This is the first in a three-part series.
Name: Human papilloma virus, HPV
Science Facts:
Prevalence: Verbatim, from the CDC: “Human papillomavirus (pap-ah-LO-mah-VYE-rus) (HPV) is the most common sexually transmitted virus in the United States. Almost every sexually active person will acquire HPV at some point in their lives.”
Symptoms: usually none.
What’s The Worst Case Scenario?: Cervical cancer.
Yes, I said cancer. Hang on a second and let’s talk about cancer!
HPV is a virus that can invade your cervix epithelium. Your cervix is a special type of place, speaking science-wise, because the tissue there changes from the type of tissue that’s in your vagina (squamous epithelium) to the type that’s in your uterus (columnar). Any area in the body where two different types of cells come together is more vulnerable, because they’re already not really sure what’s going on. “What type of cell am I supposed to be? Is this uterus or vagina?” is the normal state of cells in your cervix. Now imagine that same identity-crisis cell infected with a virus.
The reason we do pap smears every three years, and used to do them annually, is that the cervix goes through a predictable series of changes before you have all-out cancer. You can get ASCUS, which is atypical squamous cells of undetermined significance, which means these are cervical cells that are extra-confused, probably because they have HPV in them. ASCUS can progress to LSIL, which stands for low-grade squamous intraepithelial lesion, which means these cells are really confused and starting to act funky about it. LSIL can progress to HSIL, high-grade squamous intraepithelial lesion, which is where we start to get worried. Only after HSIL progresses outside of its local site do we call it carcinoma-in-situ, a type of cancer. We can treat all of these at every stage if your gynecologist catches it!
Hey, something less scary than cancer but still scary: genital warts. Many strains of HPV cause genital warts. In fact, if you’re a cis dude, since you don’t have a cervix, that’s probably the only reason you care about HPV. Also, HPV causes regular, non-genital warts. We freeze ‘em or burn ‘em off and that’s usually that. Cool.
What’s the Treatment For Cervical HPV?
Dear Every Single Cervix-Owning Person Reading This: Get Your Pap Smear. Do not skip annual gynecologist visits. Even though we don’t do pap smears every year, the best way to keep yourself safe is to be honest with your doctor about your sexual behaviors. We’re not here to judge—I promise doctors have heard a lot weirder stories. We’re just here to let you know about any risks you have and do what we need to make sure you’re healthy.
Management of cervical changes with HPV can be complicated, which is why I have a special app on my phone that tells me what to do with your pap results, and why the American Society for Colposcopy and Cervical Pathology has a complicated set of guidelines. In short, we can watch & see if you clear it (many people do! See “Nicole, Please Reassure Me”, below) with a repeat pap in a year, we can look at the cervix with a special camera (colposcopy), and we can take out part of the cervix that has the weird changes, with either a little loop of heated wire (LEEP), cryotherapy (old-school, still works), or conization (removing a little cone of the infected cervix, a more extensive procedure).
“But Nicole, I Got Gardasil! I Got Vaccinated Against HPV!” AND I AM PROUD OF YOU AND YOU DID THE RIGHT THING. However, much like there are many different types of milk in the world (chocolate, soy, almond, etc), there are many types of HPV, called different viral strains, each with slightly different DNA makeup. Unfortunately, the Gardasil you got (if you got it more than one year ago) only covered four strains of HPV (strains 16, 18, 6, and 11, if you wanna know). Strains 16 and 18 cause the majority of cervical cancer (70% and 20%, respectively, for the two strains), while the other two strains (6 and 11) cause warts. We now have vaccines that cover nine strains of HPV, and vaccines that cover even more are in the works. But there are a lot of strains of HPV out there, and our vaccines don’t work against all of them. You can still get infected by HPV even if you’ve gotten the vaccine. However, if you contract HPV and you haven’t received the vaccine, you can still get vaccinated for exactly the same reason! In fact, studies have shown that infection with multiple subtypes of HPV simultaneously puts you at much higher risk for developing cervical dysplasia, the precursor to cervical cancer.
Use condoms! Here is some good and bad news: condoms are only 70% effective at preventing HPV transmission, because it’s shared via skin-to-skin contact. That means anything that isn’t covered by the condom isn’t protected.
Nicole, Please Reassure Me, I Feel Horrible: okay okay okay okay! I know I said the big C-word and I’m so sorry. I know I used a lot of caps and bold up there, and it was very upsetting, and I am so sorry. I feel very strongly about HPV because WE CAN DO THINGS ABOUT IT! The first thing I will tell you is that HPV is INCREDIBLY common. In case you want me to say it again, ALL sexually active people will come into contact with HPV. That’s according to the Center for Disease Control, I am not making this up. Basically, you have HPV. Also, have you ever had warts anywhere on your skin ever? That’s also HPV. This isn’t really even a bug where you can call your recent partners & be like “YO, HPV, GET ON THAT” because HPV can take a while to show up; it can take years from infection to progression of symptoms, so partner-blaming “you gave me this STD” is not so clear-cut with HPV. You should definitely still tell your partners, though, I am not giving you a free pass here.
That being said, here is the most reassuring fact I can tell you: Studies have shown that more than 90% of new HPV infections, including those with high-risk types, clear or become undetectable within two years, and clearance usually occurs in the first 6 months after infection.
This is why our first-line management is just watchful waiting, even if you have cervical changes that could be due to HPV. 90% of the time, the immune system clears HPV on its own. This is true even for genital warts—most warts will spontaneously regress in six months as your immune system clears the virus. Why would it be harder to clear HPV? Since it’s the most common sexually transmitted virus, it’s very easy to become coinfected with multiple strains of HPV (why you should get vaccinated even if you’ve received a diagnosis of HPV). It’s so common that we don’t even test for most types of HPV, because then everyone would be positive—our HPV testing only detects high-risk subtypes that cause cervical cancer. In short: everyone has it, 90+% of people get rid of it on their own, and even if you don’t we have very good treatments for it.
If you want to buy a stuffed HPV toy, you can do so here.
Me reading the title: Man, I’ve got to schedule an appointment for a pap smear sometime soon
Me after reading the whole thing: I wonder if there’s an opening this afternoon
Saaaame. I unfortunately have to postpone the annual appointment because I just discovered that my ob-gyn of the last ten years doesn’t take my current state-provided insurance, so now I have to find a new one. I’m vaccinated and yet my selection priorities just rapidly shifted from “best reviews” to “first available.”
Your local Planned Parenthood can probably get you in p quick! And we are ace at Paps.
I’m unemployed but this article has made me unreasonably paranoid about the HPV-cancer thing, is a pap smear free/cheap at PP?
Do you live in the US? Have you looked into your Obamacare options? My mister is an unemployed student and the state pays his insurance – and for something routine like a pap, it’ll definitely work.
PP usually has a sliding scale based on your income. They may also be able to offer some kind of financial assistance.
(I’d second the recommendation to see if you’re eligible for insurance coverage under the ACA– you might qualify for Medicaid or subsidies).
Yay for this! I had an abnormal pap over 4 years ago now from HPV. I had a colposcopy and the abnormal cells were removed and everything was a-okay after that and my gynecologist even told me afterwards that I have a beautiful cervix, which is 100% the greatest compliment I have ever received.
Ha! I once had my doctor tell an observing med student that I had a “textbook cervix,” and I too am unreasonably proud of it.
Good for you! I was told that mine is “freestylin,'” because my ob/gyn is the most upbeat vagina-centric Miss Frizzle-type there ever was.
Now I’m picturing a cervix freestyle rapping while the uterus beatboxes behind it…
I was once told by a gyn that I had a “dainty cervix.” I’ve never gotten a weirder compliment.
I had a positive HPV test that then cleared the next time around! It happens.
Do we know why the upper limit on the vaccine is what it is? I was like 1 year too old when it was released and I am still mad about it.
Public Health population averages.
Basically, they figured that by twenty-whatever, so many people will have already come into contact with so many strains of HPV that the potential benefit of those people getting the vaccine is lower than the cost of giving it to all of them.
But you’re not an average, you’re a person. So, if you know that you had non-condom protected sex with 397 people by age 22, then getting the vaccine at 23 is probably not gonna do much for you, despite being young. If you’re a virgin for all sorts of sex at age 30 (but then decide you’re going to have LOTS of it, with lots of partners!!!) then the vaccine would probably be helpful.
If you’re over the age, you can find doctors who will give it to you, although you may need to INSIST, and you may need to pay out of pocket.
Yeah, I’m 33 now, so I think they would prob try to talk me out of it (though the “I have multiple partners and my partners have multiple partners” thing might convince them…)
I was over the age limit when I got vaccinated, and I did pay out of pocket. Well, I paid for part of it. My partner, who had just told me that he wanted to have other partners, paid for 2/3 of it. He agreed with me that if I was going to be taking on extra STI risk without actually having more partners myself– I’m monogamous– his chipping in toward the cost of my vaccination series was only fair.
When I explained why I wanted it, no one tried to talk me out of it. Gynecologist and nurse practitioners were all very supportive and, to a one, said that while they understood why the CDC had the age limit it does, they don’t *like* age limits on anything that helps protect people’s sexual health.
They decided on the upper limit of 26 because most women will have already been exposed to HPV by that age. It’s definitely not true of everyone (especially because lots of women wait to have sex until “later”), but that was the overall decision made, particularly for health insurance coverage decisions. If, however, you want the vaccine and are over 26 you can still get it! It just usually means you need to pay for it yourself.
I was also wondering if there’s any significant benefit to getting the vaccine at an older age (e.g., 30s), if you’ve been sexually active for a long while.
However, if you contract HPV and you haven’t received the vaccine, you can still get vaccinated for exactly the same reason! In fact, studies have shown that infection with multiple subtypes of HPV simultaneously puts you at much higher risk for developing cervical dysplasia, the precursor to cervical cancer.
Since it’s the most common sexually transmitted virus, it’s very easy to become coinfected with multiple strains of HPV (why you should get vaccinated even if you’ve received a diagnosis of HPV).
This really interested me. I’ve been wondering hard about why I am “too old” to warrant the vaccine. Now, yeah, I’m definitely getting it. (If I can pay for it.) I’m 32, have had 3 sexual partners, plan on AT LEAST a few more before I die (NOT of cervical cancer, knock on fucking wood).
::high five::
This is great. Don’t forget that cis dudes can also care about HPV because of the risks of anal and throat cancers! (They should also care because they should care about women they sleep with, but that’s a discussion for another day.)
Yeah, I would HOPE they’d care about potentially giving their partners cervical cancer…
I’m a lot more likely to follow the recommended pap smear schedule, now that the government no longer recommends routine pelvic exams. Huzzah!!
Nicole, THANK YOU so much for writing this! I was recently diagnosed with HPV, and went in for a colposcopy this morning. My doctor said I looked nervous, and I guess I was, because reading what you’ve written here makes me feel incredibly reassured and also a little verklempt.
There have been many times when I have felt like Toast content has been written specifically for me, but I’ve never felt it more than today. Thank you so much.
This is a great and helpful article!
As a child who suffered with warts on her hands and feet (UGH SO GROSS) and who still occasionally gets the annoying little flat ones on my hands (*sigh*), let me share with y’all that when I first heard about HPV at my campus healthcare center (sex ed failure–it’s not just a recent thing!), I was actually a little relieved because now at least I could rationalize that I had a reason for getting these things instead of just feeling cursed by god.
I had a my very first abnormal possibly pre-cancer pap smear last year. I was never vaccinated because I am hella old, and the abnormal pap came after a decade of monogamy. I was shocked and frankly scared. Now it’s time for me to book the year-later followup pap, and I’m still scared. I know the odds are that it’s already cleared, but I’m scared it hasn’t. I know there are treatments, but the treatments scare me. This is the kick in the pants I need to just go ahead and book the appointment, because no matter what the results are, it’s better to know. Thank you.
Good for you for taking care of yourself! The treatments don’t sound so fun, but I’m sure if (IF) you need any you will come through them fine.
Same thing recently happened to me. Sadly, the nurse basically told me that my husband had to have been cheating on me for this to happen. And that definitely could be the case, and should perhaps be part of the conversation, but I was relieved to find out that HPV does not mean infidelity full stop.
Anyway, the more information that’s out tree, the better! Thanks, Toast!
What the hell?? That is incredibly irresponsible of the nurse, IMHO, because I know the first time I ever had a wart on my body (HPV) it was on my hand, and I think I had only kissed like one person in my life at that point, let alone sex. The thing to remember is that HPV isn’t transmitted only sexually, and no one strain is an exclusive STI. They don’t discriminate.
THANK YOU, FORMER ROOMIE, FOR REMINDING ME TO GET A PAP SMEAR SCHEDULED.
SO SO important to get regular screens!!! I’ve had two LEEP procedures & I shudder to think if I hadn’t been keeping on top of it. I schedule my annual exam on my birthday every year so I don’t forget how long an interval it’s been.
I’m sure you don’t judge, but there are a lot of judgey doctors out there.
O HAI. Cozy internet friends, let me tell you about my HPV and how you should definitely get screened right effing now.
See, I hate pap smears. HAAAAATE them. So I hadn’t had one in…some time. A period of time, let’s just say. And the only reason I’ve had one at all recently is because I got a big ole nasty ruptured ovarian cyst a couple years ago, which required emergency surgery. And then I had to get a gyno (who I LOVE because she is the Fastest Hands in the West) and then she was like “hmmm, this looks odd” and I had a culposcopy and then she was like “hmmmm, that’s not good” and then I had a surgery where they scooped some of my cervix out with an electric wire and then they biopsied it…
and then they were like, “well, the good news is you HAD cancer?” because they managed to get it all the first time. But I never would have known if I hadn’t had an unrelated medical emergency (thank you Godzilla the exploding ovary, you are truly my hero) and that idea sometimes keeps me up at night. Please get tested! Please be safe! Y’all are precious toasties and the world needs you around and healthy. Hurray for Pap Smears! (although I still hate them…and now I need to get them every 6 months until FOREVER)
Actually, it is annoying as fuck that my gynecologist’s office holds my BC scrip hostage if I don’t get a yearly pelvic exam, despite even that being unnecessary. I’m monogamous and in a long-term relationship with someone who also had not been sexually active before we met. I have no personal or familial history of reproductive tract abnormalities. I don’t need a yearly pelvic, and I definitely don’t need a yearly pap (which, to be fair, they do follow current guidelines on, so I don’t have one every year).
I’d recommend going to another provider– that’s not the standard of medical practice anymore (per the US Preventive Services Task Force, the American Congress of Obstetricians and Gynecologists, the American Cancer Society, et al). You should be able to space them out every three years or so if you’re low risk.
If you have a Planned Parenthood near you, I’d highly recommend going there. The ones that I’ve gone to will give you a year’s worth of pills at a time without a lot of rigamarole.
Ok, but I have heard conflicting info from MEDICAL EXPERTS on this question, so I pose it to Nicole/everyone here for some clarification: can you “cure” HPV or like, no longer have it? I’ve been told yes. But, really?
My (non-medical-professional) understanding, from the article and other sources, is that the vast majority of HPV infections are not inherently dangerous and your body will clear most of them by itself. So, yes, it’s pretty common to be infected with HPV and then no longer have it months later.
Only a few strains of HPV actually cause serious problems like cervical cancer. If you do have one of those strains, and a pap smear shows that you have (e.g.) abnormal pre-cancerous cells, you can’t be “cured” as such. But you can get medical treatment to remove those particular cells, and that treatment will drastically reduce your risk of developing cancer.
So basically “treatment” is not the same as a “cure”, but you’ll hopefully live a long and healthy life afterwards.
Ah, HPV, my old friend.
I got to be on what felt like the cutting edge (ew) of HPV back in 2005, when I had an abnormal pap and got a letter in the mail from my gyno that I had “pre-cancerous cells” in my cervix. I nearly passed out with worry. This was before every doctor and her sister was shouting from the rooftops about the vaccine and certainly the first time I had heard about the virus. I had only had a few sexual partners at the time, the most recent being women, so I had sort of (foolishly? whatever) tuned out of the STI stream-of-information.
Anyway, I went in and she did the hot wire loop thing which made me feel totally ill just thinking about it (I have a *very* weak constitution when it comes to medical stuff, sadly for my childhood dream of being an obgyn), but from then on it’s been clear sailing. The appointment took no more time than a normal appointment would, and I ended up getting the vaccine as well (see above about multiple strains) and haven’t thought anymore about it until recently when I had a small and obnoxious little wart show up. Got that sucker taken off too and now I’m back to good.
The hardest part about HPV? Convincing my male partners that it matters.
I'm not an expert by any means, but I don't think age has much effect on your immune system until you're elderly. (Unless you have a medical condition that compromises your immune system at a younger age, e.g., HIV/AIDS).
I know that pediatricians hold off on giving some vaccines to newborns because they're too young to mount an effective immune response, but, once you're past that point, I don't know that your age really makes any difference. There are certain vaccines (e.g., for whooping cough) where older kids and adults need to get booster shots, but that has more to do with the way the vaccine is formulated and how effective it is.
I think I might bite the bullet, and see if I can pay out of pocket for the Gardasil injection. I think my doctor would probably be willing to do it. (I feel you on the sore arm thing! Not looking forward to get my flu shot this month for that reason).
thanks so much for this! the first time I had an abnormal pap come back, the (older male) gyno did nothing to reassure me and gruffly said I needed to get tested for cancer. I was 21 and scared shitless. Then I got referred to a lady gyno who quickly reassured me that HPV is extremely common and I would probably be fine, and I was.
thanks so much for this! the first time I had an abnormal pap come back, the (older male) gyno did nothing to reassure me and gruffly said I needed to get tested for cancer. I was 21 and scared shitless. Then I got referred to a lady gyno who quickly reassured me that HPV is extremely common and I would probably be fine, and I was.
I HATE the tone of this piece. It’s too scoldy and scare-mongery. Plus, why not talk about HPV testing instead of pap testing?!? Why not mention self-swabbing for HPV (ok, I know this is not widely available yet, but it’s coming)? Why are we so scoldy and pushy only with women–why don’t men bear any of the responsibility for this, since after all, that’s where most women are getting it? AAARGH.
Awesome, thanks for the info — and 100% do get the Gardasil! I think everyone should get it.
I am a bit odd like that but I try and drop it into conversation with my cervix-ed friends, hoping they'll get it. I was on the old end to get it when it came out originally, so I am pretty unusual among my friends to have had it done.
(but just so you're fore-warned, I found it quite a lot worse than the flu shot — the second shot was *painful*. And also please do keep getting the pap smears — one of my few friends to be vaccinated still got precancerous cells last year and had to have a bit of her cervix burnt off. Life is random and unfair. On the positive side, I just got my latest pap results today and the cells are normal fine no worries.)
I have had a couple of conversations where the topic strayed to that of Michael Douglas attributing his throat cancer to oral sex — and in both cases the men thought it was a joke. When you say 'actually HPV can cause throat cancers' they suddenly get a worried look.
I just wish Douglas's publicist hadn't made him climb down from that statement — I don't know if one can tell what causes throat cancer, but it seems that a lot of people have no idea it can be caused by viruses we consider STDs.
Back in my slut days, my doc would 100% shame me for my behaviour. I have fired her and found new primary care. But it was suuuuper hard to find a new GP. And my mom and several of my besties are docs in town and STILL I had trouble. We need better GP coverage in Canada!