Tag Archives: hpv

My Pap Came Back Abnormal…Now What?

Pap tests come back abnormal all the time so this re-post from E.G. Hanna still applies…
Pap test

So you got your annual screening and a few weeks later you get a phone call stating your pap test came back “abnormal.” Don’t freak out! This can mean a couple different things. To be clear, infections like chlamydia or yeast do not count as an abnormal pap! An abnormal pap means atypical cells on your cervix, that is, that the cells have begun to change in such a way that may be or become cancerous. This is called dysplasia.

After a pap smear comes back abnormal, what happens next depends upon a couple of factors, including your age and the severity of the dysplasia.

You may only need to repeat your pap smear in a few months, as often a health immune system can fight off the changes itself. Or you and your provider may opt for a colposcopy, which is a better way of looking at the cervix. A speculum is inserted into the vagina, solution is applied to the cervix with a cotton swab to highlight abnormal areas of tissue, and then a special microscope is used to look at the cervix. This allows the provider to see the dysplasia and, if deemed necessary, take one or more small tissue samples. This biopsy may feel like a small pinch and, while slightly uncomfortable for most women, it is usually tolerated very well. This biopsy allows the pathologist (the person who examines the tissue sample at the lab) to get a more detailed and accurate reading of the cervical cellular changes.

Depending on the colposcopy results, you may need to go back to pap smears every 3-6 months or, if the dysplasia is severe, you may need further treatment to fully remove the abnormal tissue. This treatment may consist of cryotherapy or a LEEP (Loop Electricosurgical Excision Procedure). Cryotherapy uses a freezing chemical to remove abnormal cells, allowing healthy cells to grow back in their place. A LEEP cuts away abnormal cells with a thin wire carrying an electrical current. Though both procedures may sound intimidating, in truth they are not very painful (many patients tell me their LEEP was more comfortable than their colposcopy, because of the numbing solution applied).

Cervical dysplasia is most often caused by HPV, a very common virus transmitted through sexual contact. Here are a few tips on how to avoid HPV and cervical changes:

Don’t smoke! Smoking is not good for your immune system, and you need a healthy immune system to fight the virus.

Consider the Gardasil vaccine, which protects you from 4 strands of HPV, 2 of which cause 75% of cervical cancers.

Use condoms. Though they may not fully protect you from HPV, as HPV is passed through skin to skin contact, because condoms cover parts of sexual anatomy they reduce the chance of transmission. Try female condoms too, which cover more skin.

Practicing abstinence or limiting sexual partners is also helpful, but isn’t foolproof. The CDC sums it up really well: “People can also lower their chances of getting HPV by being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has had no or few prior sex partners. But even people with only one lifetime sex partner can get HPV. And it may not be possible to determine if a partner who has been sexually active in the past is currently infected. That’s why the only sure way to prevent HPV is to avoid all sexual activity.”

Most of all, if you have a pap come back abnormal, keep these two things in mind: 1) Don’t panic. 2) Don’t ignore it. Cervical dysplasia is treatable and it does not necessarily mean you have or will get cancer. The keyword there is “treatable,” meaning you must see your provider for treatment to avoid detrimental effects to your health!

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The New HPV Vaccine

vaccineHPV (Human Papillomavirus) is a viral infection most commonly transmitted through genital skin-to-skin contact and oral, anal, and vaginal sex. There are approximately 100 strains of the virus that exist in the HPV family but only a few of the strains cause warts and cancer, including cervical, vulvar, anal, head, throat and neck cancer. According to the Centers for Disease Control (CDC) about 79 million are currently infected. Approximately 14 million people will become infected each year. The virus causes cervical cancer in over 10,000 women each year and 360,000 men and women will develop genital warts each year. HPV has now become one of the most common STD’s among men and women.

Merck Pharmaceutical company is now manufacturing an updated HPV vaccine called Gardasil 9. This vaccine will prevent five additional strains of (HPV) than the current (4-strain) vaccine. Gardasil 9 will protect girls and women that are between the ages of 9-26 years old from becoming infected with the HPV stains 31, 33, 45, 52 and 58, which are responsible for about 20 percent of cervical cancers. According to the FDA, adding the protection against the additional strains will help prevent up to 90 percent of cervical, vulvar, vaginal and anal cancers. Gardasil 9 is administered as three separate shots, with the first dose followed by a second two months later and then the third shot six months later.

Situations where the vaccine may not be effective:

  • Gardasil 9 has not been demonstrated to provide protection against disease from vaccine HPV types to a person who has previously been exposed through sexual activity.
  • Gardasil 9 has not been demonstrated to protect against diseases due to HPV types other than 6, 11, 16, 18, 31, 33, 45, 52, and 58.
  • Gardasil 9 is not a treatment for external genital warts and does not protect against genital diseases not caused by HPV.

Ask your health care provider about when they’ll have access to this new vaccine.

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Fun Friday: Scroguard

I tried writing an introduction to The Scroguard for about 30 minutes. For the first time ever, I’m speechless. I’m caught between ‘no.way.ever’ and ‘this thing is GENIUS’! Go to www.scroguard.com and see for yourself. Seriously, go now. This is excellent fodder for your weekend conversations.

 

 

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STD Testing During Pregnancy

cdcSo you just found out you or your partner is pregnant. There are so many things to think about, but one thing many people never think about is getting tested for STDs. Most prenatal visits include testing but it’s also important for a new or old partner to be tested so infections are not spread to mom during her pregnancy. To varying degrees, all infections have the potential to affect a developing fetus. Knowing what tests to ask for depend on risk factors such as age, number of partners, use of condoms or barriers, possible exposure and drug use. Here are the Centers for Disease Control and Prevention’s 2010 STD Testing Guidelines:

Chlamydia 

Screen all pregnant women at first prenatal visit; 3rd trimester rescreen if younger than 25 years of age and/or high risk group.

Gonorrhea 

Screen all pregnant women at risk at first prenatal visit; 3rd trimester rescreen women at continued high risk. Risk factors include: young women aged 25 years or younger, living in a high morbidity area, previous GC infection, other STDs, new or multiple sex partners, inconsistent condom use, commercial sex work, and/or drug use.

Syphilis

Screen all pregnant women at first prenatal visit; during 3rd trimester rescreen women who are at high risk for syphilis or who live in areas with high numbers of syphilis cases, and/or those who were not previously tested or had a positive test in the first trimester.

Bacterial Vaginosis

Test pregnant women who have symptoms or are at high risk for preterm labor.

Trichomoniasis 

Test pregnant women with symptoms.

Herpes (HSV)

Test pregnant women with symptoms.

HIV 

Screen all pregnant women at first prenatal visit; rescreening in the third trimester recommended for women at high risk for getting HIV infection.

Hepatitis B

Screen all pregnant women at first prenatal visit: retest those who were not screened prenatally, those who engage in behaviors that put them at high risk for infection and those with signs or symptoms of hepatitis at the time of admission to the hospital for delivery. Risk factors include: having had more than one sex partner in the previous six months, evaluation or treatment for an STD, recent or current injection-drug use, and an HBsAg-positive sex partner.

Human Papillomavirus

There is not enough evidence to make a recommendation.

Hepatitis C 

All pregnant women at high risk should be tested at first prenatal visit.

To find out more information about STDs during pregnancy, visit the CDC website.

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The Vaccine That Prevents Cancer

cancerIt is time to discuss the Human Papilloma Virus (HPV) and the vaccine that helps prevent it (again). I recently took my son to the pediatrician and noticed several Gardasil pamphlets on the rack. When the doctor entered the room I asked how many parents have had their children vaccinated. He stated that it is a mix and many parents still have misinformation on vaccinations of any kind. Some parents are also concerned about giving their child something that protects against an STD. They have a hard time wrapping their head around the idea of giving a (sexuality-related) vaccine to their 11-14 year old (it is recommended at 11-12 for both boys and girls) and feel like they have to go into detail on why they are receiving the shots. The vaccine is intended for children in order to prevent infection and possible cancer later in life.

Parents can give as little or as much information as they want on the details of HPV. Human papillomavirus (or HPV) is a sexually transmitted infection that can lead to cancer of the cervix, throat, vulva, vagina, penis, and/or anus. The HPV vaccine was introduced in the US in 2006 and has helped to decrease the HPV rate among teenage girls by 56 percent. However, we can’t celebrate yet. Nationally, 33 percent of girls ages 13 to 17 and only 7 percent of boys in the same age range have received all 3 of the recommended doses. HPV is now the most common STD in the U.S. and the major cause of cervical cancer.

Facts about HPV:

  • Nearly all sexually active people will contract a form of HPV at some point in their lives.
  • There are over 100 types of HPV, but the 4 strains that the vaccine protect against (are responsible for 70 percent of the cervical cancer cases and 90 percent of the genital warts cases
  • Approximately 360,000 people in the United States get genital warts each year.
  • More than 10,000 women in the United States get cervical cancer each year.

How to help prevent HPV:

  • Get vaccinated if your under 26.
  • Use condoms.
  • Limit your number of sexual partners.
  • Get a regular pap test (starting at age 21).

Need to schedule an appointment for the vaccine or for a pap test? You can get both at Planned Parenthood!

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Cervical Cancer is Preventable

We’ll be back with our regular posting tomorrow, but today, we’re featuring an op-ed from Dr. Sujatha Prabhakaran, MD, MPH, FACOG, our Senior Vice President of Medical Affairs/Medical Director, to mark Cervical Cancer Awareness Month.

January is Cervical Cancer Awareness Month, and it’s important to know that cervical cancer is preventable.

It is one of the few cancers that has two proven strategies to prevent – not just treat – the disease. In 2011, more than 12,000 women were diagnosed with cervical cancer and over 4,000 women died from it.

Almost all of these cases could have been prevented if these women had had access to either cervical cancer screening via Pap smears or to the HPV vaccination – or both.

One thing may not know is that Pap smears don’t usually detect cervical cancer. What they detect are precancerous cells, cells that aren’t cancer yet but show changes that suggest they could become cancerous. Once we detect precancerous cells, we are able to provide treatments to either destroy or remove these cells and prevent them from ever becoming a cancer.

Women who have regular Pap smears (every 2-3 years is now recommended for most women) have a much lower risk of developing cervical cancer because, if they have an abnormality, it is often detected in the precancerous stage.

Another way to prevent cervical cancer or prevent precancerous cells from ever developing is the HPV vaccination. Most cervical cancers are caused by the HPV virus. Seventy percent of cervical cancer cases are caused by two particular types, 16 and 18, which are included in the vaccine. By getting the HPV vaccine before they are exposed to those viruses, women can significantly reduce the risk of developing cervical cancer.

Access to these types of preventive care is vital for the health of women.

While uninsured or under-insured women do have access to Pap tests and HPV vaccinations at safety net providers like county health departments and Planned Parenthood, this access will improve as women’s preventive health services will now be covered 100 percent under the Affordable Care Act.

I’m certain this will be a welcome change for women all over the country.

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Keep Brushing and Flossing Those Pearly Whites!

tb and flossNew research is linking poor dental hygiene to an increase in oral cancer caused by the Human Papilloma Virus (HPV). According to a new study published in Cancer Prevention Research, people with inflamed gums, missing teeth, and other poor dental health issues are more likely to become infected with HPV. The researchers stated that they cannot emphatically state that flossing and brushing will prevent oral HPV infections but there is a link.  However, the National Health and Nutrition Examination Survey found that there was a 55 percent higher rate of having an HPV infection among the participants. The study also found that being male, smoking cigarettes (which causes poor dental hygiene), and having multiple oral sex partners increases the likelihood of oral HPV infection. It is unclear if the poor dental health creates an entry for the HPV or if good oral health practices help to reduce the risk factors attributed to oral sex and smoking. The good news is that once they are able to pinpoint risk factors, medical and dental providers can identify the behaviors that can help patients reduce or even eliminate their risk.

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Is it a Bump or Something Else?

Many people find bumps or pimples from time-to-time on their genital area from shaving or allergic reactions, but sometimes they are unsure if it is something else. If it is flesh-colored and looks like a tiny cauliflower, it could be genital warts caused by the Human Papilloma Virus. There are about 40 different strains of the virus that can be spread through sexual contact. Some of them cause warts, changes in cells, some can increase the risk of certain types of cancers, and many of them do nothing. According to the CDC, there are 360,000 people who develop genital warts each year. Warts usually develop six weeks to six months after infection. The warts are usually painless but may itch and can grow in more than one place. They may also become bigger and multiply. If you are concerned that you or a partner may have genital warts, schedule an appointment to have a medical provider look at it.

To help prevent becoming infected you can:

  1. Use a condom every time.
  2. Get the Gardasil vaccine that protects you from the two HPV strains that cause 90% of all the cases of genital warts.
  3. Keep your immune system healthy by making healthy food choices and staying active.
  4. Stop smoking! Smokers may be more likely to develop warts and have them come back if they are removed.

Genitals warts can be removed, but they may grow back because the virus always lives in the body.

poke

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Michael Douglas, Sex Educator

mdSome interesting news stories have popped up this week after Michael Douglas talked about his throat cancer diagnosis from 2010. He’d spoken about it while he was undergoing treatment, but in an interview with The Guardian he discussed how it’s one of the types of cancer that are often caused by HPV, the human papilloma virus.

When people talk about the cancers that are caused by HPV, they generally focus on cervical cancer since it’s been the most predominant type. However, if the recent increases in these oral and throat cancers continue, they may take the leading spot by 2020. Thankfully they respond very well to treatment, but unlike pap smears to detect cervical cancer, we don’t have any routine screenings to look for them.

Though the FDA has recommended the vaccine for both boys and girls and funding is available to help cover the cost, more than two-thirds of kids in the target range have not received it. The resistance comes from a variety of places – some parents are concerned generally with the safety of vaccinations, and getting three shots over the course of six months requires multiple visits to a health provider. There’s also the fact that bringing pre-teens in for shots involves more discussions than when they’re toddlers, and many parents aren’t eager to discuss sex. Finally, some parents and conservative groups have expressed worry that kids who receive the vaccine will see it as ‘permission‘ to have sex.

Any time you combine a movie star, a sexually transmitted virus, and headlines about oral sex, people are likely to take notice, and kudos to Douglas for using his position to bring some more attention to this issue. I hope that soon, we won’t need any extra motivation when it comes to using a cancer-preventing vaccine, but I’m really glad he stepped up in the interim.

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What is a Pap Smear, Anyway?

A lot of women understand a pap smear as something they have to do to get their birth control, and may not know much about it beyond that. I know that when I decided to get on birth control at 18, I had to go get a full well-woman exam, and all I knew was that it was awkward and the speculum was uncomfortable. It was years before I actually knew what the purpose of the exam was, beyond getting a prescription for birth control. Because a pap involves a pelvic exam, I’ve noticed some women assume that if they had a pelvic exam, a pap was done. Not true! Let’s discuss what actually goes on in a pap smear, and when and why you should do it.

Your well-woman visit consists of your breast exam, a bimanual exam (performed by the doctor with both hands, to check the size, shape, consistency, and location of the cervix and uterus), and a pap smear. The pap smear is the part that involves a speculum.

The Speculum: Everyone's Favorite (not).

The practitioner takes a small brush and collects cells from your cervix, and at the lab a cytologist examines the cells to make sure they look normal.

Normal cells mean you don’t have cancer. Abnormal cells require further testing to require if you have precancerous changes (dysplasia), or possibly cancer. Cervical cancer often has no symptoms until it’s advanced, and symptoms may include irregular bleeding, which can be caused by other things and, therefore, be overlooked. Because of this, it’s important to get your pap smear regularly even if you feel fine.

The important thing to remember about a pap smear is that it’s a cancer screening, not an infection screening. Don’t assume that because you had a pelvic exam, you had a pap! Some infection screenings require a sample of vaginal discharge, and usually this means a practitioner will require a speculum exam.

A pap smear won’t tell you if you have a sexually transmitted infection (although abnormal results may indicate the presence of high-risk HPV, a second test must be done at the lab to confirm), or a common vaginal infection such as yeast, bacterial vaginosis, or trichomonis. If you have symptoms of infection, be sure to talk to your healthcare provider.

Here’s some questions you might want to ask yourself and your health care provider:

Do I need a pap smear if:

  • I have irregular bleeding or bleeding after sex?

If you are due for one or if all infections have been ruled out, probably. Ask your healthcare provider!

  • I have discharge, odor, or pain during sex?

You definitely need an infection screening, which will involve the provider inserting a speculum and taking a sample of discharge for testing. They most likely will not do a pap at this time.

  • I want to get tested for STIs?

A pap doesn’t directly test you for HPV or other STIs. You can get screened for most infections through urine and blood tests.

For routine pap screenings, current testing guidelines state:”It depends on your age and health history. Talk with your doctor about what is best for you.”

Most women can follow these guidelines:

  • Starting at age 21, have a Pap test every 2 years.
  • If you are 30 years old and older and have had 3 normal Pap tests for 3 years in a row, talk to your doctor about spacing out Pap tests to every 3 years.
  • If you are over 65 years old, ask your doctor if you can stop having Pap tests.

Ask your doctor about more frequent testing if:

  • You have a weakened immune system because of organ transplant, chemotherapy, or steroid use;
  • Your mother was exposed to diethylstilbestrol (DES) while pregnant; or
  • You are HIV-positive

If you are younger than 21 and require birth control, ask your healthcare provider what you need to do to get a prescription without a pap smear.

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