After the birth of my first child in 1994, I received a pretty scary phone call from my doctor: the Pap smear from my six-week checkup was abnormal and he wanted to do a biopsy.  Of course all I could think about was cancer and of course the biopsy showed that I had cancerous cells growing on my uterus caused by a disease I had never heard of before, the human papillomavirus (HPV).  I was stunned to learn that I had a sexually transmitted disease—I had never had any symptoms.  And now I had the disease.  I wanted to learn all I could about my disease so I would know exactly what was wrong with me and how I could best care for myself.  What I learned is essential information for any woman who has sex.

The human papilloma virus (HPV) is actually a group of more than 70 types of viruses that can cause warts, or papillomas. Some types of HPV cause common warts on hands and feet and some are sexually transmitted and can cause warts in the genital and anal area of both men and women. The warts caused by HPV may have many different characteristics. They may appear small or large, flat or raised, single or multiple; sometimes the warts may not even be visible. The most common places to notice warts are outside the vagina, on the penis, and around the anus. In women, HPV can cause warts to grow inside the vagina and on the cervix as well. In about half of all cases, persons infected with HPV do not have any warts, so like me, such people may not even know they have HPV until it has progressed.

HPV is passed by direct contact with a wart or skin that is infected with the virus. It is possible to get the warts on hands and in the mouth through contact during foreplay or oral sex. About 50% of individuals who are infected with HPV never develop genital warts, but are still capable of transmitting the virus to others. Most commonly HPV is transmitted through such sexual behavior as engaging in unprotected sex, having sex with more than one partner, beginning sexual activity as a teenager, and being in a sexual relationship with someone who has multiple sex partners.  Naturally you can reduce your chances of contracting HPV by using latex or polyurethane condoms during sex, but transmission may still occur if warts are on parts of the body not covered by the condom.  You can also protect yourself by limiting your number of sex partners.

For many people who have HPV infection, there are no obvious signs of infection, such as warts.  However, if warts are present, a doctor can diagnose HPV infection by their characteristic appearance and the history of how they developed. In women, to look for warts on the cervix or in the vagina, a doctor may use a colposcope, which is like a telescope. Also, as in my case, Pap smear results may suggest an HPV infection. There is currently no blood test that has proven reliable in the diagnosis of HPV infection.

HPVs are now recognized as the major cause of cervical cancer. Some types of HPVs are referred to as "low-risk" viruses because they rarely develop into cancer, and the HPV viruses that can lead to the development of cancer are referred to as "cancer-associated types." These cancer-associated types of HPVs cause growths that usually appear flat and are nearly invisible, as compared with the warts that are a sign of the low-risk viruses.  Both cancer-associated types and low-risk types of HPVs can cause the growth of abnormal cells in the cervix, but generally only the cancer-associated types of HPVs may lead to cervical cancer. Abnormal cervical cells can be detected when a Pap test is done during a gynecologic exam.

Most HPV infections go away on their own without causing any type of abnormality. But if you have a cancer-causing HPV strain (as opposed to just a wart-causing strain), any mild abnormalities in your cervix may progress to more severe abnormalities or cervical cancer.  However, the chances are fairly small that you would develop cervical cancer if the abnormalities were left untreated.  Studies suggest that whether a woman will develop cancer depends on a variety of factors acting together with cancer-associated HPVs. These factors may include smoking, decreased resistance to infection, and infection with agents other than HPVs. Don’t panic if you have HPV and you find out it is a cancer-causing strain: it doesn’t mean you will get cancer.  But, please, if you have any reason to believe that you may have HPV, get it checked out immediately, and always get your yearly Pap smear.

If abnormal cells are found on a Pap test, the next step is usually colposcopy and biopsy of any abnormal areas. Colposcopy is a procedure in which a lighted magnifying instrument called a colposcope is used to examine the vagina and cervix. Biopsy is the removal of a small piece of tissue for diagnosis. Although there is currently no medical cure to eliminate a papillomavirus infection, the warts and cell abnormalities these viruses cause can be treated.  The methods used include cold cautery (freezing that destroys tissue), laser treatment (surgery with a high-intensity light), LEEP (loop electro surgical excision procedure, the removal of tissue using a hot wire loop), as well as conventional surgery. Similar treatments may be used for external genital warts, as well as drugs such as podofilox gel, which is a patient-applied treatment for external genital warts; imiquimod cream, which is a patient-applied treatment for external genital warts and perianal warts; chemical treatments (including trichloracetic acid and podophyllin), which must be applied by a trained health care provider to destroy warts; and Interferon, an antiviral drug, which can be injected directly into warts. The development of a vaccine against HPV is under way, but is still not available.

Once someone is infected, he or she carries the virus for life even if genital warts are removed. And you never know how you might be affected by HPV.  I carried it for years without knowing I had it, and I passed it on to all of my sexual partners, who passed it on to theirs and so on and so on.  Who knows how many people developed genital warts or even cancer, like me.  But I was lucky.  My cancer was removed and I was able to go on to have two more healthy, beautiful children.  My cancer was caught early enough that it didn’t destroy my life, and I always have a Pap smear every year, just in case it decides to come back.  Avoid my pain: protect yourself against HPV with intelligent choices and a yearly Pap.  It could save your life.