What’s Pap-pening? What You Should Know About HPV and Abnormal Pap Tests

My patients have told me that they don’t like when I call them on the phone. It’s not that they don’t like me, but rather they have learned to expect that normal results will come electronically or from my medical assistant. Abnormal results, however, will come directly from me. “I’m calling to tell you that your Pap came back abnormal.” “My what?” “Your Papanicolaou test.” “My Papanico-what?” Let’s break things down from the basics to the details.
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The Pap test looks for pre-cancerous cells on the cervix.

These cells are graded by level from normal, to slightly abnormal, to significantly abnormal, to cancer. You can rest assured that if your doctor calls saying you have an abnormal pap, you don’t have cancer. Otherwise he or she would have said, “You have cancer.” Pap testing can be done from as frequently as every 6 months, to as infrequently as every 2-3 years in some cases. You and your doctor can discuss how often your pap should be done. The Pap is a screening test that randomly collects a sample of cells from the cervix. If abnormal cells are detected, often a more targeted test is indicated to determine if the Pap accurately represents the cells of your cervix. That targeted test is called a colposcopy.

HPV, or Human Papilloma Virus, is the virus that causes precancerous changes on the cervix.

It is also the virus that causes genital warts, though different strains are responsible for warts. HPV is tested as an adjunct to certain Pap results, and is routinely tested over the age of 30. If you test positive for HPV, you will never know when, where and from whom you contracted it. Men aren’t tested for it. Imagine that your Pap is like that T-Rex in Jurassic Park, the first movie. It only saw the people if they moved. Similarly, the Pap will only detect HPV if it is “moving”, or replicating. HPV could have been present for years even with normal testing, but if it was dormant in a small quantity, it may not have been detected.

HPV does not necessarily stay forever.

It is a virus that your body can, in theory, fight off and destroy. Staying healthy and eliminating or minimizing exposure can help your body to have the immune strength to fight this virus. I stated that you cannot know a partner status, but condom use can at least decrease potential exposure. There is an FDA approved vaccine for HPV. It protects against the 9 most common strains of HPV. This is especially important to administer BEFORE exposure, meaning girls and boys should ideally get the vaccine before the onset of sexual activity. Getting the vaccine does not mean you can skip paps (#sorrynotsorry) and you should still see the gyne at least annually.

And NOW men and women can get the HPV vaccine up to age 45

I wrote an entire post about that. Click here for more on the new guidelines.
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Rarely does someone get cervical cancer if they follow the screening guidelines and recommendations from their doctor. Even if you get that call about an abnormal pap, if you do your part and follow up for testing as recommended, you can avoid devastating results and stay safe.
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Now You AND Your Sons and Daughters Can Get the HPV Vaccine up to age 45. Here’s why you should…

On October 5th, 2018, the FDA approved the HPV vaccine for men and women between the ages of 27 and 45.

That is in addition to the already established population and youth and young adults between the ages of 9 and 26 regardless of gender.

But recently I came across THIS post on Instagram:

Before getting your daughter or son vaccinated, read this book [The HPV Vaccine on Trial: Seeking justice for a generation betrayed.] It’s a real page turner. This vaccine can severely disable young people and even result in infertility and death. Side effects are very under reported. I have been speaking out about this since the vaccine was fast tracked. Here’s the proof.

I was especially shocked that this post was written BY A GYNECOLOGIST!

The HPV vaccine should not be feared.

Rather it is many boys’ and girls’ first line of defense against a virus that is literally around practically every corner.trust-tru-katsande-501831-unsplash

HPV, or human papillomavirus, is a sexually transmitted virus that can cause many types of cancer.

Yes, HPV is the cause of 75-95% of all cervical, vulvar and penile cancers. (Source: The CDC.)  Not only is HPV the cause of most cervical cancers and GENITAL WARTS, but most people in their lifetime will also be exposed to HPV during sexual intercourse. Quoting a Pubmed article from the Journal, Sexually Transmitted Diseases from 2014:

We estimated the average lifetime probability of acquiring HPV among those with at least 1 opposite sex partner to be 84.6% (range, 53.6%-95.0%) for women and 91.3% (range, 69.5%-97.7%) for men. Under base case assumptions, more than 80% of women and men acquire HPV by age 45 years.

“More than 80% of woman and men acquire HPV by the age of 45.”

That. Is. A. Lot.

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While that number seems high, many will never know they have the virus. Our immune system in many cases is strong enough to fight off the HPV virus.

Now, to be fair, vaccines work best before a person is exposed to whatever the vaccine is for. Like if you get the flu, the ACTUAL FLU, the flu vaccine afterward will likely do you no good. Likewise, if you have already been exposed to a strain of HPV, the vaccine won’t protect you against THAT strain. The current HPV vaccine, however, has 9, yes 9 strains of HPV in it. That means, if you haven’t yet been exposed to all 9 of those strains, you will still benefit from it.

Side effects can occur with ANY medication.

What The Hair

Many HPV vaccination nay-sayers quote adverse events that have occurred with the vaccine. Regarding the safety of the vaccine, the CDC says:

More than 80 million doses of HPV vaccine have been distributed since the vaccine was introduced in 2006.

The most common side effects associated with HPV vaccines are mild, and include pain, redness, or swelling in the arm where the shot was given.

All vaccines used in the United States, including HPV vaccines, are required to go through years of extensive safety testing before they are licensed by the U.S. Food and Drug Administration (FDA). During clinical trials conducted before they were licensed:

  • 9-valent HPV vaccine was studied in more than 15,000 males and females

  • Quadrivalent HPV vaccine was studied in more than 29,000 males and females

  • Bivalent HPV vaccine was studied in more than 30,000 females

Each HPV vaccine was found to be safe and effective.

In 2014, CDC published a report analyzing health events reported to VAERS following Gardasil vaccination from June 2006 through March 2014. About 92% of the Gardasil reports were classified as non-serious. (Source: CDC.)

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Here’s to those who saw this change coming before the benefit to people over the age of 26 was established. If I had a nickel for every time someone has asked me,

Doc, I know I am over the age to get the HPV vaccine, but should I get it anyway?

… I would have… maybe 50 cents. So, I guess people don’t ask me a lot about vaccines that they don’t qualify for, but the handful of times the subject has come up, I have always thought that it would be beneficial. At least in theory.

If I were you, I would give it a couple of months before asking your doctor for the vaccine. I only say that because sometimes it takes insurance companies some time to recognize guideline changes and to cover them. Also, check out this post I wrote about Abnormal Pap Tests and what they mean.

Thank you for reading.

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That’s What’s Pap-pening!

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