FamilyCare of Kent

400 West Gowe St, Suite 400     Kent, WA 98032     253.859.CARE (2273)     Fax: 253.850.8894

HPV, Cancer, and You

The link between genital HPV and cervical cancer is very strong.

Most cervical precancers and cancers occur in patients who have been previously infected with genital (venereal) warts or human papillomavirus (HPV). Some of these warts can become cancerous and invasive unless precancerous changes are diagnosed and treated early. The link between genital HPV and cervical cancer is very strong. For example, HPV has been found in over 90% of women with invasive cervical cancers. Fortunately, the vast majority of HPV-infected women will not develop cancer.

Genital HPV may not cause any immediate signs. In some cases, it is present for weeks or months before you are aware of it; in others, it may remain dormant for years. Like many other viruses, signs may appear or warts may increase during times of stress or physical illness or during pregnancy, when hormonal factors and decreased immunity may play a role.

Signs of HPV Infection

Common flat warts that infect the cervix are without symptoms and usually invisible.

The outward signs include small, pink-white moist warts just inside the vagina or in the areas surrounding the vaginal opening (vulva) or anus. The warts may be flat or raised; single or in clusters. They are frequently painless and do not bleed, though some women complain of itching. However, the common flat warts that infect the cervix are without symptoms and usually invisible unless special techniques are used. Only a clinician who has been alerted by the presence of virus-infected cells in the Pap smear, and/or by outward symptoms will know to check for HPV.

Your Sexual Partner

In males, most genital warts are invisible.

However, when they do appear, they are flat, pink-white or brown-colored spots or skin thickenings on the penis, scrotum, anal opening, or surrounding tissue. In 20% of cases, HPV infects the urethra, the urinary opening of the penis. The skin changes are best observed under magnification with a hand lens and after a vinegar solution has been applied to the surface skin. (See our brochure titled, "Human Papillomavirus (HPV) and Cervical Cancer—What a man needs to know.")

To prevent cervical cancer and precancer associated with genital HPV, you should know:

• how the virus is spread
• whether you have been exposed
• who is at greater risk
• what to do if you have been exposed
• how to avoid future exposure

How the Virus is Spread

Viruses can survive only if infected cells are passed from one individual to another.

Genital HPV is easily passed from one person to another during vaginal, anal, or oral sexual intercourse, usually by a partner who is not aware that he or she is infected. Venereal (genital) warts usually occur in body areas exposed to friction during sexual intercourse. The virus must be able to enter the partner’s body through tiny areas of injury to the vulva, vagina, cervix, penis, or anus. There is no danger of getting genital HPV from contact with common skin warts or from casual contacts that do not involve sexual intercourse.

Testing for HPV Exposure

A Pap smear is the most common and practical way of detecting genital HPV and HPV-related precancerous conditions.

A single Pap smear can be up to 95% accurate in detecting HPV-infected abnormal cells when it is obtained, prepared, and analyzed under optimal or ideal conditions. To ensure an accurate test, ask your clinician for instructions before your appointment (or ask for our brochure titled, "Why You Need a Pap Smear—With instructions for Pap test preparation"). Then be sure to give her/him complete and accurate information about your sexual history and health. This is especially important because your sexual well-being and future cancer-free status will be affected by decisions about how often you should have a Pap smear and whether additional tests are indicated. (Newer tests are presently being evaluated.)

Unfortunately, all of the conditions for an accurate Pap smear assessment are often not met. Some studies indicate that the Pap test misses 20-40% of infected women with abnormal or precancerous cervical cells because of faulty sampling or laboratory misinterpretation of results, or inadequate patient preparation for the test. That’s why it is wise to be fully informed about Pap smear testing and to communicate openly with your clinician about sexual matters of concern to you and to take personal charge of your sexual health.

Who is at Risk?

You have a higher-than-average risk of HPV, cervical precancer, cancer, and other sexually transmitted diseases if:

• you have had genital warts or genital herpes and other sexually transmitted diseases
• a previous Pap smear showed abnormal cells not explained by the presence of infection, inflammation, irritation, menstruation, or menopause
• you began intercourse at puberty or before age 18
• you have had more than two sexual partners in your lifetime, especially in the past year
• you take birth control pills and/or do not use barrier methods of contraception, such as condoms containing spermicides (Nonoxynol-9)
• your sexual partner has HPV, has had multiple partners, or has had intercourse with women who developed cervical cancer or precancer
• you were born before 1975 and your mother took DES (diethylstilbestrol) to prevent your miscarriage
• you have had one or more pregnancies before age 18
• you smoke or live with someone who smokes
• you use mind-altering drugs and/or alcohol
• you have altered immunity or take drugs that depress the immune system, such as cortisone or drugs used for cancer treatment
• you test positive for HIV, the AIDS-causing virus
• your diet lacks normal amounts of folic acid, beta carotene, or Vitamins C and E, commonly found in fresh fruits and vegetables
• you practice poor genital hygiene; for example, you don’t wash with soap after intercourse
• you douche more than four times a month.

What to Do If You Have Been Exposed to Genital HPV.

If screening shows that you have been exposed to HPV, your clinician will want to follow you closely with repeated Pap smears and/or further diagnostic tests.

Your clinician may apply a vinegar solution to the genital area that will bleach the warts white and view the cervix and external genitals through a special magnifying instrument or colposcope. If any unusual or abnormal tissue is found during the examination, a small tissue specimen (biopsy) may be taken for further examination.

Of course, you will want to tell your sexual partner so he can be examined also. You may want to give him our brochure, "Human Papillomavirus (HPV) and Cervical Cancer—What a man needs to know." Remember that a man or woman may be exposed to HPV years before showing any signs or symptoms. If you develop a genital wart, it does not necessarily mean your current partner is unfaithful.

Treatment for HPV

Presently, there is no treatment that can eliminate the virus from the entire cervix and genital tract.

The goal of therapy is to control the growth of and discomfort due to visible lesions, as well as destroying any precancerous condition. Standard treatments for genital warts or precancerous conditions include cryotherapy (freezing), chemicals, surgical removal, and immune therapy. HPV-reinfection may occur easily, regardless of treatment, either by transmission from an infected partner, from regrowth of HPV-infected cells not destroyed by previous treatment, or from the presence of untreated but infected tissue that initially appeared normal. Until new treatment is found, prevention is your best defense against HPV.

How to Avoid Exposure

The guidelines for safer sex are:

• know your partner and avoid casual sex, particularly with bisexual men, I.V. drug users, and promiscuous or high risk males
• limit and/or reduce the number of sexual partners
• practice preventive measures, including visual genital inspection, use of condoms containing Nonoxynol-9, diaphragms, and vaginal spermicides containing Nonoxynol-9
• avoid anal intercourse and sexual practices that may injure delicate genital and anal tissue
• always wash your genitals with soap and urinate after sex
• abstain from intercourse when either partner has unusual genital signs or symptoms
• obtain regular Pap smear evaluations and discuss sexual matters of concern with your clinician
• encourage your partner(s) and friends to have regular check-ups
• avoid mind-altering drugs/alcohol and smoking.

Take Charge of Your Sexual Health

To avoid cervical cancer, there are two things you can do.

First, prevent HPV infection by following the guidelines for avoiding exposure.

Secondly, obtain accurate Pap smear screening to detect early precancerous changes before actual cancer develops. You may also want to read our brochure, "Why You Need a Pap Smear—With instructions for Pap test preparation."

The more you can express your concerns and participate in your health care, the better your clinician will be able to help you. Ultimately, you should be able to make informed choices about safer sexual behavior.

This brochure was prepared as an expression of our dedication to high quality Pap smear testing and our concern for your health and well-being.

Used with permission from:

ACCUPATH Laboratory Services, Inc.
10740 Meridian Ave. N., Suite G3
Seattle, WA 98133-9010
206.365.5177
800.222.8727
Fax: 206.362.0943

© 1993 R. Hasselbrack, M.D., M.S., F.C.A.P.