HUMAN PAPILLOMAVIRUS (HPV) AND RELATED CONDITIONS
Abnormal Pap Smear
Precancerous Lesions of Vulva, Vagina and Cervix (VIN, VAIN & CIN)
Dysplasia

Qualifications
Dr. Sassone's expertise and qualifications in this field are extensive, and include:

• Certificate in screening cytology from the University of Verona, Italy.

• Special training in oncology at the Radium Hospital of Oslo, Norway, and The University of Chicago.

• Supervision of the Comprehensive Gynecologic Cancer Screening Clinics at the University of Messina and the University of Modena, Italy.

• Co-authorship of several papers on the use of colposcopy and on cancer of the cervix.

• Membership with the American Society for Colposcopy and Cervical Pathology

She periodically reviews the published literature and makes available to her patients the latest diagnostic and treatment modalities.

Our Services
When the papsmear is abnormal it might be due to a transitory infection or to a lesion that must be identified and treated to prevent the development of cancer. Certain conditions and habits predispose to cancer of the cervix and they will be reviewed to identify women at risk.

The most important step is to have a thorough examination that will include the following tests:

Wet Mount Exam
Immediate microscopic examination of the vaginal secretion is performed, to identify infections due to bacterial vaginosis, trichomonas and yeasts. With this method it is also possible to evaluate the degree of local inflammation, and to give an approximate evaluation of the hormonal state. For a more reliable hormonal evaluation, inflammation must be treated and resolved. Very low hormonal stimulation to the vaginal walls must be corrected as it might be a source of error in the interpretation of the papsmear.

Microbiology, mycology and virology
Appropriate viral bacterial and yeast cultures are sent to the laboratory. The presence in the genital tract of a few virus types of the HPV family and Chlamydia infection predispose to the development of dysplasia and cancer. Yeast vulvo-vaginitis might interfere with the resolution of other infections. Because HIV infection is associated with a more aggressive course of precancerous lesions, testing is indicated for all those who might have been exposed. For those who want HIV testing, a blood sample is collected in the office and sent to the lab.

Colposcopy
A detailed examination of vulva, vagina and cervix is carried out, when appropriate, with a magnifying instrument called Colposcope. This examination is complementary to the papsmear. The papsmear collects superficial material that is screened for abnormalities, but cannot tell where and how extensive the abnormalities are. With colposcopy we identify the lesions and describe their location and extension.

Biopsies
It is often necessary to confirm the colposcopic impression by taking very small tissue samples (biopsies). These are sent for interpretation to the laboratory. Results are usually available in a week's time.

Treatment
For low-risk cases, periodic checking with papsmear, HPV DNA, and wet mount is all that is needed. Half of the very low grade lesions (i.e.: CIN1, mild dysplasia) resolve spontaneously within one year. Treatment of more advanced precancerous lesions (i.e.: CIN 2-3, severe dysplasia) is carried out in the office, without loss of working days and with none to minimal discomfort. Topical medications and electrical surgery (LEEP) are the most commonly used methods. If laser treatment is the chosen modality, Dr. Sassone performs it as an ambulatory procedure, at the hospital. Smoking and dietary deficiencies might interfere with successful treatment: review of habits and counseling are provided. Experimental treatments are available in selected cases.

What About the Male Partner?
One or more of the over 100 types of Huma Papilomavirus (HPV) are present in the skin of most of us. For women, several of the HPV types are potentially carcinogenic, while they do not seem to carry the same risk for men. Venereal warts, also caused by HPV, can develop equally in men and women.

Men carry HPV and can pass it on to their partner even when there are no visible lesions. Dr. Sassone performs male examination and treatment for HPV. If a male physician is preferred, here are the names of two doctors who can provide thorough examination and treatment:

David Frankel, MD
263 Seventh Avenue, suite 4D
Brooklyn
178-369-3559

Marc Gossin, PA
80 East 11th Street, suite 211
Manhattan
212-677-1777
www.alwaysyourchoice.com

More Information
Condom use does not prevent HPV transmission because the virus can be shared by contact with the skin of the genitals, the anus, and with oral sex. On the other hand, condoms diminish the viral load transmitted to the partner and the irritating effect of sperm in the woman's vagina. Recent studies have shown that HPV-positive women become negative sooner if the partner starts using condoms consistently.

The safest choice for a couple is to remain monogamous, because each new partner brings her or his own HPV types, augmenting the burden of the immune system. On the other hand, after two people have shared their HPV types, and no new ones come into the picture, the immune system has a better chance to handle the virus successfully.

To detect disease invisible at the naked eye, men should undergo acetic acid soak followed by magnifying-lens examination, a procedure equivalent to colposcopy for women, but not all physicians are equally interested and trained. Even when no lesion is found, the examination should be periodically repeated. HPV testing of the semen and examination of the urethra and bladder are necessary in selected cases. A rectal examination, HPV rectal swab, and acetic acid soak are mandatory.

The best defense against HPV, for both men and women, is an effective immune system. Healthy diet, exercise, adequate rest, and stress-reduction practices are all related to immune balance. Smoking apparently lowers folic acid level in the tissue, giving an advantage to HPV.

Treatment modalities to enhance tissue immunity (Imiquimod, Interferon A) are available. Lesion destruction diminishes the viral load, causing indirect immune stimulation. Lesions can be eliminated chemically (podofillin, tetrachloroacetic acid) or surgically (excision, desiccation, chryoablation, laser ablation, etc).

Further Reading
Download the Human Papilloma Virus (HPV) infection and their connection to cancer of the neck of the uterus, vagina, vulva and rectum (PDF 140KB) written by Dr. Sassone.

If you are unfamiliar with some of the terminology used in this page, please visit our glossary.