The Scoop on the Human Papilloma Virus
by Virginia Graham, NP, MPH, Comprehensive Care Center, St. Luke's/Roosevelt Hospital
In June of last year, the Food and Drug Administration
or FDA, approved a vaccine that
can prevent the transmission of a virus responsible for over 70% of all
cervical cancers.
The virus is called human papilloma virus or HPV and it is one of the
most common
sexually transmitted infections, or STIs, in the United States. Unfortunately,
the vaccine,
called Gardasil, works best in women who have not been exposed to HPV.
Human Papilloma Virus (HPV) is a virus that causes
over 99% of all cervical cancers.
There are about 30 different strains of HPV that can produce damage to
a woman’s
cervix and genital area. However, not all the strains cause cervical cancer-only
about one-
third. The cervix is the area where the cells from the vagina meet the
cells from the
uterus. It is the opening to the uterus; the organ that houses the fetus
while the woman is
pregnant. Every month those women who are menstruating, loose or shed
the lining of
their uterus in the form of a period. When a woman has a pap smear, the
clinician takes a
sampling of the cells from her cervix. It is sent to a lab where the slide
is read by a
cytologist. It tells the provider whether there is damage from the human
papilloma virus.
Women may be told that they have “abnormal” or “atypical”
cells and need a colposcopy.
Since a pap smear is just that, a smear or a sampling of superficial cells
from the cervix, it
is never a diagnosis. A colposcopy is the next step. A colposcopy is nothing
more than
looking at the cervix with a pair of binoculars on a stand. That magnifies
the cells and
allows the clinician to see if there are any abnormal areas. If so, a
biopsy is taken and
sent to the lab for a diagnosis. Depending on the location and severity
of the report, the
woman may need the abnormal cells removed, or if “low grade,”
she will need to be
followed closely. There is no cure for HPV, but it can be managed. That
is why women
need pap smears.
Men carry HPV and can pass it on to their female partners.
Most do not know that they
have it. Many years ago, doctors thought that if women with HPV get cervical
cancer,
then men must be at risk for cancer of the penis. Some men are, but those
numbers are
very small. However, researchers have noted a rise in the number of cases
of anal cancer,
particularly in men who have been anally receptive during sex. Numbers
for women are
also rising. As a result, some providers have started doing anal pap smears
during annual
exams. In most cases, HPV is responsible for cancer of the anal canal.
The Center for Disease Control (CDC) states that at
least 50% of sexually active people
will get genital HPV. Other studies project higher numbers such as 75%.
Keep in mind
that having HPV does not mean cervical cancer, just exposure to the virus.
Not all strains
of HPV cause cancer. Many are removed by the body’s immune system
soon after
exposure. Some hang around for awhile, eventually leaving. It is the strains
that stay and
integrate themselves into our cells that cause problems.
In June 2006, the Food and Drug Administration (FDA)
approved a vaccine, Gardasil,
which can protect the recipient from four strains of the human papilloma
virus (16, 18, 6
and 11). Two of the strains (16 and 18) are responsible for about 70%
of all cervical
cancers. The other two (6 and 11) strains cause 90% of all genital warts.
In order for the FDA to approve a vaccine, the research trial must show
that their product
is both safe for the participants as well as effective, that is: does
it work? The vaccine
was tested using females, ages 9 through 26. It proved to be successful.
Therefore, that is
the population for whom Gardasil was approved. It is a series of three
injections. The
side effects are mainly soreness at the site of injection and headache.
To work best, the
vaccine should be given to girls before they become sexually active.
If a female is already exposed to HPV, the vaccine will not protect them
against that
strain that they already carry. So, for now, young girls and young women
are the only
individuals eligible for the Gardasil vaccine. There are studies including
men and “older
women” currently going on, but we will have to wait for the results.
Other drug
companies are also working on vaccines.
If your doctor’s office does not carry the vaccine, the New York
City Department of
Health does in the immunization clinics. A call to 311 can direct you
to the nearest
immunization clinic.
Remember-condoms limit the transmission of HPV, but only if they are used
every time
and put on correctly. HPV has no symptoms; only if you have genital warts
will you see
it. Every woman who has ever been sexually active needs a pap smear. That
is the only
way that you can see if you have HPV.
Virginia Graham NP, MPH has been working with women who are infected and
affected
by HIV for over twenty years. For the past ten years, she has been working
at St.
Luke’s/Roosevelt Hospital Center in their Comprehensive Care Center.
Any questions or
comments can be directed to vgraham@chpnet.org.
