diagnosed with hpv: managing treatment, support and cancer risks
hpv is the most common sexually transmitted infection – 75 per cent of sexually active canadians will have the virus at some point in their lives.
9 minute read
once you’ve been diagnosed with hpv, get involved in your treatment plan with your doctor to understand and address any immediate health concerns and to stay vigilant about any of the associated health risks.
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being diagnosed with the human papillomavirus (hpv) can be unsettling. you might find yourself asking, ‘why me? what did i do wrong?’ such questions are common, but it’s important to remember that hpv is very common and can remain dormant for years.
hpv is the most common sexually transmitted infection – 75 per cent of sexually active canadians will have the virus at some point in their lives. the thing is, you might not even realize it because hpv often doesn’t present with any symptoms, which makes it challenging to detect when or how the virus was spread.
here’s how you can manage a hpv diagnosis.
understand hpv: what you need to know after diagnosis
in most cases, your body can fight hpv on its own and clear it the same way as a common cold virus. the virus lingers but will go away without causing any health problems in one or two years. hpv that doesn’t clear is what can lead to health issues. in fact, hpv is a group of more than 100 different types of viruses, of which about 40 are spread through sexual contact. these can infect the genital areas of women and men, including the cervix, vulva, vagina, anus and penis, as well as some parts of the mouth and throat. while there’s no cure for the hpv virus itself, there are treatments for the health problems that hpv can lead to.
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another important distinction is infection by high-risk hpv or low-risk hpv: high-risk hpv can cause cells to change, leading to cancer such as cervical cancer in women, penile cancer in men, anal cancer in both women and men, and oropharyngeal cancer, which is cancer in the back of the throat including the base of the tongue and tonsils.
according to the canadian cancer society, hpv infection causes almost all cervical cancers (now the fastest increasing cancer in women). when abnormal cells are not found early, typically through a pap test, and treated, that’s when risk of cervical and other cancers rises. the choice of treatment largely depends on the stage of the disease at the time of diagnosis.
infection with low-risk hpv doesn’t cause precancerous changes to cells but can lead to genital warts that can develop weeks or months after skin-to-skin sexual contact with someone who is infected. genital warts can be treated with prescription medication, freezing and removal, or surgical removal by laser or excision. they aren’t typically considered dangerous, although you can still pass the virus onto sex partners even after the warts are treated. the period of contagion isn’t known.
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if you’re sexually active, experts advise protecting your partner from the virus by using a condom and other barriers like an oral dam – put them on before skin-to-skin sexual contact – these barriers will reduce the risk of hpv infection.
collaborate with your healthcare provider on hpv treatment
follow-up tests and treatment for abnormal pap test results could include another pap test, a hpv test that removes a sample of cells for testing, or a colposcopy, where a specialist uses a lighted magnifying instrument called a colposcope to examine the vulva, vagina and cervix.
once you’ve been diagnosed with hpv, get involved in your treatment plan with your doctor to understand and address any immediate health concerns and to stay vigilant about any of the associated health risks.
testing will monitor hpv infection to see if the infection has cleared from your last screen or whether the infection has caused the cells in the cervix to change and need treating. there is no routine test for men to check for high-risk hpv strains that can cause cancer. but some doctors are recommending anal pap tests for gay and bisexual men who are at higher risk of anal cancer caused by hpv.
a 2020 paper led by the dalla lana school of public health at the university of toronto looked at the challenges of implementing medical screening programs for minority sub-populations in canada, noting the uncertainties with no standardized national evidence-based guidelines to follow.
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explore the connection between hpv and cancer risks
the mind-bending fact about high-risk hpv is the latency period where exposure to the virus could have happened decades ago, says dr. kathy han, a radiation oncologist with princess margaret cancer centre at the university health network in toronto. she talks about the complexity of the gynecological cancers she specializes in, like cervical cancer where most cases are hpv-driven. vaginal and vulvar cancers can also be associated with hpv. “it really can affect women of all ages. i’ve treated women in their 20s and one of my oldest patients was in her 90s and she had been widowed for 20-plus years.”
for women who have regular pap smear tests, cervical cancer is caught early and treated by removing abnormal tissue. the good news is that cervical cancer develops slowly, starting as a precancerous condition called dysplasia that is almost 100 per cent treatable, mount sinai health reports.
“because i’m a radiation doctor, the women i see, for various reasons either do not have access to a family doctor and that’s why they can’t get a pap test or sometimes it’s missed on testing, or sometimes they have a history of sexual abuse and they can’t tolerate any awake exam,” han explains. her patients already have a diagnosis and are dealing with the fear and uncertainty of what comes next.
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“sometimes i have women who come in and they say, ‘i should have had the pap or should have done this,’” han says of the guilt some patients carry and the stigma surrounding hpv. “we provide all the support and i tell them, don’t think about what if, or you should have done this or that. let’s focus on now and how we can get you through treatment and hopefully get rid of this cancer permanently.”
find support after an hpv diagnosis
talking openly about hpv can be hard. in her book strange bedfellows, physician ina park of the university of california, san francisco, looks at the long history of sexually transmitted infections, or stis, and why people are reluctant to discuss them. she writes, “despite all the science to the contrary, people still see stis as a punishment for being promiscuous – a kind of ‘mark of sin.’ the language we use to talk about stis reflects that – saying someone is ‘clean’ implies the opposite is ‘dirty.’”
what’s a more appropriate attitude toward hpv and other stis? according to park, there’s “a fine line between ‘this happens to everyone, so we shouldn’t feel ashamed’ vs. ‘this happens to everyone, so we shouldn’t care.’ the middle ground is yes, this happens, but the consequences of not treating it can be serious. get tested and take charge of your health, but don’t shame each other.”
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there are growing support groups and advocacy for people with hpv, so connecting to find referrals to sexual health clinics and services is possible and recommended. don’t go it alone! for example, action canada for sexual health and rights has a free access line to call: 1-888-642-2725 to link you to local support services and provide information. a team member can also direct you to sexual health clinics throughout provinces and territories across canada for confidential testing, counselling and treatment. clinic professionals can also help you navigate the healthcare system.
in addition, resources in ontario can be found here at the provincial website, listing sexual health clinics in public health units and community health centres. in b.c., the non-profit options for sexual health has a clinic finder and appointment booking service for more than 60 clinics in the province. another example is sexual health nova scotia which represents the provincial network of community-based sexual health centres.
hpvinfo.ca is a resource and advocacy group with webinars, facebook events and information to create awareness about hpv. the group is administered by the society of obstetricians and gynaecologists of canada, a leading authority on sexual and reproductive health.
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mental health for people living with hpv is also a concern. behavioural science has explored the psychological, social and communication challenges posed by the virus and its link with cancer. research out of the u.k. has shown lack of awareness of hpv as a possible cancer cause contributes to shock and anxiety in response to an hpv-positive test result. “women frequently focus on the sexually transmitted nature of hpv, which can have implications for their sexual partners and relationships,” notes hpv world, a clinician-led newsletter to share the results of complex research in the field.
“if hpv is diagnosed when it has already caused pre-cancerous abnormalities, the psychological impact can be greater, because fears regarding cancer come into play… even in cancer patients, the negative connotations of an sti can add additional psychological challenges to the already considerable psychological burden of a cancer diagnosis.”
for people with a cancer diagnosis, talk to your healthcare provider and reach out to the canadian cancer to society to find peer support groups and further resources to help you cope and manage the physical and psychosocial impacts of hpv-driven cancer and treatment.
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stay positive: there’s hope after hpv
the hpv vaccine works. beginning in the 2000s, many countries, including canada and the u.k., started immunizing school-aged girls and later boys with the hpv vaccine. results have shown a decrease in the high-grade lesions and experts anticipate a decrease in cervical cancer diagnoses down the road because the disease develops many years later – most cases occur in people under age 50. the vaccine is most effective when it’s given during the pre-adolescent years, according to data by researchers at the university of saskatchewan’s school of public health. the publicly-funded school-based schedules for the hpv vaccine start in grades 4 to 7.
in canada, hpv vaccines are recommended for everyone between nine to 26 years old. the vaccine may also be available for those who are older and there are “catch-up programs” across the country. even if you have already had hpv infections, you can still benefit from the vaccine for hpv types that you haven’t been exposed to.
hpv self-screening, widely used in the u.s., is now in b.c. and being considered by other provinces and territories. people from 25 to 69 with a cervix in b.c. can now order a kit to self-screen for hpv or have their screening sample collected by a healthcare provider. self-screening helps to remove obstacles like cultural barriers, history of trauma, the need for transportation, childcare and booking time off from work for traditional testing.
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“whereas pap tests detect changes to the cells of the cervix that have been caused by hpv, hpv testing can detect the presence of high-risk types of hpv before cell changes have occurred,” says dr. gina ogilvie, tier 1 canada research chair in global control of hpv-related diseases and prevention at the university of british columbia and scientist at bc cancer. as olgivie notes, “cervix self-screening is not only more effective, but also safe and easy and will help us prevent many unnecessary deaths.”
and leading cancer treatments are saving lives. han was drawn to gynecological cancer because she can cure patients with radiation treatment. much of her research has focused on brachytherapy, which is internal radiation treatment that has been developed to target and destroy tumours without damaging other tissue and organs. the device is inserted into the patient’s cervix for mri imaging to identify the tumour location.
“then we design a very precise internal radiation plan that really blasts the tumour while minimizing radiation dose to the bladder, rectum, small bowel, et cetera,” han says. “i always tell my patients that my goal is not only to cure them, but also to do it with as little damage and long-term side effect as possible.”
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precision medicine is making a difference, she adds. “we can really highly individualize each patient’s treatment so that not every patient gets the same cookie-cutter plan.”
reach out to hpvinfo.ca and the canadian cancer society for more information. healthing.ca would like to hear from you! share your own experiences navigating the canadian healthcare system with hpv.
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