Melanie Cole, MS (Host): Genital human papillomavirus is the most common sexually transmitted infection in the United States. There are over 40 types and 13 of which can lead to cancer. We're here to offer information for protecting yourself against HPV, as well as screening and treatment options.

Welcome to Conversations with MIT Health. I'm Melanie Cole and joining me today is Jennifer Shark. She's a Certified Nurse Midwife with MIT Health. Jennifer, thank you so much for joining us. Before we get into HPV and cervical cancer, tell us a little bit about yourself and how long you've been with MIT Health.

Jennifer Shark, C.N.M.: Sure, my name is Jennifer Shark. I am a Certified Nurse Midwife, which means that I am a registered nurse with advanced training in obstetrics and gynecology. And I have been with MIT Health for a total of about 10 years.

Host: Wow. So you have a lot of experience in all these topics that you and I have talked about on many episodes. Tell us a little bit about HPV, how it's transmitted, how common it is. Tell us about what this is.

Jennifer Shark, C.N.M.: So, HPV is an extremely common sexually transmitted infection. HPV causes genital warts and cervical cancer. And it does not require intercourse to be transmitted. It can also be transmitted through just skin to skin contact.

Host: Yikes, well I think that's what makes it so common and much more contagious. So you just said how it's transmitted, skin to skin contact. What about things like surfaces? Does it live on surfaces?

Jennifer Shark, C.N.M.: You cannot get HPV from surfaces.

Host: Now, how do we know if we have it? Does it have symptoms? Do you feel it? Does it hurt? Tell us about the symptoms.

Jennifer Shark, C.N.M.: So for the vast majority of cases, HPV is completely asymptomatic. So there are no symptoms, specifically in the cancer causing strains. There are wart causing strains which cause genital warts, but they don't always show up as genital warts. In long term infection with HPV, there can be symptoms such as bleeding with intercourse or other unexpected vaginal bleeding, and that should always be checked out by your care provider.

Host: So then when you say checked out, what does screening for HPV look like? So if we notice something, we go into our provider, but is there a screening? And if so, what is that?

Jennifer Shark, C.N.M.: When we screen for HPV, we do it through the PAP smear. There's currently not a better way to test only for HPV, but we are hoping in the near future that there will be more tests available for screening.

Host: So now let's talk about cervical cancer and the HPV vaccine. The link between these has been definitively described. We have this new vaccine, Gardasil, not so new really. So I'd like you to speak about the link between HPV and cancer and the vaccine Gardasil.

Jennifer Shark, C.N.M.: So, there are about 13 strains of the HPV virus that can cause cervical cancer, and nearly all cases of cervical cancer are caused by the HPV virus. So, getting vaccinated dramatically reduces your chance of ever getting cervical cancer. Everybody under the age of 46, who is an adult should get the vaccine and most people will get it between the ages of 11 and 13 at their pediatricians.

Host: So this vaccine is absolutely a game changer. It's one of the only vaccines we have that is a cancer preventive vaccine. So you mentioned the age limits and when we start giving it to our kids in their tween years before they become sexually active. What if you're somebody who is past the age limit or didn't get both doses? Can you get that later on in life?

Jennifer Shark, C.N.M.: If you are under 46, you can get it very easily through your OBGYN or primary care provider's office. If you are over 46 and you want the vaccine, you can still get it, you just may have to pay out of pocket for it.

Host: Well, that's so interesting. Now, do women who have been vaccinated still need to have a PAP smear and be screened for cervical cancer? What's the current guideline on that for PAP smear and cervical cancer and how has Gardasil changed the recommendations that we've always had?

Jennifer Shark, C.N.M.: We do recommend that everyone still get their PAP smear screening even if they have been vaccinated. The current HPV vaccine protects against seven cancer causing strains and the two most common wart causing strains. So, there are still HPV strains that cause cancer that are not covered by the vaccine.

We recommend that cervical cancer screening with a PAP smear begin at age 21 and that can be a discussion between you and your provider if you have never been sexually active by the age of 21. You can have a negotiation. You can have a shared decision making discussion with your provider about the best time for you to begin cervical cancer screening.

Host: If someone is told that they tested positive for HPV. Are there treatment options? When we hear about sexually transmitted infections, there are usually some treatment options. What do we do for HPV?

Jennifer Shark, C.N.M.: So, for most people who contract HPV, their immune system will clear it out on their own within two years. So, with initial diagnosis, we usually will just recommend close monitoring. If we also see that the HPV virus has caused cellular changes on the cervix, then we recommend closer follow up.

Host: Are there any myths about this vaccine, Jennifer, that you've heard in your many years and experience, whether it's from parents concerned about giving their children Gardasil at 11 years old or young women getting their first PAP smears. Are there any myths about the HPV vaccine you'd like to share and bust up?

Jennifer Shark, C.N.M.: There is a lot of misinformation around the internet, especially about the HPV vaccine. Things like it causes stroke or blood problems or infertility, and all of those are patently untrue and have all been disproven. HPV vaccine is an incredibly safe vaccine. Like all vaccines, anyone can have a potential vaccine reaction, but the HPV vaccine has been widely studied and widely used, and it is incredibly safe and incredibly important at preventing cervical cancer.

Host: It is certainly such an important vaccine. How can patients schedule an appointment for HPV and cervical cancer screening at MIT Health?

Jennifer Shark, C.N.M.: So if a patient would like to have the HPV vaccine, they can call their primary care provider's office or the OBGYN office and schedule a visit with a nurse to start receiving the vaccine and they can get their full three doses of vaccine with us. And if they are ready to have a PAP smear, they can schedule that either with their primary care provider or with the OBGYN office.

Host: Thank you so much, Jennifer, for clearing up some of those myths and misconceptions about such an important vaccine and a game changer in the world of cervical cancer. Thank you again. And that concludes this episode of Conversations with MIT Health. Please visit our website at health.mit.edu for more information and to get connected with one of our providers. I'm Melanie Cole. Thanks so much for joining us today.