GynoFiles

HPV disease and what to do after a positive HPV test, or after an abnormal pap smear, or after prior treatment for precancerous changes of the cervix has been the subject of a lot of controversy. In the US, almost every strategy we use prevents cervical cancer reliably as long as you are following gyno advice. Ultimately we fail when we don't get the patient in for testing or follow up. But, we are still in search of a way to more reliably go after patients that are likely to progress to cervical cancer, and be able to be patient and wait for HPV disease to resolve if it is likely to not progress to cervical cancer. The newest meeting of the minds that follow this subject closely was in March of 2012, specifically looking at how the cervical biopsies are interpreted. This meeting was called CAP Pathology and Laboratory Quality Center and the ASCCP Consensus Conference: The Lower Anogenital Squamous Terminology Standardization Project (The LAST Project)  . Their object is...

If you get an HPV vaccine, and the take is appropriate, you are basically immune to getting HPV. But the question is, are others immune as well? Antibodies can be in our system from infection or vaccination, and they can protect us from new infections. Naturally acquired antibodies (just after being exposed to the HPV) probably are not as strong as the ones that we get from being vaccinated, but actually researchers are not sure. About 50-70% of women exposed to a particular HPV type will develop what is called type-specific antibodies. Since there is not a routine test of our antibody level after we get an infection, its unclear whether naturally acquired antibodies provide complete future protection against new HPV infection. It's even more uncertain as to whether these antibodies can also help prevent the progression to precancerous disease of the cervix (also called CIN). Researchers in the PATRICIA HPV 16/18 trial. Published Costa Rica HPV 16/18 vaccine tr...

Currently if you have an early precancerous change of the cervix, or cervical intraepithelial neoplasia, or CIN, the treatment, is to watch if very early, and then if it advances to moderate or severe disease (II or III) is to surgically remove the abnormal area. This is done with a LEEP or a freezing called cryosurgery. A group of researchers from Bochum, Germany and Vienna Austria have looked into using Imiquimod for the treatment of pre-invasive cancer of the cervix. This is a medication used for the treatment of genital warts caused by HPV, and marketed as Aldura, and we have written on some of this progress in prior posts. Most of the topically applied medications for HPV caused genital warts are locally destructive medications that essentially burn off the warts. Imiquimod is different because it works locally on the immune system to enhance the body's ability to reverse the changes of the cells that HPV has induced to effectively resolve the infection. A group,...

When a woman gets an early pre-cancer of the cervix, called mild dysplasia, or CIN I, she is likely to resolve her infection, or at least keep it in check so that it doesn't progress, and it's only likely to progress to overt invasive cancer in about 1/100 cases. Even if she has severe dysplasia, or CIN III, she only has a 1/10 chance of progressing to invasive cancer. The reason that so many women clear or control their disease is related to an innate immune response that some women can count on. The cervical pre-cancer is caused by the Human Papilloma Virus (HPV). Various types of HPV viruses cause other diseases rather than just cervical cancer, including genital warts. It has been shown that the warts too can be cleared by an immune response. To aid the ability of the body's immune response to clear the HPV Virus a novel wart treatment called imiquimod was developed and approved for use in 1997. In 1999 a small group of women (56 women) were given the opportunity to ...

Pap test guidelines are changing rapidly, and you may not need a test yearly. You should have a pap test when your gyno recommends that you have a pap test, and remember, pap tests are different than pelvic examinations. Pap tests themselves are an actual sampling of the cervix. The pelvic examination checks you for conditions of the vagina, the vulva, the uterus and the ovaries. The pap smear can pick up abnormal ovarian and uterine lining cells, but that's not primarily what it is aimed to do. As for when to have the test: every year, every other year, every third year or every fifth year will depend on your age, your prior tests and whether you are getting an HPV test also. The guidelines as to when to have a pap do vary very slightly from one organization to the next and they have changed recently. So it's important if you are a mom of a young woman, ask your gyno what she currently recommends for your daughter, it's changed over what she recommended for you! The cur...

A reader asked several great questions regarding the findings of CIN, in her case I/II or mild to moderate dysplasia, on the pathology report of a D and C and then NovaSure done. NovaSure endometrial ablations are to treat heavy menstrual cycle bleeding which is the result of the shedding of the endometrium, or the lining of the uterus. CIN stands for Cervical Intraepithelial Neoplasia. This is a term for precancerous changes of the cervix itself. It is not likely the cause of any heavy menstrual bleeding. It is not likely the cause of any actual symptoms at all (spotting and discharge are sometimes associated, but not often). It is the result of an HPV infection, and it can lead to cancer. The chance that a woman will have cervical cancer after a CIN I diagnosis is probably about 1/100...after a more high grade diagnosis ...CIN II or CIN III....more like 10/100. Other tests are useful, like an HPV 16/18 test, or the actual pap smear. But bottom line, CIN cannot come from the lining...

Genital warts come from viruses, and we catch a wart when we are in contact with and subsequently infected with a virus that causes them unless we have previously been protected by the vaccination. If you have a genital wart odds are it came from the HPV Virus Particle virus types 6, and 11 of the Human Papilloma Virus (HPV). And there are about another dozen HPV types that can cause these. These are highly infectious and studies show they have an with an incubation period which ranges from 3 weeks to 8 months. If you had sexual contact with some one only prior to that then you might be a case of virus reactivated. But for most women, the warts come from contact within the last 3 weeks-8 months. When you come in contact with some one who has the type of HPV virus that causes the genital warts or condyloma then you will likely, if you have acquired infection, do so fairly rapidly.  The main way that HPV is transmitted is sexually, but non-sexual contact is possible:...

The HPV Virus Colposcope Pap smear guidelines are changing, and will continue to change. The biggest changes in recommendations are for when and how often to get your pap smear. If you have gotten a call about an abnormal pap smear, or an abnormal pap smear with a positive High Risk HPV test, you probably want to know a lot about what this means. Especially if you've not had an abnormal result before. It is a big subject to try to cover all the important aspects of this topic in a simple blog post and I always encourage women to write down their questions and know that when you come in for your consultation or your second opinion appointment with us we will provide you with hand outs and pictures that will help you tell the whole story! When patients come for consultation and discussion of management of a prior abnormal pap smear it's important we know their age, their previous STD history, their actual pap smear results, any prior cervical treatments, and of course th...