What Every Woman Needs to Know about HPV

This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Welcome to the show. I'm Deborah Howell, and today our guest is Dr. Stephanie Wyckoff, who received her medical degree from New York Medical College. She completed her internship at Westchester County Medical Center and her residency in obstetrics and gynecology at White Memorial Medical Center in Los Angeles. She's been practicing medicine in Southern California since finishing her residency. MemorialCare Medical Group recently welcomed a group of OBGYN physicians and midwives, including Dr. Wyckoff, to their new Fountain Valley office located at the new Health and Wellness Pavilion at Orange Coast Memorial. And we're so pleased to have her on our show today. Welcome, Dr. Wyckoff.

Stephanie Wyckoff, MD: Thank you very much.

Deborah Howell (Host): Human papillomavirus is the most commonly sexually transmitted infection in the U.S., and most HPV infections don't cause any symptoms and go away on their own. But HPV is important mainly because it can cause cervical cancer in women. What is HPV?

Stephanie Wyckoff, MD: HPV stands for what is called human papillomavirus. It's a DNA-based virus that has over 100 different strains that are divided into low-risk and high-risk strain classes. About 40 or so of these strains infect the genital area, causing genital warts and the low-risk strains and certain cancers with the high-risk strains.

Deborah Howell (Host): Okay, and how is HPV spread?

Stephanie Wyckoff, MD: It is spread by skin-to-skin contact mostly. As you said, it's the most common sexually transmitted disease that we know of, and it can be transmitted by genital-to-genital contact, mouth-to-genital contact, anal-genital contact, or even hand-to-genital contact.

Deborah Howell (Host): Wow. I hadn't realized hand-to-genital. Wow, that's incredible. Does HPV cause health problems?

Stephanie Wyckoff, MD: It is mostly associated with genital warts, as I said, as cancers. It is most commonly associated with cervical cancer. It has also been associated with anal cancer as well as oropharyngeal cancers.

Deborah Howell (Host): Okay, not very pleasant. So how can I avoid HPV and the health problems that it can cause?

Stephanie Wyckoff, MD: It's very, very difficult to protect yourself against HPV. There is no treatment for it. Condoms provide some protection, but condoms don't even cover all of the areas where HPV can be contacted from. But they're the best form of defense that we have, unfortunately. There's also three different HPV vaccines that help to create immunity to certain of the viral strains, the most virulent strains that are known.

Deborah Howell (Host): Okay. And who's a good candidate to get vaccinated?

Stephanie Wyckoff, MD: The vaccination is recommended for boys and girls, girls or women between the age of 9 to 26, and boys between the age of 9 or men to 21, and immunocompromised men up to 26. The earlier that you get the vaccine, obviously the more protection that it provides, the more immunity that you can get before. It's best to get the vaccine prior to your first sexual contact.

Deborah Howell (Host): Okay, so basically what age are we talking?

Stephanie Wyckoff, MD: Most recommended is around 11 to 12. So a lot of pediatricians are giving it in their practices. And if you get it prior to the age of 15, it is a two-dose vaccine given six months apart. After the age of 15, it is a three-dose vaccine with the primary vaccine and then the second one at two months and six months or one month and six months, depending on which vaccine you receive.

Deborah Howell (Host): Got it. And how do I know if I have HPV?

Stephanie Wyckoff, MD: It's very difficult to know. It's actually very asymptomatic for the most part. The only test that we have for HPV right now is with a cervical swab. So we test for it when gynecologists do your Pap smear, which is a screening test for cervical cancer. And the Pap smear started at the age of 21. And up to the age of 30, we do what's called reflex testing for HPV. If there's any abnormalities on the Pap smear, they will check for HPV. After the age of 30, then we do what's called co-testing with the Pap smear, where we test automatically to see if they are negative or positive for HPV.

Deborah Howell (Host): Got it. How common is HPV and the health problems caused by it?

Stephanie Wyckoff, MD: HPV is, like I said, very prevalent. The CDC estimates that by the age of 50, 80% of American men and women will have been infected by the virus at some point in their life. The younger you are, the more likely your body is to clear it. The body clears it generally over two years, and then you have immunity to whichever strain you were infected by at that time, but that doesn't mean that you can't be reinfected again with a different strain of HPV.

Deborah Howell (Host): You just knocked me sideways. Did you say 80%?

Stephanie Wyckoff, MD: 80%. And that's, if you ask me, that's a low estimate.

Deborah Howell (Host): My goodness. I had no idea.

Stephanie Wyckoff, MD: Yeah.

Deborah Howell (Host): Well, that's why we do things like these podcasts. So if you're pregnant, will having HPV affect the pregnancy?

Stephanie Wyckoff, MD: HPV does not affect the pregnancy. It does, whether you are positive or negative for cervical HPV or even if you have genital warts present at the time of your delivery, it is still standard of care right now to proceed with a vaginal delivery. There have been rare cases of babies developing HPV type warts in their throat. However, that is still rare, and it's determined that the benefits of a vaginal delivery still outweigh those risks.

Deborah Howell (Host): Okay. Okay, good to know. And can a woman be treated for HPV or health problems caused by HPV? And that goes for men as well.

Stephanie Wyckoff, MD: Correct, yeah. There's no treatment for HPV at this time. The best is... if your body can clear it, and the prevention that is afforded by the vaccination, if you are able to get them. The best thing that you can do is to make sure that you keep current with your Pap smears as recommended by your gynecologist, as that is currently the only screening test we have. There's no way to screen or test right now for men or the anal or mouth cancers.

Deborah Howell (Host): Okay. I want to repeat this. We did say this once already, but I think it's so important. Most HPV infections do not cause any symptoms and go away on their own, but HPV is important mainly because it can cause cervical cancer in women, so you do need to get checked. Tell me what you should do as a 15-year-old woman seeing your doctor at your annual exam.

Stephanie Wyckoff, MD: A 15-year-old woman seeing her pediatrician, if she has not already received the HPV vaccination, she should definitely discuss with her pediatrician about starting the course of vaccinations that are recommended and to use condoms whenever they become sexually active until they're in a sure, standard relationship.

Deborah Howell (Host): Let's do the same thing for a 15-year-old male.

Stephanie Wyckoff, MD: Same thing. If they have not received the vaccination, it is highly recommended because they can still carry HPV even though they cannot be tested for it, and they can pass it on to their female partners or their male partners. So the vaccination is also helpful in prevention of the transmission from male to female or male.

Deborah Howell (Host): And this doesn't go away just because you get 50 or 60 years of age, correct?

Stephanie Wyckoff, MD: Correct. You can test positive for HPV at any point in your life. And that doesn't point to when you might have contracted the virus. It can be years later after having been exposed that you can test positive or have cervical changes. Progression from infection to cervical cancer, they think, takes about 20 to 25 years.

Deborah Howell (Host): Wow. And if you have the genital warts caused by HPV, are they treatable?

Stephanie Wyckoff, MD: They are treatable. There are medications, creams that can be prescribed that you can treat at home. In the office, we can use a diluted acid, which is very effective in removing them, or freezing therapy can also be used. In worst cases, at times they are taken to the operating room and laser destruction is performed.

Deborah Howell (Host): Okay. And is there an incidence of recurrence?

Stephanie Wyckoff, MD: Absolutely. Anytime that you have the virus or even if you clear it and it's a reinfection, you can always have a recurrence, which is why you really need to stay current with Pap smears in your exam.

Deborah Howell (Host): Okay. Thank you so much. Is there anything else we should know about HPV?

Stephanie Wyckoff, MD: Just one of the biggest questions that I am always asked is, how do I tell my partner? What do I tell my partner? I've only had one partner. It's a very difficult discussion to get into because, as I said, it is so prevalent. 80% of people, like I said, are infected at some point in their lifetime, and there's no test in males and there's no treatment for it. So it's a very difficult, and I understand, sometimes emotional conversation to have with your partner, but I just say to sit down and be honest and say, you know, I tell them, you know, they probably carry it. We can't tell them for sure, but unfortunately, there's no screening for them. So it's just, I don't know how to answer this. It's a very difficult conversation for them to get into, and usually I tell them, just be honest with them. They carry it, and there's nothing they can do.

Deborah Howell (Host): Honesty is the best policy.

Stephanie Wyckoff, MD: Correct.

Deborah Howell (Host): For more information about MemorialCare OBGYN services and providers, visit www.memorialcare.org/OBGYN. We want to thank you so much, Dr. Wyckoff, for your time and your expertise in being on the show today.

Stephanie Wyckoff, MD: Thank you so much. It was my pleasure.

Deborah Howell (Host): That's all for this time. I'm Deborah Howell. Have yourself a terrific day.