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Questions from April 2009

Mary-Anne Asks:

I am 27 and my HPV test (following an abnormal Pap) detected low risk HPV type71. What should be the best treatment for this type and what should I do from now on? Will the HPV vaccination help me(since I am only 1 year older from the deadline of 26)? How can I prevent my partner from be infected?

The vaccine protects against HPV strains other than the one you have (types 16 and 18 which cause the majority of cervical cancer and types 6 and 11 which cause genital warts).  The vaccine protects against these types prior to exposure to them.  The use of HPV genotypes in the US has only recently been approved, and only for HPV 16 and 18.  So there are no clinical guidelines for  management of other types, such as HPV 71.  Also, currently, the vaccine is only recommended in women up to age 26. To prevent your partner from infection your best bet is to use condoms.  HPV can be spread through skin to skin contact and the condom may not cover all areas that could lead to transmission. But it does offer some protection against HPV.

Tanya Asks:

IS THERE ANY VACCINATION FOR THOSE WHO HAVE BEEN INFECTED BY HPV?

You ask whether the HPV vaccine can be given to someone who has already been diagnosed with HPV. The answer is yes, maybe.  The only vaccine currently available is Gardasil. It protects against 4 different strains of HPV; two that cause cervical cancer and two that cause genital warts. So if someone has had one of the HPV strains, but not the others, the vaccine may still offer protection against the ones that that person hasn't already had. The vaccine does not cure existing HPV infections, it is not designed or meant to be a ‘therapeutic’ vaccine.  Such vaccines are currently in clinical trials.  It is also important to remember that there are age restrictions currently for the vaccine. It has been approved for women ages 9-26. So if you are older than that your insurance generally will not pay for the vaccine. There is a three dose series costing approximately $360 for the drug plus an administration fee for each dose. Most insurance plans are currently covering it.  Your best bet is to discuss your situation with your healthcare provider before you decide to get the vaccine. 

Dionne Asks:

What can be done to boost the immune system to fight off the virus &/or cell changes?

The obvious ways to make sure that your immune system is strong are to take care of your health by eating a well-balanced diet, exercising and not smoking.  Those healthful behaviors affect us in so many ways. 

Marte Asks:

I have most of the symptoms of cervical cancer. What do I do?

Your question sounds urgent!  In its early stages, cervical cancer or early cervical pre-cancerous abnormalities usually have no signs or symptoms. That's why it's important to get Pap tests regularly. Symptoms usually do not show up until the cancer becomes invasive and grows into nearby tissue. The most common symptoms at this stage are:

 

  • Unusual discharge from the vagina
  • Blood spots or light bleeding when you're not having your period
  • Bleeding or pain during sex

 

Additional symptoms may occur. These include:

  • Anemia because of abnormal vaginal bleeding.
  • Ongoing pelvic, leg, or back pain.
  • Urinary problems because of blockage of a kidney or ureter.
  • Bleeding from the rectum or bladder.
  • Weight loss.

If these are the symptoms you are experiencing, speak to your healthcare provider right away!  Don't ignore the symptoms. Don't waste any time in contacting your physician. Ignoring the symptoms can give the cancer time to grow into a more advanced stage and lower your chance for the treatment to be effective.

 

However, you should realize that just because you have these symptoms doesn't mean you have cervical cancer. You can have these symptoms for other reasons. Nevertheless, it is important to check with your healthcare provider to find out what's causing them. Finding cervical cancer early means you have a better chance of the treatment being successful.

Bitsy Asks:

I have received all 3 cervical cancer vaccine shots. How soon can I become pregnant?

Good for you for getting all three doses of the cervical cancer vaccine. It is extremely important to finish all three doses to obtain the maximum benefit.  Getting pregnant now after receiving the vaccine should not give you any concerns. The vaccine is considered a class B drug regarding teratogenicity (possibility of affecting a fetus).  This means it is very safe and in the clinical trial data and pregnancy registry since approval of Gardasil, it is clear this is a safe drug and likely does not affect a fetus.  So all of this equates to the conclusion that you do not have to wait to delay getting pregnant after the 3 dose series.

Jackie Asks:

I’m 18 and have already taken 2 cervical cancer vaccine shots and am scheduled to get my last one in December. I just found out I am 7 weeks pregnant. Will the vaccine harm my baby? Will I have problems or something like that? I read that pregnant women should not take the vaccine.  I am worried.

You ask about the effect of the cervical cancer vaccine on pregnancy.  You should not get the third shot while you are pregnant. The vaccine is not recommended for women who are pregnant.  So far in the ongoing registries, there is no evidence that the vaccine harms the baby. You should definitely talk to your doctor about your concerns, but I don't think you need to be overly worried. Good luck with your pregnancy. Make sure you see your doctor regularly while you are pregnant.

Maureen Asks:

Do you know why older women cannot get the HPV vaccine, even if they have taken the HPV test and results show they do not have any of the cancer causing HPV virus types?

Gardasil, the only vaccine currently in the US market, was approved in June 2006 in the US by the Food and Drug Administration for girls and women between the ages of 9 and 26 and has been recommended by many organizations for routine use in 11 and 12 year old girls.  The vaccine is not approved for women over age 26 in the US.  As more data is generated on clinical trials, this may change. 

Beverly Asks:

Is it true that some women diagnosed with HPV can also get the vaccine to prevent them from getting other strains?

Yes, it is true that women who have been exposed to HPV may still get some benefit from the cervical cancer vaccine.  The maximum benefit is achieved when the vaccine is administered prior to any HPV exposure.  The vaccine is approved for women between the ages of 9 and 26.

Tanika Asks:

Can HPV strains that cause cancer be spread thru kissing?

You asked about kissing as a mode of transmission for HPV.  It is not believed that HPV is harbored in the mouth. Thus, the answer to your question is "probably no," HPV cannot be spread through kissing. You may be confusing HPV with the Herpes simplex virus (HSV) that causes cold sores.

Rachel Asks:

I would like to start the 3-series vaccination for my 15 year-old daughter. My insurance does not cover the cost; and my primary physician quoted me $150 per shot - $450 total. This sounds extremely high to me. Are there places that offer this service cheaper? What is a reasonable amount to pay?

Your 15 year-old daughter may be eligible for the vaccine under the federally funded Vaccines for Children Program depending on your family income. Most local health departments utilize this program to pay for children's vaccines. I would suggest that you contact your local health department and ask them if they offer the vaccine on a sliding fee scale.  I applaud you on taking the preventive step of getting your daughter vaccinated.

Monica Asks:

My daughter has been recommended for the vaccine against cervical cancer. Will the injection make her get her periods sooner? Would it in any way cause her menstrual problems?  She hasn't started menses yet?

You asked about the cervical cancer vaccine. The vaccine is recommended for young girls to prevent HPV infection. It works best when given before a girl or woman has had any exposure to the HPV virus, which is transmitted through sexual contact. The vaccine has no effect on menses or her menstrual periods. It should neither hasten nor delay menses. What is does is to establish protection so that any HPV your daughter may be exposed to at some point in her future will not have an opportunity to invade the cells of her cervix and start to cause the cervical changes that can lead to cancer. It has been approved by the US Food and Drug Administration. It is recommended in many countries and by many physician organizations and by the Centers for Disease Control and Prevention (CDC).

Debra Asks:

I am trying to find out how long high risk HPV can stay dormant?  If you had cervical dysplasia 14 years ago (removed it with a LEEP procedure) and have not had signs of HPV or abnormal Pap smears for the next 14 years, could you have the same HPV strain reoccur and cause cervical cancer?

There is no definitive answer to your question as to how long high risk HPV infections can remain dormant. It varies greatly from person to person. High risk HPV infections can remain dormant for many years. Removing the abnormal cells in your cervix with a LEEP or Cone procedure will not eliminate HPV. It is thought, though, that after such a procedure, your body will mount an effectivie immune response to assist in clearing the virus. That is why these procedures are so effective. But this does not happen in all women and it is impossible, at this time, to predict who will have a persistent HPV infection which may lead to a recurrence of abnormal cells. That is why you need to talk about your concerns with your provider and continue to take good care of yourself and get regular checkups and Pap tests, especially if you have had a procedure for abnormal cervical cells.

Angela Asks:

I was just diagnosed with HPV and have been in a relationship for 2 1/2 years. Can I keep having sex with my partner?  Did he give it to me?  Can I give it back to him if he gave it to me?

You ask a question that a lot of people have asked. Chances are that your partner has the same HPV types that you have since you're in a long term relationship. There's a lot we don't know about HPV, but most experts think that the HPV virus doesn't 'ping-pong' back and forth between the same partners. Condoms do offer some protection against HPV transmission, as well as other sexually transmitted infections. But HPV can be spread through genital contact and that contact can occur outside of the area covered by a condom. So condoms don't offer complete portection against HPV, but they might offer you some peace of mind. 

HPV is a very common infection. But because it can be undetected in your body for years, it is hard to say who may have given it to you. Most HPV will be attached by your body's immune system and cleared up on its own, usually within a year or maybe two. But some HPV types hang around for a long time before they start causing trouble.  Thus, it is hard to know how long you've had the HPV and who gave it to you. Don't jump to conclusions.

Your best bet is to talk to your health care provider and ask these same questions. The two of you and perhaps your partner can have a discussion about the best course for you to take.

Johnetta Asks:

I just found out I have HPV and it's really hard for me to understand this. I have only had one partner and feel like maybe he has cheated on me and that is how I got it. I had a Pap a year ago and it was clean and this year it wasn't. I have abnormal cells. So I talked to my partner who swears he didn't cheat. But if he didn't cheat on me, how did I get HPV if it's sexually transmitted?

I can imagine the shock of hearing that you have HPV and I know that many women have the same questions that you do about how they got this virus. HPV is the most common sexually transmitted infection. Nearly 80% of American adults will have it sometime in their lives. It is transmitted through sexual contact. That means genital contact of a close nature, with or without sexual intercourse. HPV viruses can live for many years in your body without any signs or symptoms before starting to effect these changes in your cervix. The  HPV virus can remain "latent" in your body without your knowing it. Thus, it is very hard to know where you contracted the virus.  It is important for you to continue to get your regular checkups, Pap and HPV tests and follow your doctor's advice.

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