Don't freak out HPV

Shieva Ghofrany: [00:00:00] Okay, just got to the office. It's Wednesday morning and I have to do a quick video because I have a ton of charts. So hpv, yes, I know I've talked about it before, but I'm gonna keep talking about it because it keeps coming up over and over and over as it will keep coming up over and over and over because it's prevalent. 

So this is for all you people up there who are anxious. Please listen to me. Okay. Stats about hpv, 90% of us in our lifetime will. Why? Why? Why would 90%? Because it's so prevalent because it lives in the head and neck and it lives in the genitals, and it doesn't just live on the shaft of the penis or in the vagina. 

It lives on the vulva. It lives on the skin around the shaft of the penis. What does that mean? Well, that means a condom is not gonna completely cover it, so Oh my God. You mean I'm gonna get exposed to it statistically? Yes you are. Well, what can I do? You can get the Gardasil HPV vaccine when you're young. 

Right now they just approved of it for women up to age 45, and I believe men up to age 45. Um, should you get it? Yes. That's a whole nother [00:01:00] controversial conversation to me. It's not a controversy. Yes, you should get it, but that's a conversation we can have at another time. So nuggets about hpv, 90% of us will be exposed to HPV in our lifetime. 

The likelihood of it causing cervical. . Teeny, teeny. Does no one get cervical cancer? No. Unfortunately, some people do. The vast majority of people who do get cervical cancer, it is caught very early because it is a very step-wise fashion where the changes occur slowly, slowly, slowly. So again, 90% hpv, very rare to have cervical cancer. 

Most who find cervical cancer, especially when they're getting regular pap, We'll find it early, which means it is very easy to deal with. Yes, there will be a small segment where that is not the case as with any cancer, but that is not the norm. So when you hear you have hpv, do not freak out. What can you do to prevent it? 

Well, you could be abstinent, but that's not realistic, right? So short of that, , as with anything sexually related, choose wisely the number of partners you have. But [00:02:00] even that is not gonna even come close to preventing it because you can have one partner in your lifetime use condoms every single time. And if that one partner had sex once with someone else, statistically you would still likely get it. 

So again, how do you prevent it? You can't necessarily, which is why I say to. Don't freak out about it. Something you can't 100% prevent is not worth your time and anxiety and energy, right? There are two broad strains of hpv. There's what they unfortunately labeled the low risk subtypes, which can cause warts, and then the high risk subtypes, which can cause abnormal pap smears. 

It doesn't mean you're at high risk for cervical cancer, it means. Those subtypes are the ones that have been found to cause cervical cancer, and there are hundreds of subtypes, some of which we've characterized, nine of which are being prevented with the vaccine if you got the vaccine prior to having sex, even once. 

Okay, so what if you have HPV in your pap smear? What do you do? Well, there's different stratification, different algorithm as to how abnormal your pap smear is. Four patients [00:03:00] yesterday. Four. This was unusual for me. I. Three to five patients a day, but yesterday, four for four on my day off when I came in to make phone calls, had never heard that they had had it. 

And that's the unusual part. Most of my patients, when I call. Hey, you've been exposed to hpv. Not a big deal. I open with not a big deal. Most of them go, you know what? Now that you mention it, I think I had that when I was younger. Four outta four yesterday. We're kind of like, wait a minute. What an all in monogamous relationships, all of whom I believe they and their partners have not been with anyone else. 

How can that happen? Well, the. Your body can suppress it, so it's at very low levels and not detectable on the test. And then all of a sudden, one year, maybe your immune system was a little bit down, maybe the test is getting more sensitive, maybe a lot of things. But what happens is all of a sudden the pap smear cells still show up as normal. 

So technically your pap smear is normal, but the HPV viral part of it shows up as positive, and then they look for the more concerning subtypes of which luckily none of these patients had. So their algorithm said [00:04:00] normal. HPV positive, come back in a. They don't need to do that other test called a coloscopy, where many of you might have been called by me and said, Hey, pap smear is actually a little abnormal, not a big deal. 

Come on in and we do a coloscopy. I basically tell patients it's like a microscope for your cervix where we look at the cells in order to do the diagnostic part, where we look and see. Couple little samples, little biopsies to prove that the changes are usually just mild and then your body regresses those changes back to normal. 

If they are more aggressive changes, then you'll talk to your doctor about whether or not to take those changes out. So again, I'm gonna repeat it. HPV common, 90% of US men and women will carry it in our lifetime will be exposed to it. Will we all know about it? No. How would we find out about it? Only from the pap smear because there's no blood test equivalent. 

Will your male partner. . No he won't because guess what? They just don't find out about it. Cuz there is no pap smear equivalent. Unless they've had warts or unless they've been told by a previous partner, they [00:05:00] don't know about it. Which means that they are unwittingly walking around thinking they don't have it and they're not giving it to us, but they're giving it to us. 

Okay. And I'm not blaming them, I'm just saying we need to have a two-way street of conversation so that they understand when we come to them saying, so turns out I. I tell patients all the time, don't feel like you're, oh my God, I, I'm telling you, I gave you something because you might have gotten it from your current wonderful husband of 30 years who had sex with one previous partner 30 years ago, and that's okay. 

He should know that he's probably either gave it to you or now that he's been with you, he's gotten it and all he needs to do is look down and make sure that he doesn't have any lesions or. , which frankly is what men should be doing anyway, right? Like he doesn't have to all of a sudden look now. So to answer the question about once you find out you have it, does that necessarily mean your partner has it? 

Most likely, yes. But can they be tested? No. Um, again, beyond the scope of this conversation, but should you tell every partner about it in the future? The unfortunate answer is yes, you really [00:06:00] should. I have a whole little script I tell my patients, so we'll post that in another video one day. Um, but yes, you should tell everyone, we should all tell everyone because again, it's nothing to be ashamed of. 

H V A is common. Cervical cancer is rare. Please get vaccinated, especially for your young people before they start having sex, more so than cervical cancer even to help. Head and neck cancer and colorectal cancer, which is on the rise potentially from hpv. Okay, hope that helped. Bye. Have a great Wednesday. 

I'm gonna go do charts.