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 HPV:  WHAT YOU SHOULD KNOW

What is HPV?
HPV is the common abbreviation for human papilloma virus, a group of over 100 viruses that infect humans.  Approximately one-third of these viruses can infect the genital and reproductive tracts, at times causing problems in both females and males.  Other types of HPV can cause warts on the hands, feet and other areas of the body.  Human papilloma virus is now the most common sexually transmitted infection, with approximately 50% of sexually active individuals infected in the United States during their lifetime.

If HPV is so common, why have I never heard of it?
Only in the last ten years have we had the technology to test for the DNA of this virus.  Most people who get this virus do not develop any significant medical problems, and may not even know they have it.

What about HPV infections in the genital area?
Some strains of HPV cause genital warts.  These are growths or bumps that may appear in females on the vulva, and on the penis or scrotum in males.  Both sexes can also acquire warts in the groin or around the anus.  They can be spread through skin-to-skin contact.  These warts may be raised or flat, single or multiple, small or large.  These types of HPV will eventually resolve over weeks or months and do not necessarily need to be treated, although treatment options are available.

Other strains of HPV can produce cellular changes inside the reproductive tract that cannot be felt or seen with the naked eye.  In women, the Pap smear results can sometimes indicate the presence of microscopic or sub clinical HPV changes on the cervix.

Can HPV cause cervical cancer?
Virtually all (97%) cases of cervical cancer are caused by HPV.  Thirteen strains of HPV are known as "high risk" because they are associated with cervical cell changes that could eventually lead to cancer.  It is now possible to test for the presence of these 13 strains of HPV by using special types of Pap smears.

Only a small proportion of women who have a cervical infection with high-risk HPV will develop cervical cancer.  Since it is not possible to tell in advance who will or will not develop cancer, it is important for women with these HPV strains on their cervix to have frequent monitoring with their health care providers.  The American Society for Colposcopy and Cervical Pathology (ASCCP) recommends that all women who have been newly diagnosed with high-risk strains of HPV have a screening exam called colposcopy to make sure no cancer is already present.  Colposcopy is viewing the cervix under magnification, and usually includes taking biopsies (little snips of tissue) of the cervix.  If a woman chooses not to have colposcopy, then it is important to have Pap smears every four months or so to monitor for cancerous changes.

What can I do to prevent getting HPV?
The only sure way to prevent exposure to the genital strains of HPV is through sexual abstinence.  Condoms with the spermicide nonoxyl-9 help protect against the type of HPV which infect the cervix, but don't help much to protect against genital warts.  Make self-protection decisions about sexual partners.  Remember, the more sexual partners one has, the greater the likelihood of HPV infection.

In the near future, a vaccine may become available to protect against the most common strain of high-risk HPV (type 16).

What can I do if I am infected with high-risk cervical HPV?
If you smoke, STOP!  Smoking facilitates the progression to cancer for those people who have a cervical HPV infection.  Limit the number of sexual partners, and use condoms with spermicide every time you have intercourse.  Take a daily multivitamin, and supplement with antioxidants such as beta carotene if your diet doesn't provide an abundance of these nutrients.  Get a total of 1 mg folic acid (Vitamin B6) each day.  Keep your immune system as healthy as possible by getting enough sleep and exercising regularly.  Most importantly, have regular follow-up visits with your health care provider.

Will I have HPV forever?
While many more studies need to be done in order to answer this question, it appears that HPV infection is extraordinarily common but persistence is rare.  For most people it appears that the immune system ultimately succeeds in clearing the virus from the body--or that the virus is suppressed below our current ability to detect it.  Being infected once, however, does not necessarily produce immunity from getting it again.

I am shocked to have an STI (sexually transmitted infection)!  How do I respond?
This virus will not change your life.  If you have genital warts or cervical changes, there may be a short period of time during which treatment and follow-up may be a nuisance, but little more.  Cervical cancer, the most serious problem associated with HPV, is rare and usually prevented by regular screening visits with your health care provider.

From the Nurse Practitioners at the UNC Student Health Center
December 2002

Information
For more information, or if you think you have genital warts, contact the UNC Student Health Center at 351-2412.