A Q&A with SMH Family Nurse Practitioner Maggie Tabano, ARNP
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To learn more about Human Papillomavirus (HPV), the HPV vaccine and cervical cancer, we reached out to SMH Family Nurse Practitioner Maggi Tabano, ARNP
Like all viruses, Human Papillomavirus (HPV) causes infection by entering the body’s cells and replicating, or making copies of itself, then infecting other cells. There are more than 150 different types of the sexually transmitted disease (STD); about 40 of the HPV types infect the genital area and are spread by skin-to-skin contact during sex. Categorized into low-risk or high-risk HPV, Human Papillomavirus can cause health problems such as genital warts and cancers.
Eight out of 10 people will get HPV in their lifetime, making it the most common sexually transmitted infection. But regular screenings and getting vaccinated can help prevent it.
1. What are the signs and symptoms of HPV infection?
Often times, there are no symptoms of an HPV infection. In fact, most HPV infections go away within a few years, but some last longer and can result in an outbreak of genital warts, small bumps or a group of bumps in the genital area. Because the virus is not always active, it can take years for symptoms to appear or for the infection to be detected. Without symptoms, the infected person can unknowingly pass the infection to others.
2. What diseases can HPV cause?
In most people, the immune system is strong enough to fight off most high-risk and low-risk HPV infections and can clear them from the body. Infections that are not cleared from the body are called persistent infections. A persistent infection with a high-risk HPV type can cause cells to become abnormal and can lead to a condition called “pre-cancer.” It usually takes years for this to happen, and that is why regular medical examinations are important.
HPV infections also can cause:
- Cancer – At least 13 high-risk types of HPV are linked to cancer of the cervix, anus, vagina, penis, mouth, and throat. Most HPV-related cancers are caused by two high-risk HPV types: HPV 16 and HPV 18.
- Genital warts – About a dozen types of HPV cause genital warts; these types are categorized as low-risk types. Most cases of genital warts are cause by HPV 6 and HPV 11. Genital warts can grow on the vulva, vagina, cervix, penis, or anus. Genital warts are not cancer and do not turn into cancer.Note that not all HPV infections will cause genital warts or cancer.
3. What are the treatments for HPV?
While there is no treatment or cure for HPV, the health problems that some HPV infections cause can be treated. Genital warts can be treated with a prescription medication from a healthcare provider. Cervical pre-cancer and other HPV-related cancers can be treated, but early-stage diagnosis makes a big difference in treatment success; prevention and regular screening are key.
4. How can I prevent HPV infection?
Get vaccinated. The Human Papillomavirus vaccine protects against the HPV types that commonly cause cancer, pre-cancer, and genital warts.
Get screened for cervical cancer regularly. HPV vaccination helps prevent HPV infection, but it is not a cure for HPV. Regular gynecological exams and cervical cancer screening can detect signs of abnormal cell changes of the cervix, allowing early treatment so they do not become cancer. Use a latex condom, if you are sexually active. Using a condom can lower your chances of getting HPV, but it does not fully protect against HPV infection because the disease can infect areas not covered by a condom.
5. Who should get the HPV vaccine?
The U.S. Centers for Disease Prevention and Control (CDC) recommends the HPV vaccine for girls and boys/women and men, ages 9 to 45. HPV vaccination, given in a series of shots, works best when it is done before a person is sexually active and potentially exposed to HPV. But it still reduces the risk of getting HPV if it’s given after a person has become sexually active.
The ideal age for HPV vaccination is between 11 and 26 years. The series of shots can be given at the same time as other vaccines for childhood illnesses.
For those 9 to 14 years old, two shots of vaccine are recommended; the second shot should be given six to 12 months after the first one. For those age 15 and older, three shots of vaccine are recommended, and they should be given within six months.
Studies show that getting all doses of the HPV vaccine before you are sexually active can reduce your risk of getting certain types of HPV-related cancer by up to 99 percent. Those already infected with HPV should still get the vaccine if they are younger than age 26 as it helps protect against other types of HPV that can lead to cancer.
6. Should I still get screened for cervical cancer if I’ve gotten the HPV vaccine?
Yes. As mentioned before, the vaccine is a prevention method, not a cure. Women who have been vaccinated still need to have regular cervical cancer screening. (See guidelines below.)
7. How often should women be screened for cervical cancer? Which tests are recommended?
Screening frequency and testing method depend on the woman’s age and health history. The American College of Obstetricians and Gynecologists recommend:
- Women ages 21 to 29 should have a Pap test every three years; HPV testing is not recommended.
- Women ages 30 to 65 should have a Pap test and an HPV test done every five years (preferred). It also is acceptable to have only a Pap test every three years.
- Women who have a history of cervical cancer, are infected with human immunodeficiency virus (HIV), have a weakened immune system, or who were exposed to diethylstilbestrol (DES) before birth might require more frequent screening and should consult their own doctor for screening guidance.
- Having an HPV vaccination does not change screening recommendations. Women who have been vaccinated against HPV still need to follow the screening recommendations for their age group. You can schedule a Pap and cervical cancer screening at most gynecologist offices, and some primary care physicians also offer cervical cancer screening.
8. Are there side effects to the HPV vaccine?
Millions of people have been vaccinated against HPV since the vaccine came out, and the most common reported side effects are: soreness and redness at the shot site; fever; headache or fatigue; nausea; and muscle/joint pain. For more on HPV vaccine safety, visit the CDC website.
9. Where can I get the HPV vaccine?
HPV vaccinations are administered at pediatrician’s offices, gynecologist offices, or the local Health Department.
10. Is there a genetic test to determine cervical cancer risk?
No. Cervical cancer is not a hereditary disease. Virtually all cases of cervical cancer are caused by HPV infection, and just two HPV types, 16 and 18, are responsible for about 70 percent of all cases.
* Updated March 2019 to reflect the FDA's October 2018 recommendation expanding use of the vaccine to age 45.
An ARNP with advanced training in genetic counseling, Maggi Tabano, MSN, AOCN, is certified as a family nurse practitioner by the American Nurses Credentialing Center and as an advanced oncology nurse practitioner by the Oncology Nursing Certification Corp. Tabano, a former University of South Florida professor in the graduate-level oncology program for nursing students, is dedicated to improving patient care through disease prevention, education and counseling.