HPV — Q&A with Dr. Susana Campos

Susana M. Campos, M.D., M.P.H. Gynecologic Oncologist Dana-Farber Cancer Institute

Is it possible to prevent cervical cancer without a vaccine?

Cervical cancer screening done according to American Cancer Society guidelines in conjunction with proper follow up will prevent most, but not all cases of cervical cancer. Pap smears (with or without the HPV test) can find cell changes in the cervix early before they become cancerous. In addition, when cancer screening guidelines are followed, most, but not all cervical cancers are found at an early, curable stage.

What are the risk factors for genital HPV?

The main risk factors for genital HPV are age and sexual history. Those younger than 25 and those who had their first sexual intercourse at age 16 or younger or have had multiple sex partners are at increased risk. Even women who have only had one sex partner can become infected with HPV. This is more likely for women who have a partner who has had many different sex partners.

If a woman is told her Pap smear is “suspicious,” does that mean she has or will have cancer?

No. An abnormal result does not mean a woman has HPV or cervical cancer. Other reasons for an abnormal Pap smear include infections, such as yeast infections, irritation and hormonal changes. If a Pap smear is abnormal, the doctor may do the test again or perform an HPV test. If the suspicious changes persist, other tests such as a colposcopy or a biopsy may be warranted. A colposcopy is a procedure to closely examine the cervix, vagina and vulva for signs of disease.

If HPV goes away, can you get it again?

Yes. There are many types of HPV, so you can get infected again.

Why do other sexually transmitted infections, such as HIV infection, increase the risk of HPV?

Infection with HIV dampens the immune system and reduces the body’s ability to fight infections that may lead to cancer. Many people infected with HIV have other viruses that cause certain cancers like HPV, which can causes cervical cancer and some types of anal, penile, vaginal, vulvar and head and neck cancer.

Can genital warts cause cancer?

No. HPV types that tend to cause genital warts are not those that cause cancer. However, an individual can be infected with multiple types of HPV. The presence of warts does not rule out the possibility of high-risk types of the virus also being present.

If HPV has no symptoms, how does a person know he or she is infected?

One way is the presence of genital warts, which are typically small, flesh-colored or gray swellings in the genital area or throat. Most women who have HPV infections, however, never know it unless an HPV test is performed with a Pap smear. This is a DNA test that detects most of the high-risk types of HPV.

If a woman has a normal Pap smear, does that mean she does not have HPV?

Not necessarily. There are often no symptoms associated with HPV. Patients with a normal Pap smear can have HPV but it does not necessarily develop into cervical cancer. It means only that no cell changes were seen on the Pap smear.

Does infection with HPV 16 or 18 always result in cancer?

No. The body’s immune system can often eradicate HPV 16 and 18 within one to two years. Some HPV infections, however, can persist for many years and can lead to more serious cellular abnormalities or lesions that, if untreated, may progress to cancer.