HPV 101: Why you have a Pap smear and what it means

I have had the HPV conversation with a lot of women in my office this month as pap smear after pap smear has come back abnormal and we move to the
necessary steps of follow up. My patients are mostly young women, and my
discussion of HPV (human papillomavirus) is usually the first time that they are
really learning about this little virus. I am always surprised at how little women
know about why we do Paps and how abnormal results can affect them. So here
is a primer for Pap smears and HPV- with a little history thrown in!

The cervix is the opening to the uterus, and is found at the very top of the
vagina. Back in the day, cervical cancer was the leading cause of death
in women, and no one knew why, or how to test for it. Enter Dr. Georgios
Papanicolau, who in 1923 was doing research on female guinea pigs and
studying vaginal fluid to try to better understand the menstrual cycle. As chance
would have it, one of his guinea pigs had uterine cancer and he realized that
he could plainly see the abnormal cells under the microscope. It was an “a-
ha!” moment for Dr. Papanicolau and a breakthrough in what ultimately became
known as the Pap smear.

Cells are obtained from a woman’s cervix with a brush and studied under
the microscope. Abnormal cells signal precancerous changes that can then
be treated, thus preventing cervical cancer. But the cause of these cellular
abnormalities was still a mystery. Then in 1983, German virologist Harald zur
Hausen proved that HPV was the cause of cervical cancer, and went on to win
the Nobel Prize for this important scientific discovery.

So now we know: HPV is the cause of abnormal pap smears.

How does someone get HPV? It is sexually transmitted. As a matter of fact,
HPV is the number one sexually transmitted infection out there. Between 75-
80% of Americans have been exposed to HPV at some point in their lifetime.

Patients ask me all of the time what they can do to prevent getting it, and the
answer gets tricky. HPV is small enough that even condoms don’t protect you
entirely. The key would be not to have intercourse with anyone who has already
been exposed- but how can you tell if someone has been exposed? While men
certainly carry this virus, most never know that they have it, because it does not
cause any symptoms at all. And it is not something that they are ever tested for,
so when someone tells you that they have “been tested for everything”, it usually
does not include HPV.

I tell my patients not to stress about an abnormal pap smear, even if it means
that they have been exposed to HPV. So have 8 out of 10 people out there! It is
so common that I hate to give it the stigma of an std. It is something that people
live with, and that their immune systems fight successfully every day. Keep on
top of your pap smears and follow ups, and HPV won’t interfere too much with
your life.

For our younger generation of daughters, consider the HPV vaccine. Once HPV
was definitively linked to cervical cancer, the scientific world raced to develop a
vaccine, and Gardasil was introduced in 2006. In 2009, it was approved by the
FDA for young boys as well, since they are carriers of the virus and transmit it to
women. It has been safely given to thousands of young women and men, with
the understanding that it is most effective BEFORE the onset of sexual activity,
and hence before exposure to HPV. This vaccine is the newest tool in our
evolving fight against abnormal pap smears and cervical disease in women.

Dr. Papanicolau would have been proud.