HPV Protection, Screening and Vaccination
Dr. Emily LaSota discusses what HPV is, how it's transmitted, prevention, and treatment options.
Featured Speaker:
Emily LaSota, MD
Emily LaSota, MD is a Board-certified obstetrician/gynecologist on the Medical Staff at Southwest General. Transcription:
HPV Protection, Screening and Vaccination
Evo Terra (Host): Did you know that HPV is the most commonly occurring sexually transmitted disease, and effects the lives of not just girls and women but also boys and men? That’s why today I'm discussing HPV protection, screening, and vaccination with Dr. Emily LaSota, a board-certified obstetrician-gynecologist on the medical staff at Southwest General. This is Southwest General Healthtalk. I'm Evo Terra. Let’s start with what may seem an obvious question, Dr. LaSota, but what is HPV?
Emily LaSota, MD (Guest): HPV is an acronym that stands for human papilloma virus. So it’s a group of viruses. There are actually over 200 different strains of the virus that typically infect surfaces on the outside of out bodies. That includes surfaces like our skin, lips, mouths, and then obviously genitals. So penis, vagina, vulva, even into the cervix.
Host: So I know HPV is often associated with cancer. So how do we screen for HPV cancers?
Dr. LaSota: So because HPV effects certain areas of the body, we can typically screen for HPV in the areas that it infects. The number one area that HPV likes to infect and hang out is the cervix. For those people who forgot their high school anatomy class or health class, the cervix the part of the uterus that opens up when a woman dilates and has a baby. When a woman is not having a baby, it is closed, and it is found at the top of the vagina. So we can only really see it when we do a pelvic exam looking at the cervix. HPV loves to hang out in this area. So the way that we can screen for HPV is to take a swab of the cervix called a pap smear that collects cells from the cervix, and then looks at them under a microscope to see if they look abnormal. In that same specimen, we can test to see if there's also HPV in that person’s cervix.
Host: So we’re looking for an abnormal pap smear, but an abnormal pap smear doesn’t always mean HPV correct?
Dr. LaSota: That is correct. So HPV is the number one cause of abnormal pap smears. In upwards of 90% of abnormal pap smears, we find HPV. There are different scenarios where an abnormal pap smear does not necessarily mean HPV, but we do co-test meaning we test the cells of the cervix and we test the HPV virus to determine what is the cause of these abnormal cells.
Host: Let’s focus on cancer for a moment and HPV. What types of cancers are caused by HPV?
Dr. LaSota: The number one cancer most commonly caused by HPV is cervical cancer. Cervical cancer in the United States is rather rare. Because we are so good at screening for it with pap smears, we tend to catch it early. Globally there are many countries that do not do routine pap smears. Countries I guess classically considered “third world countries”. In these countries, cervical cancer is very prevalent and is a horrible disease, horrible condition to get. Fortunately in the United States we do not see that as much. HPV can also cause cancers, although less frequently, of the vagina, the vulva, even the penis. We are seeing an increase in the number of cancers of the head and neck caused by HPV. Women and men can carry HPV on the vagina and the penis. We have seen it increasing in prevalence most likely due to increase in number of sexual partners and the way people are having sex. HPV can transfer to the mouth during oral sex. It can infect the tongue, the mouth, and the throat. There are two different kinds of cancer of the head and neck. There are HPV associated cancers, there are non-HPV associated cancers. Those cancers are more likely caused by smoking, alcohol use over the lifetime of the person. For the first time recently, we’ve started to see HPV associated cancers of the head and neck outnumbering these non-HPV cancers. So if that is a trend we’re seeing in society, it’s very, very important to be aware that if we can prevent HPV infection we can prevent these cancers of the mouth, throat, and neck which, again, are not very fun cancers to get. Treatment that is rather painful, uncomfortable. So we should be doing all we can to prevent cancers of the head and neck.
Host: Absolutely. Anything we can do to prevent would be an excellent thing. Now let’s talk about prevention because the V in HPV is virus. So should my child, for example, get the HPV vaccine?
Dr. LaSota: Currently the HPV vaccine is approved by the FDA for people ages 11 through 45. It used to only be approved for people from ages 11 to 26, but that was recently expanded. We know that the earlier a person is vaccinated against HPV, the more robust their immune response. Pediatricians should be asking parents if they would like their child to get the HPV vaccine around ages 11 or 12. The earlier the course is given, and it is a two-dose course at that time, the more robust the response in the future. Getting an HPV vaccine can prevent an infection with several strains of HPV. Like I said at the beginning of my talk, there are many strains of HPV. There are about 40 that tend to infect the genital track. The current HPV vaccine covers nine of them. Nine of the most common HPV strains. Getting it does not guarantee 100% your child will never get HPV, but it does protect against high risk strains, strains that can lead to cancer, and common strains.
One question that I get or one concern that I get from parents a lot of time is, “Well, I don’t want my child getting the HPV vaccine because…” and one of the reasons is I don’t think my child will get HPV in their lifetime or I don’t want my child to have sex thinking there are no consequences because they’re protected against HPV. We see that in practice children that get the HPV vaccine are not more likely to have sex, have earlier sex, or have more sexual partners than people who do not get the HPV vaccine. In general, teenagers usually don’t hold off from having sex because they fear HPV. More real-world consequences that they think of when they have sex is other STDs—gonorrhea, chlamydia—and pregnancy. So HPV does not encourage early sex. It does not encourage sexual promiscuity. It is essentially a cancer vaccine. In the United States, it’s estimated that 80% of all adults will have contact with HPV at some point in their lifetime. Even if one person’s child does not have sex until they get married and that is the only person they ever have sex with, it’s very likely that their partner did have sex with someone prior to that encounter and could expose them to HPV. So this is something that I recommend across the board to all parents to talk to their pediatricians about, and if appropriate—in most cases it is—get that HPV shot for their children at an early age.
Host: That’s a rather eye-opening look at the statistics of things. I know that vaccines in America are generally safe, but what about possible side effects to this particular vaccine?
Dr. LaSota: The number one side effect that we see from the Gardasil vaccine is pain at the injection site. Of all the vaccines, I would say that it probably causes more muscle soreness than the average vaccine, but that’s the number one side effect. This vaccine has been given to tens of thousands if not hundreds of thousands of patients, and it has been proven safe. Again, approve by the FDA. This vaccine does not contain mercury, thimerosal, or dead virus. It contains virus like particles. Of course with any vaccine, it can cause an adverse allergic reaction. So anytime a patient does get the vaccine, we ask that they remain in the office for 15 minutes following the injection to make sure they’re doing okay.
Host: All great reasons why it’s the right thing to do to have your child vaccinated, obviously. What about concerns around fertility? Will this vaccine effect fertility?
Dr. LaSota: So the HPV vaccine does not affect fertility. It is a way to prevent cervical cancer and cervical abnormalities. It is more likely to effect fertility if you do not get the HPV vaccine. If a patient has an abnormal pap smear, has precancerous cells on the cervix, and needs procedures on the cervix that effect the surgical length or cervical function, that would be more likely to cause problems either getting pregnant or in pregnancy. So in order to keep the cervix as healthy as possible and keep it intact for a healthy pregnancy, I recommend getting the HPV vaccine so that we can keep it healthy.
Host: Smart play. I know we touched on this earlier, but I really want to drive the point home. As someone who does not have a cervix, how does HPV effect males? People like me.
Dr. LaSota: Men can be carriers of the HPV virus. Men currently cannot be tested in the United States to see if they are carriers. There are no FDA approved tests for males. Because they can be carriers, like I said they can get cancers of the penis—although those are more rare than cervical cancer. Bigger is that they can transfer it to their partner. So they can be carriers and not be aware of it, give it to their partner, and then their partner can subsequently have problems with their cervix, abnormal pap smears, require procedures to prevent cervical cancer. For men themselves, they can get head and neck cancers, obviously. So when someone in a couple has HPV, they typically can transfer it to their partner. One or both of them can potentially have the virus infect their oral mucosa—meaning their mouth and their throat. Again, it can lead to head and neck cancers. There have been celebrities in the news that have had head and neck cancers, and some have become advocate for HPV vaccines because theirs has been found to be HPV associated cancers.
Host: So you just said that there's not a test for males and HPV if I heard you properly, but are there any ways to screen boys or males for HPV?
Dr. LaSota: Unfortunately, there is not yet in the United States. We can assume that if they have a partner who is positive for HPV, they are most likely infected. That being said, one thing that I have not touched on yet is is HPV a lifetime infection or can it be cleared? So we know that some people can clear the virus. So even if they are infected with it, they may clear it and it may resolve in their bodies. The average time that it takes a person to clear the virus is about 8 to 12 months. Unfortunately, we cannot tell if a person if the type of person who will clear it or someone who will harbor this infection kind of chronically for years and years and years. We know that there are some things that make a person more likely to not clear it. Things that affect the immune system. So people that smoke, people that have HIV, people that are on chronic steroids. Those people are more likely to be unable to clear the virus and harbor it over long periods of time.
Host: So I'm out of the age range for recommendation, but I do have a 29-year-old son. So should my son receive the vaccination?
Dr. LaSota: Definitely in terms of age, I recommend the earlier the better. We also have to think about risk factors for acquiring HPV. It depends on a patient’s sexual practices, risks, underlying conditions I think after age 26. From ages 11 to 26, I recommend everyone get it. It is approved up until age 45 now. So it is something that I believe people over 26 should definitely speak with their doctors about. If someone is married in a monogamous relationship, neither of them have HPV, there's still a possibility in the future they may encounter HPV whether it’s with a new sexual partner. They can assess that likelihood with their partner and their doctor. Your son would be eligible to get the HPV vaccine. There’s no harm in getting the HPV vaccine. But in adults who are in more established relationships, I think that’s a conversation best had with their primary care provider.
Host: Always a good idea. Dr. LaSota, thank you. This has been a very eye-opening conversation.
Dr. LaSota: You're welcome. It’s my pleasure. I hope everyone listening learns something.
Host: Again, that was Dr. Emily LaSota, a board-certified obstetrician-gynecologist on the medical staff at Southwest General. To learn more about Southwest General’s women’s health services, visit swgeneral.com. Thank you for listening to this episode of Southwest General Health talk. I am Evo Terra. If you found this episode helpful, please share it on your social channels and be sure to check out our entire library of past episodes, which you can find at swgeneral.com.
HPV Protection, Screening and Vaccination
Evo Terra (Host): Did you know that HPV is the most commonly occurring sexually transmitted disease, and effects the lives of not just girls and women but also boys and men? That’s why today I'm discussing HPV protection, screening, and vaccination with Dr. Emily LaSota, a board-certified obstetrician-gynecologist on the medical staff at Southwest General. This is Southwest General Healthtalk. I'm Evo Terra. Let’s start with what may seem an obvious question, Dr. LaSota, but what is HPV?
Emily LaSota, MD (Guest): HPV is an acronym that stands for human papilloma virus. So it’s a group of viruses. There are actually over 200 different strains of the virus that typically infect surfaces on the outside of out bodies. That includes surfaces like our skin, lips, mouths, and then obviously genitals. So penis, vagina, vulva, even into the cervix.
Host: So I know HPV is often associated with cancer. So how do we screen for HPV cancers?
Dr. LaSota: So because HPV effects certain areas of the body, we can typically screen for HPV in the areas that it infects. The number one area that HPV likes to infect and hang out is the cervix. For those people who forgot their high school anatomy class or health class, the cervix the part of the uterus that opens up when a woman dilates and has a baby. When a woman is not having a baby, it is closed, and it is found at the top of the vagina. So we can only really see it when we do a pelvic exam looking at the cervix. HPV loves to hang out in this area. So the way that we can screen for HPV is to take a swab of the cervix called a pap smear that collects cells from the cervix, and then looks at them under a microscope to see if they look abnormal. In that same specimen, we can test to see if there's also HPV in that person’s cervix.
Host: So we’re looking for an abnormal pap smear, but an abnormal pap smear doesn’t always mean HPV correct?
Dr. LaSota: That is correct. So HPV is the number one cause of abnormal pap smears. In upwards of 90% of abnormal pap smears, we find HPV. There are different scenarios where an abnormal pap smear does not necessarily mean HPV, but we do co-test meaning we test the cells of the cervix and we test the HPV virus to determine what is the cause of these abnormal cells.
Host: Let’s focus on cancer for a moment and HPV. What types of cancers are caused by HPV?
Dr. LaSota: The number one cancer most commonly caused by HPV is cervical cancer. Cervical cancer in the United States is rather rare. Because we are so good at screening for it with pap smears, we tend to catch it early. Globally there are many countries that do not do routine pap smears. Countries I guess classically considered “third world countries”. In these countries, cervical cancer is very prevalent and is a horrible disease, horrible condition to get. Fortunately in the United States we do not see that as much. HPV can also cause cancers, although less frequently, of the vagina, the vulva, even the penis. We are seeing an increase in the number of cancers of the head and neck caused by HPV. Women and men can carry HPV on the vagina and the penis. We have seen it increasing in prevalence most likely due to increase in number of sexual partners and the way people are having sex. HPV can transfer to the mouth during oral sex. It can infect the tongue, the mouth, and the throat. There are two different kinds of cancer of the head and neck. There are HPV associated cancers, there are non-HPV associated cancers. Those cancers are more likely caused by smoking, alcohol use over the lifetime of the person. For the first time recently, we’ve started to see HPV associated cancers of the head and neck outnumbering these non-HPV cancers. So if that is a trend we’re seeing in society, it’s very, very important to be aware that if we can prevent HPV infection we can prevent these cancers of the mouth, throat, and neck which, again, are not very fun cancers to get. Treatment that is rather painful, uncomfortable. So we should be doing all we can to prevent cancers of the head and neck.
Host: Absolutely. Anything we can do to prevent would be an excellent thing. Now let’s talk about prevention because the V in HPV is virus. So should my child, for example, get the HPV vaccine?
Dr. LaSota: Currently the HPV vaccine is approved by the FDA for people ages 11 through 45. It used to only be approved for people from ages 11 to 26, but that was recently expanded. We know that the earlier a person is vaccinated against HPV, the more robust their immune response. Pediatricians should be asking parents if they would like their child to get the HPV vaccine around ages 11 or 12. The earlier the course is given, and it is a two-dose course at that time, the more robust the response in the future. Getting an HPV vaccine can prevent an infection with several strains of HPV. Like I said at the beginning of my talk, there are many strains of HPV. There are about 40 that tend to infect the genital track. The current HPV vaccine covers nine of them. Nine of the most common HPV strains. Getting it does not guarantee 100% your child will never get HPV, but it does protect against high risk strains, strains that can lead to cancer, and common strains.
One question that I get or one concern that I get from parents a lot of time is, “Well, I don’t want my child getting the HPV vaccine because…” and one of the reasons is I don’t think my child will get HPV in their lifetime or I don’t want my child to have sex thinking there are no consequences because they’re protected against HPV. We see that in practice children that get the HPV vaccine are not more likely to have sex, have earlier sex, or have more sexual partners than people who do not get the HPV vaccine. In general, teenagers usually don’t hold off from having sex because they fear HPV. More real-world consequences that they think of when they have sex is other STDs—gonorrhea, chlamydia—and pregnancy. So HPV does not encourage early sex. It does not encourage sexual promiscuity. It is essentially a cancer vaccine. In the United States, it’s estimated that 80% of all adults will have contact with HPV at some point in their lifetime. Even if one person’s child does not have sex until they get married and that is the only person they ever have sex with, it’s very likely that their partner did have sex with someone prior to that encounter and could expose them to HPV. So this is something that I recommend across the board to all parents to talk to their pediatricians about, and if appropriate—in most cases it is—get that HPV shot for their children at an early age.
Host: That’s a rather eye-opening look at the statistics of things. I know that vaccines in America are generally safe, but what about possible side effects to this particular vaccine?
Dr. LaSota: The number one side effect that we see from the Gardasil vaccine is pain at the injection site. Of all the vaccines, I would say that it probably causes more muscle soreness than the average vaccine, but that’s the number one side effect. This vaccine has been given to tens of thousands if not hundreds of thousands of patients, and it has been proven safe. Again, approve by the FDA. This vaccine does not contain mercury, thimerosal, or dead virus. It contains virus like particles. Of course with any vaccine, it can cause an adverse allergic reaction. So anytime a patient does get the vaccine, we ask that they remain in the office for 15 minutes following the injection to make sure they’re doing okay.
Host: All great reasons why it’s the right thing to do to have your child vaccinated, obviously. What about concerns around fertility? Will this vaccine effect fertility?
Dr. LaSota: So the HPV vaccine does not affect fertility. It is a way to prevent cervical cancer and cervical abnormalities. It is more likely to effect fertility if you do not get the HPV vaccine. If a patient has an abnormal pap smear, has precancerous cells on the cervix, and needs procedures on the cervix that effect the surgical length or cervical function, that would be more likely to cause problems either getting pregnant or in pregnancy. So in order to keep the cervix as healthy as possible and keep it intact for a healthy pregnancy, I recommend getting the HPV vaccine so that we can keep it healthy.
Host: Smart play. I know we touched on this earlier, but I really want to drive the point home. As someone who does not have a cervix, how does HPV effect males? People like me.
Dr. LaSota: Men can be carriers of the HPV virus. Men currently cannot be tested in the United States to see if they are carriers. There are no FDA approved tests for males. Because they can be carriers, like I said they can get cancers of the penis—although those are more rare than cervical cancer. Bigger is that they can transfer it to their partner. So they can be carriers and not be aware of it, give it to their partner, and then their partner can subsequently have problems with their cervix, abnormal pap smears, require procedures to prevent cervical cancer. For men themselves, they can get head and neck cancers, obviously. So when someone in a couple has HPV, they typically can transfer it to their partner. One or both of them can potentially have the virus infect their oral mucosa—meaning their mouth and their throat. Again, it can lead to head and neck cancers. There have been celebrities in the news that have had head and neck cancers, and some have become advocate for HPV vaccines because theirs has been found to be HPV associated cancers.
Host: So you just said that there's not a test for males and HPV if I heard you properly, but are there any ways to screen boys or males for HPV?
Dr. LaSota: Unfortunately, there is not yet in the United States. We can assume that if they have a partner who is positive for HPV, they are most likely infected. That being said, one thing that I have not touched on yet is is HPV a lifetime infection or can it be cleared? So we know that some people can clear the virus. So even if they are infected with it, they may clear it and it may resolve in their bodies. The average time that it takes a person to clear the virus is about 8 to 12 months. Unfortunately, we cannot tell if a person if the type of person who will clear it or someone who will harbor this infection kind of chronically for years and years and years. We know that there are some things that make a person more likely to not clear it. Things that affect the immune system. So people that smoke, people that have HIV, people that are on chronic steroids. Those people are more likely to be unable to clear the virus and harbor it over long periods of time.
Host: So I'm out of the age range for recommendation, but I do have a 29-year-old son. So should my son receive the vaccination?
Dr. LaSota: Definitely in terms of age, I recommend the earlier the better. We also have to think about risk factors for acquiring HPV. It depends on a patient’s sexual practices, risks, underlying conditions I think after age 26. From ages 11 to 26, I recommend everyone get it. It is approved up until age 45 now. So it is something that I believe people over 26 should definitely speak with their doctors about. If someone is married in a monogamous relationship, neither of them have HPV, there's still a possibility in the future they may encounter HPV whether it’s with a new sexual partner. They can assess that likelihood with their partner and their doctor. Your son would be eligible to get the HPV vaccine. There’s no harm in getting the HPV vaccine. But in adults who are in more established relationships, I think that’s a conversation best had with their primary care provider.
Host: Always a good idea. Dr. LaSota, thank you. This has been a very eye-opening conversation.
Dr. LaSota: You're welcome. It’s my pleasure. I hope everyone listening learns something.
Host: Again, that was Dr. Emily LaSota, a board-certified obstetrician-gynecologist on the medical staff at Southwest General. To learn more about Southwest General’s women’s health services, visit swgeneral.com. Thank you for listening to this episode of Southwest General Health talk. I am Evo Terra. If you found this episode helpful, please share it on your social channels and be sure to check out our entire library of past episodes, which you can find at swgeneral.com.