Transcription:

Dr. Michael Smith (Host):  Fact or myth. HPV infection is no big deal. It always clears on its own. What do you think? Welcome to The GW HealthCast. I’m Dr. Mike Smith and today’s topic is HPV, Facts and Myths. My guest is Dr. Beverly Long. Dr. Long is the Assistant Professor of Gynecology and Oncology at George Washington University and is affiliated with The George Washington University Hospital. Dr. Long welcome to the show.

Beverly Long, MD (Guest):  Hi, thanks for having me.

Host:  So, what do you think about my teaser there? Is HPV no big deal and it clears on its own all the time? Is that myth or fact?

Dr. Long:  Myth. But with a caveat.

Host:  Well go ahead. Tell us the caveat.

Dr. Long:  HPV shouldn’t be thought of as a big deal because almost everyone who is sexually active will get HPV at some point in their life. However, it’s not – it doesn’t always clear on its own. I kind of think of HPV as like the common cold. So, there’s a lot of different strains and most people will get it and you can get it many times over. And it usually clears, but it doesn’t always.

Host:  Right, right. So, I tried to stump you Dr. Long with a tough one to begin with and you got it perfectly right. So, let’s do this. Tell us a little bit more about HPV infection. You know the who, the what the where, the how, the why.

Dr. Long:  So, HPV infection is very common, at least 70 or 80% of people who are sexually active will get it at some point. Most people will clear it on their own in about six to 18 months. However, some people have persistent infection. There’s a lot of different types of HPV and some types are more likely to cause cancer than others. And there’s other types that cause genital warts. It can be acquired by both men and women at any age.

Host:  So, I saw a statistic on the HPV.com website that said something along the lines of 50% of all the infections occur in the age group between 15 and 24. Do you think a lot of my listeners would find that 15, that seems pretty young. What do you think about that?

Dr. Long:  Fifteen does seems pretty young, I mean it probably depends on the population that you are screening. But the high risk of HPV in that population is why we don’t test for HPV in women who are under 30.

Host:  Okay.

Dr. Long:  Because it’s so common that…

Host:  Yeah, it’s so common you are going to find it right?

Dr. Long:  Yeah.

Host:  So, here’s another fact or myth that kind of plays into that lower age range. My child is a preteen. There’s nothing for me to worry about. Myth or fact?

Dr. Long:  Myth. So, a child being a preteen even if she never – she or he never has intercourse until later; there is no reason not to protect them now. The vaccination can be given as early as age 9 and is currently recommended to be given in the series around age 11 or 12 and then it offers protection for when your child does become sexually active.

Host:  Right. That myth or fact that I just stated was supposed to be a lead in to vaccinations. You did it perfectly. I want to talk a little bit more about vaccinations because I know in general, there is growing concern in the general population about vaccines and all that kind of stuff. And so, you gave us some information there but let’s step back and talk a little bit more about the vaccine. Maybe you can give us a rundown of what is a vaccine, what is actually in it and when is it appropriate to give it.

Dr. Long:  So, the vaccine is given in an injection and it’s actually made up of the protein capsule that surrounds the HPV DNA virus. So, for someone who doesn’t know kind of what a virus looks like; the DNA is basically the blueprint for how the virus spreads in your body and makes more copies of itself in your body and it’s protected by a protein capsule that your body can recognize as an antigen or as a protein that shouldn’t be there; that it should fight against. So, the vaccine is made against the protein, but it doesn’t have any risk of giving you the actual virus. Because the DNA is not there.

Host:  Right, right. So, what would you like to say to parents that are hesitant about the vaccination? I mean everything you just said, they hear that, but they still maybe are worried about it, wrong or right; there’s a lot of let’s be honest, misinformation about vaccinations I think out there. What could you say to a parent who is worried about this and who may not do the vaccination when it is available and safe?

Dr. Long:  So, there are a lot of different reasons that parents think that the vaccination may not be a good idea. And many of them are reasonable but they are myth. So, one thing that parents worry about is that the vaccination might make their child think well now it’s okay to be more promiscuous and to have more intercourse. But there have been studies that have shown that there is no change in sexual activity after the vaccine is given. So, that is one reason that we can kind of take off the table for not getting the vaccine.

The other thing that I think people worry about are side effects of the vaccine. There’s a lot of kind of myths about an increased risk of POTS syndrome or Guillain Barre virus or just other usually autoimmune type diseases that people think are associated with the vaccine. But, large studies in Europe and Australia and the US have shown that there’s no increased risk of those problems after the vaccine. It is given in a young age group where those problems might show up, so there may be an association; but it does not seem that the virus causes those. I mean the vaccine causes those. The vaccine is associated with a small risk of fainting. So, that’s why patients have to be observed for 15 minutes after being given the vaccine. But that’s not a long-term risk.

Host:  Right, right. And when do you again recommend – I think you touched on this a little bit, but when is the recommendation for giving the vaccine?

Dr. Long:  The ACOP recommendations are for age 11 to 12, but the vaccine is approved for anyone aged 9 to 45.

Dr. Smith:  Nine to 45. So, it is rare, but some girls will go on and women will go on to develop what’s called cervical dysplasia. Can you tell us about that?

Dr. Long:  Yes, so cervical dysplasia is caused by the HPV virus. The virus gets into the cells in the cervix and causes precancerous changes. Those are graded as changes from 1, 2 and 3. So, CIN1 or the dysplasia that’s level one is actually a very mild form of dysplasia that probably won’t ever lead to cancer. It’s usually just a really indolent variety that will clear on its own. But CIN 2 and 3 are more severe changes. And those can lead to cancer, so they do need to be treated.

Host:  And how is that treated?

Dr. Long:  So, when someone has an abnormal PAP smear, the next step is to do what we call colposcopy and that is to determine if there is any dysplasia or precancer. And that’s done by placing acetic acid or like a vinegar solution on the cervix and looking with a magnifying camera to identify any changes. And any abnormal tissue is biopsied and then we get the dysplasia result. If you have CIN1 at that time, then you just keep monitoring it to make sure that it doesn’t progress. But with CIN 2 and 3; it’s usually treated with an excisional procedure. So, that’s either a LEEP which is a small excision that’s done with a hot wire, so it can be done in the office. Or a conization which is done in the operating room and can be a little more tailored to the type of dysplasia that you are treating.

Host:  And with those kinds of treatments, if there is that level 2, level 3; what is the general outcome with that once they are treated?

Dr. Long:  Most patients will clear even level 2 and 3 dysplasia, if they are treated.  And then it just requires monitoring with PAP smears in one and two years to make sure that it has cleared.

Host:  Okay. So, Dr. Long I have another fact or myth for you. Are you ready? Here we go. Boys can’t get HPV.

Dr. Long:  Myth. That was an easy one.

Host:  I was hoping so. That was like a softball, right. I threw it right up there for you. Tell us about the risk with boys and what do we do with them?

Dr. Long:  So, unfortunately there is no clinical test that is used currently to test boys for HPV. But that doesn’t mean that they cannot acquire it. So, HPV in boys also causes genital warts just like in women. And it can also – just like it causes cervical, vulvar and vaginal dysplasia and cancer in women; it can cause penile cancer in men and just as importantly it can cause throat and oropharyngeal cancer in men. So, cancer of the mouth and throat. And that cancer is actually surpassing cervical cancer as a problem in the US because there is not a way to screen for it the same way.

Host:  Yeah, I say some interesting reports on that, that those kinds of cancers are increasing and it’s quite alarming. So, what a great conversation. HPV, there is a vaccine, we do recommend that. It is safe, and I appreciate you helping my audience understand that it is safe and effective. Let’s end this way Dr. Long; what would you like people to know about HPV infection?

Dr. Long:  I would like people to know that HPV is very common. It’s not something to be embarrassed or ashamed about. It’s only something that you need to watch. If HPV infections are monitored closely; it’s very rare for them to turn into cancer as long as you are getting the recommended screening and following up with your doctor. However, HPV should cease to be a problem once everyone is vaccinated.

Host:  Right. That’s kind of the big one, right. That’s the big message I guess, vaccination.

Dr. Long:  Right because even though it can be treated; it can be – it’s a lot of work to treat it. So, if you want to avoid those kinds of visits; just get the vaccine.

Host:  Makes sense to me. Dr. Long I want to thank you for the work that you are doing and also thank you for coming on the show today. You're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr. Long or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment.  I’m Dr. Mike Smith. Thanks for listening.