HPV 101

What Your Doctor May Not Tell You About HPV and Abnormal PAP Smears
By Joel Palefsky, M.D., Jody Handle

CHAPTER ONE

The Facts

An estimated 75 percent of sexually active adults have or will have transmitted human papillomavirus (HPV) at some point in their lifetimes.

Over 75 percent of women have never even heard of HPV. It's important to understand that HPV should not be confused with HIV, which stands for “human immunodeficiency virus.” These two viruses are very different and affect women differently. That said, HPV and HIV can both infect women, and the interaction between these two viruses is discussed later in the book.

If it were up to me, the moment a woman came in for an annual gynecologic exam, she'd be told about HPV: the risk factors, the frequency, the consequences. Knowledge is power, says “Schoolhouse Rock,” and I believe that knowledge leads to wiser, more informed choices. That's why I'm starting off this book with a crash course.

Why should you care about HPV? Because HPV is the most common sexually transmitted virus. HPV can be frightening, since not only do most women acquire it at some point, but it contributes to the development of precancerous cervical disease (also known as cervical dysplasia, or cervical intraepithelial neoplasia) and cervical cancer. HPV, along with other factors, is the cause of dysplasia. But wait-there's more! HPV is versatile and also causes warts!

Your doctor may talk to you about Pap smears, warts, and dysplasia. So why don't doctors tell their patients about HPV? Probably a bunch of reasons. Perhaps they're embarrassed to talk about sexually transmitted diseases (STDs), like many people are from time to time. A few doctors don't know much about HPV themselves. Maybe they don't even know the risks involved with HPV. Others don't bother saying anything about HPV because there's no treatment for the virus itself, only treatment for the diseases the virus causes (such as warts, precancerous lesions of the cervix, and cervical cancer). They're all reasons why yon may have to bring up the subject with your doctor if he or she doesn't. (You'll notice that I use the word doctor in this book. However, a wide range of health professionals actually provide many of the services referred to in the book, including nurses, nurse practitioners, and physician's assistants. So if one of these other health professionals is involved in your care, you can substitute them for doctor as appropriate.)

From your perspective, discussing STDs could be difficult as well. Many health professionals have difficulty leaving their own personal prejudices and judgments at the door, so you may feel as though Dr. Smith is condemning you when she says the risk of HPV increases with the number of sexual partners. Indeed, though she's telling the truth-your sexual behavior does affect the chances of getting any STD-her tone may suggest condemnation, disappointment, arrogance, or condescension.

The real issue, after all, is not your past behavior. You can't change that and Dr. Smith can't change that. What you can control is your health and practices in the present and future, and even there, I've heard horror stories from patients.

“I had a friend with HPV, so when my doctor told me I had it, I knew how to handle it and what it meant,” said Karen, twenty-seven. “Then he told me that everyone on the street probably had it, so I didn't have to tell my partner!”

Why would you tell your patient that her partner doesn't need to know she has a sexually transmitted virus? Especially when he might have been the one who gave it to her?

Your past choices, whether or not you regret them now, are unchangeable. If you didn't know your partner had HPV-indeed, maybe he didn't know-then that's unfortunate … and also in the past. Now, you have the power to monitor your health, keep the HPV under control, make more educated choices about your sexual practices, and inform your partners so they can make more educated choices. With the knowledge in this book, you're armed with information that can save your life and other people's lives. You have the power.

Now that you know why I think you need to know this information, let's get started.

Copyright © 2002 by Dr. Joel Palefsky

About the Author

Dr. Palefsky is a professor at the University of California San Francisco and a leading HPV expert. Dr. Joel Palefsky and Jody Handley both live in San Francisco, CA.