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Healthy You

Answering Questions About HPV

October 15, 2020 11:00 AM with Dr. Melissa Lippitt

Most cases of cervical cancer stem from an easily preventable virus called human papillomavirus (or HPV), which is easily preventable from a readily available vaccination.  Dr. Melissa Lippitt from the Gynecologic Oncology department will be taking your questions live, on HPV, cervical cancer, the vaccination and more.

HPV

You can submit your questions in early below, set a reminder for the day and time to come back, or ask your questions live during the chat.

Ben (Moderator) - 10:50 AM:
Welcome Dr. Lippitt, and welcome everyone else to the NorthShore University HealthSystem's latest chat on HPV. The chat will begin in 10 minutes, but please start submitting your questions now.

Ben (Moderator) - 11:00 AM:
We are now ready to get started with the chat.

Dr. Melissa Lippitt - 11:01 AM:
Welcome! My name is Melissa Lippitt, MD MPH. Thanks for coming to this chat. I am a gynecologic oncologist here at NorthShore. I treat all types of gynecologic cancers and we perform both surgeries and administer chemotherapy as needed. HPV infections are really common and the majority of men and women will have an HPV infection at some point in their life. However, usually, people are asymptomatic and often will actually clear the virus. Sometimes, however, HPV can lead to genital warts or can be associated with cancer. The gynecologic cancers associated with HPV include cervical cancer, vulvar cancer, and some vaginal cancers. Fortunately, we now have an HPV vaccine and our goal is to be able to prevent many of these cancers for future generations.

  Jon (Glenview, IL) - 11:01 AM:
When should my child receive the HPV Vaccination?
Dr. Melissa Lippitt
Great question. The HPV vaccine is recommended as a routine vaccination for boys and girls to be given at age 11 or 12 years. The vaccine is approved to be given as early as age 9. I recommend you talk to your pediatrician specifically about the HPV vaccination and about what age they are typically giving the vaccine to their patients. We know though that vaccine rates aren't as high as we would like - for a variety of factors - so as a parent being an advocate for your child to receive the vaccination is important!

  Lauren (Chicago, IL) - 11:05 AM:
I had a slightly abnormal pap test and my doctor said I don't need a follow up right away because the guidelines had changed last year. What do patients need to know about the new guidelines, and is it safe to wait longer between paps?
Dr. Melissa Lippitt
There are a variety of different results that someone can have on a pap smear. In addition to the pap smear itself we also typically do a test for HPV as well. The combination of the specific results of the pap smear and the HPV results (along with a person's age) usually determine the appropriate follow up. The new guidelines are based on the risk of someone having a pre-cancer for cervical cancer or even cervical cancer. Probably based on your specific results and HPV testing (if done) the risk of a pre-cancer was low enough to not warrant further workup. It is typically safe to wait more than one year between pap smears depending on the specific pap smear and HPV results. The new guidelines help tailor the follow-up to the individual. I encourage you to discuss any specific concerns you may have about your specific results with your provider.

  Sam (Niles, IL) - 11:12 AM:
I don't know if I ever had the HPV shot. My medical records are spotty, are any problems with getting vaccinated twice?
Dr. Melissa Lippitt
That's a great question. We typically do not recommend repeat vaccination if someone has already received the vaccine but this is a unique situation. There is probably not a problem with receiving the vaccine if you have already had it in the past. Mainly, the question is whether you should get it at this point and that may depend on your age. The HPV vaccine is recommended for routine vaccination for boys and girls at age 11 or 12 years. It is recommended that everyone through age 26 years be vaccinated if not adequately vaccinated previously. In October 2018, the FDA expanded its approval for the HPV vaccine in males and females ages 27-45 but recommends shared decision between the patient and provider about whether previously unvaccinated adults should receive the HPV vaccination. I would recommend you speak with your doctor about their recommendations. But if you are 26 or younger I would especially encourage you to be vaccinated.

  Jim (Skokie, IL) - 11:19 AM:
If I am infected with HPV orally, can I pass the virus to my children if I kiss them?
Dr. Melissa Lippitt
Thanks for the question. Usually, we do not know whether or not someone has an oral HPV infection as we do not have a routine test for oral HPV infection. Typically, the only times that we know that someone has an HPV infection is if they have evidence of pre-cancer or a cancer of the mouth or throat. I am not an expert in HPV-related head and neck cancers so I do not specifically know the risk related to a known infection and passing the virus to your children. Sometimes, people get HPV (human papillomavirus) confused with HSV (herpes simplex virus). HSV is what causes typical oral herpes also known as cold sores and can be passed for from a parent to a child just by kissing them if the parent is known to be infected.

  Jane (Evanston, IL) - 11:26 AM:
Is there anyone you don't recommend getting the vaccine? Allergies or high-risk people or something like that?
Dr. Melissa Lippitt
Yes - there are a few times that we do not recommend giving the vaccine. We do not recommend giving the vaccine to anyone with a history of a severe allergic reaction (e.g., anaphylaxis) to a vaccine component. Our current 9-valent HPV vaccines is produced in Saccharomyces cerevisiae (baker’s yeast) and are contraindicated for persons with a history of immediate hypersensitivity to yeast. We also do not recommend giving the vaccine when someone is pregnant. For anyone who is immunocompromised (examples include HIV or on immunosuppression medications), these are the people at the greatest risk of a persistent HPV infection and it leading to cancer so we actually strongly encourage these individuals to receive the vaccine.

  Celeste (Naperville, IL) - 11:31 AM:
When a person is "cleared" of HPV, does that mean it's gone or dormant? Can you still spread it if you are cleared?
Dr. Melissa Lippitt
That's a good question, Celeste. To be honest - we sometimes say "cleared" and don't actually know if the virus is completely eradicated or if it may be dormant. For women, if they have a history of a positive HPV test and then have a future negative HPV test we typically think of them as having cleared the virus. However, it is possible that there is still some virus in some cells that may become reactivated from being "dormant" in the future. If someone has a negative HPV test then we often think of them as being low risk for spreading an infection. However, anytime someone has a new sex partner, at any age, there is always a risk of also getting a new HPV infection.

  Sean (Deerfield, IL) - 11:39 AM:
Have there been any new advancements or changes in the detection and treatment of cervical cancer in the last few years?
Dr. Melissa Lippitt
In terms of detection of cancer - our mainstay of detection is still using pap smears with HPV testing to try and identify women who may have pre-cancer or even an early cervical cancer before they would otherwise have presented with symptoms from their cervical testing. We know are doing more screening for specific types of HPV - specifically, HPV16 and 18 - which we know have the highest likelihood of causing a cervical cancer. For treatment, our newest FDA approval was in 2018 for an immunotherapy drug (pembrolizumab) that we can use for some women if their cervical cancer comes back or is not responding to our standard chemotherapy. We are always looking for new treatment options though! There are also currently clinical trials looking at other treatment options for cervical cancer including new chemotherapy drugs, other targeted drugs, other ways to use immunotherapy drugs and a TILs trial (a type of immunotherapy that uses T cells from the tumor itself to fight cancer).

  Jenna (Chicago, IL) - 11:47 AM:
I had a type of HPV and my immune system cleared it. Am I immune to other types of HPV now?
Dr. Melissa Lippitt
Unfortunately, it probably means that you are now immune to the specific type of HPV infection that you had but not necessarily to other types of HPV infection. This is one of the reasons that our current HPV vaccine, Gardasil 9, actually targets 9 different HPV types: 2 types that are known to cause genital warts and 7 types that are known to cause cancer. These 7 types of HPV included in the vaccine are responsible for almost 90% of cervical cancer cases in the US.

  Loretta (Evanston, IL) - 11:51 AM:
How long does it take for HPV symptoms to start showing?
Dr. Melissa Lippitt
That's an excellent question and it depends. The majority of people will actually never have any HPV symptoms and will clear the virus on their own. This is especially true for younger people and is one of the reasons that we do not recommend even starting to screen for cervical cancer with pap smears/HPV testing until people are 21 except in a few rare cases. Many other people won't have any "symptoms" from HPV essentially until/if they develop a cervical cancer and then can present with a variety of symptoms. Usually, pre-cancer changes in the cervix, known as dysplasia, are not associated with any symptoms at all.

  Jill (Wilmette, IL) - 11:55 AM:
If my mom had breast cancer, am I at higher risk for cervical cancer? Are there any genetic tests I should get to find out if I’m at increased risk for cervical cancer?
Dr. Melissa Lippitt
No, you won't be at a higher risk of cervical cancer if your mom had breast cancer. Over 99% of cervical cancer is caused by the HPV virus, which is a sexually transmitted infection. Thus, I would not recommend any genetic testing related to the risk of cervical cancer. However, if your mom had breast cancer, that can be associated with family history/certain genetic abnormalities. I would encourage you to speak with your doctor about whether you should have genetic testing done because of possible increased risk for yourself for breast cancer or other non-cervical cancers.

Ben (Moderator) - 12:00 PM:
That's all the time we have for questions. Thank you Dr. Lippitt for your time and expertise!
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