HPV & Personal Reasons (cont'd Henrietta)

                Chlamydia.  Gonorrhea.  Syphilis!  

                Every good blog post begins with some scary words.  These are mine for today.  They are all sexually transmitted diseases, but I’m sure most of you knew that already.  With those words come some very negative connotations, both about the diseases themselves and the people who are infected.  It’s unfortunate because the more open people are about their problems, the more they can help others in similar situations. 

                The human papillomavirus is also a sexually transmitted disease.  For me, it is the virus that I am most passionate about: it served as the basis for half my doctoral thesis and I was infected with a strain of the virus at age 23.

Here the facts about HPV:

More than 130 different types of human papillomaviruses (HPVs) have been identified.

30 of these 130 are mucosal HPVs that can infect the genital tract; they are broken into two groups known as high risk and low risk viruses.

Nearly 50% of the population has been or will be infected with a strain of HPV at some point in their lives; most will never know it.

Many infections cause no symptoms and are eventually cleared by our immune systems.

Low risk HPVs (ex. types 6 and 11) can cause benign cellular proliferations, also known as warts.

High risk HPVs (ex. types 16 and 18) are associated with carcinomas of the anogenital tract (ex. cervical cancer).

Cervical cancer is one of the leading causes of women’s death in developing countries.

Cervical cancer is the sixth most common cancer in women worldwide.

Condoms cannot cover every area that is infected by the virus so it is possible to infect others even when using protection.

Yearly Pap smears test the cervix for cellular transformation.  Get a Pap smear at your annual check-up.  Follow up on any abnormal results.  Please.  I beg you.  Even if you have the vaccine, get a pap smear every year.

The HPV vaccines serve as a way to boost your immune system against a few of the high and low risk viruses.  This way, your immune system is more likely to clear the infection before it has a chance to turn your cells cancerous.

                I was at work when I received a phone call from my gynecologist’s office.  “Call us back immediately” are never good words.  When I did call back, I was inundated with words like “abnormal cells,” “colposcopy,” “CIN III,” and “cancer.”    

            

                I panicked.  Closing myself in a conference room, I called my Dad, who is a family doctor.  He helped calmed me down some, but both of us were still slightly concerned upon hanging up.

                I scheduled a follow up appointment then turned to the most daunting place possible for answers: Google.

                I’d been getting Pap smears for five years.  I’m ashamed to admit it, but I had no idea why I needed a Pap smear.  It was just what was done each year at my annual check up.  The results always came back normal so it never occurred to find out what “abnormal” meant.  Google answered those questions for me quickly, I assure you.  

Cancer.  Cancer!  The word was everywhere.  Did I have cancer?  Will I get cancer?  What the hell does CIN III even mean?  Do I have a …sexually transmitted disease…?  The words were too hideous to even say out loud.  

A week later, my colposcopy confirmed that I had abnormal cells on my cervix, which needed to be removed.  One month later, they were cut away by a loop electrosurgical excision procedure (LEEP) in an operating room of Brigham and Women’s Hospital in Boston, Massachusetts.  I refused general anesthesia so I talked with my anesthesiologist during the procedure, which was headed by my excellent gynecologist and witnessed by no less than five medical students.  (The second part didn’t thrill me.)  Follow up tests confirmed she had removed all the abnormal cells and two years of Pap smears every three months followed.  At age 26, I was cleared to be back on a schedule of yearly Pap smears and I haven’t had an abnormal result since.  

Medically, I was cured.  Scientifically, I was intrigued.

When I asked to be tested for HPV immediately following the LEEP, I was told that it was unnecessary: an abnormal cervix was almost always due a high risk HPV infection so I could safely assume I had it.  This killed me.  I wanted so badly to believe that I was one of the few who had this happen without an HPV infection.  I didn’t want the stigma or pain of knowing I had an STD or that I was somehow “impure.”  Her swift and concise statement shut the door on that one little hope so I had to face it.  

I started graduate school about four months after my LEEP.  When it came time to choose an avenue of research, we were subjected to weekly meetings and discussions about different labs and their research topics.  The minute I heard one man discuss an HPV project in his lab, I was hooked.  I picked his lab immediately, asked for the HPV project, and never looked back.  I spent six years studying a single protein from human papillomavirus type 16.  I took tremendous pride in that work.

It can take up to ten years (or longer!) for an abnormal cervix to turn cancerous.  Typically, this is not a fast process (although, it can be).  Because of this, abnormal Pap smear results are broken down further to tell the patient to what degree their cervix has changed from normal (also termed “dysplasia”).  CIN stands for cervical intraepithelial neoplasia and is rated from I (mild) to III (severe).  The dysplasia can also be graded as low, high or malignant.

Lucky me: I had a high grade CIN III.  However, I was treated properly and timely.  Today, I’m a very healthy 30 year old woman.  This is why you get Pap smears.  HPV is so prevalent in our society.  It can turn your cervix into a ticking time bomb that you don’t even know is rigged until it is too late.  By the time you start to show outward symptoms (such as bleeding), you are very far along in the process and, quite possibly, have developed cancer.  This is how Henrietta Lacks first realized she had cervical cancer – her tumor bled with barely a touch according to her treating doctor.

For any more reason why women should openly discuss HPV, forget the shame of having an STD, get regular Pap smears and see their doctors annually, I highly recommend googling the story of Jade Goody.  

   

I hope this post has provided you with a background on HPV and, at the patient level, what happens with an infection.  My next post is going to dive down inside the infected cervical cells to show you, at the protein level, what HPV is doing and how that leads to clinical symptoms.  We’re going to connect the macro world with the micro world…

Pap smear – a test invented by Georgios Papanikolaou where cells are gathered from the cervix and placed on a slide for view under a microscope.

Colposcopy – a way to magnify a doctor’s view of the cervix and confirm a Pap smear result.  A small concentration of acetic acid is applied to the cervix to enhance the doctor’s view of abnormal cells.

LEEP – electricity is passed through a wire loop and used to both cut and cauterize the cervix as the area of abnormality is removed

Dysplasia – term meaning abnormal development

Neoplasia – term meaning abnormal growth or proliferation

References

de Villiers EM, Fauquet C, Broker TR, Bernard HU, Hausen Hz (2004) Classification of papillomaviruses. Virology 324: 17

Hausen Hz (1996) Papillomavirus infections - a major cause of human cancers. Biochim Biophys Acta 1288

Hausen Hz (2002) Papillomaviruses and cancer: from basic studies to clinical application. Nature Reviews Cancer 2: 342

Baseman J, Koutsky L (2005) The epidemiology of human papillomavirus infections. Journal of Clinical Virology 32(suppl1): S16 - S24

http://www.nlm.nih.gov/medlineplus/ency/article/001491.htm

Skloot, Rebecca.  “The Immortal Life of Henrietta Lacks” (2010) Crown Publishers, New York, New York.

Me, myself, and I