CAKE Byte - Dr. CAKE's Sexual Health Update

Every girl knows the deal: you go for your regularly scheduled, not so desirable but necessary annual gynecological exam expecting the same old, same old - a few pats here and few strokes to the breasts, an unexciting pelvic exam, that strange feeling when the cold metal speculum is inserted and your doc q-tips your cervix for the Pap smear, et voila, c'est fini, n'est pas?. But wait...a week or so later, your Gyno calls with some unnerving news - your Pap smear came back positive for abnormal cell growth. For many women this means one thing, you have been exposed to HPV. What is a sexually active girl to do?

Well, first off, don't freak out - You are not alone. About 20 million people -- men and women -- are thought to have an active HPV infection at any given time.

Most people have never heard of it - 70% of you - and even more have never discussed it with your doctor - 89% - but HPV or the Human Papilloma Virus is the most common sexual transmitted disease in the U.S., with some 5.5 million new cases a year. Some studies estimate that the majority of the sexually active population is exposed to at least one or more types of HPV over their sexual lifetimes - but most do not develop symptoms. HPV is spread via skin to skin contact, not through the exchange of bodily fluids. Because HPV is so common and prevalent, a person does not need have to have a lot of sexual partners to come into contact with it. Let's back up a bit and give you some key facts on STDs in general and how they disproportionately affect women:

Fascinatingly frightening, right? The only good part about all of this is that STDs are preventable, and most are treatable. With the exception of HIV, accurate information, regular screening, and correct treatment will enable the majority of you to live with a STD, if you get one. But in order to either prevent or live with a STD, you really need all the facts. For some reason, the whole HPV story is still undercover - so CAKE is stepping up to the challenge to keep you informed about your sexual health.

Now, back to our story. If you have an abnormal pap smear, chances are you have been exposed to HPV, and you fear the worst: developing warts that...take over your body...and never go away, and you'll never be able to have SEX AGAIN and on top of it all, you'll probably get cervical cancer!!!! Don't get ahead of yourself...it's not going to go down like that. Take the reality step by step.

A little background on HPV:

There are 100 types of HPV of which only 30 can infect the genital area. Some HPV types can cause genital warts, but most HPV infections are temporary and have no noticeable symptoms. HPV is the cause of almost all of cervical cancer in women. While there is currently no cure for HPV, some symptoms can be treated. And since early detection is critical to minimizing negative health consequences, it is advised that women get routine Pap smears to identify abnormal changes in cervical cells.

What's the relation between HPV, cervical cancer and warts?

HPV is a very common virus, and most women with HPV do not develop cervical cancer. Only certain types of HPV are linked with cervical cancer. These are usually called "high-risk" types. The types of HPV that cause raised external genital warts are not linked with cancer. These are called "low-risk" types. These wart-types of HPV usually are not usually found on a female's cervix, and therefore, are not going to carry any risk of cancer.

It is common for a person to be exposed and have more than one type of HPV, including several "high-risk" types. Yet, most women do not develop cervical cancer. Cervical cancer usually takes years to develop. The majority of cases of cervical cancer are in women who have either never had a Pap smear, or have not had one in five years or more. Cervical cancer can be prevented if a woman gets a Pap smear at regular intervals. This way, if abnormal cell changes are found, it can be monitored and treated before progressing to cervical cancer. This is why getting screened on a regular basis is important; screening can catch any potential problems before they progress.

Most of the time, men will not have any symptoms or health risks, such as cancer, with the "high-risk" types of HPV. It is the female's cervix that needs to be monitored. If you have this type of HPV you do not have to be concerned about your male partners because men are not at risk for developing harmful symptoms. However, if you show signs of external warts you should disclose this to your partner as they can be spread during sexual activity. Remember these warts are treatable and removable by a physician by minor surgery or freezing methods. However, the virus can remain dominant for some time and can be passed along to your partner without you knowing or without any external symptoms.

You may also discover that you have HPV on your own as well, since warts are one of the symptoms of the virus. If so, you should head straight to your doctor, so he/she can see if there are any non-visible abnormalities and take care of the warts.

Can a man find out if he has HPV?

Research has shown that the HPV test usually shows false negative results in men. This is because it is difficult to get a good cell sample to test from the thick skin on the penis. Most people will not have visible symptoms if they are exposed to HPV. Therefore, for most, the virus is subclinical (invisible). This is especially true for men. If a man is exposed to the cell-changing types of HPV, he would be unlikely to have symptoms. If there are no symptoms for males, it is hard to test for it.

What is cervical dysplasia?

When a female goes to a clinic or her health care provider for a Pap smear, they are screening the cells on her cervix to make sure that there are no abnormal or precancerous changes. If the Pap test results show these cell changes, this is usually called cervical dysplasia. Other common terms the health care provider may use include: abnormal cell changes, precancerous cells changes, CIN (cervical intraepithelial neoplasia,) SIL (squamous intraepithelial lesions,) or "warts" on the cervix. All of these terms mean similar things - it simply means that abnormalities were found. Most of the time, these cell changes are due to HPV.

Just because a woman has cervical dysplasia, it does not mean she will get cervical cancer. It means that her health care provider will want to closely monitor her cervix every so often - and possibly do treatment - to prevent further cell changes that could become cancerous over time if left unchecked.

Cervical cancer screening: when and how?

According to the 2001 guideline by the American Cancer Society, a woman should get her first screening by age 21, or within three years of becoming sexually active - which ever happens first - and screened once a year after that.

Get screened! As most women do not know whether they have HPV, it is important for every one of us to have regular pap smears to determine whether or not there is abnormal cell growth on the cervix caused by exposure to HPV.

How are abnormal cells treated?