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Home Finding Support Finding Support Answering the Calls

Answering the Calls

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ASHA’s Kathy Lafferty reflects on nearly two decades of educating the public and health professionals alike on HPV

Over many years I have worked on hotline services that deal with sexually transmitted infections (STIs), and have answered countless questions about HPV. I have found it’s important to give callers not just information about the virus but to also address their specific health concerns and clear up common misconceptions. This is the best way to alleviate some of the anxiety callers may feel.

Questions are often as basic as “what is HPV?” to which I respond by asking the caller if he/she is familiar with warts that appear on the hands and feet. I tell them that HPV is a common skin virus that causes warts and other lesions, and that different types of HPV infect different skin on the body, including the genital and anal areas. I believe this comparison gives context to HPV. Then I cover the difference between genital warts and cervical dysplasia (abnormal cells) caused by HPV. Callers diagnosed with cervical cell changes related to the virus are usually anxious because they have read information about the link between cervical cancer and “high risk” types of HPV. I explain that most women with cervical dysplasia due to HPV do not develop cervical cancer, and that regular Pap tests as recommended by their health care provider are very important in detecting any changes due to HPV, and in making decisions about treatment and follow-up.

Many callers with an abnormal Pap test suggestive of HPV wonder why they may be told to come back for another Pap test in six months, rather than being given treatment right away. It’s especially important with these callers to place the risk of cervical cancer in perspective, that mild or even moderate cell changes often clear on their own, cancer is not a common outcome, and a watchful waiting approach is often indicated.

If a woman does need treatment for cervical abnormalities, there is usually anxiety over not knowing or understanding the exact process involved. Almost all of these women have had – or soon will have - a biopsy of the abnormal tissue and a colposcopy, so sometimes they have questions about that. With these callers I try to summarize these procedures and, if they like, discuss some of the most common treatments a healthcare provider may recommend (such as cryotherapy where the affected tissue is destroyed by freezing with liquid nitrogen). We of course will focus on a specific treatment that may be in store for them. By breaking it down and tailoring the information to their particular circumstances, hopefully they’ll not only become better informed but their worries will be lessened, too. Another common question is related to HPV’s latency period, with callers frequently asking how long they may have had the virus. I tell them that this is usually very difficult to determine, as it could be weeks, months, or years before symptoms develop or a diagnosis is made.

Because so few people actually develop visible symptoms, and HPV testing is limited, most people with the virus are not aware, yet HPV can still be transmitted without visible symptoms. It is estimated that half or more of sexually active people have, or have had, a genital HPV infection. Callers often ask about treatment if they have the virus but no symptoms: I tell them that treatment is only recommended if symptoms are detected (warts or cervical cell changes). This can be frustrating, because our nature is to do something, and not be passive!

Callers are also concerned about pregnancy and HPV, so I explain that HPV is a skin virus and not in blood and thus unlikely to infect the baby. I tell them the major concern would be if the mother had genital warts which were blocking the birth canal or bleeding at delivery. In that case, a caesarean delivery might be recommended, and this is something the caller should discuss with her healthcare provider.

We cover most any topic related to HPV you can imagine, but those are some of the more common things we discuss on the hotline. By offering callers the ASHA website and online HPV message board they can get more helpful information and have a source for support after I disconnect with them. I truly believe, though, that contact with a person over the phone via a hotline service like ASHA’s STI Resource Center is especially helpful to the caller. There have been many times I could sense that when we’re through, the caller has a reduced level of anxiety. When a caller states “you have been so helpful, I feel much better” I know I’ve done a good job!

--Kathy Lafferty is ASHA’s longest-tenured health communication specialist. Connect with her and other ASHA staff through the STI Resource Center hotline at 919.361.8488 or online.