HPV Women

There are more than 100 different papillomaviruses, or HPVs that can infect humans.  More than forty of these types of HPVs can infect the genital tract and the anus of men and women which leads to genital warts.  A subgroup of these HPVs can lead to precancerous changes in the uterine cancer, which in turn can lead to cervical and uterine cancer.  HPV infection is additionally associated with other anogenital cancers in females.  Genital warts and HPV infection is mainly transmitted through sexual contact, such as skin to skin touching and intercourse.  Your risk of developing HPV will increase with more sexual partners and with sexual partners who have had more partners themselves. 

The most common HPV types of a genital nature include types 6, 11, 16, and 18.  The most associated with benign lesions are 6 and 11 , and they tend to have the symptoms of genital warts and sometimes mild dysplasia of the cervix, and these are considered low risk types.  However, 16 and 18 are considered high risk types, and they are the ones that are found in the majority of anogenital cancers, cervical cancer, and when there is severe dysplasia of the cervix. There are other types of HPV that can affect the skin and cause common warts to show up on other parts on the body.  Today HPV infection is considered to be the most common sexually transmitted infection in the United States, and it is now believed that about 75% of the human population that is of reproductive age has had a sexually transmitted HPV at some point in that person's life.  It is estimated that around six million people will become infected with HPV every single year in just the United States alone.  Around half of those projected people are between the ages of fifteen and twenty-five. 

The HPV infection is a common infection, and often it does not lead to the development of warts, cancers, or even any visible symptoms.  Most people with HPV do not have lesions or warts at all.  In order to determine if a person has HPV, it involves a DNA test of the virus.  It also is not yet clear whether the immune system has the ability to rid the body of an HPV infection.  It seems that a person can have a positive HPV infection test, have negative tests for months or years at a time, and then have a positive result again later.  It is not sure if the HPV has been hidden the entire time or if the person has just become re-infected.  It is important to note that even if a person does not have any symptoms of HPV, it can still be spread to others through sexual contact.  In the United States and other developed countries, because of screenings through regular Pap tests for women, the number of women dying of cervical cancer has decreased.  However, in countries where women do not get regular medical care, the death rates are much higher.  Cervical cancer develops in close to 500,000 women every year in the world, and in many countries of the world, it is the most common cancer that kills women in that country.  

In a number of instances, the genital warts do not cause any symptoms to occur; however, they can cause burning, itching, or even tenderness.  They can lead to irritation.  Women who have the warts inside their vagina may have bleeding following the sexual intercourse and a vaginal discharge that is abnormal.  It is rare that bleeding or urinary obstruction would occur due to a wart in the urethral opening.

Diagnosis of HPV

HVP can sometimes be diagnosed based on an abnormal pap smear test or a change in a pap smear test.  The pap smear itself, however, is not able to definitively state that HPV is present.  Usually if there is an abnormal pap smear, the doctor will do advanced testing on the material in order to determine if there is any form of HPV present.  An HPV can also be detected through a biopsy of a genital wart that is sent to the laboratory. 

Genital warts are rather common.  There are about 500,000 new cases diagnosed annually in the United States.  They usually look like small, fleshy bumps that are raised, but sometimes they can be extensive and can look slightly like cauliflower.  They may occur over an area that is sexually exposed.  The vast majority of genital warts are caused by HPV-6 and HPV-11.

Treatment of Genital Warts

There is no cure for the HPV infection.  Women can have treatment for the lesions or warts that are caused by the virus.  Yet while the warts or lesions being removed can help to improve the cosmetic appearance, it does not prevent HPV from being transmitted to others.  Genital warts also will often recur.  One treatment that can be used by the patient is called podofilox.  it is a gel that is applied to the warts two times a day for three days and then with four days without treatment, and this process is continued for three to four weeks or until the lesions have disappeared.  It can also be applied every other day for three weeks.  Also imiquimod can be used by applying it to the warts three times a week at bedtime, and then it has to be washed off using mild soap and water between six and ten hours later.  These applications can be continued for up to a period of sixteen weeks or until the lesions are gone. There are also some treatments of genital warts that can only be completed at the office of the doctor.  One example is using a small amount of podophylline resin on the lesions and then washing off the medicine after a few hours.  The treatments will need to be repeated every week until the genital warts are gone.  Other medications include trichloroacetic acid, bichloracetic acid, 5-flurouracil epinephrine gel, or interferon alpha, but all of these must be completed by a physician.  Your doctor can also choose to use cryotherapy, which is when the genital warts are frozen with liquid nitrogen every two weeks, the doctor can remove the lesions surgically, or laser surgery can be used to remove the genital warts.

Dysplacia of the Cervix (Precancerous Changes)

Women who have had evidence of having moderate or severe precancerous changes to the uterine cervix require treatment in order to make sure that the cells do not turn into cancer.  Treatment usually involves the surgical removal of the involved tissue.  Conization is when the physician will remove the precancerous area of your cervix using either a laser, a knife, or a procedure called LEEP, which is when an electric current is used to pass through a thin wire that acts like a knife.  Additionally, cryotherapy can also be used in order to destroy the tissue areas that contain precancerous changes. 

How Does a Woman Prevent an HPV Infection?

Recently, there has been a vaccine that has been developed called Gardisil.  This vaccination has received FDA approval for use in women who are between the ages of nine and twenty-six years of age.  It helps keep women immune from types 6, 11, 16, and 18.  There is another vaccine that is currently being tested against types 16 and 19. 

Abstinence from sexual activity is another way that a woman can prevent HPVs from spreading that are transmitted through sexual contact.  Yet a person who is not having sex can still get an infection from one of the other HPV types, like the ones that cause the common skin wart.  Some have thought that HPV transmission can occur from mother to infant in the birth canal.  HPV transmission has also been documented from and to genital and oral to genital transmission.  HPV is transmitted through direct genital contact during sexual activity  The virus is not spread through bodily fluids and is not in blood or in organs that are harvested for transplantation.  The use of a condom does seem to decrease the risk of transmitting the infection during sex, but will not completely prevent the infection of HPV.  Additionally, birth control methods as well as spermicides will not prevent the spread of HPV either. 

If you have had sex or continue to have sex with a person with genital warts or HPV, it is important for you to continue to get regular Pap smears.  In this way, any changes that are observed by the doctor can be treated and then can reduce your chance of developing cervical cancer. 

Cervical Cancer

There are a number of factors that can cause cervical cancer, but one of the most prominent is HPV viruses.  If the infection does not go away, it can cause cervical cancer in some women.  It is the cause of most all cervical cancers in women.  These HPV cancers are very common.  The viruses are passed from one person to another person through sexual contact.  Some forms of HPV can cause changes to the cells in the cervix.  When these changes are found early on, the cervical cancer can be prevented by killing or removing the changed cells before those cells become cancerous. 

Early cervical cancers do not usually cause symptoms.  Yet when the cancer begins to grow larger, you may begin to notice more symptoms.  The first is abnormal vaginal bleeding.  This may include bleeding that occurs between your regular menstrual periods, following sexual intercourse, a pelvic exam, or douching, periods that last longer or are heavier than they once were, and bleeding after menopause has already occurred.  Third, there may be changes in vaginal discharge.  Pelvic pain and pain during sex may be present too.  These symptoms do not necessarily mean that you have cervical cancer, but these symptoms should certainly be checked out. 

It is highly recommended that you get regular pap smears every year.  This is a simple test that will observe your cervical cells to find abnormal cells that could lead to cervical cancer.  By finding and then treating these abnormal cells, you can prevent the majority of cervical cancer from occurring.  Treatments will be more effective if they are done earlier on.  A pap test is not usually painful, so you do not need to worry about that. 

If your doctor learns that you have cervical cancer, he or she will have to find out the extent of the disease in order to determine the best treatment.  Staging is the process of finding out if the cancer has yet invaded any nearby tissues, and if so, to what parts of the body.  Cervical cancer is known for most often invading the lungs, lymph nodes, or pelvis.  It can also spread to the bones or the liver.  Here is a description of each of the stages of cervical cancer.

• Stage 1:  With stage 1 cervical cancer, the tumor has invaded the cervix underneath the top layer of the cells, but the cancerous cells have only been found in the cervix.

• Stage 2:  With stage 2 of cervical cancer, the tumor now extends into the upper portion of the vagina.  It can extend past the cervix into the tissues that are close to the pelvic wall.  Yet the tumor does not yet invade the lower third portion of your vagina or into your pelvic wall.

• Stage 3:  For stage 4 of cervical cancer, the tumor now is into the lower portion of your vagina.  It could also have invaded the pelvic wall.  If the tumor is blocking how your urine is flowing, the kidneys may not be working well any longer.

• Stage 4:  In stage 4 of cervical cancer, the tumor now invades the rectum or the bladder or the cancer has moved into other portions of your body. 
  

• For recurrent cancer, the cancer has been treated, but has come back after a certain period of time when it could not be detected.  The cancer may show up again in the cervix or in other parts of your body.

There are many treatment options for you if you have cervical cancer.  Some of these options include chemotherapy, radiation therapy, and surgery.  You can also have a combination of these methods.  The treatment choice is often determined by the size of the tumor and whether the cancer has spread to other areas.  The treatment choice may also be determined by whether or not you hope to become pregnant someday.  You doctor can describe some treatment options for you, the results that you can expect for each, and some of the possible side effects.  You will work closely with your doctor in order to create a treatment plan that will meet your personal and medical needs.

Your doctor may refer you to a specialist for treatment.  You may wish to see a gynecologic oncologist, who is a surgeon who specializes in treating cancers in women.  Other specialists who may be involved in treating cervical cancer may include medical oncologists, gynecologists, and radiation oncologists.  You may also have an oncology nurse and registered dietician on your health care team. 

Prior to your treatment beginning, you may ask your health care team about some of the possible side effects and how the treatment you get may change your normal activities.  Because the cancer treatments can damage the healthy tissues and cells of your body, there are side effects that are common.  The side effects may not be exactly the same for everyone, and they may be different during different treatment sessions.