GynoFiles

    Did you realize the FDA has expanded the use of HPV testing for what they are calling primary HPV screening. In the past two years gynecologists, backed by data from large studies including, The Addressing the Need for Advanced HPV Diagnostics (ATHENA) trial that Dr. Trupin was a Primary Investigator for, gynecologists have been testing young ladies from 25-29 primarily for HPV. If that test is positive for HPV 16 or 18 the microscopic test and biopsy called colposcopy is used. If you test negative for 16 and 18 on the primary HPV test, but positive for one of the other high-risk types (31,33, 45, 51, 52, 56, 58, 59, 66, or 68) you then get a traditional pap test which looks for changes in the cells of the cervix. For those who test positive for the pap test, they will get their cervix evaluated by colposcopy. Women over 30 can be tested with a pap plus an HPV test together. The goal is early detection for less invasive therapies.   Primary screening test r...

Immunity, because of vaccination, is the best way we have of protecting ourselves and out children from the HPV virus and the cancers it causes. The newest version of the vaccine Gardasil has now more protection than ever and one less shot to make it even easier .  The vaccine has both gotten stronger and easier to administer. Getting us closer to the dream of eliminating cervical cancer .  Gardasil 9 is easier to administer as  now we are requiring only 2 doses instead of 3 to be protected.  We have known for many years, since the earliest vaccine research, that the vaccine protects boys as well from both warts and genital cancers, and that protecting both boys and girls helps protect their partners in the future. Now the Pediatric society has come out with strong recommendations regarding vaccination of boys as well. Making this part of routine vaccine schedules helps practices and families comply with the recommendation.  Our US Food and Drug Administra...

Cervical cancer is caused by the cancer causing infection with one of the high risk type of HPV viruses. The vaccine is recommended for girls at age 11. We may be one step closer to our dream of eliminating cervical cancer . On  the US Food and Drug Administration (FDA) in December of 2015 approved Gardasil 9 , a human papillomavirus (HPV) vaccine from Merck that prevents cancers and other lesions caused by nine HPV types, five more than the original Gardasil protected against. There is virtually 100% protection of the HPV type you get in a vaccine if you have not yet been exposed to that vaccine.It is critical that you are the one to be vaccinated, if you are the one that wants protection against HPV infection. Even though both boys and girls have been vaccinated for many years in the US, a new study indicates that if you were not vaccinated, your rate of getting HPV has not changed from your chances of getting HPV before the vaccine was invented. The study came o...

We may be one step closer to our dream of eliminating cervical cancer . On  the US Food and Drug Administration (FDA) in December of 2015 approved Gardasil 9 , a human papillomavirus (HPV) vaccine from Merck that prevents cancers and other lesions caused by nine HPV types, five more than the original Gardasil protected against. There is virtually 100% protection of the HPV type you get in a vaccine if you have not yet been exposed to that vaccine. The first vaccine protected against  HPV types 6, 11, 16, and 18. Gardasil 9 covers these as well as types 31, 33, 45, 52, and 58. These latter five are currently responsible for roughly one in five cases of cervical cancer. In the earlier vaccine there was some cross protection of other viruses, and since there are 14 HR types of HPV we can project some cross protection there as well. Gardasil is indicated  for girls and boys ages 9-26. Gardasil 9 is given on the same schedule. There is no indication to repea...

Pap tests can test for uterine cancer as well as cervical cancer. When to have your first test, how often to test, whether to also test for the HPV virus, and what this test might show including abnormal changes of the uterine lining or infections are all decisions to be made as an individual in consultation with your own provider. Pap smear guidelines have evolved rapidly in the past decade, and those who have had HPV testing, vaccination, or a series of negative tests do not necessarily 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. Women need yearly pelvic examinations even though they may not need the additional testing of a pap smear.  Pap tests themselves are an actual swabbing of the cervix so in addition to the sampling of the cervix, it will pick up cells from the uterus.. The pelvic examination checks you for conditions of the vagina, the vulva, the ut...

Dr. George Papanicolaou Inventor of the pap smear On Throwback Thursday we take a moment to celebrate Dr. George Papanicolaou who  invested the pap smear,. The degree to which this improved the health of women is untold, and like many other discoveries it was stumbled on, it was not something he set out to discover.  Dr. George began his career in a very different direction, and his doctoral thesis was on parthenogenesis. In his original appointment to Cornell medical school the research guinea pig colony had an over abundance of animals, and he decided to begin to look at material that might help him discover sexual differentiation from the x and y chromosomes to control the reproduction of the guinea pigs. They didn't have the tests we have now, and he was looking to figure out when the female guinea pigs were fertile. It was a messy and inaccurate business to constantly have to kill the animals to analyze stages of the ovary to obtain the cells doctors would use...

The high risk kind of human papillomavirus (HPV) are associated with 90-100% of cervical cancers and over 90% of anal cancers. We know that testing the anal region may be as important as testing the cervix and the vagina, but who and when to test is a very complex subject, and this post won't cover everything you will need to gab with your own gyno about .  Guidelines can be found in many organizations on line, such as the US Preventative Task Force , or the ASCCP . a question that comes up frequently is what about the "field effect" (the urethra, the clitoris, the anus, as well as the cervix and vagina and vulva) of the disease? Do you need actual pap tests of areas other than the cervix? USPT guidelines do recommend anal pap tests for HIV men who have sex with men, and for HIV women with prior cervical caner. The anal pap smears often will not get cells (about 13% of the time accordin to Dr Lamme et al in Obstetrics and Gynecology), so it may have to be repeated.  ...

Pap tests are a screening test for cervical cancer, as are HPV (Human Papillomavirus) tests , so the accuracy of a single pap is not really as helpful as having both a pap and an HPV test. Whenever you are getting screened, those at risk for abnormal tests are probably going to get the most accurate testing. If you want to know how accurate your test is, there are a lot of considerations, and basically you and your gyno will have to answer this  together. It depends if you are talking a single pap test, ever, or just one pap in a series of pat tests. Basically the pap test reduces the rate of cervical cancer by about 75%, by alerting testing in the precancerous, non-invasive stage. A pap can be fairly insensitive at picking up what is wrong on any single test, inaccuracy can be as high as missing 10 to 15% of cases. HPV is a DNA virus that infects skin and mucosal tissues and causes cell changes that lead to what is known as cell proliferation (overgrowth) and conve...

We may be one step closer to our dream of eliminating cervical cancer . The HPV vaccination has gotten an upgrade! On December 10th the US Food and Drug Administration (FDA) today approved Gardasil 9 , a human papillomavirus (HPV) vaccine from Merck that prevents cancers and other lesions caused by nine HPV types, five more than the original Gardasil protected against. The Gardasil vaccine is still available now, and the newest version will be available in Feb 2015 for those who want to schedule appointments or consultations . There is virtually 100% protection of the HPV type you get in a vaccine if you have not yet been exposed to that vaccine. The first vaccine protected against  HPV types 6, 11, 16, and 18. Gardasil 9 covers these as well as types 31, 33, 45, 52, and 58. These latter five are currently responsible for roughly one in five cases of cervical cancer. In the earlier vaccine there was some cross protection of other viruses, and since there ar...

In a world wide study of over 17,00 young women looking at individuals ages 15-26 who received the HPV Vaccine , it has been shown that the vaccine works to reduce all HPV disease. This study was headed by researchers in Columbia, and looked at those young women who tested HPV negative at the time of receiving their vaccine. It was important that the individuals studied were negative for HPV disease as this vaccine is a prophylactic vaccine: it does not treat those exposed. They watched the patients closely for about 3 and a half to 5 years. and have proved the vaccine is 100% effective in reducing the risk of getting precancer of the cervix, the vulva, or the vagina and was highly effective in reducing the rates of warts as well. It is of critical importance to get the young men and women their vaccinations when they are young. If you have questions see your health care provider .

Pelvic examinations are critically important to rule out STD lesions, skin cancers, pelvic floor disorders, and so much more. But as a first step, especially for tests you need when you are asymptomatic, we have tried to improve testing for women (and men). Improved testing may be checking urine or blood, and it turns out that checking the urine is an excellent way to detect genital diseases. Gynos have been using urine tests for Chlamydia and Gonorrhea for a long time . A simple urine test for human papillomavirus (HPV) has now been shown to accurately detect HPV, which is now known to be present, at some time, in the lives of 2/3 individuals. The study was published online on September 16 in BMJ. You do need your gyno to validate the results however and to determine if you need a cervical cancer test, which cannot be done on urine. We also know that we have over 170 types of HPV that can be detected, but we worry the most about HPV 16 and 18, and type spec...

Cervical cancer detection is more than just a pap smear, it's getting regular pelvic examinations, following up episodes of bleeding or pain, and having a personal gyno to consult regarding how to lower your cancer risks. But, ultimately, most do rely on regular pap smear testing to determine their risk for cervical cancer. Pap smears are a sampling of the cervical cells to determine whether the cells are normal. As such pap tests don't treat cancer, they seek it, as in a simple screening test. Pap smear testing cannot detect all cancer, just most of it, yet who to test, and exactly how to test has been under debate as we try to further eliminate cervical cancer, but focus on safety and cost for American women. Many organizations have produced pap smear guidelines. American Cancer Society recommendations can be found at this lin k  . The American Society for Colposcopy and Cervical Pathology can be found at this link , where they discuss the guidelines that were put in pla...

The CDC is trying for figure out why more women are not taking advantage of the HPV Vaccine . Rebecca B. Perkins, MD, from the School of Medicine, Boston University, Massachusetts, and colleagues sent a 15-item questionnaire to 1000 A COG members . Of the 366 obstetrician/gynecologists who completed and returned the questionnaires, 92% reported offering vaccination to patients, but only 27% of their eligible patients were vaccinated. The most highly cited barrier to vaccination was refusal by parent or patient.  HPV Vaccination prevents cervical cancer Young men and boys can be vaccinated, and their vaccine will help prevent cervical cancer too You don't know if you have HPV unless tested HPV vaccination prevents vaginal, vulvar, anal and probably many oral cancers The first HPV shot is the most protective, but you are not as well protected over time if you don't get your boosters; the newest study says 2 doses are enough! Protection lasts a long time, recent stud...

All STDs can be treated, but knowing if you are cured, if you are immune, or if you have become reinfected by your partner is an important consideration. If you had an STD treated the next step is to figure out if you were really cured. And each STD has both an incubation rate (before which you won't even know you need to be cured), and a time to cure if it's treated. HPV disease is odd, you can't cure it with treatment, but you can get over it. About 80-90% of women will eliminate their HPV infection within 8-24 months. Although some who we think are clear have just reduced their virus amount by about 90% to undetectable levels. The good news about reducing your viral amount to undetectable levels is that cervical cancer is often kept at bay by just having an immune system fight it off. Knowing whether you are then immune to getting reinfected with the same HPV virus is a very difficult concept.Although we do develop antibodies to HPV after being infected, they are...

Many women wonder if they have an HPV infection, and for more about the HPV virus you can check this site at the CD C. There are many options now in HPV testing that can check the cervix, the vagina or the rectal area. But few women get offered any testing other than testing of the cervix. We are following this subject closely as there are new developing tests of the activity of your infection, and tests of the specific type of HPV. If you wonder if you have HPV a few questions can predict the outcome of any test you may have. Firstly, have you been sexually active? About 30% of women will test positive for HPV after their first 2 years of having sex. Well, even if you say no, you haven't been sexually active this may not actually be protective against HPV infection. Non-sexual HPV transmission is possible. In fact we are getting away from calling HPV a "sexually transmitted disease" because it is transmitted in so many other ways, and perhaps is mostly tra...

The numbers of men and women who have HPV is staggering, the numbers of people who have had it at some time in the past, makes the affected population be so high as to consider this disease almost universal.  The current prevalence of HPV: who has it in our population is according to the newest study is over two thirds of the population; and the incidence: who has had HPV at any time in their life (cumulative incidence) is therefore almost everyone. In this new study presented showed that 69% of Americans have the HPV virus, they looked at all strains of the HPV virus, including those that cause warts and throat cancer.   Not just the strains that cause cervical cancer. This study looked at a wide range of ages, and looked at many tissues, including skin and gut that aren't traditionally thought of as the HPV harboring organs. Our immune system can keep this virus quiet for years. Newer, more accurate, testing has been able to identify these viruses as we never have be...

Video Colposcopy at Women's Health Practice We know that the Human Papilloma Virus (HPV) has almost 100 different types or "cousin" virus out there. And many are either completely harmless or virtually never seen in people. You can be tested for this virus. So your question may be if you test positive for the HPV virus which do you have, and then the question remains: if you have one of the HPV virus how serious is this infection. For women who have had testing for the first time, we are certainly not going to know how long you have carried the virus if you test positive, but we know a lot more about various types of the HPV infection. About half the women with  high grade abnormal pap smears will have HPV 16 or 18. The National Cancer Institute estimates that about 1 in 5 women who test positive for HPV 16 or 18 will develop the severe dysplasia that is the step before invasive cancer. About 70-75% of all cervical cancers are caused by HPV 16 or 18, and m...

Close to the May 13th birthday of Dr. George Papanicolaou's the FDA approves HPV test as the first line test for cervical cancer instead of getting a pap smear  At Women's Health Practice we are excited to thank our ATHENA study participants for leading the way to one of the momentous FDA decisions of the decade. US Food and Drug Administration (FDA) today approved the cobas HPV Test (Roche Molecular Systems, Inc) for primary cervical cancer screening in women aged 25 years or older. This decision heavily relied on this test for their ruling. We have been following the FDA's position on this test. It was the first human papilloma virus (HPV) DNA test approved alone to detect high-risk HPV. The test is recommended for first-line screening, and can specifically identify HPV genotypes 16 and 18, which are responsible for about 70% of all cervical cancers. It also concurrently detects 12 other high-risk genotypes (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, ...

Most women have not ever had a Human Papilloma Virus.(HPV) test although we know that the root of cervical cancer resides with cells of the cervix being transformed into precancerous and then cancerous tissue. Many women are even told they should not have a HPV test because it is such a common infection without consequence, it may cause unnecessary testing if done too often on the wrong patients. Most women who have had HPV testing were first found to have an abnormal pap, although testing both HPV and the cells by pap together is starting to be more commonly performed. Roche's Cobas HPV DNA test got a unanimous "yes" vote by and FDA committee to becoming the "test instead of the pap test," as the first screen for cervical cancer. Final FDA approval is waiting.Pap tests then would only be added on to women who have a positive HPV test. The reasons for this lies in the accuracy and ease of this test and in the data that shows that while we do a great job now, w...

The pap test and HPV testing on the pap is a cellular biopsy to determine the health of your cervix. We have arrived at the concept of a "liquid biopsy," for some organs meaning that we can check the health of that organ with the appropriate blood test. In some cases this actually means harvesting cells from the blood stream. In the case of the cardiovascular system it means determining the nature of levels that correlate with the condition of your blood tests. But Heart Health means overall cardiovascular system health. Your blood pressure should be normal, your heart should beat at a modest pace, and your blood vessel walls should be pristine clear of inflammation and plaque build up. How we determined this used to be a weight, a blood pressure check and a cholesterol measurement. The addition of lipid tests that are beyond the cholesterol number, and delve into the fat and carbohydrate metabolism has been the newest frontier in heart health testing. But we can look at he...