People with HPV are at risk of developing genital warts and some cancers, said Debbie Saslow, managing director of HPV and gynecological cancers at the American Cancer Society.
Saslow has spent nearly 25 years studying HPV and works to raise awareness about the HPV vaccine.
This conversation has been edited and condensed for clarity.
ÇNN: What does HPV cause?
Debbie Saslow: Almost everyone will get HPV at some point, and most people will have no symptoms. Some types of HPV can cause warts on the skin, some can cause genital warts and some can cause cancer.
The types of HPV that cause cancer are transmitted through intimate skin-to-skin contact, so it occurs mainly through sexual activities. The most common HPV cancer in women is cervical cancer. Although some women may not be familiar with the cervix, many go to the gynecologist to screen for cervical cancer with a Pap test or HPV. The most common HPV cancer in men is throat cancer, although women may also have it. It is in the oropharynx, which is at the back of the throat and tonsils. The other four types of cancer are anal cancer in men and women, penis cancer in men and vulva and vaginal cancers in women.
Not that many people get to the point where they are symptomatic, because tests are very common in the United States, but pain after sex and abnormal bleeding are two symptoms of cervical cancer.
CNN: How can people decrease their chances of getting HPV?
Saslow: Being vaccinated can prevent more than 90% of HPV cancers and more than 90% of genital warts. It is recommended for boys and girls from 9 to 12 years old, but people up to 26 years old can still get the vaccine.
Secondary prevention for women aged 25 to 65 with a cervix is screening for cervical cancer. By finding it and treating or removing cancer or the cervix, you can prevent cancer.
The preferred screening method is an HPV test every five years. Unlike the Pap test, the HPV test predicts the future. For example, if someone has been HPV positive for two consecutive years, even though the cervical cells are normal, it is a sign that the infection may progress to pre-cancer.
If someone has a negative HPV test, the chance of having cervical cancer in the next five or 10 years is almost zero.
There are no HPV tests recommended for men because there is no HPV test for men. The only exception is for anal cancer. It is not a national recommendation, but anal screening can be used for men who have sex with men. Condoms can slightly reduce the risk of HPV transmission. It is a good idea to use them in any way to reduce the risk of other viruses.
CNN: If someone is having sex with multiple partners, should that person be tested more often?
Saslow: Sexually active people with more than one partner at the same time are at greater risk of contracting HPV, but are not at greater risk of contracting HPV, of contracting pre-cancer or cancer faster than someone who contracted HPV from a mutually monogamous partner.
The risk is greater, but it does not change the screening interval. The time between HPV infection and pre-cancer is a decade, so that’s why five years between exams is really safe. The time between exposure of HPV infection to cancer is almost 20 years, so we have plenty of time to discover it.
CNN: What do you say to parents concerned that their children will become sexually active sooner if they get the vaccine?
Saslow: There are many studies that show that it is not true. There have been studies in which researchers asked whether there was any difference in the number of sexually transmitted diseases, the age at which people started having sex or unwanted pregnancies, and the general answer is no.
For parents who think it’s true, do you tell your kids, when you’re teaching them how to drive, not to put on your seat belt because it will speed them up? You don’t do that, and it’s exactly the same logic with the HPV vaccine.
We recently changed the text of the guideline to strengthen the vaccination recommendation at age 9. Before I said to vaccinate at 11 or 12 years old, or you can start at 9 years old. Now we say only 9 to 12 years old. Studies have shown that when we offer the vaccine to a 9 or 10 year old child, parents are not thinking about their sexuality. When children are 11 or 12, that is where their parents’ minds tend to go.
CNN: Should college students get the HPV vaccine?
Saslow: Remember that if the vaccine is not given at age 12, it is still recommended until age 26. Adults up to 45 can ask their provider about it, but the effectiveness declines dramatically around the college years, around the age of 18.
College is a good time to pick up people who have been lost or people whose parents have chosen not to give their children the vaccine, because then the person can make a choice for himself.
When you leave college, the effectiveness of this vaccine is low. Mainly because people are already exposed to HPV and the vaccine only works before you are exposed.