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Human Papillomavirus (HPV) is the most common sexually transmitted infection, yet many women don’t understand what it means for their health. At North Delhi Uro & Gynae Clinic, we help women make informed decisions about HPV prevention and screening.
HPV is a group of viruses belonging to the Papillomavirus family: – More than 200 types identified – Named for causing papillomas (warts) – Spreads through sexual contact – Most common STI worldwide – 80% of sexually active people infected at some point – Most infections clear naturally
Key Concept: Not All HPV Causes Cancer
Low-Risk Types (Cause Genital Warts, Not Cancer): – Types 6, 11 – Cause benign genital warts – Not associated with cancer – Treatable, uncomfortable but not dangerous
High-Risk Types (Cancer-Associated): – Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68 – Type 16: Causes 50% of cervical cancers – Type 18: Causes 20% of cervical cancers – Also associated with other cancers
Key Facts: – Nearly 100% of cervical cancers caused by high-risk HPV – Not all women with HPV get cancer – Only persistent infection (>12 months) progresses to cancer – Immune system clears infection in 90% of women – Cancer development takes 10-15+ years – This timeline allows prevention through screening
Immunosuppression: – HIV/AIDS – Organ transplant recipients – Chronic diseases affecting immunity
Smoking: – Reduces immune response – Doubles cancer risk
Long-Term Oral Contraceptive Use: – Modest increased risk – Benefits usually outweigh risks
Multiple Sexual Partners: – Increased HPV exposure
Early Sexual Activity: – Cervix less mature, more vulnerable
Partner with Multiple Partners: – Increased exposure to HPV
HPV and Other Cancers
HPV also associated with: – Anal Cancer: HPV-related in 90% of cases – Oropharyngeal Cancer: HPV-related in 25-50% of cases – Penile Cancer: Less common – Vulvar and Vaginal Cancers: Small percentage
How HPV Spreads: – Sexual contact (most common) – Genital-genital contact – Oral-genital contact – Skin-to-skin contact – Rarely: Mother to baby during birth
Prevention: – Condoms: 70% reduction in transmission – Monogamous relationships: Reduce exposure – HPV vaccination: Best prevention – Abstinence: Eliminates risk
Incubation Period: – Variable: Weeks to months – Can take years to develop symptoms – Testing may show HPV without obvious signs
HPV Testing and Screening
HPV DNA Testing: – Detects presence of HPV virus – Determines if high-risk types present – More sensitive than Pap smear – Now preferred for cervical cancer screening
Testing Methods: – Reflex HPV Testing: Do HPV test if Pap abnormal – Primary HPV Testing: HPV test alone (emerging standard) – HPV + Pap Co-testing: Both tests simultaneously
Ages 21-29: – Pap smear only every 3 years – HPV testing not recommended (high infection rate, low cancer risk) – Natural immunity usually clears infection
Ages 30-65: – Option 1: Pap smear every 3 years – Option 2: HPV test every 5 years – Option 3: Co-testing (HPV + Pap) every 5 years – Most effective: HPV-based screening
Ages >65: – Stop screening if adequate prior testing – Continue if previously abnormal
Special Populations: – HIV-positive women: Different guidelines – Immunosuppressed: More frequent screening – History of abnormal results: More frequent
HPV Positive, Pap Negative: – High-risk HPV detected – Pap smear normal – Options: – Repeat HPV test in 12 months (most common) – Repeat HPV in 6 months – Colposcopy (if preferred)
HPV Positive, Pap Abnormal: – Requires colposcopy – Evaluate for precancer or cancer
HPV Negative: – Excellent prognosis – Screening interval: 5 years – Very low cancer risk
Colposcopy: – Magnified visualization of cervix – Biopsy if lesions identified – Allows diagnosis of cervical intraepithelial neoplasia (CIN)
CIN1 (Mild Dysplasia): – HPV-related changes – 70% regress spontaneously – Management: Repeat testing or surveillance – Treatment: Often not needed
CIN2/3 (Moderate-Severe Dysplasia): – Significant cancer risk (40-60% progress) – Treatment required – Options: – LEEP: Loop Electrosurgical Excision – Cold Knife Conization: Surgical removal – Laser Therapy: Destroys tissue – Cryotherapy: Freezing destroys cells – Success rate: 90-95%
Cancer: – Requires oncology consultation – Treatment: Surgery, radiation, chemotherapy – Depends on stage
Gardasil 9 (Most Common): – Protects against 9 HPV types – Types 6, 11 (warts) + types 16, 18, 31, 33, 45, 52, 58 – Covers 90% of cervical cancers – Most comprehensive protection
Cervarix: – Protects against types 16, 18 – Less common than Gardasil
Effectiveness: – 99% effective if given before exposure – 70-90% effective if previously exposed to some types – Best results with pre-exposure vaccination
Ages 9-14: – 2-dose series (0 and 6 months) – Preferred schedule – Higher antibody response
Ages 15-26: – 3-dose series (0, 1-2 months, 6 months) – Catch-up vaccination – Vaccination recommended through age 26
Ages 27-45 (Emerging Indication): – Can still be vaccinated – May not have been exposed to all types – Individual risk assessment – FDA now allowing up to age 45
Special Populations: – Immunocompromised: 3-dose series regardless of age – Pregnant women: Defer until after pregnancy – Breastfeeding: Can vaccinate
Safety: – Most common side effect: Arm soreness – Fainting: Rare (patient counseled to sit) – Very safe overall – Extensively studied – No causal link to serious adverse events
Side Effects: – Pain at injection site – Mild fever – Temporary soreness – Serious side effects: Very rare
Vaccine Effectiveness Data: – 99% protection against vaccinated types if given before exposure – 70% protection if previously exposed – Durable protection (15+ years documented) – Protection appears lifelong based on studies
Myth 1: “HPV vaccine causes infertility.” Fact: No scientific evidence supports this. Millions vaccinated with normal pregnancies.
Myth 2: “If I’m vaccinated, I don’t need screening.” Fact: Vaccine doesn’t protect against all types. Screening still needed.
Myth 3: “Only promiscuous women get HPV.” Fact: HPV very common. Can be acquired from single partner. Affects respectable women.
Myth 4: “HPV always causes cancer.” Fact: 90% of infections clear naturally. Only persistent infection risks cancer.
Myth 5: “I shouldn’t vaccinate if I’m already exposed.” Fact: Vaccine protects against other types. Still beneficial.
Myth 6: “Once vaccinated, I’m protected for life.” Fact: Long-term studies show protection, but ultimate duration not yet determined.
Communicating with Partners: – Partners who contract HPV often asymptomatic – Doesn’t indicate infidelity or specific exposure time – Can be present for years before detection – Transparency important for relationship health
Partner Notification: – Many gynecologists recommend partner notification – Partners can get vaccinated if appropriate age – Awareness helps monitor health
Sexual Activity with HPV: – Can continue sexual activity – Use condoms to reduce transmission – Treat any genital warts if present – Partner at risk but risk acceptable with condoms
If Low-Risk HPV Causes Warts: – Cryotherapy: Freezing – Laser: Destroys warts – Topical Treatments: Imiquimod, sinecatechins – Surgical Removal: For extensive warts – Podofillin: Chemical treatment
Management: – Warts often recur (HPV remains) – Multiple treatments may be needed – Vaccination prevents future warts in vaccinated partners – Psychological support for anxiety
When to Seek Care
Contact Dr. Anju Bala For: – Abnormal Pap or HPV results – Genital warts – Desire for HPV vaccination – Questions about HPV risk – Abnormal vaginal bleeding – Suspicious lesions
HPV is common and usually harmless. Regular screening and vaccination are your best defenses. Most women with HPV never develop cancer. Understanding HPV empowers you to make informed health decisions.
Stay informed. Stay protected.
Contact North Delhi Uro & Gynae Clinic: – Address: C-5, Model Town 3, New Delhi 110009 – Phone: 9910118030 – Doctor: Dr. Anju Bala (MBBS, MD, DNB) – Obstetrician & Gynaecologist
Knowledge is prevention. Prevention is health.
