HPV DETECTED: NOW WHAT?
Recurrent Human Papillomavirus (HPV) is a concern I am seeing more often in clinic. HPV is the most common sexually transmitted infection and expresses no definitive symptoms. Detection of a strain of HPV will be found on a routine pap smear, and will ordinarily become a ‘watch and wait’ situation if present. Pap smears are completed more regularly (yearly) to see if HPV persists If oncogenic strains are present, further investigations may be warranted. The issue is that a lot of women who have an abnormal pap smear once, will go on to have continual abnormal pap results. This can potentially progress to changes in cervical cells, leading to differing degrees of dysplasia. The big question is, why is HPV not clearing?
First up, we need to understand there are different strains of the virus and some are more problematic (more oncogenic) than others. The two nasty strains we want to be very aware of are HPV 16 and 18. There are more than 100 types of HPV, among them, two serotypes (16 and 18) are related to 70% of cervical cancers and precancerous cervical lesions.These can be present on a pap smear and then clear before the next one. The type of strain is not related to any level of persistence.
Red flags for HPV or cervical changes are bleeding or cervical pain with intercourse. If you are between pap smears, it is prudent to investigate these with a medical practitioner. This is especially so if you have been with a new partner.
Having HPV is not a case of being dirty or more sexually promiscuous. A high percentage of us will be exposed to HPV within the first couple of years of becoming sexually active and will clear it with no worries. Though, there is a small percentage of women who will be exposed and will not clear it within a year. And so in these cases we need to understand why our immune system is not able to respond to this virus appropriately.
What we need to think about
- Immune function: What is going on with the immunity of the body? Are there reasons this might be knocked out and not doing its job? For example, poor sleep patterns, dysregulated blood glucose, crappy diet/nutrient deficiencies (i.e. adequate vitamin D and zinc are majorly important), gut health issues, and high alcohol intake.
- Vaginal dysbiosis: A healthy vaginal microbiome is protective against infection; it’s the vagina’s job to have an immune surveillance system and be highly acidic to create an inhospitable environment to unwanted microbes. Research reports a dynamic interplay between the microbiota of the vagina and HPV acquisition and persistence. Further, the environment of the vagina influences the development of cervical intraepithelial neoplasia (CIN) and cervical cancer. Specifically, it has been shown that bacterial vaginosis (BV) and any kind of genital inflammation (seen in aerobic vaginitis (AV) or from an infection like ureaplasma) are potential drivers for HPV.
- Methylation: We need healthy cell division as well as appropriate gene stability and expression (to modulate viral-infected cells). So if there are issues with methylation (i.e. MTHFR SNPs), or deficiencies in crucial vitamins responsible for methylation, we are more likely to see poor clearance and persistence in infection. Hypomethylation could also be associated with CIN severity.
Recommendations
- Working with a natural health practitioner well versed in HPV means you can unearth the root of the issue. There are many direct ways to influence the vaginal environment to promote clearance, as well as understanding the factors to address as mentioned above to adopt a whole system approach.
- Consider general vaginal health. Wearing G-strings? This can lend to butt microbes moving into the vagina (i.e. enterococcus). We don’t want a tightrope between the two if a dysbiotic environment is assumed. See my recent blog on the vaginal microbiome for more reccos.
- Cut out alcohol and sugar, sort out sleep and whatever else might be smashing the immune system.
- Focus on a blood sugar stabilising diet. Both Glucose Goddess and Lara Briden have great information in this arena.
- Complete blood work ups and targeted nutritional therapy as required
Given all of the above, one of the best ways to avoid this is to prevent contracting HPV in the first place. A lot of women will now have Gardasil vaccine and many will be on some kind of hormonal birth control (HBC) in their early years for sexual activity. This creates a false sense of security against sexually transmitted infections. The Gardasil vaccine does not prevent all types of HPV, and HBC does nothing for any kind of sexually transmitted infection. This is a huge area of concern in my opinion.
As women, our vaginal microbiome is of utmost importance for our fertility and unprotected sex can bear a burden on this environment, lending to risks of viral and bacterial infections. The best way to conserve this environment and prevent exposure is to practise protected sex, especially outside of committed relationships (where testing has not been done to know what you’re up against!).
In summary
There is much that can be done if a strain of HPV is detected in a routine pap smear. Testing usually won’t occur for another year, so you have time to consider all factors relating to its presence and support eradicating it. If anything, it’s a little nudge to let you know some health fine tunes are in order.