South Carolina Perinatal Associaton: Striving to Improve the Health of Pregnant Women, Infants and Children.

 
 
Home
Calendar
Perinatal Links
Member Services
Board of Directors
News/Legislation
Committees
        
° Education
° Membership
° Public Affairs

 
         
          



 

ASK THE EXPERT

From the desk of: 

Laura K. Stickler, M.D..
Assistant Professor
Department of Obstetrics and Gynecology
Medical University of South Carolina 

Get the facts on 
Human Papilloma Virus  (HPV) 

Background:

HPV, or human papilloma virus, is a virus that commonly affects men and women worldwide. HPV is the cause of warts occurring on the hands and feet, genital warts, cervical dysplasia, and cervical cancer. There are over 100 types of HPV and about 30 infect the genital tract. Those that cause genital tract disease can be divided into low and high risk subtypes. Low risk HPV subtypes normally cause genital warts and mild cervical dysplasia while high risk subtypes typically cause the more moderate to severe dysplasias and cervical cancer. Most HPV infections resolve without requiring therapy. When infections do not spontaneously resolve, warts, dysplasia and cancer can develop.

Genital warts (condyloma accuminata) are fleshy growths that are generally encountered on the external genitalia but can also be found in the vagina or on the cervix. They can range in color from pink to brown, and can grow in clusters or alone. There are approximately 1 million new cases of condyloma each year in the United States. Genital warts may disappear over time without treatment, however, the lesions may recur if the virus is still present. Various treatment options include topical medications, freezing, burning or laser removal. Again, warts may reappear after destructive therapy if the body's immune system has not cleared the infection. Therefore, multiple treatments may be needed.

Cervical dysplasia can also be referred to as a precancerous lesion of the cervix. The cervix connects the vagina to the uterus and is the area evaluated during a pap smear. Dysplasia can vary from mild to severe. Schiffman and Solomon (Med. 2003;127:946-949) report that there are more than 1 million cases of mild dysplasia annually in the United States and about 330,000 cases of moderate and severe dysplasia each year. These precancerous lesions may resolve on their own, but the more severe the dysplasia the less likely resolution is to occur. Mild dysplasia may be followed by physicians while moderate and severe changes are more apt to require treatment. Treatment options are similar to those available for genital warts. Freezing, laser ablation, and surgical excision (including electrosugery) are the most common procedures used.

There are almost 10,000 new cases of cervical cancer each year in the United States. Around 4,000 women die yearly from the disease in this country. These statistics are minor in comparison to other parts of the world. If cervical dysplasia is left untreated, it can progress to cancer. This progression is typically slow but can happen quickly with more aggressive strains of HPV. Cervical cancer is detected through a pap smear. If a pap smear returns as abnormal, a is usually performed. This test magnifies the cervix and allows sampling of abnormal appearing areas. If cervical cancer is found, it can be treated with surgery, radiation, chemotherapy or a combination of the three.

How is  HPV transmitted?

HPV is transmitted by any kind of sexual activity involving genital contact. This contact does not have to be vaginal intercourse. It can be passed from partner to partner by hand-to-genital, oral-to-genital, or genital-to-genital contact. As many HPV infections clear prior to the appearance of warts or abnormal cervical cells, many patients may never know they were infected. Unfortunately, the lack of signs like dysplasia or warts does not mean the infection cannot be transmitted. In fact, this is why the disease is so prevalent worldwide. Many patients infect their partners without ever knowing it.

How is  HPV diagnosed?

Most HPV infections are detected by pap smears. Abnormal pap smear results are divided into general categories. Colposcopic examinations, and biopsies if indicated, then give an accurate diagnosis of what type of dysplasia is actually present.

Genital warts are easily recognized by physicians. Patients often present to their doctors with the complaint of “bumps” on their genitalia. As previously mentioned, condyloma have a very characteristic appearance. They are growths that range from flesh colored to pink to brown.

Can HPV be treated?

There is no treatment for HPV and most HPV infections resolve over time. There are treatments for the health problems associated with HPV. Cervical dysplasia can be monitored with frequent pap smears if mild, but moderate and severe dysplasias are usually treated. Abnormal cells can be frozen, ablated with laser, or excised.

Patients usually elect to treat genital warts rather than wait to see if they go away on their own. In addition to the above therapies for dysplasia, topical medications are also used to treat warts.

Again, therapy for cervical cancer is much more aggressive. Treatment includes surgery, radiation, chemotherapy, or all three modalities.

Can HPV recur?

If abnormal cells and warts are treated rather than observed until spontaneous resolution occurs, the dysplasia or condyloma may reappear. This happens if the body's immune system has not yet cleared the infection.

Can HPV be prevented? 

Physicians have long educated their patients to remain abstinent and use condoms as a means of preventing STDs (sexually transmitted diseases), including HPV. In 2006, the FDA licensed a vaccine to prevent HPV infection. Gardasil is a recombinant vaccine (this means it contains no live virus) designed to prevent infection with HPV types 6, 11, 16, and 18. HPV types 6 and 11 cause the vast majority of genital warts and a small percentage of dysplasia. HPV types 16 and 18 are responsible for triggering most cervical cancers and moderate to severe dysplasias.

 Who can receive the HPV vaccine?

HPV vaccine Gardasil is indicated for girls and women ages 9-26. The vaccine causes the body to produce antibodies that when exposed to HPV 6, 11, 16, and 18, recognize and attack the HPV virus preventing the infection. The best treatment plan is to administer the vaccine series prior to any exposure to HPV, but even patients treated previously for warts or dysplasia are candidates for vaccination. .

Gardasil is not yet indicated for boys and men. When more information is available, it may be licensed and recommended for them as well.

How and when is the vaccine administered?

The vaccine is given as a series of 3 injections over a 6 month period. The second and third doses should be given at two and six months (respectively) after the first dose. HPV vaccine can be given at the same time as other vaccines and is very well tolerated and effective.

Will girls and women be protected against HPV and associated diseases, if they only get part of the vaccine series?

There is no information on how much protection girls and women would get from receiving only one or two doses of the vaccine. Therefore, it is very important that girls and women receive all three doses of the vaccine. If the series is not completed in 12 months, the girl or woman will need to start over with the first injection.

Does vaccination replace the need for routine pap smears?

The vaccine Gardasil does NOT provide protection against all HPV subtypes. Therefore, regular pap testing remains important for early detection of any abnormal cervical change. Condom use is still necessary as well since the vaccine does not protect against other STDs.

Should pregnant women be vaccinated?

The vaccine is not recommended for pregnant women. If a woman finds out she is pregnant after she has started the series, she should wait until after her pregnancy to resume the series. Again, if the series is not completed within 12 months of the first dose, the woman will need to started over with the first injection.

How expensive is the HPV vaccine and is it covered by insurance?

The retail price of the vaccine is $128 per dose ($384 for full series). Most health plans (insurance, HMO, managed care contracts) cover recommended vaccines. If your private health insurance does not cover the vaccine, Vaccines for Children (VFC) program allows children and adolescents to get VFC vaccines through Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC). Uninsured clients, Medicaid-eligible clients, American Indian and Alaska Native can obtain the vaccine for free through VFC sites or providers. If your doctor is a VFC provider, he/she may charge an administration fee for the vaccine. The best advice is to check with your provider.

Ask the Expert Archives

View previous issues by clicking on the title:

Get the facts on Fetal Fibrinectin (fFN) testing
By Stephen T. Vermillion, M.D., Maternal Fetal Medicine Specialist, Greenville, SC.

What kind of babies can be cared for in a level I hospital?    By Faye Jackson, RN, Perinatal Nurse Inspector, South Carolina DHEC

To top of page

 
Home Member Services Perinatal Links

Copyright © 2003-2008  South Carolina Perinatal Association
All Rights Reserved