HPV stands for Human Papilloma Virus. It is a virus that is transmitted by direct contact and over 75% of the population has it. As a gynecologist, I will focus here on the sexually transmitted types.
It may surprise you to know that this virus can be transmitted orally, digitally and even if a condom is used. It may also surprise you to know that while an HPV vaccine exists, and I highly recommend it for both young men and women as it covers the four most common strains, there are over 100 strains of the virus. Some of the strains are regarded as ‘high risk’ because they can act aggressively and cause a cancer. Other strains are considered ‘low risk’ because they can’t kill you, but I can guarantee you that not one of my patients would want any form of that strain either as they can cause genital warts. This is why the screening well-woman exam is so important. When transmitted sexually, HPV prefers to invade the cervix, which is deep in the vagina. There are no symptoms. There is no pain, abnormal discharge or odor until a tumor exists. And this never has to happen. Cancer of the genitals is completely preventable with proper screening.
SO WHAT IS THE TEST?
We have traditionally recommended the Pap smear. To perform the Pap smear, the gynecologist passes a brush along the cervix to essentially exfoliate the cells that are on the surface so they can be looked at under a microscope. We want to see that the cells are not disfigured. The good news is that so much is known about how HPV transforms cells toward a cancer that the Pap smear can detect the stages that the cell goes through. Based on the stage of transformation, there are treatments that can get rid of those transformed cells and never allow a cancer to develop.
The bad news is that the Pap smear reading can be wrong up to half of the time. This means that up to 50% of the results that come back as “normal” may have missed an underlying abnormality. This is where HPV testing can help. We have the capacity to test for the virus itself from the same Pap smear sample. This result guides us as to whether we should believe what the Pap is saying or investigate further. It is not mandatory for a gynecologist to test for HPV at the time of a Pap. There are guidelines that are followed based on the patient’s age and history for testing it. In my office, I do offer the testing to all my patients. I test not only for the presence of the virus but which strain may be present. I also test for something called HPV E6/E7.
HAVE YOU HEARD OF E6/E7?
E6/E7 is a specific gene within the virus itself, though not all of the HPV strains have it. The evidence suggests that if you have been exposed to one of the strains that does have this gene, your cells would be more likely to progress to cancer than if you have been exposed to an HPV that does not have that gene.
This is a brand new test that is cutting edge. In fact, it is so new that the medical community has not yet decided how it will be incorporated into routine screening. Based on alarming results of an ongoing observational study that I am conducting in my practice, I have no doubt that this will change how we screen in the near future.
So get your screening exam and ask your doctor which testing is best for you. Cervical cancer is a completely preventable disease. While there is not yet a cure for the virus, there is a cure for what the virus can do.