To review practical tips when counseling HPV discordant couples.
ICID has published a peer reviewed, evidenced based booklet about HPV testing reviewing the issues about 1) HPV testing and cervical cancer screening, 2) sexual transmission of HPV, 3) HPV vaccine as part of the pre or post-HPV test counseling, 4) HPV testing and the delivery of results and 5) complex psycho-social issues.
HPV is the most common sexually transmitted infection in the world and most sexually active individuals will have an HPV infection at some point in their lives.Condom use for vaginal and anal intercourse offers some protection although it is incomplete. Most women having a pap test do not realize that in fact, we were already testing them for a complication of an STI without telling them! Self-blaming or partner-blaming might arise when a positive test if found. When counseling a couple, it is important to know if it is a new, an unstable or a stable long-term couple. Are questions about infidelity issues, sexual practices or cancer risk? Is it about emotional needs or information needs. Also, we need to know what part is leading to uncertainty, anxiety, sexual dysfunction or stress. It is also important to rapidly assess if the persons consulting you are concerned, anxious, hypochondriac or obsessive-compulsive. Discussing levels of risk can be quite difficult since people are seeking information. Discussion, counseling or therapy about emotional issues such as anxiety, guilt, negative anticipation, depression could be dealt by a psychologist knowledgeable about HPV issues.Discussion, counseling or therapy about sexual issues such as loss of sex drive, withdrawal, negative feelings about the partner, depression and sexual activities level of risk of transmission/acquisition could be dealt by a sex therapist knowledgeable about HPV issues. Issues of using barriers methods such as a condom or dental dam, prophylactic HPV vaccine use for the infected female and or her sexual partner, either male or female are also issues to be discussed during counseling sessions. Answering honestly about unknown such as the risk of recurrence and further risk at other sites may help compliance for the follow-up visits and time will help to answer some of the remaining questions
HPV testing has the potential to greatly change the way we screen to prevent cervical cancer. Changing from looking for abnormal cells to looking for an STI has the potential to harm fragile persons or relationships. Knowing practical points on how to counsel about these sensitive issues may alleviate the psycho-social burden of receiving a positive HPV test results.
Steben M, Kettner J, Medwick H, Ronald A, Wurtak G. Counselling Patients About HPV Testing, INTERNATIONAL CENTRE FOR INFECTIOUS DISEASES