The dreaded HPV


Shieva Ghofrany: [00:00:00] You know, I loves me talking about some HPV and heart base. So today we're gonna talk about HPV because we haven't talked about it in a while, and I've had to make like as usual. Like all weeks, probably 10 to 12 phone calls every couple days. Hey, it's Sheba calling about your pap smear. Turns out you have H P D.

So I tried to say in a very casual way. Why? Because I know that it freaks you guys out and I don't want it to. So let's go through the facts. Hpv, human papilloma. It is a persistent little virus. They believe that 80 to 90% of us in our life are going to be exposed to this virus because it can live on the skin, on the skin, in the genitals, in our mouths, in our rectum.

That's how we get exposed to it. 80 to 90% of us can get exposed. What can it cause That sounds so terrible and devastating, doesn't it? Well, the answer is, , it actually doesn't, or it shouldn't, in fact, if we learn about [00:01:00] it. So while hpv, human papilloma virus can cause very egregious things, it often does not.

So, as I describe it, it's a very smart virus in that it infects 80 to 90% of us, but the likelihood of that infection causing the call, the concerning issues like cervical cancer, head and neck cancer, Anal cancer. Very, very, very small. Okay, so number of us who have hpv, super high, number of us who have something really bad, like those cancers really low.

And more importantly, the likelihood of us catching, especially cervical cancer super early and therefore curing it. Remember how I've said things like if I can find and fix it, then I'm not that worried. Really high. How do we find and fix it through the pap smear? So hear me out on this one. HPV is a virus.

We get it [00:02:00] typically from skin to skin contact through sex. Condoms do not fully protect it because if this is the penis and the condom covers the penis, This, the HPV can live all around the skin in the area around the penis and all around the vagina and Volvo, I mean within the vagina and on the Volvo.

So the condoms do not protect it. So even if you are using condoms 100% of the time, even if you said to me, I've only had sex with one person with condoms the entire time. I would say, I believe you. That doesn't mean you didn't get hpv. You could still get it because it can live that tenaciously on the skin, so you should not be devastated or worried.

That's one nugget. Okay. The broad categories of HPV v. Sadly, we're named poorly to incite anxiety. I'm kidding. That's not why they named them this way. But they were named in two broad categories because there are many, many strains of hpv, and the two broad categories are the high risk strains of hpv, [00:03:00] so the high risk subtypes and the low risk subtypes.

I hate those names because as you know, if you know me, I like words and I do not like words that incite anxiety. High risk types versus low risk types does not sound good, especially because the high risk types, which merely means those types which might change the cells in your cervix and therefore cause cervical cancer.

Very rarely cause those things. So even if you have those high risk subtypes, you are not at high risk for having cervical cancer. You just have those types that might turn into cervical cancer. Now, if you have the other low risk types, then you are at risk for having warts. Guess what? The majority of us, when we have the HPV.

First of all, don't even know exactly which strains we have cuz we haven't gotten that sophisticated yet. But we actually often have both subtypes. And then within those broad categories of high risk subtypes, low risk subtypes, there are multiple strains. . [00:04:00] So how would you know you have it? Well, if you are a young woman who happens to have had warts, then you know that you have had hpv.

If you are a young woman who ha happens to have had changes in your pap smear, then you know you have had hpv. If you are a man who has had words than you know, U F H H P V, if you have a, um, if you are a man who's had an abnormal pap smear, then you would know. No trick question because men don't have pap smears.

They have no pap smear equivalent. And that's important because when a woman finds out she has HPV and then she thinks she has to go back to her partner or her future partners and tell them this egregious news that she's so worried about, she thinks that she's telling him something that he must already know he's negative cuz he's been tested.

And the answer is no, he hasn't been tested because he can't be tested for hpv. And guess what? He might not even know that he can't be tested for. He might not know that there's no pap smear equivalent. He might not know that there's no blood test for it. [00:05:00] So you as the woman, cannot go to him feeling guilty and bad and saying it like, oh my God, I'm telling you something devastating.

Because the fact is you as a woman, we as women are getting it from men often as well. We all are carrying it. Okay, so let's digest the things we've already talked about. HPV human papilloma virus, very common virus. 80 to 90% of it in our lifetime will be exposed to it. Very common to get it. Very uncommon to get cervical cancer or colorectal head and neck cancer.

Which are the other things that it can cause? Two broad categories. High risk subtypes, low risk subtypes, high risk can cause abnormal pap smears, which can in theory lead to cervical cancer. Low risk can cause warts. Let's focus on the high-risk category for now, because that's the one that everyone freaks out about.

You have a pap smear. Pap smears nowadays start at 21, not earlier, because it's so common to get HPV when you first start having sex. And the young [00:06:00] healthy body is so likely to either clear the virus or suppress the viral activity so much that it's not gonna cause cervical cancer at a young age. So we don't start pap smears till 21.

When you have your pap smear and you get the response from your doctor saying, Hey, you're all in the. Your Pap smear is normal. That doesn't necessarily mean you don't have hpv. That just means at a young age, the HPV has not yet shown up on the test because it hasn't done anything to your cells. I'm not gonna go through all the algorithm of the test right now because it's too complicated, but suffice to say there is a point at which we change how we do the test, meaning at a certain age we decide the algorithm changes whether or not we're checking for just the cells or the actual h.

So let's say you have an abnormal pap smear. Let's say your doctor calls you like I do again, 10 to 12 times every two to four days and say, Hey, had an abnormal pap smear. What does that mean? Does that mean that you need to run and go to the doctor's office and like have something bad happen? No, [00:07:00] that just means you're gonna go back for a follow up test depending on how abnormal your pap smear is, if it's slightly abnormal.

you and your doctor will talk about what the follow-up will be. Often the follow-up will be something called a coloscopy, where the doctor looks at your cervix with a microscope and puts some vinegar like solution ascetic acid on your cervix to bathe your cervix to allow some of these changes to show up from the HPV virus because the HPV virus.

Can get into the cervix and there's a specific zone of cells in your cervix that the HPV has a predilection for, and it likes to change those cells and slowly, over the course of years, it can turn those cells into cervical cancer. The bad news is, Tons of us get the virus. The good news is the virus is really slow and really dumb, and it takes a really long time for these changes to occur.

So we as doctors and patients have the luxury of waiting and watching and waiting and watching. So we do this [00:08:00] coloscopy. We look with this microscope. We take little samples that we then send to the lab. Most of the time the lab sends back the results saying These are mild change. Leave that patient alone.

Her robust immune system will suppress those changes or even regress them back to normal as long as she doesn't smoke. Cuz smoking allows that virus to do worse things cuz the cigarettes, the nicotine actually helps the virus and as long as her immune system is typically pretty strong, her body will regress the changes back to normal.

She might not get rid of the virus ever. We don't know if your body gets rid of it, but your changes will often. Because they are not yet cancer. They're just slightly abnormal changes. So your doctor will have you come back at certain intervals to watch and make sure those changes have gone away. Okay?

So again, abnormal pap smear does not equal cancer. Abnormal pap smear really means, huh, something a little bit abnormal here. Let's just take a closer look. The vast, vast, vast [00:09:00] majority of times, like I can almost guarantee. Like 99% of the time, I can guarantee my patients that if they have an abnormal pap smear, they're gonna come in.

Their changes are gonna be mild, and I'm not gonna do anything more than have them come back in six to 12 months, even if their changes are what we unfortunately call severe changes. Even then, the solution is we remove a bigger part of their cervix and then they are not going to end up having cervical cancer because those severe changes are not going to turn into cancer.

They just have a slightly higher chance of turning into cancer. So those severe changes we have to be a bit more cautious about because they might turn into cancer and they might turn into cancer sooner. So those are the ones that we remove. Okay. Mild changes, they're gonna go on their own. Most likely.

We're gonna wait and watch severe changes we're gonna take away because we don't wanna wait and watch those ones. What's the likelihood of an ab abnormal pap smear representing cancer all of a sudden? So small. Assuming [00:10:00] you've been going for your screening test through the years. , is it possible? Yes, of course.

Every now and then, does every doctor have that anecdotal data that one patient where it's kind of a bizarre, unique situation where her cancer just did not behave like anyone else's? Yes, but that is not the norm. The norm when it comes to cervical cancer is a very slow. Very predictable progression. So of all the cancers that gynecologists worry about, cervical cancer is low on the list of things we worry about.

Not because it doesn't happen, but because we have a very controllable, predictable algorithm as to how we can pre prevent it. So again, you've heard me say this, the things that I can find and fix. I'm not worried about. It doesn't mean those things don't exist, and I wanna be really clear about this. I'm not that type of doctor who's comforting because things don't happen.

I've told you guys this before, shit is gonna happen. I know it's gonna happen, so I don't wanna be falsely comforting and make it sound [00:11:00] like nobody's gonna get cervical cancer. People get it in developing countries, people still get cervical cancer and die from cervical cancer, but that's because.

Screening has not yet been widely accepted there because of the cost and things like that. In America where we have screening, we can find it and we can fix it early. So the vast majority of people in America will not get cervical cancer. Or if they get it, they will catch it early and they will be fine.

So of all the things to worry about, please don't have cervical cancer behind on your list. Please do not freak out when your doctor calls and tells you you have an abnormal pap smear. Go back and do all the follow ups. Don't let this comfort you so much that you forget to do your follow up. Do your follow up.

But don't freak out. Don't be devastated. Don't use that language. My patients say to me, oh my God, I'm devastated. Oh my God, I can't believe you just called and said to me, I have an abnormal pap smear. And I'm like, okay. Clearly I have not done a good job in preemptively telling you that this could. Okay.

And [00:12:00] again, even if you've only had sex with one person, even if you've used a condom, this could still happen. Hpv, 90% of us have it. Very few of us are gonna have cervical cancer. Yes, it can cause warmth. Yes, it can co cause abnormal pap smears. Yes, it can cause anal cancer and head and neck cancer, which are the bigger concern.

I don't wanna have a whole discussion about the HPV vaccine because it's kind of controversial, but suffice to say this. , would I get it? Yes. Will my children get it? Yes. My oldest one already has gotten it. The biggest reason I would advocate for it outside of cervical cancer, because again, cervical cancer should be avoided and I'd like to avoid it, but like I said, we have good tests to find and fix it.

What is a bigger concern to me even than cervical cancer is head and neck cancer, which is on the rise, which is not screened for, which does not. A great prognosis and which does not have great treatment. So if I were to [00:13:00] advocate even more for the HPV vaccine, I would advocate for it because of the increased risk of head and neck cancer.

And if I'm not being very clear here, that is because of oral sex. So if you're talking about when to give your children the HPV vaccine, you wanna think about that even earlier than you would think about. If they were having sex, right? So many of my patients will say, well, she's not even close to having sex.

She's 14, 15, 16. I'm thrilled to hear that. I hope she's not even close to having sex at 14, 15, 16. The reality is many girls are, but I know many girls aren't, but they might be close to having oral sex. So it's something to consider. And nowadays, boys and girls are getting. and they're vaccinating the insurance companies and the FDA has approved up to age 45 for women.

So if you are someone who might be in a new relationship, you absolutely can and should go get the vaccine. Okay, that's hpv. That's all I can think of. All right. I hope that [00:14:00] helps. HPV is common. Do not freak out.