Can HPV really lead to cervical cancer?

Human papilloma virus, or HPV, affects nearly all sexually active men and women at some point in their lives. Many people “clear” or fight off their infections without ever knowing that they had an infection at all. However, a percentage of people with the virus do not clear their infections and may develop genital warts, cervical cancer, or other types of cancer.

We spoke to Dr. Terez Yonan, an adolescent medicine specialist at CHOC Children’s, to get the facts on HPV and how it can indeed lead to cervical cancer.

terez-yonan-do
Dr. Terez Yonan, an adolescent medicine specialist at CHOC Children’s.

How common is HPV?

There are nearly 80 million people currently infected with HPV in the United States, according to the Centers for Disease Control, and nearly 14 million people, including teenagers, become infected with HPV each year.

How does HPV lead to cervical cancer?

The most common way to contract HPV is through sexual contact, from a direct transmission from one person’s genitals to the other. When transmitted vaginally, the HPV cells will integrate into cells of the vaginal wall and cervix. This changes the composition of the normal, healthy cells and you end up with dysplasia, also known as abnormal and pre-cancerous cells. This can worsen and turn into cervical cancer.

For people with a normal immune system, it could take years for HPV to turn into cervical cancer, but for someone who is immune-compromised, that process could take just a few months.

HPV does not always lead to cervical cancer. There are what we call high-grade infections and low-grade infections. Low-grade infections are easily cleared by the body on its own. It takes about two years for a healthy person to clear HPV. High-grade infections can last longer in the body and put you at risk for cervical cancer or genital warts. Although not considered dangerous, genital warts are unsightly and can cause irritation depending on where they are. If not treated, warts can grow into different types of cancer, including oral and anal and penile cancer.

What are the warning signs of cervical cancer?

Most of the time, people don’t know they have HPV because there are no warning signs. In some cases, genital warts may appear. Abnormal vaginal bleeding can be a sign of cervical cancer. If you notice abnormal bleeding, consult your primary care provider, gynecologist, or adolescent medicine specialist.

Can I get tested for HPV?

A Pap smear, also called a Pap test, is a pelvic exam designed to test for cervical cancer in women. An HPV test can be done using the same sample of cells collected during a Pap smear.

When should I get my first Pap smear?

A Pap smear is intended for healthy, sexually-active people. They are generally not recommended before 21 years of age. For people who are immunocompromised, Pap smears are recommended when you become sexually active regardless of age because of the increased risk for picking up infections , and for those infections to more quickly develop into cancer.

How often should I get a Pap smear?

Someone who is immunocompromised needs two Pap smears within the first year of becoming sexually active. If those are normal, the exam can be done annually. Healthy women in their 20s need a Pap smear every three years. Beginning at age 30, Pap smears can usually be done every five years.

Who can do my Pap smear?

You can get a Pap smear from your adolescent medicine specialist, family medicine provider, internal medicine provider, or gynecologist. Nurse practitioners and physician assistants  in each of these offices can perform the exam as well.

What does an abnormal Pap smear mean?

If your results are abnormal, you will undergo more frequent Pap smears for monitoring, until your results are in the normal range. The frequency of these Pap smears will be determined by your doctor, but it could range from every three months to every year. Since many people’s bodies clear HPV on their own, when the results are clear again, you will return to an every three- or five-year schedule for Pap smears, depending on your age.

Your doctor may suggest a colposcopy, another type of cervical cancer test. This gives them a better view of your cervix. If they identify cells that may be abnormal, they will perform a biopsy and remove a tiny sample of tissue from either the inside or outside of your cervix. If the biopsy confirms the presence of abnormal cells, your doctor will discuss specific treatment options.

How can I prevent cervical cancer?

Receiving the HPV vaccine is the only way to protect against cervical cancer. Each year in the U.S., 13,200 women are diagnosed with cervical cancer. This number has decreased since the introduction of the HPV vaccine.

What happens if I get cervical cancer?

If you are diagnosed with cervical cancer, you will be referred to a gynecologic oncologist—a doctor who specializes in cancers of the female reproductive system. Most cases require chemotherapy, and some require radiation as well. Surgery may be a treatment option.

Get more facts about HPV

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Does my child need the HPV vaccine?

Human papilloma virus, or HPV, affects nearly all sexually
active men and women at some point in their lives. Many people “clear” or fight
off their infections without ever knowing that they had an infection at all. However,
a percentage of people with the virus do not clear their infections and may
develop genital warts, cervical cancer, head and neck cancers, and penile
cancers.

We spoke to Dr. Marisa Turner, a CHOC Children’s pediatrician, on the most common myths she hears from parents regarding the HPV vaccine.

dr-marisa-turner-choc-childrens-pediatrician
Dr. Marisa Turner, a CHOC Children’s pediatrician, addresses the most common myths about the HPV vaccine.

Myth 1: My child is
too young. They don’t need the vaccine yet.

Some parents decline the HPV vaccine because they think
since they have years until their child is sexually active. However, many
parents don’t realize the vaccine is more effective the earlier it is given.
The immune response to the vaccine is better when given younger, therefore only
two doses are needed if the series is started prior to the 15th birthday.

The
number of recommended doses depends on the child’s age when they receive their
first dose.
A two-dose series is given for children starting the
series before their 15th birthday. Children who start the series on
or after their 15th birthday will receive a three-dose series.

Myth 2: You can only
get HPV if you’re sexually active.

Although sexual intercourse is the most common way to get HPV, it is
not the only way to get it. It could take just one encounter to catch the
virus, and most people who carry the virus have no symptoms and don’t realize
they even have it. Even for those that are having protected intercourse, you
can still catch HPV despite using a condom.

Myth 3: Giving my
child the HPV vaccine will make them become sexually active.

Multiple studies have shown that giving this vaccine doesn’t
increase rates of sexual activity in those patients compared to those who don’t
receive it.

It’s important for adolescents to take a part in their own health
and begin to realize that decisions they make now can affect them later in life
and their future health.

Myth 4: Getting the
vaccine will guarantee my child does not contract HPV.

Most adults are likely to get HPV at some point in their
lives. Some people clear it on their own, but others do not. If your child is
vaccinated against HPV and later contracts HPV, it’s s likely to be a strain
you can clear on your own.

The HPV vaccine prevents against the nine strains of HPV
most likely to lead to cancer. About half of all new infections are in people 15-24-year-olds,
the peak age at which one should receive the HPV vaccine.

Myth 5: HPV only affects females, so my son does not need the HPV vaccine.

The HPV vaccine has benefits for males too. It prevents oral,
anal and penile cancer, and genital warts. Getting vaccinated will also help
prevent them from passing it on to other partners, which can happen even in the
absence of visible symptoms of HPV.

Myth 6: This vaccine
is new, so it must not be safe enough to give my child.

The HPV vaccine was first administered in 2006. Prior to
coming to market, it was studied for many years. Ongoing studies have tracked
patients for years after receiving the vaccine, and they have not shown any
adverse effects. The HPV vaccine is administered and studied all over the
world.

Each year in the U.S., 13,200 women are diagnosed with
cervical cancer. This number has decreased since the introduction of the HPV
vaccine.

Myth 7: My child
doesn’t need the HPV vaccine. If they contract HPV, we’ll just treat it.

There is no good treatment for HPV. Some strains clear on
their own, but others do not. It’s better to get vaccinated and lower your risk
of getting HPV in the first place.

Myth 8: Getting the
HPV vaccine will affect my child’s fertility later in life.

Receiving the HPV vaccine will not affect fertility. However, having HPV can cause changes in the cervix which can later affect fertility.

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HIV Symptoms and HIV Prevention

By Dr. Sora Song, pediatric resident at CHOC Children’s and Dr. Terez Yonan, adolescent medicine specialist at CHOC Children’s

HIV (Human Immunodeficiency Virus) is a virus that can spread through certain body fluids eventually attacking the body’s immune system and because of its potential severity, everyone who is sexually active should be aware of HIV symptoms and how to prevent HIV. HIV is a life-long illness, but people living with HIV have many different treatment options. Anyone who is HIV-negative and at risk of contracting the virus should know what they can do to decrease their chances of becoming infected PrEP and PEP, in addition to practicing safe sex, are options available for preventing HIV infection.

HIV symptoms in men and HIV symptoms in women

How long it takes for HIV/AIDS symptoms to appear can vary from person to person. Some people could look and feel healthy for years while they are infected. It is possible to infect others with HIV even if you have no symptoms. This means that getting tested regularly is important, even if you feel fine.

When a person’s immune system is overwhelmed by AIDS, they might notice:

  • Extreme weakness or fatigue
  • Rapid weight loss
  • Frequent fevers that last for weeks with no explanation
  • Heavy sweating at night
  • Swollen lymph glands
  • Minor infections that cause skin rashes and mouth, genital and anal sores
  • White spots in the mouth or throat
  • Chronic diarrhea
  • A cough that won’t go away
  • Trouble remembering things
  • Severe vaginal yeast infections that don’t respond to usual treatment
HIV prevention: PrEP

PrEP stands for pre-exposure prophylaxis. PrEP can stop HIV from infecting your body and spreading throughout your body. It is not a vaccine. PrEP is a pill that is actually a combination of two HIV medicines (tenofovir and emtricitabine) under the trade name Truvada®. This medicine has been approved for daily use. PrEP can cause side effects like nausea in some people but these generally improve over time. These side effects are not serious or life-threatening.

PrEP is taken before HIV exposure. It is taken every day. This is for people who don’t have HIV and are at very high risk for infection. It is recommended for those who:

  • have a sex partner who is HIV positive
  • have sex with a partner whose HIV status is unknown
  • are not in a mutually monogamous relationship with a partner who tested HIV-negative
  • have injected drugs or have shared needles in the past six months

For those at very high risk for HIV infection, PrEP can greatly lower your risk of infection if taken daily.

When used as directed, daily PrEP pills can reduce the risk of getting HIV from sex by more than 90 percent and from injection drug use by more than 70 percent. PrEP can be very effective if used as directed but is much less effective if not taken consistently. PrEP can only be prescribed by a health care provider. Your risk of getting HIV from sex can be even lower if you combine PrEP with condoms and other methods of prevention. PrEP should be used daily and for as long as there is risk for HIV infection.

HIV prevention: PEP

PEP stands for post-exposure prophylaxis. It is a method of HIV prevention after possible exposure. It should be started within 72 hours (three days) after possible exposure to HIV. PEP has little or no effect in preventing HIV infection if it is started later than 72 hours after HIV exposure.

Someone using PEP will take a combination of medicines, usually all in one pill, that fights HIV infection. This pill can cause some side effects like nausea, in some people. These side effects are not serious or life threatening. PEP is only used for 28 days after possible HIV exposure. It is not a substitute for other HIV prevention methods, such as pre-exposure prophylaxis (PrEP). Someone can switch to PrEP right away after completing PEP for continued HIV prevention.

PEP is for people who are HIV-negative or don’t know their status and, in the last 72 hours, may have been exposed to HIV:

  • during sex
  • at work through a needlestick or other injury
  • by sharing needles
  • during a sexual assault

PEP can help prevent HIV infection when taken correctly, but it is not 100 percent effective. If you may have been exposed to HIV in the last three days, or if you aren’t sure if you have been exposed to HIV or not, talk to your healthcare provider immediately. Start PEP as soon as possible to give it the best chance of working. Individuals should continue to use condoms with sex partners and practice safe drug injection practices (for example, using your own sterile needles) while taking PEP. These different methods can reduce the chances of transmitting HIV to others if you do become infected while you’re on PEP.

Testing while Preventing HIV

Anyone who uses PrEP or PEP needs to have close follow-up with their medical provider to get testing for HIV and other sexually transmitted infections. PrEP users should have repeat testing done on a routine basis because if someone becomes HIV positive, they need additional blood tests as well as different medications for HIV treatment. PEP users need to see their providers more often to ensure the medication is working.

Talk to your health care provider about whether PrEP or PEP is right for you.

Learn more about adolescent medicine at CHOC.

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Teens and STIs: A Check-up on Sexually Transmitted Infections

By Dr. Kristen Kurtz, pediatric resident at CHOC Children’s

It’s important for parents to educate themselves on the prevalence of teens and STIs, and what they can do for prevention. Sexually transmitted infections (STIs), also known as STDs, are infections that can be passed from person to person during sexual contact including oral, vaginal and anal sex. Some of the most common STIs include chlamydia, gonorrhea, syphilis, genital herpes, human papillomavirus (HPV) and HIV. About half of all new sexually transmitted infections are diagnosed in teenagers each year. It is important for all sexually active people, including sexually active adolescents and young adults, to be tested for these infections each year. Early detection is critical because some of the infections do not cause symptoms. The CDC and AAP recommend annual screening for ghonnerea and chalamydia for people who are sexually active. We recommended regular HIV screening for anyone who is sexually active.

Chlamydia

The most common STI is caused by a bacterium that is passed from person to person in bodily fluids. Most people who are infected do not have any symptoms, but symptoms can include:

  • discharge (abnormal fluid) from the vagina or penis
  • pain or burning with urination
  • abdominal pain
  • pain during intercourse
  • swelling or pain in the testicles

Serious consequences include chronic abdominal pain, infertility and abnormal pregnancy that can be dangerous for mother and child. Chlamydia is curable with a single dose of antibiotics. If any symptoms appear, it’s important to seek medical attention immediately.

Gonorrhea

Gonorrhea is caused by a bacterium that lives in warm, wet body parts (such as the mouth, anus and reproductive tracts). It is passed from person to person during contact between these body parts, and does not require a transfer of bodily fluids (ejaculation) to be spread. Most people who are infected do not have any symptoms, which may include:

  • discharge from the vagina, penis or anus
  • pain or itching during urination
  • abdominal pain
  • pain during intercourse
  • swelling or pain in the testicles

Serious consequences can include chronic abdominal pain, infertility and abnormal pregnancy that can be dangerous for mother and child. Gonorrhea is a little harder to treat but is curable. Treatment is often given in the doctor’s office and includes an antibiotic injection plus a single dose of antibiotic tablets.

 Syphilis

Bacteria spread by direct contact (touching) with an open sore can cause syphilis. Syphilis bacteria can even infect healthy skin. Sores most commonly occur on the external genitals, vagina, anus or rectum, but they can also occur on the mouth or lips and be spread during oral, anal or vaginal sex.

Symptoms of syphilis appear in three stages:

  • Stage 1: a painless, reddish-brown sore on the genitals, mouth, anus or rectum
    • Sometimes the sore is in a place that is hard to see on your own. This makes it more important to have routine medical exams.
  • Stage 2: flu-like illness with fever, decreased energy, rash and sore throat
  • Stage 3: complications occur, including brain damage, mental illness, heart disease, and/or death

Syphilis is curable with a single dose of an antibiotic injection if caught early enough. More prolonged treatment is needed for stage 2 or 3 syphilis. This means that getting tested routinely is important, even if you feel fine. Getting additional testing immediately is important if any symptoms appear.

Herpes

Genital and oral herpes are caused by a virus that is passed from person to person during direct skin contact, usually during sexual contact. It can be transmitted even when there are no visible sores. Genital herpes causes itching at first, followed by the appearance of painful blisters that can cause burning in the genitals. There is no cure for herpes. The herpes blisters will go away without medication, but the infection is not gone and will be spread during unprotected sex, even if no blisters are present at the time.

To help manage herpes, an antiviral medication can be taken to prevent or shorten outbreaks (recurrence of herpes bumps). The medication also helps prevent viral shedding – the process by which someone with herpes but no bumps can pass it to others. The medication can be used for oral or genital herpes.

Human Papillomavirus (HPV)

HPV is a virus that is passed from person to person during skin contact. It can cause genital warts, cervical cancer, penile cancer and anal cancer. HPV is the only vaccine-preventable cause of cancer. There is no cure for HPV, but there is a vaccine available to help prevent infection with the most common cancerous strains of the virus. Learn more about the HPV vaccine.

HIV

HIV (human immunodeficiency virus) is a virus that suppresses the immune system, and ultimately leads to AIDS (acquired immunodeficiency syndrome). HIV can cause a wide variety of symptoms, from those of the common cold to severe infections and mental illness. It is very important for sexually active individuals to be tested for HIV regularly, due to the variable nature of its symptoms and progression. Although there is medication available to manage symptoms, the is currently no cure for HIV.

Tips for preventing infection with STIs

It is important to know that some forms of birth control (the pill, patch, ring, implant, shot and IUD) all work to prevent pregnancy, but do not protect against STIs. There are, however, several ways to help prevent STIs.

First, talk to your partner about how you want to practice safe sex. This can include waiting to have sex until you both get STI testing. Once you’re both negative, use condoms with every sexual act. Using condoms is the most effective way to prevent the spread of STIs during sexual contact, including oral, anal and vaginal sex.

It is important to remember that condoms only protect against:

  1. infections that are transmitted in bodily fluids, and
  2. infections that are transmitted by direct contact only if the area is covered by the condom.

If a person has bumps or sores on a body part that is not covered by a condom, the infection can spread to another person. One other option available to prevent STI spread is the dental dam. The dental dam is a sheet of latex that can be used to cover the vaginal or anal area during oral sex to prevent spread of infection.

Learn more about adolescent medicine at CHOC.

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Teen Pregnancy Prevention Month: What Parents Should Know

By Dr. Rachel Watson, pediatric resident at CHOC Children’s

Pregnancy during the teenage years can be a significant source of social, economic and interpersonal stress for an adolescent and their family. Only 40 percent of teen mothers earn their high school diploma by age 22, as opposed to 90 percent of women who do not give birth during their teenage years. Less than 2 percent of teen mothers graduate from college by age 30.

In the U.S., teen pregnancy has been steadily declining over the past decade. Although the reasons are not entirely clear, it is thought that the largest contributors are increased access to sexual health information and increases of prescription written for and use of birth control have contributed to this decline. The U.S. has seen a decline in teen birth rates in all 50 states and among all racial and ethnic groups. However, each year more than 200,000 teens will give birth in this country.

teen-pregnancy-statistics

Teen birth rates are higher in individuals who are living in poverty, living in a single-parent household, in foster care, and/or facing racial discrimination.

What can parents do to prevent teen pregnancy?

Have open, honest discussions with your teen about sex, sexuality, and healthy relationships.

  • Be honest. Let your teen know that talking about sex isn’t easy, but that it is important that information about sex comes from you.
  • Be available and keep all lines of communication open with your teen. They may not want to discuss these topics with you initially, but let them know that it’s important to have these discussions to avoid potentially harmful situations.
  • Give your teen a chance to talk and ask questions.
  • Leave behind judgement. Instead, be curious.
  • Show your love and support.
  • If you are having a difficult time with these conversations, consider asking a pediatrician/medical provider, trusted family member, or priest, minister or rabbi for help.

Start these conversations early

  • Fifteen percent of 15-year-olds report sexual activity in the past.
  • Lay the groundwork before the onset of puberty.
  • Answer their questions truthfully at any age. This will build trust, starting in toddlerhood.

Schedule regular appointments with your teen’s medical provider.

  • Doctors and nurses use this opportunity to discuss the advantages and disadvantages of different contraceptive methods, sexually transmitted infections, and what steps your teen can take to protect themselves.

Know where your teen is and what they are doing, particularly after school.

Know your teen’s friends.

Be aware of your teen’s use of social media

What can educators to do prevent teen pregnancy?

Discuss normal sexual development and sexuality.

Earlier implementation of comprehensive sexual education in schools.

  • 8 in 10 teens did not receive sexual education before their first sexual encounter. Include conversations on how LGBTQ youth can have safe relationships as most sexual education focuses on heterosexual relationships. Your medical provider can help with this, too.

Talk about how to use condoms correctly and stress the importance of using a condom every time to prevent sexually transmitted diseases

Visit these resources for additional information, or speak to your child’s primary care physician:

Learn more about adolescent medicine at CHOC.

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