, even though that's not life-threatening," Dr. Lindley said. "But for the women who have precancerous HPV, they might never know."

There is some good news, though.

Research suggests that most people's immune systems can eliminate the majority of low-risk HPV infections within a year or two.

"Your body can actually clear the HPV virus," Dr. Lindley said. "Natural immunity is very effective."

That is especially true in teenagers, she said.

Though it's possible for the immune system to fight off certain strains of HPV, about 10 percent of people with the virus remain infected. For those folks, there is no absolute cure.

Katie is discouraged that there isn't more she can do at this point.

"I'm a proactive person who likes to get answers and fix things," she said. "In this case, the general consensus is that there's nothing I can do. It's frustrating."

Testing and prevention

Testing for HPV isn't typically done during an annual gynecological exam. Many doctors only administer an HPV test if a woman has an inconclusive or abnormal result from a Pap smear — or if a woman requests it, like Katie.

"It's scary to think how long I could have gone not knowing about this risk to my health," she said. "I just assumed that I was fine because all my Pap smears were normal."

Prevention of HPV is difficult, partially because of the sheer number of people who already have it.

Condoms have been shown to be less than 70 percent effective against HPV, which can also infect areas that are not covered by a condom.

Lately, most HPV-related discussions have centered around the Gardasil HPV vaccine, which was introduced in 2006 and is mostly administered to women ages 9 to 26.

However, that doesn't necessarily make the vaccine ineffective for other age groups.

"There is no one who is not a candidate," Dr. Lindley said.

She recommends it for most of her patients.

"Let's say you have a 50-year-old who is widowed and dating," said Dr. Lindley. "Of course you want to be protected against that."

The Gardasil vaccine was designed to target just four of the 40 HPV subtypes that infect the genitals. But those four types are responsible for the majority of genital wart and cervical cancer cases.

"That's one thing I have to remind my patients about," Dr. Lindley said. "It's not a vaccine that protects you against everything, but it does protect you among the four most common."

The vaccine might bring some peace of mind, but it also comes at a relatively high cost. Each shot in the three-dose regimen is about $120, plus extra fees for a doctor to stock and administer the vaccine.

It's been a boon for Merck & Co., Inc., the company that makes the vaccine. In 2008, worldwide sales of Gardasil brought in $1.4 billion.

Dr. Lindley said many insurance companies still do not pick up the tab for the vaccine, particularly if women fall outside of the recommended 9- to 26-year-old age range.

Some experts have questioned how long Gardasil's protection will last, though Dr. Lindley said that doesn't seem to be a problem.

"There have been many years of data in the United States, and there is no sign that people are breaking through the vaccine," she said. "Is it possible that people will need a booster shot in the future? Yes. Just like tetanus. But we haven't seen that yet."

The vaccine has also come under fire by some conservatives, who fear that vaccination will encourage promiscuous behavior.

"Obviously we're not giving the shot to a 16-year-old and telling them to go out and have sex," Dr. Lindley said.

"It's not even about becoming sexually active now. You're really vaccinating them against their future."

Facts about HPV

Approximately 20 million Americans are currently infected with HPV, and another 6.2 million people become infected each year.
There are many myths about how people get HPV. You cannot get HPV from being unclean, from toilet seats or from having an abortion. Also, you are not more likely to get HPV from having rough sex or sex during a period.
Beyond health risks, HPV also comes with a huge price tag. A study in the "American Journal of Obstetrics and Gynecology" estimated the annual cost of HPV-related conditions in the U.S. at $2.25 billion to $4.6 billion.

About the vaccine

In 2006, the Food and Drug Administration approved the Gardasil vaccine, which protects against four types of HPV; two that cause genital warts and two that cause cervical cancer.

Here are some facts about the vaccine:

Despite concerns about the safety of Gardasil, the Centers for Disease Control and Prevention found that reports of serious adverse effects, including death following the administration of the vaccine, were not related to the shot.
Most doctors recommend that girls receive the vaccine before they become sexually active. Gardasil is only effective in preventing HPV infections, not in treating those already infected by HPV.
On Sept. 9, a Food and Drug Administration committee will meet to determine whether Gardasil should be approved for use in males. HPV causes about 250,000 new cases of genital warts and 7,500 cancers in males every year. Vaccination would also help prevent the spread of the virus to their sexual partners.
In California, a state bill was introduced that would have required girls entering the sixth grade to be vaccinated. It has been withdrawn for further consideration.
Virginia and the District of Columbia passed legislation in 2007 that requires girls entering the sixth grade beginning this year to receive the HPV vaccine unless their parents or guardians opt out.
The following states require schools or health departments to provide HPV and vaccination information, and in some cases provide the vaccine: Louisiana, Michigan, Colorado, Indiana, Iowa, New Jersey, North Carolina, Maine, North Dakota, Texas and Washington. Utah passed legislation in 2007 establishing an awareness campaign on the causes, prevention and risks of cervical cancer.
The federal government has made the HPV vaccine mandatory for female immigrants seeking to become legal permanent residents. The shots are not mandatory for U.S. citizens.

Source: The National Conference of State Legislatures

Getting the vaccine

Chances are your family doctor or gynecologist can administer the HPV vaccine. If not, the vaccine is also available at both Planned Parenthood clinics in the Coachella Valley.

Women between the ages of 18 and 26 might qualify for the Merek vaccination assistance program, which makes the vaccine available at a $20 co-pay for each shot. (The vaccine is a round of three shots.) Women who don't qualify for the program can also receive the vaccine at $160 per shot.

To make an appointment, call the toll-free number, (888)743-7526.

	Home \| Meet \| Ask Dr. Lisa FAQ \| Hormones, Diet & Sex...Oh My! \| Women's Health Issues \| Lectures & Videos \| Health Topics \| Contact Could you have HPV? The answer might surprise you Virus that affects as many as 8 in 10 women by age 50 often goes undiagnosed, even though some strains can be deadly Maggie Downs • The Desert Sun • September 6, 2009 Katie didn't show any signs of having an STD. She was healthy. She had annual exams with the gynecologist. She never had an abnormal Pap smear. But during her most recent exam, the single, sexually active 28-year-old asked her doctor about testing for HPV, human papillomavirus, just in case. In addition to being the most common sexually transmitted infection, HPV is almost always the cause of cervical cancer — a disease that strikes with 11,270 new cases in the U.S. each year and kills around 4,070 women annually, according to the American Cancer Society. It was with this in mind that Katie asked for the test. "I'm a worrier, and I don't like to leave any stone unturned," she said. "I wanted to be able to definitively say that I have a clean bill of health." That wasn't the case. Katie was soon notified that she tested positive for a high-risk type of HPV, the kind that could turn into cancer someday. She immediately fired off questions for the nurse practitioner. "(The nurse) said I was very well informed and know more than most people — which is scary, because I didn't know much about HPV at all," she said. Katie's situation isn't unique. Fifty percent of all sexually active adults already have some form of the virus. The Centers for Disease Control and Prevention also estimate that 80 percent of all women will contract HPV by age 50. "If you're young and dating, there's basically a 1-in-2 chance that person has the HPV virus," said Dr. Lisa Lindley of the Rancho Mirage Women's Health Center. "It really makes you stop and think." There are more than 100 strains of HPV, which is passed through skin-to-skin contact. Of those, about 40 strains can infect the genitals, including the penis, vulva, anus, vagina, cervix and rectum. But it is far more of a medical concern for women than for men, according to Dr. Lindley. "It is implicated in cancers of the penis and cancer of the larynx, but that's not nearly as common as cervical cancer," she said. About 15 high-risk strains of HPV can lead to cervical cancer. Two of those have been shown to cause 70 percent of all cervical cancers. Most people who become infected with HPV never know they have it. There are no symptoms, unless you have the kind that manifests itself in the form of genital warts. "The irony is that if a woman has warts, that's what brings her into the office to see me, even though that's not life-threatening," Dr. Lindley said. "But for the women who have precancerous HPV, they might never know." There is some good news, though. Research suggests that most people's immune systems can eliminate the majority of low-risk HPV infections within a year or two. "Your body can actually clear the HPV virus," Dr. Lindley said. "Natural immunity is very effective." That is especially true in teenagers, she said. Though it's possible for the immune system to fight off certain strains of HPV, about 10 percent of people with the virus remain infected. For those folks, there is no absolute cure. Katie is discouraged that there isn't more she can do at this point. "I'm a proactive person who likes to get answers and fix things," she said. "In this case, the general consensus is that there's nothing I can do. It's frustrating." Testing and prevention Testing for HPV isn't typically done during an annual gynecological exam. Many doctors only administer an HPV test if a woman has an inconclusive or abnormal result from a Pap smear — or if a woman requests it, like Katie. "It's scary to think how long I could have gone not knowing about this risk to my health," she said. "I just assumed that I was fine because all my Pap smears were normal." Prevention of HPV is difficult, partially because of the sheer number of people who already have it. Condoms have been shown to be less than 70 percent effective against HPV, which can also infect areas that are not covered by a condom. Lately, most HPV-related discussions have centered around the Gardasil HPV vaccine, which was introduced in 2006 and is mostly administered to women ages 9 to 26. However, that doesn't necessarily make the vaccine ineffective for other age groups. "There is no one who is not a candidate," Dr. Lindley said. She recommends it for most of her patients. "Let's say you have a 50-year-old who is widowed and dating," said Dr. Lindley. "Of course you want to be protected against that." The Gardasil vaccine was designed to target just four of the 40 HPV subtypes that infect the genitals. But those four types are responsible for the majority of genital wart and cervical cancer cases. "That's one thing I have to remind my patients about," Dr. Lindley said. "It's not a vaccine that protects you against everything, but it does protect you among the four most common." The vaccine might bring some peace of mind, but it also comes at a relatively high cost. Each shot in the three-dose regimen is about $120, plus extra fees for a doctor to stock and administer the vaccine. It's been a boon for Merck & Co., Inc., the company that makes the vaccine. In 2008, worldwide sales of Gardasil brought in $1.4 billion. Dr. Lindley said many insurance companies still do not pick up the tab for the vaccine, particularly if women fall outside of the recommended 9- to 26-year-old age range. Some experts have questioned how long Gardasil's protection will last, though Dr. Lindley said that doesn't seem to be a problem. "There have been many years of data in the United States, and there is no sign that people are breaking through the vaccine," she said. "Is it possible that people will need a booster shot in the future? Yes. Just like tetanus. But we haven't seen that yet." The vaccine has also come under fire by some conservatives, who fear that vaccination will encourage promiscuous behavior. "Obviously we're not giving the shot to a 16-year-old and telling them to go out and have sex," Dr. Lindley said. "It's not even about becoming sexually active now. You're really vaccinating them against their future." Facts about HPV Approximately 20 million Americans are currently infected with HPV, and another 6.2 million people become infected each year. There are many myths about how people get HPV. You cannot get HPV from being unclean, from toilet seats or from having an abortion. Also, you are not more likely to get HPV from having rough sex or sex during a period. Beyond health risks, HPV also comes with a huge price tag. A study in the "American Journal of Obstetrics and Gynecology" estimated the annual cost of HPV-related conditions in the U.S. at $2.25 billion to $4.6 billion. About the vaccine In 2006, the Food and Drug Administration approved the Gardasil vaccine, which protects against four types of HPV; two that cause genital warts and two that cause cervical cancer. Here are some facts about the vaccine: Despite concerns about the safety of Gardasil, the Centers for Disease Control and Prevention found that reports of serious adverse effects, including death following the administration of the vaccine, were not related to the shot. Most doctors recommend that girls receive the vaccine before they become sexually active. Gardasil is only effective in preventing HPV infections, not in treating those already infected by HPV. On Sept. 9, a Food and Drug Administration committee will meet to determine whether Gardasil should be approved for use in males. HPV causes about 250,000 new cases of genital warts and 7,500 cancers in males every year. Vaccination would also help prevent the spread of the virus to their sexual partners. In California, a state bill was introduced that would have required girls entering the sixth grade to be vaccinated. It has been withdrawn for further consideration. Virginia and the District of Columbia passed legislation in 2007 that requires girls entering the sixth grade beginning this year to receive the HPV vaccine unless their parents or guardians opt out. The following states require schools or health departments to provide HPV and vaccination information, and in some cases provide the vaccine: Louisiana, Michigan, Colorado, Indiana, Iowa, New Jersey, North Carolina, Maine, North Dakota, Texas and Washington. Utah passed legislation in 2007 establishing an awareness campaign on the causes, prevention and risks of cervical cancer. The federal government has made the HPV vaccine mandatory for female immigrants seeking to become legal permanent residents. The shots are not mandatory for U.S. citizens. Source: The National Conference of State Legislatures Getting the vaccine Chances are your family doctor or gynecologist can administer the HPV vaccine. If not, the vaccine is also available at both Planned Parenthood clinics in the Coachella Valley. Women between the ages of 18 and 26 might qualify for the Merek vaccination assistance program, which makes the vaccine available at a $20 co-pay for each shot. (The vaccine is a round of three shots.) Women who don't qualify for the program can also receive the vaccine at $160 per shot. To make an appointment, call the toll-free number, (888)743-7526.