February 15, 2019 by John Fernandez and Tanya Racoobian
HPV’s Greater Health Risk
Human papillomavirus, or HPV, has gained much attention over the past decade, as more research points to its strains as causes of certain types of cancer. Now a report by the U.S. Centers for Disease Control and Prevention (CDC) shows that the risk may be more widespread than previously thought.
The report, released last month, found that nearly 1 in 5 U.S. adults under the age of 60 are infected with one of 14 “high-risk” strains of HPV. These strains, according to other studies, are sexually transmitted and have been linked to 31,000 cancer cases each year. Those cases include cervical, vaginal, vulvar, penile and oral cancers.
Jose S. Soza, M.D., a family medicine physician with Baptist Health Primary Care, has seen patients with HPV-related cancer and credits an increased awareness of the ill effects of the virus to early diagnosis of these cancers.
Increased Awareness About HPV
“We’re getting to know more about HPV,” he said. “Patients are more aware of it and more open to discussing it and its early symptoms with their doctors.”
He points to HPV-related infections, such as genital warts, to illustrate that openness. He says more sexually active young adults are more likely now than just a decade ago to seek treatment for this common sexually transmitted disease, or STD.
But, Dr. Soza warns that the typical STD screenings do not include HPV testing. “We check for chlamydia, syphilis, Herpes I and Herpes II, and HIV, but HPV is not routine in these types of blood tests,” he said. For routine HPV testing, he says the U.S. Preventive Services Task Force (USPSTF) guidelines recommends women, ages 30-65, have an HPV test in combination with a Pap test if they want to extend their screening to every five years. This “co-test” determines if high-risk strains of HPV are present in the cervix.
Dr. Soza points out, however, that the American Cancer Society recommends that women between 21 and 29 have a Pap test every three years – at ages 21, 24 and 27 – to test for cervical cancer and pre-cancers. These women, the American Cancer Society guidelines say, should not get the HPV test, in combination with the Pap test, because HPV is so common in this age group that it’s not helpful to test for it unless a Pap test shows abnormal results.
HPV tests can also be used as a tool for detecting anal cancer, but the evidence to suggest regular screening remains insufficient, Dr. Soza says.
Similarly, there are no routine pre-cancer screening guidelines for penile, oral or vulvar cancer. Penile and vulvar HPV infections may show up as lesions on the skin. HPV infections of the mouth, tongue or throat often cause lesions, swelling, hoarseness or general discomfort, and are detected incidentally while trying to determine the cause of those symptoms.
Since 2006, HPV vaccines have been available to girls and women between the ages of 9 and 26. In 2009, the U.S. Food & Drug Administration (FDA) also approved an HPV vaccine for males between the same ages. Dr. Soza recommends his patients follow these vaccination schedules to prevent some of the high-risk strains of HPV that have been shown to develop into certain types of cancer.
The CDC guidelines recommend routine HPV vaccination at age 11 or 12 years for both boys and girls. Before the age of 15, the recommended immunization is two doses, administered 6 to 12 months apart. After age 15, the CDC recommends three doses of the HPV vaccine, with the second dose administered 1 to 2 months after the first dose, and the third dose given 6 months after the first dose.
For people who missed earlier HPV vaccinations, females may receive the vaccine through age 26 and males through age 21 years. Males aged 22 through 26 years may also be vaccinated.
Practice Safe Sex
For adults who did not receive the HPV vaccine prior to their 26th birthday, Dr. Soza encourages the use of barrier protection during sexual activity. As with other STDs, condoms effectively reduce the risks of spreading HPV between partners.
Additionally, Dr. Soza recommends reporting any genital sores, oral discomfort or other unusual symptoms to a doctor, dentist or other healthcare provider, so they can determine if the underlying cause is an HPV infection and take appropriate action.
“HPV and the cancers it can cause are a significant public health concern,” he said. “But awareness and taking proper preventive steps can reduce individuals’ risks now and in the future. We’re hopeful that the steps we’re implementing today will lead to a tangible reduction in the number of cases of HPV-related cancers in the decades ahead.”