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Cancer. Vaccines. Sexually transmitted infections. Three topics that bring strong reactions, lots of questions, and more than a little misinformation. And a real conversation about HPV has to involve all three of these hot topics.

In this episode, Dr. Elizabeth Campbell joins us to talk about what men AND women need to know about all three of them and HPV, the human papillomavirus.

We cover the most commonly asked questions about HPV, including:

• What is HPV?
• Can HPV be spread without sexual intercourse?
• What are the symptoms of HPV?
• Can men get HPV?
• Who should be tested for HPV?
• Can HPV be treated?
• Will HPV go away on its own?
• How can you reduce your risk of getting HPV?
• What are the side effects of the HPV vaccine?
• Do young people who get the HPV vaccine become more sexually active?
• How can you talk about the HPV virus with your child?
• Can adults get the HPV vaccine?

More resources

• View Dr. Elizabeth Campbell’s profile
• From the blog: What is HPV?
• From the blog: Better education for young people needed about oral sex disease risk
• Learn more about women’s health services at U-M Health

Transcript

Dr. Preeti Malani (00:01):

Cancer, vaccines, sexually transmitted infections, three topics that bring strong reactions, lots of questions, and more than a little misinformation. And our featured topic today connects all three of them. We're talking about HPV, human papillomavirus. And our guest today is well positioned to get us answers to all our questions. We're joined by Dr. Elizabeth Campbell, an obstetrician and gynecologist at University of Michigan Health Von Voigtlander Women's Hospital. HPV is a major public health issue in America, and there's no shortage of misinformation and confusion out there about what it is, what it does and whether or how it can be prevented. We're going to cover it all today. I'm Dr. Preeti Malani. Thank you for joining us on the Michigan Answers Podcast. Hi, Dr. Campbell. Thanks for joining us today.

Dr. Elizabeth Campbell (00:58):

Hi, thanks so much for having me.

Dr. Preeti Malani (01:00):

So our team has scoured the internet and pulled together a list of the most searched questions about HPV. This is a hot topic, and I'm guessing one that you get a lot of questions about in clinic too.

Dr. Elizabeth Campbell (01:10):

Definitely.

Dr. Preeti Malani (01:11):

So let's get started. First question, what is HPV?

Dr. Elizabeth Campbell (01:15):

HPV or human papillomavirus is a DNA virus of which there are greater than 100 strains identified in humans passed primarily through sexual activity. It is actually now the most common sexually transmitted infection.

Dr. Preeti Malani (01:31):

That gets to the second question, how does HPV spread and in particular, can it be spread by non-sexual means?

Dr. Elizabeth Campbell (01:37):

So the primary means is through sexual activity, but that can be through a variety of different activities. Not always vaginal penetrative intercourse. HPV can also be passed through anal intercourse, oral sex, and we believe through close skin to skin contact.

Dr. Preeti Malani (01:55):

What are the symptoms of HPV?

Dr. Elizabeth Campbell (01:56):

Unfortunately, there are no symptoms of HPV, which makes it very hard to detect. And the reason that most people are not aware that they have HPV.

Dr. Preeti Malani (02:05):

And is this any different between males and females?

Dr. Elizabeth Campbell (02:08):

No difference between males and females. Both males and females can develop the only outward sign of HPV, which is condyloma or warts.

Dr. Preeti Malani (02:19):

Next question is what can the long term effects of HPV be?

Dr. Elizabeth Campbell (02:23):

So the majority of HPV infections will clear within the first couple of years of exposure. However, if HPV persists, it can lead to health problems. Those include condyloma, as I mentioned, as well as several precancerous and cancer conditions. The most commonly known cancer associated with HPV is cervical cancer. However, HPV also causes many cases of other anal genital cancers, including vaginal, vulva, and anal. And now the most common HPV related cancer is actually oropharyngeal cancer, which can develop in both males and females.

Dr. Preeti Malani (03:01):

So let's talk about testing. How do you test for HPV and who should be tested?

Dr. Elizabeth Campbell (03:05):

The only HPV test currently is that which is associated with the pap smear. Pap smears are most commonly done of the cervix. However, paps can also be done of the vagina and the anus. The most commonly used test is the pap smear of the cervix. However, in higher risk patients, they may undergo pap testing of the vagina and or anus as well.

Dr. Preeti Malani (03:27):

Can you just talk a little bit about high risk HPV? I've seen that some patients have a designation of being high risk.

Dr. Elizabeth Campbell (03:33):

So as I mentioned earlier, there are over 100 different strains or types of HPV. A certain subset of those are considered high risk, and that those are the types that have been identified in association with cancers and precancerous.

Dr. Preeti Malani (03:47):

How is HPV treated?

Dr. Elizabeth Campbell (03:49):

Unfortunately, there is no treatment for the virus itself. We rely on our immune systems to clear HPV over time. In the majority of people, HPV will be cleared within the first couple of years. However, in those where HPV persists, it can lead to precancer or cancer, and there's no treatment for the virus itself. There can be treatment for the pre-cancers or cancers.

Dr. Preeti Malani (04:10):

Can you talk a little bit about those types of treatments for the pre-cancers?

Dr. Elizabeth Campbell (04:14):

So primarily in my work, we see the majority of cases of cervical pre-cancers. When those are identified, it is primarily found first by a screening pap smear, following that they may get referred for an additional test called a colposcopy in which we examine the cervix closer and identify areas with these potential pre-cancers. We can perform surgical procedures, including both excision and ablation to treat those precancerous conditions with the hope of preventing them from returning to cervical cancer. The same can be done both in the vagina, the vulva and the anus.

Dr. Preeti Malani (04:53):

Yeah, and I imagine those particular patients than are monitored on a frequent basis.

Dr. Elizabeth Campbell (04:58):

That's correct. They're monitored more closely afterwards and they don't return to the standard screening interval that low risk patients undergo.

Dr. Preeti Malani (05:06):

Does it ever go away in its own?

Dr. Elizabeth Campbell (05:08):

The majority of the time HPV actually does go away. The immune system can effectively clear HPV from someone's system. Once it is gone, we believe the majority of the time HPV will not reoccur.

Dr. Preeti Malani (05:20):

I suppose it depends on what people's risk is also.

Dr. Elizabeth Campbell (05:23):

That's correct. So those patients that are immunosuppressed are at much higher risk for getting HPV and of not being able to clear HPV. So that includes people living with HIV or those that are immunosuppressed for a variety of other medical reasons, including medications.

Dr. Preeti Malani (05:41):

Can you prevent HPV?

Dr. Elizabeth Campbell (05:42):

You can. HPV vaccine is actually very effective at preventing against nine different strains of HPV, which include many of those high risk strains.

Dr. Preeti Malani (05:52):

Are there side effects to the vaccine?

Dr. Elizabeth Campbell (05:54):

No. Like any vaccine, someone can experience arm soreness, but other than that, there are no side effects to the vaccine.

Dr. Preeti Malani (06:00):

In your experience are more people getting the vaccine now that it's been available for so long?

Dr. Elizabeth Campbell (06:04):

More and more people are. However, I think there's still very poor uptake overall of the vaccine. And we would hope that it would be improved in the future.

Dr. Preeti Malani (06:13):

Yeah. So what advice do you have for parents talking to their kids about the vaccine, especially since it is associated with sexual activity?

Dr. Elizabeth Campbell (06:22):

So I think that the vaccine is very important to prevent future health risks, which can include genital condyloma as well as several pre-cancers and cancers. The vaccine is most effective given before the onset of any sexual activity, which is why it is crucial to give at a younger age, with a recommendation being to give at age 11 to 12. So I think the other important factor is that the HPV vaccine is important to give to both males and females. Vaccinating males is also very helpful to prevent their future cancer risk as well as to prevent HPV transmission. The vaccine has been around for a number of years and it's well established that it is safe and that it is very effective at preventing future health issues, which can include condyloma or warts as well as several pre-cancers and cancers that could affect the child at a much later age.

Dr. Preeti Malani (07:18):

Do you have a sense that some parents are hesitant because of the conversations that HPV vaccine might raise?

Dr. Elizabeth Campbell (07:25):

I think that is a concern that a vaccine that is linked to sexual activity may then promote sexual activity. But studies have shown that that is not actually true, that adolescents that are vaccinated against HPV have no change in sexual practices versus adolescents that are not vaccinated.

Dr. Preeti Malani (07:48):

Yeah. So important information to get out. Is there any exciting research underway regarding HPV that you wanted to share with us?

Dr. Elizabeth Campbell (07:55):

I think there's one exciting new area in that HPV vaccination is primarily targeted towards the young, so individuals around age 11 to 12, but the HPV vaccine has actually recently become licensed for individuals up to age of 45. And there's newer research showing that the HPV vaccine given as an adjunct to those treatments for cervical pre-cancers may help significantly reduce the risk of HPV persistence and recurrence of those precancerous conditions in those individuals.

Dr. Preeti Malani (08:28):

Dr. Elizabeth Campbell, thank you for sharing your time and your expertise with us today and thank you to our listeners for tuning into this week's episode of Michigan Answers. If you enjoy today's episode, please subscribe wherever you get your podcasts. We're unpacking some of the most search for health topics on the internet. And if you're interested in learning more about how Michigan medicine is improving lives and advancing health, you can visit Michigananswers.com. See you next week.