COUNSELLING A DIAGNOSIS
There is a balance to be reached between ‘over-normalising’ a diagnosis of a viral sexually transmitted infection (STI) and failing to empathise with the potential psychological impact of a diagnosis. A diagnosis of HPV-related disease raises questions for the affected individual, their partner(s) and health practitioners regarding mode of transmission and ongoing intimacy. It is important to emphasise that a diagnosis of HPV does not necessarily imply multiple sexual partners or other concurrent sexual partners.
Holistic management of affected individuals and/or their partner(s) includes proactively providing information and education (e.g. handouts), directing the person to reputable sources of information (e.g. www.hpv.org.nz), and referring them to a sexual health specialist if required.
| KEY INFORMATION FOR PERSONS WITH HPV INFECTION |
|---|
| Vaccination against HPV has been available for many years and everyone who is eligible should get vaccinated. |
| 80% of unvaccinated adults will get infected with HPV at some point in their life. Given that infection is asymptomatic in most infected individuals it is easily shared through sexual (including oral) skin-to-skin contact. |
| There is no need to alter sexual activity with a stable partner because sharing of HPV would have occurred long before the clinical appearance of lesions or an abnormal smear result. There is no way to know which partner infected an individual with HPV or how long ago infection occurred. Having HPV does not mean that a person or their partner is having sex outside the current relationship. |
| In most infected individuals, the virus is harmless and will not develop into warts, pre-cancer or cancer. |
| In a subset of infected individuals, HPV causes genital warts (which are harmless). The causative HPV type is different from the types of HPV that cause abnormal cells or cancer. |
| In a small number of infected individuals, HPV can cause abnormal cells that sometimes progress to cancer, including cervical, vaginal, vulval, anal, throat and penile cancers. |
| There is no treatment to eliminate HPV; where infections resolve, this is due to elimination by the body’s immune system. |
| There are effective treatment options for genital warts and abnormal cells. |
| HPV does not affect fertility. |
| HPV does not stop individuals from having a normal sex life. |
| There is no single HPV test (e.g. a blood test) to check for HPV status at multiple body sites. This means there is no test that can help answer the questions “Do I have HPV?”, “Does my partner have HPV?”, “Has my HPV gone?”, “Can I have the vaccine?” |
| KEY INFORMATION FOR PERSONS WITH ANOGENITAL WARTS |
|---|
| Routine STI screening does not include testing for either HPV or herpes simplex virus. There is no definitive way to know when an individual was infected with HPV. |
| If left untreated, genital warts may go away, stay the same, or increase in size or number. |
| If warts are in the pubic region, avoid shaving or waxing because this may spread the warts. |
| The types of HPV that cause genital warts rarely cause cancer. |
| People with a cervix with genital warts need to have regular cervical screening, following the same guidelines as similar individuals without visible genital warts. |
| Genital warts can develop months or years after being infected with HPV, and can be passed on to another person even when there are no visible signs of warts. |
| There is no reliable way to know when HPV was acquired. Sex partners tend to share HPV, even when they do not show signs of HPV. The presence of genital warts does not mean that a person or their partner is having sex outside the current relationship. |
| Although genital warts are common and benign, a diagnosis does have considerable psychosocial impact. |
| Genital warts can be treated, but available therapies do not treat the virus itself. Therefore, it is common for genital warts to come back after treatment, especially in the first 3 months. |
| Affected individuals should inform their current sexual partner(s) that genital warts may be transmitted. Partner(s) may benefit from getting tested for other STIs. A current partner may already have HPV even though they may not have visible signs of warts. |
| Abstinence from sexual activity with new partners is recommended until the warts are gone or removed. HPV may remain, and can still be passed on to partners, even after the warts are gone. |
| Condoms may reduce the chances of transmitting genital warts if used with every sex act. However, HPV can infect areas that are not covered by a condom and condoms may not fully protect against HPV. |
| The HPV vaccine prevents most cases of genital warts in individuals who have not yet been exposed to wart-causing types of HPV, but will not treat existing HPV or genital warts. |
| It is not clear whether there is any health benefit to informing (future) partners about a past diagnosis of genital warts because it is not known how long the virus remains after warts are gone. |
| KEY INFORMATION REGARDING CERVICAL CANCER SCREENING |
|---|
| HPV is a common infection and is often cleared by the immune system. A positive HPV test does not mean that a person has cancer. Most people who have HPV do not develop abnormal cells or cancer. |
| HPV is often shared between partners and can lie dormant for many years; having HPV does not imply other sexual contacts, nor should it necessarily raise concerns about a partner’s health. |
| Most cervical cancers can be prevented by HPV vaccination and undergoing regular cervical screening. If any abnormalities are detected, then National Cervical Screening Programme guidelines should be followed; this is the most effective strategy for preventing the development of invasive cervical cancer. |
| KEY INFORMATION ABOUT PREVENTION |
|---|
| HPV vaccination, ideally before the first sexual activity, is the first line of defence and the most effective way of preventing HPV infection. |
| Condoms used consistently and correctly may lower the chances of acquiring and transmitting HPV and developing HPV-related diseases, such as genital warts and cervical cancer. However, HPV can infect areas that are not covered by a condom, so condoms do not fully protect against HPV. |
| Although limiting the number of sex partners can prevent HPV, it is important to note that even people with only one lifetime sex partner can get HPV. |
The Ministry of Health supports the use of these clinical guidelines, developed by clinical experts and professional associations to guide clinical care.
Produced by the Professional Advisory Board (PAG) of the Sexually Transmitted Infections Education Foundation
Website by Original Image