A couple of months ago I wrote the article 5 Reasons to see me for your Pap Test and planned to write this article answering your HPV questions as a follow-up but as time passed it kept being put on the backburner.
Then I read a compelling article titled Why a mom with cervical cancer needs women — and their doctors — to hear her story. That article contains helpful information about cervical cancer screening, the importance of reviewing your own health information, and the value of looking at the whole picture (including all symptoms) to diagnose and treat well. And it gave me a little kick in the bum to finish this article!
As a Naturopathic Doctor with a practice focus on Gynecological Concerns, I see many patients with abnormal Paps/HPV. Most of these patients have already seen their medical doctor and often ALSO a specialist but may not have had the time to ask their questions and get clear answers. So, I make sure to allow time to answer my patients’ questions as well as provide a space to address fears, anxieties, and concerns.
I’m sharing answers to the most common HPV questions my patients ask me. If you have a question I have not covered here, please ask in the comments and I will do my best to provide a helpful answer!
What is HPV?
HPV stands for Human Papilloma Virus which is a very common sexually transmitted infection. There are many strains of HPV – some cause warts on the skin or abnormal cells on the cervix and some can cause cancer. You can be infected with more than one strain at a time.
I feel embarrassed/ashamed – will people judge me for having HPV?
I understand! It can be incredibly stressful to find out that you have a sexually transmitted infection! Many people feel embarrassed and worry that their partner or others will judge them.
Did you know that up to 75% of of sexually active people will be infected with HPV in their lifetime? That is 3 out of 4 people, so chances are you know several people who have had HPV.
Most people will clear the infection so if they do not have clear symptoms (warts or abnormal cervical cells), many may never know they ever had it.
Can HPV be cured or cleared by the immune system?
This is the MOST COMMON question I am asked!
The short answer is: Yes, your immune system can clear HPV. For many people this happens before they are even aware they have it.
If the immune system clears the infection, warts can resolve or be removed and not recur or abnormal cervical cells can become normal again. For many people they will never have a recurrence.
However, due to limitations in testing, it is hard to know if in some cases the virus remains inactive in the body with the potential to become active again in the future.
In some people the immune system does not clear HPV and it persists or becomes worse.
I’m scared – will I get cervical cancer?
This is a fear that so many of my patients share with me! Thankfully, it is unlikely you will get cervical cancer but it is important not to ignore this issue.
In many people the immune system will clear the virus and abnormal cells will become normal again. In some cases the abnormal cells can slowly progress to become cancerous.
High-risk strains can progress to cancer. HPV 16 and 18 are currently the most common high-risk strains and cause about 70% of cervical cancers. HPV strains 31, 33, 45, 52, 58, and others are also high-risk strains.
Even if you have a high-risk strain, in most cases HPV will not progress to cancer. However, it is important to monitor these abnormal cells and treat where appropriate.
Low-risk HPV strains cause about 90% of genital warts and rarely progress to cancer. HPV 6 and 11 are currently the most common low-risk strains.
How is HPV diagnosed?
Many people have no symptoms at all! Currently there are only 2 ways to know you have HPV:
- You have warts. Warts may appear anywhere on the body, but at times warts can be very small and difficult to diagnose based only on appearance. Warts can appear on both men and women.
- You have an abnormal Pap test. When there is an active infection affecting cervical cells, these cells become abnormal in appearance. Females and people with cervixes can be diagnosed via a Pap test (which examines cervical cells under a microscope). There is no equivalent to the Pap test for males or people without cervixes so in those people the only way to diagnose HPV is if warts are present.
- You have a positive HPV DNA test. When infected, HPV DNA is detectable and can be tested to determine if it is a high-risk or low-risk strain.
For more information on the Pap test, see my article 5 Reasons to see me for your Pap Test.
What is the HPV DNA test?
An HPV DNA test may be done on the same sample as a Pap test or on a sample taken separately. This test detects whether you are infected with a high-risk strain of the virus.
This testing can be helpful to determine the best course of treatment and follow-up after an abnormal Pap test and is being used more frequently. In some parts of the world it is included as part of cervical cancer screening and I am seeing it more and more frequently in my practice.
In Ontario, only a medical doctor can do an HPV DNA test and it is NOT covered by OHIP, so if you choose to have this testing done you will pay out-of-pocket.
How do I know if my sexual partner has HPV?
This the SECOND MOST COMMON question I am asked! Why? Because everyone wants to know HOW they got HPV and to PREVENT future infections!
The problem is, it is very difficult to know who does or does not have this virus.
If your sexual partner does not have warts or abnormal cervical cells, unfortunately there is no way to know if they currently have HPV. They may carry the virus and be able to infect sexual partners without having any signs or symptoms.
There is currently no blood test for HPV infection. This means that many people may never know they have it and may be infecting others with HPV.
Can I spread HPV to my partner?
You can be infected with or transmit HPV during sex or intimate skin-to-skin contact. For this reason, it is important to practice safer sex by speaking to your partner about your respective STI histories, using condoms (which are very effective at preventing sexual transmission), and avoiding skin-to-skin contact while you or your partner have skin lesions such as warts.
How often should I have a Pap?
If you are or have been sexually active, a Pap test is recommended every 3 years starting at age 21 and continuing until at least age 70.
If you have had an abnormal Pap result, you should be screened more frequently depending on the severity of the abnormal cells, your treatment, and the results of your treatment.
If you have been successfully treated, you may also continue with more frequently screening. This will depend on your specific situation.
Should I do any other testing?
This depends on your situation:
- You have not had an abnormal Pap result: No additional testing is necessary, only continuing to have a Pap test when recommended.
- You have an abnormal Pap result: Depending on the severity of the abnormal cells, you may do another Pap test in 6 months or be referred (by your medical doctor) for colposcopy and possibly HPV DNA testing.
What is colposcopy?
Colposcopy is an exam done by a specialist to look more closely at your cervix to identify potentially abnormal cells. During a colposcopy, the specialist may take a biopsy sample to test for abnormal cells.
How can I treat HPV?
Remember, in most cases the immune system will clear HPV! In many patients there is no need for any treatment at all.
If you have HPV that is persisting without resolving, becoming more severe, or is a high-risk strain, then you may choose to treat via Naturopathic Medicine. Naturopathic treatment can be added either before, at the same time as, or after conventional medical treatments.
The most common conventional medical treatment for HPV is LEEP, which stands for Loop Electrosurgical Excision Procedure. LEEP removes layers of abnormal cells from the cervix. As with any medical procedure, there are risks. Only medical doctors offer LEEP, so speak to your medical doctor to understand the risks and benefits.