— Lorrie, Ohio HPV (human papillomavirus) is spread through sexual contact and invades the cells of the vagina and cervix. Most women clear the virus without any special form of treatment, since the infected cells are shed from the cervix and vagina. However, in some women the virus is not cleared but rather remains in some of the cervical and vaginal cells. This persistence of HPV increases the risk of developing cervical cancer and, more rarely, cancer of the vagina. Unfortunately, once you have been infected with HPV, there is no treatment that can cure it or eliminate the virus from your system. A hysterectomy removes the cervix, which means that the risk of developing cervical cancer because of persistent HPV infection will essentially be eliminated. However, since HPV can also persist in cells of the vagina, a hysterectomy does not necessarily render you free of the virus. As for the risk of reinfection with HPV, because the virus is spread from person to person through sexual contact, and because there are several different strains of HPV, you could become infected with a new strain even after a hysterectomy if you or your partner has sexual contact with other partners. However, because HPV most commonly persists in the cells of the cervix, the chance of developing a new, persistent HPV infection after a hysterectomy is low. Q2. What are the symptoms of HPV in men? Are they the same as in women? And how can a man be tested for HPV - what tests would you recommend? The symptoms of HPV in men differ from those in women. Men often have asymptomatic disease (meaning there are no symptoms) — even more commonly than women. That said, the most common sign of HPV in men is penile warts. HPV can also cause anal warts and is a risk factor for anal cancer in men. There is some controversy about whether HPV can also increase the risk for cancer of the tongue in men. HPV testing in men is done by swabbing the tip of the penis with a special culture swab. This swab is then tested for the virus. Q3. I’ve heard a lot about HPV lately. What are the common treatments for this virus? Does it go away after treatment or can it come back? — Rachel, Maryland HPV, or human papillomavirus, is a sexually transmitted virus. It causes cervical dysplasia (abnormal changes in the cells that line the cervix, which is the opening to the uterus) and results in an abnormal Pap smear. If left untreated, some cases of HPV can progress to cervical cancer. The most important part of treatment for HPV is getting regular Pap smears so that any abnormal cells can be removed before they become cancerous. This is actually the main treatment for HPV — the elimination of cells on the cervix that are abnormal. This is done by colposcopy, whereby the cervix is examined with a microscope, and the abnormal cells are removed by means of a biopsy. If the abnormal Pap persists, the entire abnormal region of the cervix can be removed in a procedure called a cone biopsy. While some cases of HPV infection disappear spontaneously, most persist. A new vaccine, called Gardasil, can now protect women against HPV. It is given in three parts and is very effective. However, the vaccine must be given to a woman before she becomes sexually active in order to protect against HPV. This is why it is currently recommended for girls and young women between the ages of 11 and 26. Q4. I had HPV some years ago. I had it removed by laser, and my Pap tests have been fine since. Then I had a complete hysterectomy. Now that there is a vaccine against HPV, should someone like me get it? Can the virus come back and lead to cancer, even though I’ve had a hysterectomy? — Marie, Kansas The human papillomavirus (HPV) infects the cells of the cervix during sexual activity. While 70-90 percent of these infections go away without treatment, (mostly through shedding of the cells on the surface of the cervix and vagina), the virus may persist in 10-30 percent of cases. When the virus persists, there is an increased risk for cancer (cervical cancer and vaginal cancer) and genital warts, though it generally takes about ten years from the time of infection with the virus to the development of an HPV-related cancer. It’s most likely that you were infected with HPV many years ago. The abnormal cells on your cervix were probably discovered during your Pap smear, which was being done as a standard screening test for cervical cancer. The discovery of abnormal cells on your Pap smear would prompt testing of the smear for HPV to help determine whether the abnormal cells were of high or low risk. A positive HPV test would be evidence that your abnormal cervical cells were at somewhat high risk of becoming cancerous, and so laser surgery was recommended. Subsequently, it sounds as if you had your uterus and cervix completely removed. You may want to confirm with your doctor that you in fact had a “total hysterectomy” (in which the cervix is removed), as opposed to a “subtotal hysterectomy” or a “supracervical hysterectomy”— these are surgeries in which the uterus is removed but the cervix is left in place. If you no longer have a cervix, and presuming you did not have invasive cervical cancer at the time of your laser treatment or hysterectomy, you cannot develop cervical cancer now. However, that does not change the fact that you have been infected with HPV. You should discuss with your doctor what type (or types) of HPV you were infected with, so that you can be appropriately followed. The higher-risk types are HPV serotypes 16, 18, 11, and 6. Unfortunately, the vaccine against HPV probably won’t be of much help to you. It is designed to protect women from becoming infected with the high-risk types of HPV, so it’s most appropriate for women who have never been infected with the virus. Since you have already had HPV, and abnormal cells were probably found on your cervix, this vaccine will not be beneficial — it cannot clear up an already-established infection or reverse abnormal changes in the cells of the cervix. Learn more in the Everyday Health Sexual Health Center.
