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HPV (human papilloma virus) and Pap Smears

What every college student should know

The new HPV vaccine, Gardasil, is now available at Hall Health.

The most important points:

1. 75% of sexually active men and women will have an HPV infection at some time.
2. These HPV infections are usually asymptomatic and go away on their own.
3. Some HPV infections are associated with abnormal Pap smears.
4. A small number of women with abnormal Pap smears will develop a pre-cancerous condition know as dysplasia—an abnormal development of cervical cells which, if left untreated for 8-10 years, can evolve into cervical cancer.
5. Annual Pap smears and appropriate tests for HPV, followed by appropriate treatment, can almost always prevent the development of severe dysplasia and cervical cancer.

What is HPV?

HPV (human papillomavirus) is a family of viruses that cause several distinct clinical conditions:

1. Common warts: run-of–the-mill warts most often seen in children and young adults.  These warts often go away by themselves, but can also be treated, which hastens their disappearance.
2. Genital warts:  visible on the external genitalia of men and women.  These warts are transmitted by sexual activity and, while very distressing to those who have them, are “benign”—they are treatable and not associated with the development of cervical cancer.  The most common subtypes are HPV-6 and HPV-11.
3. Genital tract infections.  These infections are not apparent—neither men nor women are aware that they have these HPV infections.  They most often go away on their own, but sometimes the infections can cause abnormal Pap smears.   Some HPV types that cause abnormal Paps have the potential to cause cervical cells to change from normal cells to precancerous cells (dysplasia) and eventually to actual cancer cells; these are known as “high risk” HPV types.  The most common subtypes are HPV-16 and HPV-18. 

The interval between infection with HPV and changes on the cervix detectable by Pap smear can be a few months to many years; the interval to cervical cancer (if not treated appropriately) is usually 10 to 20 years. 

How are HPV infections spread?

HPV viruses that cause genital warts and HPV-related cervical changes are sexually transmitted—in fact, they are the most common STD among college students.  Sexual intercourse is the most common means of spread, but any sexual contact of the genital area can spread the virus.  Thus, it is possible for women or men who have never had intercourse to have HPV infections.

Who gets HPV infections?

75% of sexually active men and women will have an HPV infection.  In a carefully designed study done here at the University of Washington, over one third (38.8%) of young women who did not have evidence of HPV infection at the start of the study were infected by 24 months into the study.  An equal percentage of women who became sexually active for the first time had become infected by 24 months.

What factors increase the risk of HPV infection?

Smoking is very strongly associated with an increased risk of HPV infection, as well as the development of cervical dysplasia and cancer.  Having multiple partners increases the risk.  If a woman’s partner has had previous partners, this increases her risk.  And, if a woman has known a new partner less than 8 months before they have sex, the risk of HPV infection is increased.

Are condoms protective?

A 2006 study shows that consistent condom use can reduce the risk of cervical and vulvovaginal HPV infection.  Condoms also protect couples against the spread of chlamydia, HIV, and trichomonas, and should therefore be used.

Do these HPV infections ever go away?

Yes. The average duration of cervical infections is about 8 months; 90% of young women will have cleared the virus by two years. However, a few women will have detectable infection for much longer.

Do partners pass the same HPV virus back and forth?

No.  Most often, both partners are infected by the same virus and develop immunity to that virus.  Neither partner is susceptible to reinfection by the same virus once they have cleared the virus.  However, all sexually active people are susceptible to new infections with different subtypes of HPV virus.

Is there any known way to decrease the risk of HPV infection?

Sex within a mutually monogamous relationship is the biggest safeguard.  Knowing a new partner for 8 months or longer before sex also reduces the risk, probably because that time period allows any HPV infection present to clear.

As mentioned above, not smoking is one of the most important things a woman can do for her general health and for cervical health as well.  Also, a daily multivitamin with folic acid and a diet high in beta carotene (yellow and orange fruits and vegetables, and dark-green leafy vegetables) are known to be beneficial to cervical health.  

What is a Pap smear and why should women get them every year?

A Pap smear is taken by collecting cells from the surface of the cervix and using a small soft brush to collect cells from the small canal that goes from the cervix into the uterus.  These cells are evaluated under a microscope by an expert for abnormal cells.  An annual physical exam and Pap smear are by far the best means of protecting yourself against the development of dysplasia associated with HPV infections.

What does the future hold for treatment or prevention of HPV infection?

A vaccine has been developed to prevent cervical cancer and is now available at Hall Health Center.  This vaccine helps protect against HPV types 6, 11, 16, and 18. The Advisory Committee on Immunization Practices has recommended vaccination for girls and women ages 9 to 26.  A vaccine has not yet been tested in men.  Complete information about the vaccine is available on the Hall Health Center web site http://hallhealth.washington.edu/  (click on Health Information and then look under HPV).

Additional sources of information:

Our knowledge about HPV infections is growing rapidly; thus, what we “know” changes constantly as new information is added to our body of knowledge.  At the same time, there is a great deal of misinformation about HPV out there, especially on the web.  Below are sources of additional—and reliable—information on HPV infections:

American Social Health Association: http://www.ashastd.org/

Centers for Disease Control and Prevention (CDC): HPV Infection: www.cdc.gov/std/hpv/
National STD Hotline: 1-800-227-8922

American College of Obstetricians and Gynecologists: http://www.acog.org/

For further information, call the Triage Nurse in Women’s Clinic: 206-685-1031 or the Triage Nurse in Primary Care: 206-221-2517.

For an appointment, call the Appointment Desk: 206-616-2495.

After Hours Consulting Nurse: (206) 744-2500

Authored by: Charles Petty, M.D., and Ingrid Helsel, R.N.
Last updated: 1/4/08
Last reviewed: 08/09