Wednesday, December 9, 2009

Let's talk about H-P-V, let's talk about you and me.

We had a doctor tell us that you spend about 3 times the amount of time in a room explaining a finding of an abnormal pap smear than you do explaining a finding of full blown cervical cancer.  This is my response to a friend asking about HPV:

HPV, the kind you are referring to, is a virus that affects certain kinds of mucosa (internal goey tissue).  It can infect other kinds of tissue and give common hand warts and other stuff, but unfortunately for everyone, the kinds of HPV people care about basically just enjoy the genital mucosa and anal mucosa.  I mean, who doesn't. Anyway, there are a whole lot of different kinds (like 130) and there are 4 that people mostly care about.  2 that cause most of the genital warts (6 and 11).  By definition, they aren't really a problem. Ugly, but not really a problem.  By  the very fact that they are causing a wart, that means they are being harmless. 

The real problem is a few other strains that like to bury themselves into DNA (because it's soft and warm and there's candy in there) and hang out causing bad changes in genital and anal tissues, with types 16 and 18 causing most of the trouble.  They can, although seldom, cause cancer (cervical and anal). 

Now it's only certain strains, mostly 16 and 18, and they only bury themselves sometimes (in general, sexually active people have a 50% lifetime risk of exposure to the bad kinds, 75% lifetime risk of all kinds), and from there, only rarely do they actually cause cancer (1.3% lifetime risk of invasive cancer).  And, the great part for us is, they only ever do so in a very predictable fashion.  That is, they move from burying themselves, to a sort of abnormal, precancerous tissue, to full blown invasive, bad cancer.  Many cancers just pop in, full blown, no warning, totally uninvited.  Cervical and Anal at least have the decency to bring a bottle of wine.

So, a pap smear checks for the presence of these precancerous tissues, and a polyposcopy (or colposcopy) is an examination (scope) of the vaginal cavity and cervix (polyp and colpos respectively.  I'm kidding, not that medical terms are that far off from the ridiculous, but if the latin term for vagina were polyp, it would give a whole different meaning to certain nasal issues) looking for abnormal tissues and polyps to sample and evaluate to see what sort of stage they at in the progression of HPV, if any.  Basically it's the next step after an abnormal pap smear.

The beauty to all this is that, when caught early, it's super duper treatable.  That's why they do pap smears.  Death rates from cervical cancer have plummeted since the pap caught on (first tried as a follow up to the macarena, then realized to be a far more potent test than dance move, particularly because of the part in the dance when the vagina is swabbed.  Went fine in Europe, didn't catch on in the US.  Americans are prude). And with the guardasil vaccine, things are expected to really turn the corner.


Lindsay said...

Alas...even GOOD insurers don't cover the pretty expensive Gardasil. Damnit.

Nicholas said...

This is what I took from this post:

HPV...causes warts...genital mucosa...problem...bad changes...sexually active people have a 50% lifetime risk.

I spent the next four paragraphs just worrying.

Julie said...

Off topic, but you made me think of a question that I have always had, but never asked...I think I know how other docs think of, say, orthopedic surgeons, dermatologists, neurosurgeons, etc., but what do other docs think of gynos?

And if there is a difference of opinion between male and female gynos, I would like to know that, too.

I consider your answer to be a public service announcement.

Michael Tong said...

I pressed the "report abuse" button on this one because I got bored halfway through reading this, and there have to be repercussions for things like that these days.

Also, the word I have to type in to word verify this comment is "Hinsize", which sounds like something youd do to genital warts.

Anonymous said...

Being the "friend" who requested this answer, I did not find it boring but helpful and hilarious. My visit to the doctor however was not nearly as hilarious...

Meat, M.D. said...

Lindsay, check with your insurer. Things are going to change very soon because it is clearly a winner.
Julie, I am going to write something about that, but it will take time. I appreciate that and any other requests, so if you want to hear about something, I'll do my best.
Tong, I thought we shared something special. Clearly that time I accidentally saw you having sex means nothing to you.

Julie said...

No worries...thanks for responding. Besides, I made up my own answer which amused me.

Also, I think you would be a natural for narrative medicine.