Discovery of HPV may require further tests

Q**My 18-year-old daughter recently became sexually active. Her first PAP smear showed "changes consistent with HPV." What does that mean for her? Whatever the doctor told her really upset her.

A**It's wonderful that you and your daughter have the kind of honest relationship that made her feel comfortable enough to share with you this personal information. She will be able to use your support in the months ahead.


HPV stands for Human Papilloma Virus, the kind of virus that causes warts on the hands, feet and genitals.

There are more than 60 strains of this virus. Some have a predilection for the thicker skin of the extremities and some for the thinner skin of both male and female genitalia (penis, scrotum, vulva, vagina and cervix).


As in your daughter's situation, genital warts almost always are spread through sexual intercourse with a partner who also is infected. Most experts believe the HPV now is the most common sexually transmitted disease in the United States.

We can think of two reasons why your daughter was upset by her visit with her physician. First, she probably was surprised and upset to learn she had a sexually transmitted disease. Most women with HPV infection of the cervix have no external warts. Often, the results of a PAP smear are the first indicators of the condition.

Second, her doctor probably told her there is an association between HPV infection and later development of cervical cancer. This does not mean that genital warts cause cervical cancer or that your daughter will develop it. It means that women who have had genital warts are at a greater risk for developing this type of cancer. Other factors also, most likely, play a role.

Your daughter probably will need a colposcopy (a gynecologic exam using a sophisticated microscope) to help her physician examine her cervix more closely. This exam enables the physician to decide whether to monitor the infection with a series of PAP smears or to take tiny pieces of the cervix (biopsies) for a more detailed look for abnormalities requiring immediate treatment.

Depending on what is found, various treatments are available. Most importantly, your daughter should receive regular gynecologic care in the years ahead.

A final note: Because there are so many strains of this virus, individuals can be reinfected many times. We strongly recommend that the individuals who are sexually active use condoms. Also, your daughter should notify her partner and encourage him to seek care as well.

Dr. Wilson is director of pediatric primary care of the Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.