Welcome to ReachMD. The following clinician-patient dialogue is provided in partnership with Omnia Education and supported by an independent educational grant from Roche Diagnostics.
The following is a representative dialogue between a clinician and a 26 year old patient, who visits for STD screen and learns about the value of HPV testing. Other episodes in this 3-part series can be found at ReachMD.com/HPV.
Dr. Wright: Hi Carol, I'm Dr. Wright and it is good to meet you. I see from the intake sheet that you are 26 years old and just moved here from Charlotte. Is that correct?
Carol: Yes, it is Dr. Wright. After I finished law school I clerked with a Federal judge in Charlotte and several months ago, took a position with a law firm here in Philadelphia.
Dr. Wright: Well welcome to Philadelphia then. Your intake sheet also says that it has been two and a half years since you had your last GYN visit. Is there a specific reason you are here today?
Carol: I wanted to get screened for STDs and discuss whether my IUD needs to get changed.
Dr. Wright: That is fairly straight forward. However, before we start why don’t you tell me a little about your sex life. Are you currently in a stable relationship and how many new partners would you estimate that you have you had since your last GYN exam?
Carol: Unfortunately I don’t have a boy friend right now. While in Charlotte I went with a couple of different guys for a few months each, but I was just too busy to start a real relationship.
Dr. Wright: OK, we will want to do a full STD screening. In the past, the Pap was used as a screen for STI and that there are far more sensitive and accurate tests available that use new molecular technology. This is the approach we will take for your screening other than HPV testing. That will include testing you for HIV, gonorrhea, chlamydia, and trichomonas. Since it has been two and a half years since your last examination we will also want to screen you for HPV.
Carol: Don’t you also want to take a Pap test? I thought women were suppose to get those every year.
Dr. Wright: Over the last several years there have been a lot of changes in how we screen for cervical cancer. For women your age there are two options. The first is to do a Pap test, but we no longer do Paps yearly. The current recommendation is that we only do a Pap test every three years. The other option is to test you for HPV.
Carol: I was vaccinated against HPV when I was in college so why would I need testing for HPV?
Dr. Wright: 14 different types of HPV types can cause cervical cancer. The vaccine that you got in college only protects you against two of the most common types of HPV that cause cervical disease. The test we use for screening detects all 14 types of HPV that can cause cervical disease.
Carol: So, should I get a Pap test or the HPV test?
Dr. Wright: Last year I started recommending that women your age get the HPV test rather than a Pap test. The reason is that at your age there is a high risk of developing cervical disease and the HPV test is much more sensitive than the Pap test. The Pap test can miss up to half of cervical disease whereas the HPV test misses far fewer cases.
Carol: If the Pap misses so much disease, why do people still get it?
Dr. Wright: That’s a good question Carol. I guess it has a lot to do with tradition. The Pap test has been around for over 50 years and OB/GYNs have been using the Pap test to screen for cervical cancer their whole careers. HPV testing was only recently approved to be used for cervical cancer screening, so OB/GYNs in the U.S. are just being to switch over. Countries like the U.K. and the Netherlands have already begun switching their national screening programs to HPV testing.
Carol: Would testing me for HPV require that you take blood?
Dr. Wright: No we don’t use blood to test for HPV. We take a sample from your cervix just like we would do when we take a Pap test – in fact we actually use the same collection kit that we use to take a Pap.
Carol: What will you do if I test positive for HPV? I’ve read that HPV infections are very common.
Dr. Wright: You are right Carol. About 1 in 5 women your age will test positive for HPV. The good news is that relatively few HPV positive women have significant cervical disease. Most HPV positive women will test negative for HPV over the next several years. Therefore what we do if find HPV is two things. The first thing we do is check if you have one of the two highest risk HPV types. These are HPV 16 and 18 and are the two HPV types that you were vaccinated against. If you have either HPV 16 or 18 we will take a closer look at your cervix. If you don’t have HPV 16 or 18 we will do a Pap test on the same sample that we took for HPV testing. If the Pap test is normal, we will simply have you come back in a year and retest you for HPV to see if you are still positive.
Carol: Hopefully I won’t be positive.
Dr. Wright: Agreed, you ready for your exam?
This ReachMD brief was provided in partnership with Omnia Education.For more information or to access the other episodes in this video series, visit ReachMD.com/HPV.
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