When a woman’s Pap smear—a test for detecting precancerous or cancerous cervical cells—is abnormal, and she is diagnosed with human papilloma virus (HPV), she may feel pretty worried. After all, each year, American women develop more than 20,000 HPV-related cancers. Cervical cancer is the most common, but HPV is also associated with other cancers such as vulva, vaginal, penile, anal and throat cancer.
While a HPV diagnosis is troubling—and certainly nothing to take lightly—in most cases, there is no need to panic. The HPV virus appears to be able to “clear” on its own in young, healthy women, so a woman who receives an abnormal Pap one year may have a normal one the following year. “At least 80 percent of young women will be HPV positive at some point,” says Mary Jane Minkin, MD, clinical professor at Yale School of Medicine’s Department of Obstetrics, Gynecology and Reproductive Sciences and author of A Woman’s Guide to Sexual Health. In other words, most instances of the virus won’t progress to full-blown cancer.
Still, no one can assume her body will clear the virus—particularly women ages 30 and older. Additionally, while most types of HPV resolve spontaneously, certain strains of the virus are more likely to persist and cause precancerous cell changes that can lead to cervical lesions. So the more you know about HPV and how to avoid it, the safer you’ll be. Below are ways to guard yourself against this ubiquitous sexually transmitted infection.
Get vaccinated. The U.S. Food and Drug Administration (FDA) has approved two HPV vaccines. Gardasil protects against four strains of the virus (out of more than 100), says Minkin: “The high-risk ‘baddies’ are strains 16 and 18, which account for about 70 percent of cervical cancers. Strains 6 and 11 are responsible for yucky warts. That’s why Gardasil protects against those four.”
The other vaccine, Cervarix, protects against HPV 16 and 18 but not HPV-related warts. Both are given in three injections over six months.
“All kids—girls and boys—need to be immunized,” says Minkin. Both vaccines are approved for ages 9-25. It’s best to get the vaccine before becoming sexually active. Some insurance plans cover the vaccines, as does Medicaid, and both manufacturers also offer help for those who can’t afford them (about $130 per dose).
The vaccines are not approved for people over age 26 because studies have not shown them to be effective in older people, but women 26+ can protect themselves by getting regular screenings for HPV, following up on abnormal results, having limited sexual partners (one, preferably), and making sure any sexual partner is infection-free.
Stop smoking. “That’s the best possible [step],” says Minkin. “There’s a strong association between cervical cancer and smoking.” A 2008 study at Pennsylvania State University College of Medicine found in a lab experiment that exposure to a high concentration of a key carcinogen in cigarette smoke resulted in a ten-fold increase in one of the HPV strains, HPV 31.
Insist on condoms. “Always use condoms, if you are not in a mutually monogamous situation,” says Minkin. “If a teenager tells me she’s only having sex with one boy, I ask who the boy was with before her. If she answers ‘Susie—and she’s a ‘ho’—I gently remind her that without a condom she’s having sex with Susie also.”
Still, condoms can’t protect you completely: HPV can be spread by oral, anal or genital contact.
Get regular Pap smears. “Most of the time in young healthy women, HPV does clear with the help of the woman’s immune system,” says Minkin. “That’s why we no longer do Paps in women under 21.”
According to the National Cancer Institute, women should have a Pap test every three years from age 21 on. However, women who are HIV-positive need Pap smears once or twice a year. And women who have had an HPV vaccine still need to have regular Pap smears.
Know the treatments. If your Pap test indicates some mild cell irregularities, your doctor will follow you more closely, says Minkin, hoping they clear up. If they don’t, there are a number of treatment options your physician might consider. One, a procedure called loop electrosurgical excision procedure (LEEP), involves cutting away abnormal tissue. “But recent data shows that women who have LEEPs may have pregnancy difficulties such as pre-term deliveries,” says Minkin. “We only do LEEPs or a cone biopsy”—the removal of a cone-shaped tissue sample from the cervix to test for cancer—“if we see precancerous changes.”