1 in 4 People Have HPV, but What Is It Really?

“What you need to know about HPV”

— Dr. Dale

1 in 4 People Have HPV, but What Is It Really?

http://greatist.com/live/what-is-hpv

The Basics

The fact is nearly all people who are sexually active will come in contact with the human papillomavirus (HPV) at one point in their lives. After all, it's the most common STI on earth. There are roughly 100 strains of HPV out there, but only about 40 of them infect the genital area—and even fewer are considered serious.  

How You Get It

You can contract HPV through vaginal, anal, or oral sex, and it can even be passed by a person who's asymptomatic (which is pretty common—more on that below). HPV, along with herpes, is one of the few STIs that can bypass the latex barrier of a condom and infect a person through skin-to-skin contact. 

"If your partner is a known carrier of HPV and wears a condom, you can still catch this contagious virus," says Sherry Ross, M.D., a gynecologist based in Santa Monica.

What's It Like?

Here’s the tough part about HPV: There are usually no symptoms. At least two types of HPV (types 6 and 11) can cause genital warts (in fact, 90 percent of allgenital warts are caused by those strains). But for most of the nearly 80 million people living with the infection, there are no signs.

For most of the nearly 80 million people living with the infection, there are no signs.

How Serious Is It?

Most of the time HPV clears up on its own and doesn't cause any health issues. But if you've seen a Gardasil commercial, you're probably aware of its connection to cancer. Each year HPV causes about 30,700 cases of cancer, more commonly in woman than in men. Cervical cancer is the one that gets the most attention, but other rarer cancers—penile, anal, vaginal—also have strong associations with HPV. For instance, about 5,010 people are diagnosed with anal cancer each year, and about 91 percent of those cases are caused by HPV.

One more thing: The types of HPV that cause genital warts are not cancerous. So though you might not like the way they look, technically, they're less serious.

What Can I Do?

Here's the great news: HPV has a vaccine. Gardasil, which protects against the strains that most commonly cause cancer or genital warts, has been available since 2006. There's also Cervarix and Gardasil-9—both of which protect against even more strains of HPV.

“HPV was not even on the radar for sexually active women and men 30 years ago," Ross says. "Now the HPV vaccine is part of the health care narrative for young girls and boys.”

It's recommended that children ages 11 to 12 get two doses of the vaccine, whereas people who get it later (ages 15 to 26) need the whole three-dose series.

Women between the ages of 21 and 65 should get a Pap test and/or HPV test every three to five years, depending on what your doc recommends.

Doctors Roundup: Botox? Fraxel? And? They Weigh In on the Latest Treatments and Must-Have Products

“Two of our most popular procedures featured as a favorite in Vanity Fair: CoolSculpting and Botox.”

— Dr. Dale

Doctors Roundup: Botox? Fraxel? And? They Weigh In on the Latest Treatments and Must-Have Products

http://www.vanityfair.com/style/2016/06/doctors-round-up-botox-fraxel-and-they-weigh-in-on-the-latest-treatments-and-must-have-products

We’ve asked a few of the top New York dermatologists and cosmetologists about daily skin-care essentials (aside from daily sunscreens!), plus, the latest and favorites among cosmetology treatments.

Amy Wechsler, M.D., P.C. / dramywechsler.com / 3 East 69th Street, New York City; 212-396-2500

Product and latest-treatment recommendations: La Solution 10 de Chanel, Botox, Fraxel, CoolSculpting, CoolMini.

“Moisturize! Dry skin appears wrinkly and must maintain the skin's barrier. La Solution 10 de Chanel is a perfect option, especially for those with sensitive skin. Botox is a great preventative agent as well as a treatment. If someone has the beginnings of a fine line or wrinkle on their forehead or in between their brows, for example, a low dose of Botox will allow the skin to heal, and the line will soon improve and even disappear. CoolSculpting, especially CoolMini, used for submental fat [double chins], greatly improves that area, with very little downtime. Fraxel stimulates collagen production. Having a treatment perhaps once a year will fend off early sun damage.”

(Note: you can find Laura Pietrzak, a leading authority on CoolSculpting, at Dr. Wechsler’s office.)

Patricia Wexler, M.D. / wexlerdermatology.com / 145 East 32nd Street, seventh floor, New York City; 212-684-2626

Product and latest-treatment recommendations: Wexler Intensive Night Reversal & Repair Cream, Ultherapy, ThermiSmooth 250, SculpSure, Cellfina.

“I recommend a great night cream with collagen stimulators like Retin-A, Matrixyl 3000 peptide, MMPI, plus hyaluronic acid or niacinamide for moisture. Also, antioxidants like vitamin C and E. Try Wexler Intensive Night Reversal & Repair Cream—it’s highly effective. The latest treatments for lifting and tightening: Ultherapy for lifting, Thermi250 for smoother texture and contouring. SculpSure is the newest way of melting fat to contour the body from neck to toes that treats with heat, not cold. And Cellfina is a truly long-lasting treatment for cellulite of buttocks and thighs. Restylane Silk and Belotero are the newest fillers for fine lines around the eyes and mouth. But Roloxin Lift is a topical [mask] solution that tightens the skin temporarily. Then, for at-home use, I like Tria Beauty anti-aging home laser, that is based on Fraxel technology, which can be used for surface rejuvenation of wrinkles and pigmentation.”

Gervaise L. Gerstner, M.D. / gerstnermd.com / 730 Park Avenue, New York City; 212-249-2208

Product and latest-treatment recommendations: L’Oréal Paris Revitalift, Juvéderm Voluma, Juvéderm Ultra Plus, CoolSculpting.

“Twenty-percent-glycolic pads are one-stop treatment for texture, fine lines, acne, and brown spots. Botox prevents lines from becoming permanent. Fraxel is a cumulative procedure to turn back the time of previous sun damage and prevent fine lines. Fillers are longer-lasting now, and I prefer Voluma and Juvéderm Plus, for face, and CoolSculpting, for the body. For crow’s-feet, L’Oréal Paris Revitalift Volume Filler Eye Treatment helps by replenishing skin volume around delicate eye areas, as well as around the mouth. For deeper lines, I like SkinMedica HA5, which is a hyaluronic serum that helps skin hold hydration. I also like Eminence Firm Skin Acai Masque three times a week, plus their Bamboo Firming Fluid. It’s a great answer to firmer skin.

Macrene Alexiades-Armenakas, M.D. / nyderm.org / 955 Park Avenue, New York City; 212-570-2067

Product and latest-treatment recommendations: Lancôme, Botox, Kybella.

“I recommend a multi-anti-ager on a daily basis. Look for a product that combines antioxidants, peptides, DNA repair, brighteners, and barrier repair all in one. Or layer them on. If you start Botox early enough, it prevents the repeated muscular movements from making the active wrinkles into permanent scars or creases in the skin. Kybella has shown outstanding results in reducing fat in the submental area. For deep wrinkles, I recommend Lancôme Visionnaire LR2412 4%-Cx serumand Visionnaire Rich Cream, which effectively target wrinkles as well as refine skin texture and pores. To target crow’s-feet, Lancôme Rénergie Lift Multi-Action Eye is my go-to, as its hydrating formula lifts and firms the delicate eye area and reduces the appearance of dark circles.

Robert T. Anolik, M.D. / laserskinsurgery.com / 317 East 34th Street, New York City; 212-686-7306

Product and latest-treatment recommendations: SkinMedica HA5 Rejuvenating Hydrator, Kybella, PicoSure.

“Once sun damage is present, retinoid is the most effective topical cream for restoring the skin’s appearance. Yes, Botox prevents the formation of permanent creases, and I use Fraxel lasers to remodel and build collagen in the skin. Kybella is the first injectable treatment for the improvement of the appearance of a double chin and PicoSure laser therapy for a nearly no-downtime treatment of acne scars. I recommend sunscreens, Retinoids, and SkinMedica HA5, which promotes hyaluronic-acid development in the skin that helps smooth out overall wrinkles.

Dr. David A. Colbert, M.D. / colbertmd.com/ 119 Fifth Avenue, fifth floor, New York City

Product and latest-treatment recommendations: Colbert M.D. skin care, Sublative Rejuvenation, Sublime, BTL Vanquish ME.

“I’m quite pleased with three relatively new treatments: Sublative Rejuvenation and the Sublime are two different dynamic infrared treatments that tighten jowls and erase fine lines and shrink large pores. They are both an exponentially vast improvement over short-lived results of microcurrent facials at salons and spas. The third is the aptly named BTL Vanquish ME, which seems like a magic-wand way to make excess fat vanish. As for face products, I believe facial oils are vital to healthy, glowing skin, and a few drops a day make everyone look dewy and fresh. Try the Colbert MD Illumino Face Oil—it’s like 401K for your skin. Both Botox and Fraxel have dual roles as preventative and corrective. We already know that they reduce fine lines and wrinkles, as well as freshen the skin, but Fraxel can also laser away invisible pre-cancerous skin lesions, and Botox can reduce the formation of wrinkles over time. And glycyrrhetinic acid and vitamin C brighten the skin to minimize dark spots, and I like my Retensify Firming Cream, which targets dark age spots.

Less Cervical Cancer Screening in HPV-Vaccinated Population?

“An interesting read for my female patients.”

— Dr. Dale

Less Cervical Cancer Screening in HPV-Vaccinated Population

http://www.medscape.com/viewarticle/870834#vp_2

However, he also warns that the option to screen less intensively at a later age with HPV testing instead of cytology may not be an option for all HPV-vaccinated women. There is a greater chance that women who received "catch-up vaccination" after the age of 12 became sexually active prior to vaccination, thereby increasing their risk for infection by vaccine HPV types, he explains.

"Current prophylactic HPV vaccines do not treat preexisting infections and related conditions, and therefore the population cancer risk reduction from HPV vaccines is lower in older populations," he writes.

A risk-based approach to clinical decision-making should be extended to cohorts vaccinated after the age of 12, he advises.

"Lower and upper risk thresholds, defining a risk band, should be established to decide at what age screening starts, at what frequency, and when it stops, as well as who would benefit from colposcopy with biopsy and even treatment without a confirmatory biopsy, should the risk be sufficiently high."

"Importantly," he adds, "these risk-based recommendations for clinical actions must to be conveyed to the busy clinician in a simple, clear, and direct manner."

Microsimulation Model of Different Screening Strategies

In the study, researchers used an individual-based microsimulation model of HPV and cervical cancer to project the health benefits, costs, and harms associated with different screening strategies. They looked at women vaccinated with the bivalent vaccine (HPV-2) or the quadrivalent vaccine (HPV-4) or the nonavalent vaccine (HPV-9).

Strategies varied according to whether primary screening involved cytology or HPV testing or a combination of both. Strategies also varied with respect to the age at which screening started, the interval between routine screens, and whether screening tests changed.

Cost-effectiveness was analyzed using thresholds of $50,000 to $200,000 per quality-adjusted life years (QALY) gained.

The study showed that for women who received the bivalent or quadrivalent HPV vaccines, the most cost-effective strategy was either cytology or HPV testing alone, beginning at age 25 or 30 years and repeated every 5 years

For women who received the first-generation vaccines, the cost-effectivesness of such screening ranged from $34,680 to $138,560 per QALY gained. First-generation vaccines protect against HPV16 and HPV18, which together are responsible for about 70% of cervical cancer.

It was not cost-effective to start screening earlier or to perform it more frequently, the investigators write. In women vaccinated with the later nonavalent vaccine HPV-9 — which also protects against five additional carcinogenic HPV genotypes — HPV testing alone every 10 years was efficient, the study showed. Such testing could begin at age 35 years, at a cost of $40,210 per QALY, or at age 30 years, at a cost of $127,010 per QALY.

The mean reduction in lifetime risk for cervical cancer in women vaccinated with HPV-9 was 85.3% in comparison with no intervention, the study showed. With the addition of screening, reductions in lifetime cancer risk ranged from 91% to 99%.

"Given the lower baseline disease risk in women vaccinated with HPV-9, the optimal screening strategies involved later start ages and lower frequencies than for women vaccinated with HPV-2 or HPV-4," the researchers say. "Furthermore, only strategies that involved primary HPV testing were efficient."

The screening strategies in HPV-vaccinated women led to nearly equivalent health benefits in terms of QALYs and reductions in lifetime cancer risk as the screening intensity increased, especially for women vaccinated with the nonavalent vaccine, the researchers note. "The 10-year screening interval in women vaccinated with HPV-9 remained most efficient throughout," they say.

A 10-year screening interval for cervical cancer was also proposed recently by Dutch researchers, as reported by Medscape Medical News.