HPV Facts

I am in the midst of preparing a lecture on Cervical Dysplasia, Cervical Cancer & HPV for my Women’s & Men’s Health students at the Canadian College of Naturopathic Medicine. So, I am happily armed with new research to answer your questions.

This is a fact sheet I made up ages ago that never made it onto my website. It was meant to accompany the article on Cervical Dysplasia and HPV. Sometimes having facts like these handy can go a long way to ease anxiety about confusing medical diagnoses like “abnormal pap”.

HPV Facts

  • HPV refers to the Human Papilloma Virus, which is actually a group of over one hundred different viruses. Thirty to forty of these target the anogenital tissues (others cause plantar warts, for instance).
  • HPV is associated with cervical cancer – around 90% of the time.
  • 15 types of HPV are considered “high risk” in terms of their association with cervical cancer.
  • 4 types of HPV cause genital warts. These types are actually classified as “low risk” because they are not associated with cervical cancer.
  • HPV is sexually transmitted – via any skin to skin contact (eg finger-genital, genital-genital, genital-anus). Because it lives on skin, condoms do not prevent transmission (incidentally, neither does the spermicide nonoxynol-9). Also because it lives on skin, transmission occurs between women. Even women who have only ever had female sexual partners test positive for HPV. Oh, and for those of you who worry about these things, the virus CANNOT be transmitted by inanimate objects like toilet seats. Rest assured.
  • HPV infection is usually transient, meaning our bodies can clear the infection. And we might never know we have it. According to one medical reference, “ the overwhelming majority of [HPV] infections are cleared by the host immune system and never present as warts or neoplasia”.
  • HPV is common: Up to 80% of young women (usually defined in the studies as under 30, but sometimes younger) have HPV at any given time. According to the most common estimates, 75-80% of individuals of reproductive age have had an HPV infection. While HPV is most often found in abnormally growing cells, it is also found in healthy normal cells, indicating that the virus is not the entire cause of abnormal cell growth. So, HPV doesn’t always cause cancer, and not all cancer is associated with HPV. This is critical to understanding the complex etiology of dysplasia.
  • Gardasil, the new HPV vaccine, targets only four HPV types: 6, 11, 16, & 18. The former two types are associated with warts, and the latter are the two most commonly associated with cancer out of the 15 high-risk types. So, to clarify, the vaccine, which is based on the over-simplified notion that HPV causes cancer, does not even protect against all the high-risk strains of HPV, and of course does not address the myriad of other factors that contribute to whether or not someone has persistent dysplasia. Clearly, then, this is not a prevent cancer vaccine, exactly.
  • Gardasil, then, is a vaccine against four out of one hundred types of HPV.

Cervical Dysplasia & HPV

cervix_anatomy (ADAM)Abnormal Paps, Cervical Dysplasia and HPV

A Pap test – the primary reason women are encouraged to have gynecological exams – is an evaluation of the health of your cervical cells, and a screening test for cervical cancer and precancerous changes. What does this mean? The cervix is the lower portion, or opening, of the uterus, through which blood, sperm and babies pass. You can feel it with your finger at the end of the vaginal canal: while the vaginal walls are muscular and soft, the cervix feels like the tip of the nose, with the opening palpable as a little indent. For those of you who like pictures, see www.beautifulcervix.com for a great selection of photos.

Cervical dysplasia refers to abnormal cervical cells. There are a few levels of abnormal cells that might be detected via a Pap, and then beyond that the cells become abnormal enough to be classified as cancer. Screening for cervical dysplasia has dramatically decreased the incidence of cervical cancer, as the area of abnormal cell growth can be treated long before it becomes malignant. Yet it is important to note that in practice, cervical dysplasia is fairly common, especially in women under 30. Cervical dysplasia is actually a great illustration of the capacity of the body to heal itself, with rates of regression to healthy cell form (without any treatment) as high as 75% in adults, and 91% in adolescents. Consider an abnormal Pap as an opportunity to pay attention and – with the support of your naturopathic doctor – make some healthy changes.

Causes

Cervical dysplasia is strongly associated with HPV (Human Papilloma Virus) infection (see info box). Factors that contribute to cervical dysplasia beyond HPV include smoking, lowered immune function, oral contraceptive use, poor nutrition, specific nutrient deficiencies (particularly folic acid and vitamin A), inflammation, altered vaginal flora (yeast and/or bacteria) and possibly stress. By addressing each of these risk factors from the root, naturopathic care is well-situated play a central role in both prevention and treatment of cervical dysplasia.

Diagnosis & Treatment

If cervical dysplasia as determined by a Pap test persists, you will be referred to a Colposcopy clinic, where a gynecologist will look at your cervix with a magnifying lens, and use vinegar to make areas of abnormal cell growth stand out. If they see anything that they deem suspicious, they will perform a biopsy to get more information. The biopsy provides a definitive answer to whether or not there is abnormal cell growth. (Paps are considered a screening test rather than a diagnostic test, and are not as reliable). If there is high grade dysplasia according to the biopsy, the doctor will likely recommend removing the area of abnormal cells with a loop electrosurgical excision procedure (LEEP) or another surgical means. If the dysplasia is low-grade, the recommendation will more likely be to redo the test in 3-6 months.

Given that dysplasia progresses slowly if it does progress, it is possible to initiate naturopathic treatment and then reassess (via colposcopy, Pap & potentially biopsy) in 3-6 months, rather than beginning surgical intervention right away. Treatment may focus on enhancing immunity, directly targeting precancerous cells, or addressing nutrient deficiencies. As always, treatment plans are tailored to supporting your individual needs. Your plan may include oral and/or topical herbs, specific supplements, vitamins, and dietary recommendations.

For more information on cervical dysplasia diagnosis, treatment, and prevention, please contact Dr Mahalia Freed, ND.

For more about HPV, see HPV Facts.