The STD YOU May Have: A Note From Dr. Kiarra King

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That’ll get your attention! Now that you’re here, let’s talk about a sexually transmitted disease (STD) that most will encounter in their lifetime. This includes women AND men. The stigma of STDs makes the discussion tough to have but it’s imperative as the health implications can be serious. So, let’s talk about it and break some myths surrounding this infection!

HPV viral particles, photo courtesy of masterfile.com

Now, back to the question at hand, what is the STD to which most will be exposed? The answer is human papilloma virus or HPV for short. That beautiful little virus, pictured above, is associated with cervical, vaginal, vulvar, penile, anal and head & neck cancers as well as genital warts. Of the over 150 identified strains of HPV, approximately 13 strains are linked to cancers and another 12 to genital warts.

All HPV is NOT created equal; HPV types that lead to cancer are also known as oncogenic or high risk HPV and the strains associated with genital warts are non-oncogenic or low risk HPV. With regards to women’s health, which is the focus here cause hey I’m an ob/gyn, HPV is the culprit in genital warts, abnormal Pap smears, cervical dysplasia and cervical cancer.

Pap smear cells, Photo: Science Photo Library

Ok, let’s get down to brass tacks and discuss some stats, doesn’t everything sound better with a rhyme? I mentioned in the title something that likely grabbed your attention and you’re probably wondering could you be affected.

In the US approximately 79 million people have been infected.
About 14 million people are infected yearly.
80% of sexually active people will contract HPV in their lifetime.
Infections are often is asymptomatic, so a person may not know they have HPV.
Women AND men can be infected.
About 300,000 cases of genital warts are diagnosed yearly.
Around 13,000 cases of cervical cancer are diagnosed each year.
Over 9000 HPV related cancers are diagnosed in men.

These are some pretty startling statistics. Sadly, worldwide the numbers are even more extreme due to lack of pap smear screening programs in some countries. In fact it’s estimated that yearly over 500,000 new cases will be diagnosed resulting in over 250,000 deaths!!

I know those numbers are daunting and your wondering if you’re affected. Certainly, a person with warts might notice lesions on the genital skin; for some they may cause itching or irritation. However, as mentioned previously, many HPV infections are asymptomatic. A woman might not know unless they underwent a Pap smear and the HPV test, if indicated, was positive. Historically, the Pap smear, a test that uses a special brush to collect cervical cells, was done yearly. The guidelines have changed markedly over the past several years, leaving many women confused about exactly how often they should be done.

This brings me to Pap smear screening. It’s important to note that everyone who undergoes a Pap is not automatically screened for HPV, sometimes only the cervical cells are analyzed. Additionally, Pap smear screening only takes into account high risk HPV strains, not low risk HPV, due to their association with cervical cancer.

So, who should be screened?

Pap smear screening starts at age 21. It is no longer related to the onset of sexual activity.

Between ages 21-29 Pap smears can take place every 3 years. HPV testing is only done if there are abnormal cells.

Between ages 30-65 Pap smears can take place every 5 years with an HPV test or every 3 years if only cell are collected.

Regardless of age, a woman can discontinue Pap smears after undergoing a total hysterectomy, in which the cervix was also removed, if the surgery was done for benign indications.

A woman who had a hysterectomy but whose cervix was not removed should continue routine Pap smear screening.

After age 65 Pap smears can be discontinued if a woman meets criteria.

So now that you know ALL about HPV and how to detect it, what’s next? Everyone always asks, when diagnosed, what do I do now? For most, the answer is simply to watch and wait. Fortunately, HPV can be a self limited infection, meaning the body can fight it off with its natural immune defenses. However, it may take anywhere from 6 months to 2 years for an infection to clear. In general, infections that are persistent beyond 2 years are those that can potentially cause more serious problems such as dysplasia or cancer.

So, what can one do to decrease their risk of cervical cancer and/or prevent HPV you ask? Generally, taking care of oneself with healthy diet and lifestyle choices can help maintain a strong immune system. Something I ALWAYS tell my patients to do is quit smoking! Most people know that cigarettes are bad, that they are associated with lung disease and various cancers. Many do not know that it’s associated with cervical cancer. So put down that cigarette!

Another preventative measure is the HPV vaccine. The American College of Obstetricians and Gynecologists (ACOG) recommends the vaccine for girls AND boys ages 11-12; this allows maximum effect before the onset of sexual contact. However, catch up vaccinations are allowed through age 26. In fact, the FDA recently approved the vaccine for persons up to age 45, although more studies are needed to look at efficacy in this population. I encourage you to have a conversation with your doctor or your child’s pediatrician to discuss further. It must be stated that vaccination does not eliminate the need for routine screening.

Finally, I cannot emphasize it enough, see your physician. I know that between work, taking care of kids, trying to get in some self care, fear of abnormal results and more, scheduling an appointment can be a daunting task that might get put on the back burner. BUT, most cases of cervical cancer are found in women who have never been screened or who haven’t undergone screening in the past 5 years. So in the spirit of Nike, JUST DO IT!

With proper screening and preventative health measures, cervical cancer rates plummet! In honor of cervical cancer awareness month, please share this article with your friends and family, it could save a life!!