by Andrew Pacholyk, MS L.Ac
~Peacefulmind.com

Human papillomavirus (HPV) is one of the most common causes of sexually transmitted diseases (STD) in the world. More than 100 different types of HPV exist, most of which are harmless. About 30 types are spread through sexual contact. Some types of HPV cause genital warts, single or multiple bumps that appear in the genital areas of men and women including the vagina, cervix, vulva (area outside of the vagina), penis, and rectum. Many people infected with HPV have no symptoms. (25).

There are high-risk and low-risk types of HPV. High-risk HPV may cause abnormal Pap smear results, and could lead to cancers of the cervix, vulva, vagina, anus, or penis. Low-risk HPV also may cause
abnormal Pap results or genital warts. (26).

Health experts estimate there are more cases of genital HPV infection than any other STI in the United States. According to the American Social Health Association, approximately 5.5 million new cases of sexually transmitted HPV infections are reported every year. At least 20 million people in this country are already infected. (25, 26).

All types of HPV can cause mild Pap test abnormalities, which do not have serious consequences. Approximately 10 of the 30 identified genital HPV types can lead, in rare cases, to development of cervical cancer. Specifically, HPV 16 and HPV 18 have been found in 90% of cases of cervical cancer. Research has shown that for most women (90 percent), cervical HPV infection becomes undetectable within two years. Although only a small proportion of women have persistent infection, persistent infection with “high-risk” types of HPV is the main risk factor for cervical cancer.

Cervical intraepithelial neoplasia is also called “CIN.” Sometimes it may be called cervical dysplasia. CIN means that there is a change in the cells on the surface of the cervix. The cervix is the bottom part
of the uterus. With CIN normal cells are replaced with cells that are not normal (abnormal). Over time, it is possible for these abnormal cells to turn into cancer. (3,4).

Any woman can have CIN. CIN itself is not cancer. But it can turn into cancer of the cervix. Following are the 3 types of CIN:

CIN I (1). This is also called mild dysplasia.
CIN II (2). This is also called moderate dysplasia.
CIN III (3). This is also called severe dysplasia.

It is not known for sure what causes CIN but it may be caused by a virus that is spread during sex. The virus that causes venereal warts (“HPV”) is thought to play a role in many cases of CIN and cervical
cancer. You may be more likely to get CIN if you have many sex partners or if your partner has many sex partners.

The following may put you at a higher risk of having CIN. 

*Less than 20 years of age at time of first sex.
*Having a sexually transmitted disease (STD), like HPV, herpes, or
cytomegalovirus (CMV).
*A Pap smear test that is not normal.
*Cigarette smoking.

A Pap test can detect pre-cancerous and cancerous cells on the cervix. Regular Pap testing and careful medical follow-up, with treatment if necessary, can help ensure that pre-cancerous changes in the cervix caused by HPV infection do not develop into life threatening cervical cancer. The Pap test used in U.S. cervical cancer screening programs is responsible for greatly reducing deaths from cervical cancer. For 2004, the American Cancer Society estimates that about 10,520 women will develop invasive cervical cancer and about 3,900 women will die from this disease. Most women who develop invasive cervical cancer have not had regular cervical cancer screening. (26-29)

Although there is currently no medical cure for papillomavirus infection, the lesions and warts these viruses cause can be treated. Methods commonly used to treat lesions include cryosurgery (freezing that destroys tissue), LEEP (loop electrosurgical excision procedure, the removal of tissue using a hot wire loop), and conventional surgery. Similar treatments may be used for external genital warts. In addition, some drugs may be used to treat external genital warts. More information about treatment for genital warts can be found in the:

Centers for Disease Control and Prevention’s (CDC) Sexually Transmitted Diseases Treatment Guidelines 2002. Copies of the guidelines are available at http://www.cdc.gov/STD/treatment

Alternative Medicine 

A study of the clinical efficacy of green tea extracts (polyphenon E; poly E and (-)-epigallocatechin-3-gallate [EGCG]) delivered in a form of ointment or capsule in patients with human papilloma virus (HPV) infected cervical lesions. Fifty-one patients with cervical lesions (chronic cervicitis, mild dysplasia, moderate dysplasia and severe dysplasia) were divided into four groups, as compared with 39 untreated patients as a control. Poly E ointment was applied locally to 27 patients twice a week. For oral delivery, a 200 mg of poly E or EGCG capsule was taken orally every day for eight to 12 weeks. In the
study, 20 out of 27 patients (74%) under poly E ointment therapy showed a response. Six out of eight patients under poly E ointment plus poly E capsule therapy (75%) showed a response, and three out of six patients (50%) under poly E capsule therapy showed a response. Six out of 10 patients (60%) under EGCG capsule therapy showed a response. (34).

Overall, a 69% response rate (35/ 51) was noted for treatment with green tea extracts, as compared with a 10% response rate (4/39) in untreated controls (P<0.05). Thus, the data collected here demonstrated that green tea extracts in a form of ointment and capsule are effective for treating cervical lesions, suggesting that green tea extracts can be a potential therapy regimen for patients with HPV infected cervical lesions. (34).

Women who consume low amounts of foods rich in vitamin C, beta carotene and folic acid have a higher incidence of CIN and HPV (14). A diet rich in fruits, vegetables, whole grains and legumes (beans)
will provide generous amounts of these nutrients.

Antioxidants seem to reduce the risk of CIN (8) and cancer (21). Low levels of vitamin A (16), vitamin C (15,16) and vitamin E (2,13) are associated with a greater risk of CIN and possibly cervical cancer. The amount of antioxidants in a daily multivitamin are reasonable and safe.

Copper levels tend to be higher in women with CIN (9) or gynecologic tumors (3). It may be wise to avoid taking copper supplements if dealing with CIN.

Folic acid levels tend to be lower in women with dysplasia (7,10) and HPV (4). Folic acid may help prevent CIN but does not appear to eradicate existing CIN (24). Very high doses of folic acid have been
used in treatment but the amounts present in a B-complex supplement or a daily multivitamin are reasonable for preventive purposes.

Pyridoxine (B6) levels tend to be low in cervical cancer (20). It is interesting that birth control pills can lower B6 levels (1,17) and birth control pills also seem to be a risk factor for CIN (4,5) which can progress to cervical cancer if left untreated. Taking vitamin B6 in a daily multivitamin or B-complex supplement may be beneficial, particularly if using birth control pills.

Riboflavin (B2) levels tend to be low in women with CIN (16). Riboflavin vaginal suppositories have actually been shown to cause regression of CIN (6).

Selenium levels tend to be lower in women with cervical cancer (2). Selenium has been shown to reduce the incidence of experimentally induced cervical cancer in laboratory animals (12). A dose of 200
micrograms daily of selenium is reasonable and safe (18). This amount of selenium is often available in a daily multivitamin.

Zinc levels tend to be lower in women with CIN (9) or gynecologic tumors (3). Taking 15 – 30 milligrams of zinc daily in a multivitamin is reasonable.

STD information and referrals to STD Clinics
CDC-INFO
1-800-CDC-INFO (800-232-4636)
TTY: 1-888-232-6348

References 

1. Bermond P: Therapy of side effects of oral contraceptive agents
with vitamin B6. Acta Vitaminol Enzymol 1982;4(1-2):45-54.

2. Bhuvarahamurthy V, Balasubramanian N & Govindasamy S: Effect of
radiotherapy and chemoradiotherapy on circulating antioxidant system
of human uterine cervical carcinoma. Mol Cell Biochem 1996 May 10;158
(1):17-23.

3. Brandes JM, Lightman A, Drugan A et al: The diagnostic value of
serum copper/zinc ratio in gynecological tumors. Acta Obstet Gynecol
Scand 1983;62(3):225-9.

4. Butterworth CE: Folate deficiency and cervical dysplasia. JAMA
1992;267:528-533.

5. Castaneda-Iniguez MS, Toledo-Cisneros R & Aguilera-Delgadillo M:
[Risk factors for cervico-uterine cancer in women in Zacatecas] Salud
Publica Mex 1998 Jul-Aug;40(4):330-8.

6. Chen RD: [Chemoprevention of cervical cancer–intervention study
of cervical precancerous lesions by retinamide II and riboflavin]
Chung Hua Chung Liu Tsa Chih 1993 Jul;15(4):272-4.

7. Fowler BM, Giuliano AR, Piyathilake C et al: Hypomethylation in
cervical tissue: is there a correlation with folate status? Cancer
Epidemiol Biomarkers Prev 1998 Oct;7(10):901-6.

8. Goodman MT, Kiviat N, McDuffie K et al:,,The association of plasma
micronutrients with the risk of cervical dysplasia in Hawaii. Cancer
Epidemiol Biomarkers Prev 1998 Jun;7(6):537-44.

9. Grail A & Norval M: Copper and zinc levels in serum from patients
with abnormalities of the uterine cervix. Acta Obstet Gynecol Scand
1986;65(5):443-7.

10. Grio R, Piacentino R, Marchino GL et al: Antineoblastic activity
of antioxidant vitamins: the role of folic acid in the prevention of
cervical dysplasia. Panminerva Med 1993 Dec;35(4):193-6.

11. Ho GY, Kadish AS, Burk RD, Basu J, Palan PR, Mikhail M, Romney
SL: HPV 16 and cigarette smoking as risk factors for high-grade
cervical intra-epithelial neoplasia. Int J Cancer 1998 Oct 29;78
(3):281-5.

12. Hussain SP, Rao AR: Chemopreventive action of selenium on
methylcholanthrene-induced carcinogenesis in the uterine cervix of
mouse. Oncology 1992;49(3):237-40.

13. Kwasniewska A, Charzewska J, Tukendorf A, Semczuk M: Dietary
factors in women with dysplasia colli uteri associated with human
papillomavirus infection. Nutr Cancer 1998;30(1):39-45.

14. Kwasniewska A, Tukendorf A, Semczuk M: Content of alpha-
tocopherol in blood serum of human Papillomavirus-infected women with
cervical dysplasias. Nutr Cancer 1997;28(3):248-51.

15. Liu T, Soong SJ, Alvarez RD et al: A longitudinal analysis of
human papillomavirus 16 infection, nutritional status, and cervical
dysplasia progression. Cancer Epidemiol Biomarkers Prev 1995 Jun;4
(4):373-80.

16. Liu T, Soong SJ, Wilson NP et al: A case control study of
nutritional factors and cervical dysplasia. Cancer Epidemiol
Biomarkers Prev 1993 Nov-Dec;2(6):525-30.

17. Masse PG, van den Berg H, Duguay C et al: Early effect of a low
dose (30 micrograms) ethinyl estradiol-containing Triphasil on
vitamin B6 status. A follow-up study on six menstrual cycles. Int J
Vitam Nutr Res 1996;66(1):46-54

18. Patterson BH & Levander OA: Naturally occurring selenium
compounds in cancer chemoprevention trials: a workshop summary.
Cancer Epidemiol Biomarkers Prev 1997 Jan;6(1):63-9.

19. Potischman N: Nutritional epidemiology of cervical neoplasia. J
Nutr 1993 Feb;123(2 Suppl):424-9.

20. Ramaswamy PG & Natarajan R: Vitamin B6 status in patients with
cancer of the uterine cervix. Nutr Cancer 1984;6(3):176-80.

21. Reddy BS: Micronutrients as chemopreventive agents. IARC Sci Publ
1996;(139):221-35.

22. Roteli-Martins CM, Panetta K, Alves VA et al: Cigarette smoking
and high-risk HPV DNA as predisposing factors for high-grade cervical
intraepithelial neoplasia (CIN) in young Brazilian women. Acta Obstet
Gynecol Scand 1998 Jul;77(6):678-82.

23. Yoshikawa H, Nagata C, Noda K et al: Human papillomavirus
infection and other risk factors for cervical intraepithelial
neoplasia in Japan. Br J Cancer 1999 May;80(3-4):621-4.

24. Zarcone R, Bellini P, Carfora E, et al. Folic acid and cervix
dysplasia. Minerva Ginecol 1996;48:397-400. alteration of glucose
tolerance.

25. Centers for Disease Control and Prevention, Division of STD
Prevention. Prevention of genital HPV infection and sequelae: Report
of an external consultants’ meeting. December 1999.

26. Centers for Disease Control and Prevention. Sexually transmitted
diseases treatment guidelines 2002. Morbidity and Mortality Weekly
Report 2002; 51(RR–6).

27. Chu NR. Therapeutic vaccination for the treatment of mucosotropic
human papillomavirus-associated disease. Expert Opinion on Biological
Therapy 2003; 3(3):477–486.

28. Ho GYF, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural
history of cervicovaginal papilloma virus infection in young women. N
Engl J Med 1998;338:423-8.

29. Koutsky LA, Kiviat NB. Genital human papillomavirus. In: K.
Holmes, P. Sparling, P. Mardh et al (eds). Sexually Transmitted
Diseases, 3rd edition. New York: McGraw-Hill, 1999, p. 347-359.

30. Kiviat NB, Koutsky LA, Paavonen J. Cervical neoplasia and other
STD-related genital tract neoplasias. In: K. Holmes, P. Sparling, P.
Mardh et al (eds). Sexually Transmitted Diseases, 3rd edition. New
York: McGraw-Hill, 1999, p. 811-831.

31. Myers ER, McCrory DC, Nanda K, Bastian L, Matchar DB.
Mathematical model for the natural history of human papillomavirus
infection and cervical carcinogenesis. American Journal of
Epidemiology 2000; 151(12):1158-1171.

32. Watts DH, Brunham RC. Sexually transmitted diseases, including
HIV infection in pregnancy. In: K. Holmes, P. Sparling, P. Mardh et
al (eds). Sexually Transmitted Diseases, 3rd edition. New York:
McGraw-Hill, 1999, 1089-1132.

33. Weinstock H, Berman S, Cates W. Sexually transmitted disease
among American youth: Incidence and prevalence estimates, 2000.
Perspectives on Sexual and Reproductive Health 2004; 36: 6-10..

34. WS Ahn, J Yoo, SW Huh -Protective effects of green tea extracts
on human cervical lesions – polyphenon E and EGCG – Brief Article,
Alternative Medicine Review, Nov, 2003