Time to get comfortable discussing HPV

If dental professionals aren’t willing to educate the public on oral cancer and HPV, who will?

Susan Cotten, BSDH, RDH, OMT

Original Article

The day started out like a normal Wednesday, work in the morning and then a trip to Trader Joe’s. I almost didn’t go; my to-do list was long, and the 36-mile round trip would take time away from checking things off that list, but the little voice inside my head was telling me to go.

There’s butter lettuce, and then there’s Trader Joe’s butter lettuce, so it’s always the first thing on my list. Moving through the aisles, I filled my basket with other favorites. With a full grocery cart, I headed to the shortest checkout line. Watching the two young men who were checking and bagging the customers ahead of me was a treat; they were engaging and obviously enjoying their day at work—you could sense the smiles under their masks. As the customers ahead of me left, the checkers turned to me with bright eyes peeking over their masks and said, “How are you today? Thank you for coming in!” After exchanging pleasantries, the checker asked what I do for work. I told him I’m a dental hygienist, and I speak and educate on oral cancer. With that, he stopped scanning my groceries and said, “That’s really specific; I’ve never heard of that. I’m glad neither of us smokes; we won’t ever get that cancer. Do you have any fun or interesting facts or information to share with us about oral cancer?”

From butter lettuce to oral sex

Now I knew why that little voice was telling me to go to Trader Joe’s that day. For reasons unknown to me, I was supposed to share information with these young men. It was the perfect scenario: two young, nonsmoking, white males who believe they are not at risk for oral cancer asking me to share information with them. They didn’t know my passion for this, and sure didn’t know what was about to be shared with them! I said, “I would love to share! Thank you for asking. What we now know is that the human papillomavirus (HPV) is the main cause of oropharyngeal cancer. It’s cancer in the back of the mouth, typically in the tonsils and back part of the tongue, and those most at risk are white, nonsmoking males. We also know that HPV now causes more of this cancer than it does cervical cancer.”1

By this time, the young man bagging my groceries had stopped bagging. Both young men were intent on knowing more and very surprised to learn about this cancer and to find out they could be at risk. They said they had heard about HPV and cervical cancer but not about it causing cancer in the mouth. Both continued to ask questions, wanting more information, including how HPV gets in the mouth, and specifically what they can do to help reduce their chance of getting this cancer. I shared with them that HPV is transmitted through skin-to-skin contact, orally through oral sex, and possibly through open mouth, deep, aggressive kissing. I recommended protection during oral sex just as with conventional sex. We also discussed the HPV vaccine, which they had both had; however, they didn’t know much about it and didn’t know it could aid in protecting them from persistent HPV infections, which could possibly result in cancer. It wasn’t an awkward conversation; they were truly curious and wanted more information, and I was thrilled to get to share this information with them. They both said that they go to the dentist regularly.

Many opportunities to educate

In the last 12 years of being immersed in raising awareness about HPV and oral and oropharyngeal cancer, I wish I’d kept track of the number of conversations like this that have occurred, inside and outside of the operatory. There are simply too many to recall. Another recent conversation took place while in line for Donny Osmond’s VIP preshow in Las Vegas, again with a nonsmoking male. He was in line holding a place for his wife while she was getting ready. He, too, had many questions and asked about transmission of HPV to the mouth. He stated he was aware of HPV causing cervical cancer, but not cancer in the mouth. He was most curious about what signs and symptoms to watch for and what to do if he noticed any of those. We discussed these, and I recommended he see an ear, nose, and throat specialist (ENT) for further investigation if he ever experiences any persistent signs and symptoms.

Also, while writing this article, a phone conversation with a business colleague in his 60s about my work in oral cancer prompted him to inquire further about HPV and how it gets in the mouth. He thought he knew but wanted a little more clarification. And just last week while listening to a radio program with a respected physician as the guest, the topic of HPV was brought up. The physician mentioned HPV and its association with cervical cancer and mentioned the HPV vaccine. However, the vaccine was only referenced in relation to preventing cervical cancers, not head and neck cancers or the other cancers associated with persistent HPV infections. It was a missed opportunity for a large listening audience to learn more about other HPV cancers.

It’s purely my opinion, but I think people inquire further about oral cancer and HPV because they don’t hear much about it in the media, or even in their medical and dental offices. The messaging for cancers such as breast cancer, colon cancer, and cervical cancer is intentional in the media and respective medical offices, but not so much for oral cancer. Dentistry needs to be more intentional about educating and raising awareness about HPV and oral and oropharyngeal cancers.

What we now know is this: the number of HPV-associated head and neck cancers has surpassed the number of HPV-associated cervical cancers. Unfortunately, the messaging about HPV is still focused on cervical cancer.2

Lessons learned

I’ve learned a few things during my years of work in raising awareness about HPV and oral cancer through conversations with patients and the public.

First, if the public is going to be educated and aware of HPV and its association with head and neck/oropharyngeal cancer, it will come from dental professionals. In fact, it is our ethical responsibility to share this information about “our cancer.” If they don’t hear it from us, where else? It’s okay, even essential, to talk about the transmission of HPV via oral sex, its association with head and neck cancers, and the availability of the HPV vaccine that can aid in reducing persistent HPV infections associated not only with oropharyngeal and cervical cancer but also anal, penile, vaginal, and vulvar cancers.

Society is open to hearing this information. The public wants to know how to help prevent cancers and recognize the signs and symptoms for the earliest detection. Most are still of the belief that tobacco is the only risk factor for oral and head and neck cancers. Patients and the public deserve to know this information so they can make informed decisions for themselves about their oral health. This does not need to be a knee-to-knee conversation; the optimal time to share information is during the extraoral and intraoral evaluation (EOIO). Information can also be shared in newsletters the dental office sends to patients, in social media posts, and in brochures and flyers in the office.

The public and some medical and dental professionals are misinformed about HPV. It is still the common belief that HPV is most associated with causing cervical cancer and the purpose of the HPV vaccine is to help prevent cervical cancers in females. Statistics released by the US Cancer Statistics Data Briefs, No. 26 in December 2021 based on data from 2014–2018 reveals that there are approximately 10,600 cases of oropharyngeal cancer in males and 1,800 cases of oropharyngeal cancer in females each year that are attributable to HPV types 16 and 18.2 The US FDA added prevention of oropharyngeal cancer to the HPV vaccine’s indication: “The human papillomavirus (HPV) recombinant 9-valent vaccine (Gardasil 9) received FDA approval for an expanded indication to include the prevention of oropharyngeal and other head and neck cancers caused by HPV types 16, 18, 31, 33, 45, 52, and 58.”3

People are listening! The public and our patients are listening, and they are looking for health-care professionals to share our expertise and have courageous conversations about critical health information. When I first started sharing information about HPV with my patients 12 years ago, I would bring it up when I was palpating the occipital nodes behind them so I wouldn’t have to look at them. I was very uncomfortable with this conversation at first; however, I knew it was vital information to my patients’ oral and systemic health and it needed to be shared. During your clinical appointments, find the time and place that is most comfortable for you.

Our job doesn’t end when we take off our scrubs. Be open to spontaneous conversations regarding essential information about HPV and oral cancer. In a recent conversation with Katrina Sanders, MEd, she eloquently said, “Irene Newman, the first dental hygienist—her job was not to improve production and close more cases. Her job was to be a patient advocate and educate the community.” I’m encouraging you to be like Irene Newman: be an advocate and educate the community, share the tremendous amount of knowledge, expertise, and lifesaving information you possess about “our cancer,” not only with patients, but the general public as well.

Call to action

If you are uncomfortable or lack confidence in sharing information about HPV or feel you need more knowledge, find a mentor, do some research, and be your own advocate to gain the knowledge you need. Recruit your entire dental team or dental service organization (DSO) to establish a positive, informative culture around HPV and oral cancer. Make it your mission to save lives through sharing critical information with patients and the public. Perform a thorough EOIO evaluation on every patient, tell them what you’re doing, and use that time to efficiently share information and raise awareness about what we now know concerning HPV and oral cancer.

Get yourself started with a practitioner HPV fact sheet and patient HPV fact sheet.


References

  1. HPV/oral cancer facts. The Oral Cancer Foundation. https://oralcancerfoundation.org/ understanding/hpv/hpv-oral-cancer-facts/
  2. Cancers associated with human papillomavirus, United States—2014–2018. U.S. Cancer Statistics Data Briefs, No. 26. Centers for Disease Control and Prevention. December 2021. https://www.cdc.gov/cancer/uscs/about/data-briefs/no26-hpv-assoccancers- UnitedStates-2014-2018.htm
  3. FDA adds prevention of oropharyngeal cancer to HPV vaccine’s indication. AAP News. May 2021. https://www.fda.gov/media/150779/download

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Early Detection Saves Lives

Newswise — Chulalongkorn University’s researchers have developed a cervical cancer test kit that uses urine samples. A simple, accurate, and fast method of early detection is guaranteed for its quality by the 2021 Outstanding Inventions Award from the National Research Council of Thailand. Early detection is the key to saving lives.

Cervical cancer can be cured if detected in its early stages.  Many women are, however, deterred by the rather high cost of the screening procedure, and the pap smear testing method.  This leads to late detection that can cause cancer to spread making it harder to treat.

Today, there is a new invention that makes cervical cancer treatment a simpler and pain-free procedure that can be done frequently.  The HPV paper-based DNA sensor testing kits for cervical cancer developed by the Department of Chemistry, Faculty of Science, Chulalongkorn University’s research team comprising Prof. Dr. Orawan Chailapakul, Dr. Prinjaporn Tee-ngam, Sarida Naorungroj, Dr. Somrak Petchcomchai along with Prof. Dr. Tirayut Vilaivan.

Dr. Prinjaporn, one of the main researchers on the team discussed how this innovation was conceived, “The government has consistently urged women to get tested for cervical cancer.  One of the limitations of the original form of testing which requires taking a sample of cells from the cervix on stirrups invokes fear in many women who would rather avoid the test altogether.  For this reason, we have tried to find an easier way that most women would feel more comfortable with.  This could help to increase the number of those being tested as well as the frequency of their tests so that if any anomalies are found, then treatment can be immediately provided.”

Getting to know cervical cancer and early detection methods

Cervical cancer is the second most common cancer of women in Thailand after breast cancer with an incidence rate of 10,000 new cases per year affecting women between the ages of 30-60 and claiming as many as 5,000 deaths each year.  The Ministry of Public Health recommends that from the age of 25 women should receive regular screening for cervical cancer every five years.

Prof. Dr. Orawan explains that cervical cancer is a sexually transmitted disease, mainly caused by the human papillomavirus (HPV).  The use of condoms as protection cannot prevent such transmission, and the HPV vaccine is not yet prevalent or provides 100% protection against cervical cancer.

She also stressed that “Most of those who have been affected are asymptomatic which makes it necessary for us to still be tested regularly since that is a crucial way to prevent us from the disease and death.”

The HPV paper-based DNA sensor testing kits

The cervical cancer testing kits are easier and much faster than the Pap Smear or Pap Tests currently in use.  It eliminates the need to insert a tool and hold the vaginal walls open as well as swabbing over the cervix to take cell samples that are sent to the lab for testing.

“HPV paper-based sensor testing is a way to test the DNA of the HPV virus by using PNA (Peptide Nucleic Acid) which is a synthetic substance that imitates our DNA designed to be specific according to the cells being tested which can be specified since HPV comes in many different strains and not all strains cause cervical cancer.  When designing the substance, we needed to determine which strains there were when it comes to HPV infection,” said Prof. Dr. Orawan.

The HPV paper-based sensor testing kit is something that a lot of us are already familiar with from the ATK tests we have undergone for COVID-19.

“The urine is mixed in a solution then dropped onto the paper after which we notice the change in color of the solution.  Normally the color of the solution is bright red but if the urine is contaminated by the virus the color appears lighter. The brightness of the color varies according to the amount of the virus.  We have an additional tool, used with the colorimeter application on smartphones that helps make the color more visible.”

Prof. Dr. Orawan assured us that the HPV paper-based sensor testing kit has been tested and shows a high level of accuracy with a sensitivity of 85%, specificity of 78%, and reproducibility rate of 100%.”

The HPV Testing Kits have not been produced for home use.  They are, however, being used in health centers and community hospitals.

“In the urine, there are fewer DNA materials than in tissues, which means we need to have a device that increases the DNA level so that the change of color is more visible and the device is already in use in the clinics and community hospitals.”

How to watch over our health to stay away from cervical cancer

Prof. Dr. Orawan left us with some tips on how to help women stay safe from cervical cancer.  “First, women should make sure they always keep their vaginal areas clean.  Vaccinations are good but the prevention they offer isn’t a hundred percent.  The best way is to have regular cervical cancer checkups for early detection and treatment.”

The research team hopes that this innovation will motivate women to get themselves tested regularly, with a simple and painless process, at an affordable price.  Each test kit should not exceed 500 baht.

Prof. Dr. Orawan left us with these words.   “We’d like to see women getting cervical cancer tests regularly as advised by the Ministry of Public Health.  Therefore, we have tried to make the cost of these kits as low as possible to make them easily accessible.  It would be ideal if women can be tested regularly, for example once a month at a health center nearby.”

Nursing facilities or agencies interested in these HPV paper-based DNA sensor testing kits may contact Prof. Dr. Orawan Chailapakul at the Department of Chemistry, Faculty of Science, Chulalongkorn University, email address orawon.c@chula.ac.th for more information.

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How Bad Is It Really to Never Clean Your Yoga Mat?

Your yoga mat is like your water bottle — you know you should clean it every now and then, but you probably rarely do. However, if you examined your mat under a microscope, what you’d find lurking about might change your mind (and give you the heebie-jeebies). Yep, an unwashed mat is a breeding ground for all kinds of creepy crawlies including bacteria, fungi and viruses. This includes the risk of HPV. Which makes it an especially fertile incubator for many infections (more on this later).

We spoke to Kelly Reynolds, PhD, director of the Environment, Exposure Science and Risk Assessment Center at the University of Arizona, to find out what happens if you let your mat accumulate muck, plus tips on how to clean a yoga mat

3 Reasons to Clean Your Yoga Mat Regularly

1. It Can Cause a Skin Infection

Your yoga mat may be harboring harmful germs — including viruses, bacteria and fungi — which can produce nasty skin infections. “These microbes can live on surfaces for days to months and spread from person to person via surfaces like exercise mats,” Reynolds says. Common pathogens that can be transmitted by a dirty yoga mat include:

  • Fungi that cause athlete’s foot and other types of ringworm:​ These pathogens multiply in warm, moist environments (like gym showers or around swimming pools). They are especially well adapted to thrive for long periods of time on yoga mats, Reynolds says, which is why fungal infections flourish so easily.
  • Staphylococcus or staph bacteria:​ It’s a pathogen commonly found on the skin that’s usually harmless but can cause infection when it gets into a cut. Staph infections can cause red, swollen and painful skin infections that look like pimples or boils, and can even leak pus or become crusty, according to the National Library of Medicine. They can also lead to bone infections, which can cause flu-like symptoms such as fever and chills.
  • Human papillomavirus (HPV):​ Some strains of HPV can cause warts on the skin. Plantar warts are warts on the bottom of the feet.
And while bringing your own yoga mat to the gym (versus borrowing a rarely cleaned communal mat) can help mitigate your risk of infection, it doesn’t eliminate it completely. You can still become infected by someone simply stepping on your mat on their way to the water fountain. Or you could pick up germs from the gym floor and transfer them to your mat.

“Either way, add sweat and a warm environment, like a hot yoga studio, and you may have your own fungal colony established,” Reynolds says.

2. It Can Make You Break Out

Your filthy yoga mat might be bringing on bouts of breakouts. Excess oil, dirt, dead skin cells and bacteria –— which can block your pores and produce pimples — can easily spread from an unclean exercise mat and promote acne, Reynolds says. To make matters worse, acne typically appears on areas of your body that boast the most oil glands such as your chest, upper back and shoulders, per the Mayo Clinic. And these oilier body parts are often the ones exposed to your yoga mat.

3. It Can Make You Sick

A dirty yoga mat can also ramp up your risk for catching the common cold, a respiratory infection or the stomach flu. This happens when cold and flu viruses are released into the air through a sick person’s coughs or sneezes, Reynolds says.

And someone doesn’t have to be particularly close for their germs to reach you. The spray from a sneeze or cough can travel up to 6 feet, per the Centers for Disease Control and Prevention (CDC). In fact, an April 2014 study in the Journal of Fluid Mechanics found that smaller droplets can cover even longer distances (as far as 2.5 meters or more than 8 feet).

These meddling microbes rapidly settle on surfaces — like your yoga mat — where they can survive for days and spread to others, Reynolds says. Usually, an infection occurs when you touch your germy mat and unknowingly transfer the virus to your eyes, nose or mouth from your hand.

And while the common cold or flu may be a temporary inconvenience (read: mostly harmless) for healthy individuals, those with compromised immune systems may become sicker.

For instance, people with certain medical conditions such as asthma, diabetes and heart disease, and older adults and pregnant people all have a higher risk for serious flu complications, per the CDC.

Related Reading

How to Clean a Yoga Mat

So, how often do you need to clean your yoga mat? More often than you think.

“Given that exercise mats are placed on dirty floors, often shared among users and come into direct skin and face contact, I recommend cleaning ​and​ disinfecting them before every use,” Reynolds says. “Cleaning alone will not kill most of the germs, but it will reduce dirt, sweat and oils that bacteria and fungi feed on.”

If you’re sticking to solo at-home workouts (i.e., you’re the only one coming into contact with the mat), you have a little more leeway. In this case, cleaning and disinfecting it once a week should suffice. That said, if you sweat profusely, or you’re prone to acne, you might want to wipe down your mat more often.

Here are Reynold’s tips for how to clean a yoga mat and keep it microbe-free.

If Your Mat Is Machine Washable

Toss it in the wash (by itself) and follow the manufacturer’s instructions. To properly disinfect your mat, also use a laundry sanitizer, Reynolds says. A product like Lysol Laundry Sanitizer will kill bacteria and viruses that a regular detergent might miss.

If Your Mat Isn’t Machine Washable

First, scrub it with soap and water to remove any dirt, then use a disinfecting spray or wipe, which is your best defense against germs. “Alcohol-based wipes are safe for use with most surfaces,” says Reynolds, who recommends throwing a travel pack in your gym bag.

After you clean and disinfect your mat, pat it down to dry it thoroughly. “Be sure your mat is fully dry before rolling it up to store as trapped moisture can promote more germ growth,” Reynolds says.

So, How Bad Is It Really to Never Clean Your Yoga Mat?

Doing downward dog on a dirty mat may impact each of us differently — for some it’s NBD, but for others, it can be potentially harmful. If you have a weakened immune system and are more susceptible to infection, a clean yoga mat is more important, especially if you lug it to the gym or a hot yoga studio where germs love to gestate.

But a group class isn’t the only place where you can pick up pathogens. At home, your roommate or your partner can also pass on infections if they use your mat or inadvertently cough or sneeze on it. So if your immune system isn’t robust and you live with someone, stick to separate mats and stow yours away (out of reach of random sneeze sprays) when you’re not using it.

If you’re a generally healthy person who lives alone and only uses your mat at home (i.e., never shares it with another soul or carries it to the gym), you’re probably in the clear even if you don’t clean it as often. But if you’re noticing recurring body acne or an unexplained skin infection, you may want to scrub and disinfect your mat more often.

To extend the time between washings, you can even lay a towel on top to keep sweat and body oils off the surface of your mat. Keep in mind: This strategy only works if you launder the towel with each use.

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Blood test predicts recurrence of HPV, oropharyngeal cancer

A blood test that detects circulating tumor DNA can predict recurrence of HPV-driven oropharyngeal cancer following treatment, according to research presented February 24 at the 2022 Multidisciplinary Head and Neck Cancers Symposium. The multi-institutional study, presented by Dr. Glenn Hanna from the Dana-Farber Cancer Institute, indicated that the biomarker test may detect recurrent disease earlier than imaging or other standard methods of post-treatment surveillance. Hanna said this allows physicians to personalize treatment more quickly for patients whose cancer returns.

Researchers looked at data from 1,076 patients who had one or more blood tests to detect circulating tumor tissue modified viral (TTMV) – HPV DNA as part of their post-treatment surveillance. Of the 80 patients who tested positive for the biomarker in surveillance, 95% were confirmed through imaging, biopsy, and/or endoscopy as having recurrent HPV-positive disease. The presence of TTMV-HPV DNA was the first indicator of recurrence for 72% of the patients whose cancer returned, and 48% of the recurrences were found in patients tested more than 12 months after completing therapy. Reach out to us to learn more about blood test and HPV.

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What to know about high risk HPV

Diagram showing where high-risk HPV can occur in the bodyShare on Pinterest
Illustration by Yaja Mulcare

Human papillomavirus (HPV) is the most common sexually transmitted virus, with doctors diagnosing roughly 13 millionTrusted Source new cases every year.

The virus can pass on through skin-to-skin vaginal, anal, or oral sex. A person may not realize that they have the infection because it sometimes causes no symptoms.

Read on to learn about the types of HPV, as well as testing, treatments, and methods of prevention.

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

What is high risk HPV?

Some types of HPV can cause cancer. This means that they are “high risk.”

When a high risk type of HPV infects cells, it changes how they communicate with one another. It also causes the cells to multiply. Usually, the immune system becomes aware of these cells and regulates them.

However, if these abnormal cells remain, they can continue to change and become precancerous.

HPV infects the thin, flat squamous cells that line the inner surface of some organs. For this reason, most HPV-related cancers are called squamous cell carcinomas.

The virus can also cause cancer in the glandular cells of the cervix, and this cancer is called adenocarcinoma.

There are more than 200 typesTrusted Source of HPV. Doctors categorize them as oncogenic and non-oncogenic.

At least 14 typesTrusted Source of HPV are oncogenic, meaning that they can cause cancer.

Non-oncogenic types usually cause no serious health issues. A doctor may refer to non-oncogenic types of HPV as “wart-causing HPV.”

Low risk

Low risk, or non-oncogenic, types of the virus rarely cause precancerous lesions, though they may still cause cellular changes.

If certain low risk types of HPV remain in the body, they can cause genital warts. These are benign growths that can develop around the genitals, groin, and anus.

Around 40 typesTrusted Source of low risk HPV can infect the genital area. HPV types 6 and 11 are the most common causes of genital warts, together causing around 90%Trusted Source of cases.

Some low risk typesTrusted Source can also cause the growth of warts in the mouth and throat. This condition is called recurrent respiratory papillomatosis, and it is more common in children than adults. “Papilloma” is another name for “wart.”

These growths are often benign, but they can cause severe airway obstruction and complications. In extremely rare cases, these warts become cancerous.

High risk

High riskTrusted Source HPV can cause several types of cancer if the immune system does not clear the infection.

Research suggests that HPV types 16 and 18 cause 70%Trusted Source of cervical cancer cases and precancerous cervical lesions. A small 2021 study demonstrated that just under half of the participants with HPV had type 16.

Estimates suggest that high risk HPV causes 3%Trusted Source of all cancer cases in females and 2% of all cancer cases in males in the United States.

Read more about HPV in males.

In the early stages, cervical cancer may not cause symptoms. If symptoms do occur, they commonlyTrusted Source include:

  • abnormal vaginal bleeding
  • abnormal discharge from the vagina, with a strong odor or containing blood
  • pain during sex
  • pelvic pain

High risk HPV can also affect cells in other areas, and this may also develop into cancer. Other HPV-related cancers includeTrusted Source:

Testing for HPV

The primaryTrusted Source goal of cervical screening is to identify precancerous lesions caused by HPV. Doctors can remove lesions to prevent invasive cancers from developing.

Because HPV can develop without causing symptoms, regular screenings are an important way of detecting any changes early. Anyone with a weakened immune system or a medical history of cervical lesions may need more frequent screening.

Currently, cervical cancer is the onlyTrusted Source HPV-related cancer with a test that has been approved by the Food and Drug Administration.

The United States (U.S.) Preventive Services Task Force recommends that anyone who has a cervix and is 21–29 years old has cervical cancer screening every 3 years.

For anyone who has a cervix and is 30–65 years old, the task force recommends having an HPV test and Pap smear every 5 years or a Pap smear alone every 3 years.

The Centers for Disease Control and Prevention (CDC) do not recommend that males have routine testing for HPV.

Screenings for High Risk HPV

A Pap test, or Pap smear, was once the only type of screening for cervical cancer.

It involves collecting cells from the cervix. This only takes a few minutes and is an outpatient test. The doctor sends the sample to a lab, which checks for abnormalities in the cervical cells.

Cervical cancer screening now also includes HPV testing. In some cases, a doctor may recommend having a Pap test and an HPV test at the same time.

A Pap test involves checking the cells for precancerous changes. An HPV test looks for the DNA of the virus. A doctor may only order this test if a person likely has a high risk infection.

The results of both a Pap test and an HPV test give the doctor a clearer impressionTrusted Source of a person’s cervical cancer risk. Negative results of both tests indicate a very low risk of developing precancerous cervical lesions over the next several years.

Learn what to expect from cervical screening.

Treatments

There is currently no treatment for the infection. But treatments can address the health problems that HPV causes.

Although 20–30%Trusted Source of warts go away on their own over time, treatment can help manage outbreaks and reduce any discomfort. The treatment may involveTrusted Source applying a prescription cream or gel to the area or having the warts removed.

Surgery is necessary to remove precancerous cells caused by high risk HPV. This is to prevent the cells from becoming cancerous. A doctor can remove these cells from the cervix with a procedure called loop electrosurgical excision or with cervical cryotherapy.

The treatment for HPV-related cancer tends to be the same as the treatment for other cancers in the area. The best approach can depend on the location, type, and stage of cancer. Examples of these treatments include:

Prevention

A person can reduce their riskTrusted Source of contracting HPV by:

  • getting the HPV vaccine
  • consistently using barrier methods, such as condoms or dental dams, during sex
  • limiting the number of sexual partners

Gardasil 9 is the HPV vaccine available in the U.S. It protects people from several high risk types of HPV, including types 16 and 18 — as well as the low risk types associated with warts.

The CDC says that, ideally, everyone should receive the HPV vaccine at ages 11–12Trusted Source to reduce their risk of HPV-related cancer. This vaccination comes in two doses, 6–12 months apart. People aged 15–26 receive it in three doses.

After receiving the required vaccine doses, 98%Trusted Source of people develop the antibodies necessary to protect them from high risk strains, indicating that the vaccine is highly effective.

For people who are older than 27 and have a risk of new HPV infection, a doctor may discuss the benefits of receiving the vaccine, though it may be less effective.

Outlook

For most people with HPV, the infection clears within 2 yearsTrusted Source.

With regular cervical screening, doctors are more likely to catch any cell abnormalities before they become cancerous.

If a doctor detects abnormal changes, treatment can start early, and this improves the outlook.

Summary

HPV infections are very common, and the body’s immune system usually clears them. The infection can remain in the body and cause health problems in some cases.

Getting the HPV vaccine and having regular cervical screening reduces the risk of these health problems.

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Everything You Should Know About HPV That You Weren’t Taught In School

For one: “Nearly everyone will get HPV at some point in their life.” Learn more about HPV vaccines, symptoms, tests, and treatment to protect yourself.

Unless your Google calendar says you’ve got an upcoming Pap test or HPV vaccine appointment, odds are you aren’t actively sitting there thinking about HPV. Still, given the statistics on just how prevalent the virus is, maybe you should. Here are some things you should know about HPV.

HPV, or human papillomavirus, is the most common sexually transmitted infection in the United States. Currently, 42 million people are infected with the virus in the United States, with 13 million new Americans being diagnosed with it each year. Even more sobering: “Nearly everyone will get HPV at some point in their life,” according to the Centers for Disease Control and Prevention (CDC).

But what exactly is HPV? What are the symptoms? And how do you test and treat the infection? All important questions about HPV. Get the answers below.

What Is HPV, Exactly?

Specifically, HPV is caused by a family of viruses called human papillomavirus, of which there are currently more than 200 different strains.

The part of the body the virus infects, the accompanying symptoms (if any), treatment, and how long it lasts all vary based on the exact strain(s) someone has, says Emily Rymland, D.N.P., F.N.P.-C., clinical development manager at telehealth platform Nurx.

As it goes, the types of HPV are usually broken down into two broad categories: low risk and high risk. Low-risk strains of HPV are unlikely to cause problems (infertilitycancer, etc.) down the line. High-risk strains of HPV have the potential of causing cancers, such as cervical cancer, penile cancer, anal cancer, and esophageal cancers. To be clear: Low risk is not synonymous with asymptomatic, but more on this below.

Know How Do You Get HPV?

Roughly 40 of the strains of HPV can be contracted by having sex with a person who has HPV. Transmitted through skin-to-skin contact, it can be spread through anal sex, vaginal intercourse, oral sex, scissoring, and other sex acts that involve bare skin, according to the CDC. There’s also some research that shows the virus can live on sex toys made of silicone and elastomer for up to 24 hours — even after a proper cleaning — which suggests that sharing sex toys can also transmit the virus. What’s more, the virus can be transmitted through sexual acts regardless of whether symptoms are present.

The other strains of HPV are not caused exclusively by sexual contact, and can result in common warts such as hand warts and plantar warts, says Rymland. These are the types of warts your parents were warning against when they told you to wear flip-flops on the pool deck, she adds. Note: This article is specifically covering the strains of HPV that can be transmitted sexually.

Know The Signs and Symptoms of HPV

While most strains of the virus are asymptomatic, when HPV symptoms do appear, they can often come in the form of warts, according to Rymland. Known as genital warts, these warts are small, flesh-colored bumps that show up most often on the vulva, taint, penis, cervix, or along the anal or vaginal canal. Certain strains of HPV can also cause oral warts or lesions, according to the CDC. It’s uncommon for HPV warts — no matter where they pop up on the body — to be accompanied by any other symptoms, such as pain, itching, or discomfort, says Rymland. (Related: Everything You Need To Know About Genital Warts)

“The strains that cause warts aren’t those that are associated with cancer,” explains Rymland. So, while the warts might be annoying or unsightly, the HPV strains that cause warts are considered low-risk. But don’t read it wrong: Just because your strain doesn’t cause warts, that doesn’t mean it’s high risk. Only some of the strains of HPV that don’t cause warts can lead to cancer, she says. Indeed, some strains cause neither warts nor cancer — hence the commonality of asymptomatic cases. ICYWW: The strains associated with genital warts are stains 6 and 11. Meanwhile, the strains that could cause cancer are 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 28, according to the National Cancer Institute.

That said, it’s possible to have more than one strain of HPV at the same time. Sometimes, the presence of warts will lead someone to get tested for HPV, and find out that they have an additional strain of HPV as well, says Rymland. Your practitioner will be able to identify exactly which strain(s) you have, if any, so you can receive the proper HPV treatment.

Know How to Test for HPV

If someone has a strain of HPV that is actively causing genital warts, “sometimes health care providers will diagnose genital warts from appearance alone,” sexual health expert Amy Pearlman, M.D., with Promescent, a sexual health product retailer previously told Shape. Other times, the provider will remove a tiny piece of the wart to biopsy, or test it, for any abnormality, according to Dr. Pearlman. A biopsy allows the provider to rule out other similar-looking conditions such as skin tags or moles.

However, if you don’t have any visible HPV symptoms (as most people won’t), you’ll need to be tested for the virus via a vaginal or anal pap. In fact, even people who do have genital or anal warts should still be screened for HPV because this doesn’t necessarily rule out infection with a high-risk asymptomatic strain, or multiple strains of the virus, says Rymland.

So, what does an HPV test entail? Also known as getting HPV screened, testing for HPV varies based on sex and genital make-up, as well as the type of sex you’re having (if any).

If you have a cervix, you’ll typically get screened for HPV at the same time that you get a Pap test from your gynecologist. These tests require the provider to put a speculum into the vaginal canal, then collect a sample of cervical cells with a soft brush and/or small scraping device. The provider will send this collection of cells to the lab to test for precancerous lesions caused by HPV or for cellular abnormalities that suggest that cancer is at its early stages. Another option is to take an at-home HPV-testing kit, such as those through Nurx or Everlywell, which require a quick swab of the vaginal canal (you won’t need to reach the cervix). However, at-home HPV tests only test for certain strains of the virus. Carefully read the product description to learn exactly what strains the at-home HPV test is able to find. The Everlywell HPV Test, for example, screens for strains 16, 18, and 45, while the Nurx HPV test looks for strains 16 and 18.

Regardless of your gender or sex, if you enjoy receptive anal or oral sex, your doctor may recommend an anal pap smear to look for precancerous changes, says Rymland. To note, there are currently no FDA-approved tests for oral HPV. The only way doctors are currently able to tell if you have oral HPV is if you have a strain that causes oral legions that are visible during an oral exam).

“It’s really unfortunate that there isn’t an approved regular screening for any body part other than the cervix because HPV-related cancers of the anus, penis, and throat are all on the rise, and affect all genders and sexual orientations,” she says.

Know How Often to Test for HPV

How often you should get an HPV test depends on your age, your sexual and medical history, and the results of your last HPV test. “It’s recommended that people don’t test for HPV until age 30,” according to Rymland (and the CDC, FTR). The reason? “When you’re younger it’s likely that if you do have a strain it will go away on its own [thanks to the immune system] and won’t cause any problems down the line.”

Between the ages of 30 and 65, people with cervices should get an HPV test every five years, according to The American College of Obstetricians and Gynecologists. After that, individuals who have not tested positive for cancer-causing strains do not need to continue getting screened. As always, however, it’s best to talk to your practitioner about your specific sexual practices and any other risk factors to get HPV test recommendations tailored to you.

“People with cervices should get their screenings on the recommended schedule, but unlike other STIs, you don’t need to test for it annually,” she says.

Know What Is the Treatment for HPV?

“There is no cure for the human papillomavirus itself,” says Rymland. But the immune system often clears it on its own within two years of infection, she says.

If you have a strain of HPV that causes genital warts (and they haven’t gone away on their own), you can get them removed by your doctor, usually with a process known as cryosurgery, which essentially involves freezing off the warts. Just keep in mind that removing HPV warts does not rid the body of the virus itself, and warts could return.

As for HPV treatments if you have a strain that can cause cancer that the body doesn’t clear on its own? Health-care providers will simply treat any precancerous changes, such as with the cells that line the cervix, caused by the virus, explains Rymland. These can be monitored and detected by cervical screenings and pap smears, as well as oral and anal HPV testing, she adds.

Good news: Even if cancer has developed, it’s usually treatable if caught early, she says. Treatments for these cells vary, but can include excision, lasering, or freezing of the abnormal cells, or impacted tissues. “Getting screenings on schedule is important because it allows us to catch if/when the virus has led to precancerous changes, and then provide treatment before it turns into cancer.”

Know How to Protect Against HPV

The number one thing people can do to protect against HPV is to get the HPV vaccine, according to Rymland. Known as the Gardasil vaccine, the HPV vaccine protects against 9 strains of the vaccine (strains 6, 11, 16, 18, 31, 33, 45, 52, and 58) and is FDA-approved for people of all genders over the age of 9. People should get the vaccine prior to the age of 26, as early protection offers the best protection, according to the CDC. If you’re between the ages of 27 and 45 and have not yet received the HPV vaccine, talk to your provider, as they may still recommend it as a way to protect against strains of the virus you have not been exposed to yet. Worth knowing: The age you are when you get the vaccine will impact how many doses of the vaccine you get — only two doses are needed for those who get the first vaccine before their 15th birthday, while those who get their first dose after that may need three doses, each six to 12 months apart.

Beyond the HPV vaccine, the usual safer sex practices apply here. That means knowing your own status, staying up to date on STI testing, and communicating your status with any new partner — ideally before you have sex for the first time.

It also means using barriers (dental dams, finger cots, condoms, etc) with any partner who is HPV-positive, does not know their current HPV status, or has a previous partner that has known HPV. As you now know, this can go for most pleasure-seekers, so play it safe.

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Pap smears vs HPV testing: Out with old, in with the new?

Pap smears vs HPV testing: Out with old, in with the new? ALMOST 100 years ago, Aurel Babeş in Romania and George Papanicolaou at Cornell University, two scientists without knowledge of a similar endeavour by the other, were evaluating the cervical cell changes in vaginal fluid. In 1926, Babeş introduced cytologic sampling for detecting cervical cancer and published his work in 1928. That same year, Papanicolaou presented his work on vaginal smears. Papanicolaou received more recognition for his work, and today we have the “Pap” smear and not the “Babeş” smear.

Fast-forward to 1988, when Harald zur Hausen demonstrated that cervical cancer is caused by certain types of papillomaviruses, and we know that 99.7 per cent of cervical cancer has human papilloma virus (HPV) DNA. This discovery made HPV vaccination against cervical cancer and the commercial availability of HPV testing possible. HPV vaccination has been available since 2006 and there are currently three on the market and Ian Frazer was critical in its development.

One century, four pioneers, and three vaccinations later, and cervical cancer continues to be a global public health problem and is the leading gynecologic cancer in developing countries. Pap smear screening reduces cervical cancer incidence; however, most developing countries lack the resources to implement such programs which require high coverage of women at risk, quality screening tests, and effective follow-up and treatment. Pap smear screening requires a doctor or nurse to collect a sample, to process and interpret the sample, and a pathologist to confirm positive results. All women with abnormal results should be contacted to receive appropriate treatment.

Despite these challenges, locally, there has been a steady decrease in cervical cancer rates and in our last review the incidence was 15.7/ 100, 000. In May 2018, the World Health Organization (WHO) director general announced a global call for action to eliminate cervical cancer. This aims to achieve a global incidence of 4 per 100, 000, down from the current figure of 13.5 /100, 000, through vaccination, screening, and treatment. This initiative recommends HPV DNA detection as the primary screening test rather than inspection with acetic acid or Pap smears because of the higher sensitivity of HPV testing. Should we therefore implement HPV testing as our primary screening modality?

Evidence suggests that there is a 50 per cent reduction in cervical cancer deaths and late-stage disease from a single lifetime HPV test. The improved sensitivity of HPV testing is advantageous on a public health level as it facilitates less frequent testing without compromising efficacy and makes the WHO recommendation of at least two tests in a 10-year interval between ages 35 and 45 possible. Because of the lower sensitivity of the Pap smear, more frequent tests are needed. HPV test results are automated and not prone to human interpretation while Pap smears require cytologists which may contribute to longer wait times for reports in the public setting. Some HPV test results may be ready within one to three hours. Self-test kits allow testing at home and urine HPV tests do not require a pelvic examination. HPV testing is also useful in guiding the management of abnormal Pap smears. The major limitation of HPV testing is the cost locally. Also, widespread HPV testing may increase the referrals for colposcopy unless triage measures such as Pap smear or visual inspection with acetic acid are implemented.

The WHO has advised that countries with effective Pap smear screening continue doing so until national HPV testing can be implemented. Fifty per cent of women who develop cervical cancer have never had a Pap smear and an additional ten per cent have not had one done in five years prior to diagnosis. Therefore, sixty per cent have not been adequately screened. For Jamaica, this means we need expedite the implementation of a national Pap smear screening, reminding women that doing frequent smears improves the accuracy of the test. Many advances have been made since the discoveries of Babeş and Papanicolaou; however, the importance of their discoveries remain relevant today.

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Impact of Prior HPV Infection or History of Abnormal Pap Smear and HPV

The Impact Of A Prior HPV Infection Or A History Of Abnormal Pap Smear On The Humoral Immune Response To A Quadrivalent Human Papillomavirus (qHPV) Vaccination

In 52.9% of cases, there was a history of abnormal pap smear/cervical neoplasia. At baseline, anti-HPV antibody titers at baseline: 21% were negative for all four HPV types, whereas 79% were positive for one of the four HPV types. Statistical analysis revealed that those with a history of abnormal pap smears/cervical neoplasia were more likely to have a positive anti-HPV antibody result before vaccination to one of the four kinds, (P = 0.035) Fisher’s Exact Test. In general, HPV-exposed women had greater post-vaccine GMTs and higher point estimates than HPV unexposed women. There was no indication of an anamnestic response when the rise in titers was examined using logistic regression. Prior HPV infection and cervical neoplasia in SLE had been associated with a lack of anamnestic response to the HPV vaccination. This validated the decision not to screen for HPV antibodies before vaccination.

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Men and the Human Papillomavirus

In cervical cancer awareness month, Yan-Yi Lee delves into the topic of HPV, exploring why heterosexual men in particular may be less aware of the risks and consequences. Whilst availability of the HPV vaccine is increasing, there is much to be done further raise awareness. Read more to learn about Men and the Human Papillomavirus.

 

HPV comes in more than 170 forms (with certain subtypes being more ‘deadly’ than others) and typically transmits through sexual activity. Despite it spreading equally easily and causing cancer in both males and females, there tends to be surprisingly low awareness of what HPV is among men. It is unbelievable to me that the term doesn’t even ring a bell among the highly educated male friends in my social circle, with some even confusing it with the Human Immunodeficiency Virus (HIV) or the Herpes Simplex Virus (HSV). Findings in recent scientific studies appear to align with my anecdotal observations. In the previous decade, data collected in one American university revealed that despite rising death rates in HPV-related cancer among men, less than 30% of males were vaccinated. Another report painted a similar picture: the awareness of HPV and the importance of its vaccination dropped by a whopping 10% among men between 2013 and 2018. Sexuality also appeared to play a role in HPV awareness, with the LGBTQ+ community appearing to be more conscious of the threat posed by HPV. It was found that men who have sex with men tend to be more aware of HPV and are more willing to get vaccinated for it in comparison with heterosexual men.

Reasons that account for this striking gender gap in HPV awareness are multifaceted, and the first concerns how HPV testing works. Designing a technically robust HPV test for heterosexual men is challenging; there are currently are no approved tests for penile HPV, and throat swabs appear to be unreliable in capturing the virus as well. Although urine-based tests have been tested scientifically for women, the reliability of urine tests for testing HPV has yet to be discussed in more detail for men. Further, for bisexual and gay males, anal pap tests are only given if especially requested. In the absence of reliable tests, men commonly do not know they even carry the virus (let alone know how dangerous their HPV strains are) and potentially spread it to their partners.

The second explanation for this pertains to the consequences. As HPV is the primary cause of the fourth most common cancer for females (and because detection is possible and can result in highly effective treatment), women tend to be more conscientious of HPV and the importance of tracking it in their bodies. Similarly, for gay and bisexual men and their attitudes towards anal cancer. On the other hand, the rate of penile cancer is a mere 1 to 100,000 for heterosexual men, so the stakes are lower and hence less awareness.

“A careless wild night may not only imply other widely-known sexually transmitted infections; it may also lead to an agonising cancer in older age”

Thus, what could the male population do to slow down the spread of HPV? Prevention measures are not hard to guess: using protection during sexual intercourse and getting all three doses of the HPV vaccine. In the UK, both girls and boys are vaccinated early on at ages 12-13; and contrary to popular belief, HPV vaccines can still be administered in adulthood. The vaccine would most likely be beneficial even if an individual has HPV, although this would depend on the strains of HPV currently existing in the individual’s system. In any case, a consultation with a health professional beforehand is always the best idea.

Demystifying intersexuality

It is commonly understood that a careless wild night may imply unwanted pregnancy and other widely-known sexually transmitted infections, but what many of us fails to see is the same carelessness may lead to agonising cancer in older age – particularly for women and non-heterosexual men. These cancerous infections often happen in one-night-stands, and it simply isn’t worth getting cancer for a person whose name you won’t even remember after some ephemeral dopamine and serotonin. Both genders have the responsibility and the power to protect themselves and their partners from HPV-related cancers. The fact that there isn’t as much reason to worry about HPV among heterosexual men should not excuse them from the responsibility to build awareness of it, and it is high time to find out how best to do so on a broader scale.

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Throat Cancer Caused by HPV on the Rise Among Men

Throat cancer caused by HPV on the rise among U.S. men, data shows. Oropharyngeal cancer has become the most common cancer caused by human papillomavirus over the last decade – occurring more often than cervical cancer.

The rates of men who are diagnosed with the throat cancer and die from it rose in nearly every U.S. state between 2001 and 2017, according to research conducted by the University of Texas. The rates among women only increased in the Midwest and Southeast.

“Rising oropharyngeal cancer among men is a documented public health concern,” said researcher Ashish A. Deshmukh. “Unfortunately, women in the Midwest and Southeast are also increasingly suffering from this disease.”

Throat cancer HPV

That’s also where the incidence rates among men jumped the most. And previous research has found states in the Midwest and Southeast to have particularly low HPV vaccination rates.

More than 90% of HPV-associated oropharyngeal cancers could be prevented if more adolescents received the recommended number of HPV vaccine doses, researchers said.

Oropharyngeal cancer affects the middle part of the throat behind the mouth. Symptoms include a lump in the neck and a sore throat.

There are 20,236 cases per year in the U.S., according to the U.S. Centers for Disease Control and Prevention. Seventy percent, or about 14,400 cases, are believed to be caused by HPV.

The number of people diagnosed with large tumors has increased by more than 4% per year, the University of Texas researchers found. And the death rate among men jumped by more than 2% annually between 2006 and 2017.

The researchers identified 260,182 cases of oropharyngeal cancer and 111,291 deaths between 2001 and 2017. White men ages 65 and older, and men living in he Midwest and Southeast were the most likely to be diagnosed with the cancer.

South Dakota had the most troubling surge, with a 6% annual increase. Kansas was next with an increase of 4.7%. The only states that didn’t see increases were Alaska and Wyoming.

“The marked increases in incidence among elderly men and advanced-stage tumors, as well as the concurrent increase in mortality in the last decade, are troubling,” said Haluk Damgacioglu, a postdoctoral fellow at the university.

For women, the largest jump in incidence rate was observed in Louisiana, at 3.1%.

In Philadelphia and across the country, vaccine hesitancy continues to be a driving factor in HPV vaccination rates. Some parents feel the vaccine is unnecessary because their children are not sexually active; others are concerned about side effects.

The HPV vaccine must be administered as two doses to provide full immunity. The CDC recommends children receive their two doses between ages 9-14.

The study findings were published in JAMA Otolaryngology-Head & Neck Surgery.

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