Thirty years ago, very few Americans had heard of human papillomavirus (HPV). If you were unlucky enough to have this sexually transmitted virus (and the warts-raised, cauliflower-shaped lesions that sometimes accompany it), you probably kept the news to yourself. Today, although no one is shouting her diagnosis from the rooftops, we know much more about the virus and how to prevent and treat it.
Who has it
According to the latest figures from the Centers for Disease Control and Prevention (CDC), 25 million women have HPV, making it the most common sexually transmitted infection in the United States. Though no one knows exactly how many men carry the virus—they have no regular screening test—the CDC estimates that more than half of sexually active men will be infected with HPV at some point. And the virus can be deadly: It is the cause of nearly all cervical cancers. (Significantly, the high-risk strains do not cause warts. ) Although the pharmaceutical company Merck has created a new cervical cancer vaccine, Gardasil, it is effective only against certain strains of HPV.
Fortunately, natural treatments and good nutrition, especially, can make a difference, says Anna R. Giuliano, Ph.D., a professor who led a study of women with high-risk strains of HPV that was published in the Journal of Infectious Diseases in 2003. "Although a woman with a persistent HPV infection has a much greater risk of developing cervical cancer, what we found is that if you're not eating a healthy diet of fruits and vegetables, you're at risk," she says.
How it's transmitted
HPV is highly contagious—unlike the AIDS virus, it is not spread through bodily fluids but by direct skin-to-skin contact with someone who has it. The virus can lodge anywhere in the genital areas of both men and women , which is why condoms are only partially effective against it. And though HPV is usually spread through vaginal or anal sex, it can also be transmitted via oral sex and has been linked to oral cancers.
How to detect it
Because it's usually asymptomatic in men and women, HPV is difficult to detect and easy to transmit unknowingly. One study conducted by the National Institute of Allergy and Infectious Diseases (NIAID) found that almost half of women infected with HPV had no obvious symptoms such as genital warts. Although warts can be removed with acid or a laser, these procedures don't get rid of the virus, which can remain in the tissue and re-emerge months or even years later.
Get an accurate diagnosis
The American Cancer Society estimates that 11,150 women will be diagnosed with invasive cervical cancer in 2007, and most of those cases could have been avoided with early detection and treatment.
If you're sexually active, you should test for HPV with a Pap smear, which reveals the cellular abnormalities caused by the virus. A liquid-based Pap, which provides more accurate results than a traditional test that uses a glass slide, can highlight precancerous changes in the cervix, known as dysplasia, and determine if you need more tests.
There are four categories of an abnormal Pap test: atypical squamous cells (ASC), and mild, moderate, or severe dysplasia. In general, an initial abnormal Pap test is not cause for panic: Studies show that the immune system often eliminates cervical dysplasia before it turns into cancer. For this reason, if your test is abnormal, it may be best to wait six months and get tested again.
If your Pap is an ASC "of undetermined significance," your doctor may order an HPV DNA test (also known as HPV typing), which can detect whether you have any of the high-risk strains. Of the 30 strains that infect the cervix, approximately 13 are high-risk. The two most virulent types, 16 and 18-both targeted by Merck's Gardasil vaccine-cause 70 percent of cervical cancers.
Although the HPV DNA test is considered accurate and effective, and good for recognizing high-risk strains of HPV before abnormal cell changes appear on a Pap smear, the American Cancer Society and the American College of Obstetricians and Gynecologists recommend the test only for women over 30 because so many infections clear on their own. A positive reading on the HPV DNA test would needlessly worry young women.
If you have a history of abnormal Paps or severe dysplasia, your gynecologist may suggest a colposcopy (a noninvasive procedure with an instrument called a colposcope that magnifies the cervix) as well as a biopsy, which will determine if the abnormality is dysplasia or cancer. Based on the results of your biopsy, your doctor may recommend conventional treatment But even severe forms of dysplasia can be reversed without intervention.
New and ongoing research shows that several natural remedies including a diet centered around fruits and vegetables, herbal and botanical supplements, and maintaining a strong immune system can help eliminate dysplasia, preventing cervical cancer altogether.
- Take Green Tea. A growing body of evidence indicates that green tea, which is high in flavonoid polyphenols, can prevent many types of cancer by inhibiting tumor formation and growth. In the past four years, it's also been shown to prevent and treat cervical dysplasia. A 2003 study published in the European Journal of Cancer Prevention found that green tea capsules and green tea ointment can decrease cervical dysplasia, eliminate abnormal cells, and even help the body clear HPV. Fifty-one women with either chronic cervicitis (inflammation of the cervix, normally caused by infections from certain STDs ) or mild to severe dysplasia were divided into four groups: Two groups took a 200 mg green tea capsule daily (one took the flavonoid EGCG; the other took Polyphenol E), the third group used a green tea ointment (applied to the cervix two times a week), and a fourth group took both a green tea capsule and used the ointment. (Another 39 patients were in the control group.) Those who used some form of green tea extracts had a 69 percent response rate. Within the untreated control group, the response rate was only 10 percent.
Green tea appears to induce cell death (apoptosis) and inhibit cancer cell growth, says Tori Hudson, N.D., professor of gynecology at the National College of Natural Medicine, in Portland, Ore. Hudson, who outlines sample naturopathic treatment plans for dysplasia in her book the Women's Encyclopedia of Natural Medicine (McGraw-Hill, 2007), recommends 300 mg a day of oral green tea supplements and twice weekly use of a green tea suppository.
Based on the research, Jane Guiltinan N.D., president of the American Association of Naturopathic Physicians and a professor at Bastyr Center for Natural Health in Seattle, has begun prescribing green tea both orally and topically to patients who have mild dysplasia. Eden Fromberg, D.O., an OB-GYN at SoHo OB/GYN in New York City, recommends the suppositories as part of her overall protocol for cervical dysplasia-but also for women who have HPV and no dysplasia. She points out, however, that the suppositories are not a magic bullet . "If you smoke, take the Pill, and don't get enough sleep, suppositories cannot make up for that."
Topical use of green tea may also help treat genital warts. A new FDA-approved green tea-based ointment called Veregen will be available by prescription later this year. The ointment, which was studied in two randomized, double-blind clinical studies on nearly 400 adults , can clear the warts in 10 to 16 weeks when applied three times a day.
- Try Phytochemicals. Diindolylmethane (DIM), a phytochemical found in cruciferous vegetables such as cabbage, Brussels sprouts, broccoli, and kale, appears to cause infected cells to die. Most research has focused on this phytochemical's ability to normalize estrogen metabolism, since estrogen plays a role in certain cancers . A study published in the Journal of Nutrition in 2001 showed that DIM could cause cell death of both human cervical cancer cells and the HPV-16-infected cervical cells of mice. Another promising study was done on a form of the phytochemical called indole-3-carbinol (I3C), which is released when you chew or crush a cruciferous vegetable and is immediately converted to DIM. In a double-blind, placebocontrolled trial conducted on 30 women with moderate and severe dysplasia, those who took either 200 mg or 400 mg of I3C daily for 12 weeks were 50 percent more likely to see complete regression compared with the control group.
DIM works by inducing metabolic stress within the HPV-infected cells' membranes, causing them to shut down, says Michael A. Zeligs, M.D., founder and CEO of BioResponse Nutrients in Boulder, Colo., whose DIM capsules are being used in five ongoing clinical studies. Marcelle Pick, OB-GYN, NP, and director of Women to Women in Yarmouth, Maine, says DIM has become an indispensable part of her protocol for patients with cervical dysplasia. She recommends one capsule a day.
- Eat Your Veggies. You would have to eat more than three pounds of raw broccoli or cabbage a day to get the amount of DIM in three Bio- Response capsules. But that doesn't mean you should skip your veggies. Fruits and vegetables are rich in other vitamins and compounds believed to have cancer-fighting properties, including carotenoids (also called carotenes) such as lycopene, lutein, and beta-cryptoxanthin, as well as vitamins C and E, folate, and selenium-all of which may work synergistically to offer additional protection against cervical dysplasia. The 2003 study run by researcher Anna Giuliano, which followed 433 Brazilian women with high-risk strains of HPV for a 12-month period, found that those who reported diets high in vitamin C and the carotenoids lutein and beta-cryptoxanthin were more likely to clear HPV on their own. "These women ate normal servings of carotenoid-rich fruits and vegetables-it really wasn't a lot," says Giuliano, now a professor and researcher at the H. Lee Moffitt Cancer Center & Research Institute in Tampa, Fla. Women in the study ate more than one serving a week of carrots, pumpkin, papaya, spinach, broccoli, and oranges.
Boost your immunity
Kicking HPV may be easier if you take steps to support your body's innate healing abilities.
- Investigate Acupuncture. "Anything you can do to enhance the immune system will be helpful," says Pick. She recommends acupuncture, which prompts the release of chemicals and hormones that improve the body's natural ability to fight disease.
- Relieve Stress. Recent research on stress and HPV suggests that reducing stress is particularly important in halting the progression of dysplasia to cancer. Consider stressmanagement techniques or other modalities such as yoga, massage, guided imagery, and Reiki.
- Help Yourslef To Herbs. Don't overlook the local immune system of the cervix, which can be supported with herbs and vitamins. Hudson combines green tea suppositories with three herb-based products: the Papillo, VAG-PAK , and Herbal-C .
- Stop Taking The Pill. Studies have shown an increased risk of cervical cancer in women who have taken the Pill for five or more years.
- Don't Smoke. Smokers are twice as likely as nonsmokers to get cervical cancer, according to the American Cancer Society. Tobacco by-products have actually been found in the cervical mucus of women who smoke; nicotine can damage the DNA cells of the cervix, where it acts as a local carcinogen. If you haven't given up yet, now's the time to consider doing so.
- Look Inward. A diagnosis of cervical dysplasia can be scary-but it also gives you a chance to do some internal caretaking. "When my patients are diagnosed with dysplasia, they come in terrified," says Pick. "I tell them, 'Something big has come along—a two-by-four. This is a wonderful opportunity to pause, examine your lifestyle, and make some changes before this something becomes a Mack truck.' "
- Practice Abstinence. Refraining from sex is the only 100 percent effective way to prevent getting or spreading HPV.
- Limit Your Partners. If abstaining from sex is unrealistic, you can still reduce your chances of getting HPV by having fewer sexual partners. Though there is no test to detect HPV in men, you can ask your partner to have his penis checked for warts.
- Insist On Condoms. Condoms aren't foolproof, but they do help-one study found that they reduced infection risk by up to 70 percent.
- Use A Carrageenan Lubricant. Carrageenan, a seaweed extract, appears to block HPV from attaching to and entering human cells, according to an in vitro study at the National Cancer Institute. We suggest the lubricant sold by Oceanus ($11; oceanusbrands.com).