The HPV, Cervical Cancer Connection
Twenty-four million Americans may have the human papillomavirus (HPV) and yet more than 76% US women have never heard of this sexually transmitted virus which causes approximately 93% of all cervical cancers.Scientists have discovered over sixty types of the human papillomavirus virus. Visible genital warts occur in only about 1% of sexually active adults infected with the HPV virus while other types of HPV are subclinical infections. The types of HPVs that cause genital warts are not associated with increased cancer risks and are caused by HPV types 6 and 11. HPV types 16, 18, 31, 33, and 35 have been linked to cervical cancer. These high-risk HPVs have also been linked to increased risk of cancers of the vulva, anus, and bladder.
What are the Symptoms of HPV and Genital Warts?
Often unless genital warts are located in a spot where you can see or feel them you may not know you are infected. Genital warts sometimes go undetected because they are inside the vagina, on the cervix, or in the anus.HPV is frequently difficult to detect because genital warts are often skin colored and painless and rarely cause symptoms. You should consult your physician anytime you notice unusual growths, bumps, or other skin anomalies, as well as if you experience itching, pain, or abnormal bleeding.
Diagnosing HPV...
Genital warts or HPV viruses are sometimes detected during your annual GYN examination, although the Pap smear is not a screening tool for HPV or any other STD or infection. Although most HPVs do not progress to cancer, it is especially important for women diagnosed with HPVs to have regular Pap smears.While the Pap smear is not designed to detect HPV (only abnormal cervical changes) abnormal changes may indicate HPV infection or another vaginal infection. Your physician will either order follow up screening procedure such as a colposcope or follow you closely to detect any further cervical changes when abnormal Pap results are obtained.
If your Pap smear result indicates dysplasia--it's important to note that cervical dysplasia does not mean cervical cancer. However cervical dysplasia is thought to be a precursor condition for carcinoma in situ (CIS) (also not cancer but a severe form of dysplasia) and invasive cancer of the cervix. Many cases of dysplasia regress over time, and the factors that lead to progression to invasive cervical cancer remain unclear.
In CIS, an outer layer of normal cells is replaced by cancer cells. CIS is about 95% treatable and curable. Invasive cancer of the cervix occurs when cancer cells have invaded the underlying tissues of the cervix. CIS occurs generally in women between 25 and 34 while invasive cancer of the cervix primarily occurs in women over the age of fifty.
The prognosis for invasive cervical cancer is largely dependent on the extent of disease at the time of initial diagnosis. The current death rate for cervical cancer remains higher that it should be due to the approximately one-third of women who do not have regular annual Pap smears. An estimate 90% of cervical cancer deaths could be eliminated through earlier detection with the Pap smear.
How is HPV Treated?
Treating HPV is often difficult and frustrating for both the patient and physician. Treatment of visible genital warts for the average patient often requires a few treatments. These treatments are not cures--after treatment the virus may remain in nearby skin and lie dormant in nearby skin for months or even years before becoming visible again, and in some cases visible warts never return.According to the 1998 Guidelines for Treatment of Sexually Transmitted Diseases published by the Centers of Disease Control and Prevention in Atlanta, GA, "In the absence of coexistent dysplasia, treatment is not recommended for subclinical genital HPV (without visible genital warts) diagnosed by Pap smear, colposcopy, biopsy, acetic acid soaking of genital skin or mucous membranes, or the detection of HPV (DNA or RNA). The diagnosis of subclinical genital HPV infection is often questionable, and no therapy has been identified to eradicate infection. HPV has been demonstrated in adjacent tissue after laser treatment of HPV-associated dysplasia and after attempts to eliminate subclinical HPV by extensive laser vaporization of the anogenital area. In the presence of coexistent dysplasia, management should be based on the grade of dysplasia."
The CDC recommends treatments of visible HPV genital warts that vary from patient-applied therapies such as podofilox and imiquimod to provider-administered therapies such as cryotherapy, podophyllin resin, trichloroacetic acid (TCA), bicholoracetic acid (BCA), interferon, and surgery.
