hpv-kling2ALAN KLING, M.D

Dr. Kling is a recognized expert in the field of HPV treatment, Dr. Kling has lectured on HPV at Columbia, Cornell, Mount Sinai, NYU, Yale and many other medical centers, as well as at numerous national meetings. He is up-to-date on the latest advances in the diagnosis and treatment of HPV. Dr. Kling is the recognized go-to-person for HPV-related diagnoses in the metropolitan NYC area.
Dr. Kling’s private practice offices are located on the Upper East Side in Manhattan and in Park Slope, Brooklyn. The offices are comfortable, stylish, elegantly decorated and impeccably clean. You can feel reassured that your consultation and treatment will be performed by an accomplished, experienced, and well-respected board-certified physician.

Q: What is a Pap smear?
A: A Pap smear is a microscopic examination of cells scraped from the opening of the cervix.

Q: How is the Pap smear done?
A: A cotton-tipped applicator is rubbed along the sides and floor of the cervix in order to obtain samples of the continually shedding cells, which are then placed on a slide and examined under a microscope.

Q: What is the cervix?
A: The cervix is at the end of the vaginal canal as it leads into the lower part of the uterus or womb. The cervix is the area that transitions the vagina into the uterus and has been referred to as the entryway to the uterus.

Q: What does it mean when a woman has an abnormal Pap smear?
A: There are a number of HPV strains that cause abnormal changes in the cells on a women’s cervix. The Pap test refers to the test that is done with the swab that the health care provider rubs around the cervix in order to obtain a sample of the cells which shed from this area on a continual l basis. An abnormal Pap smear indicates that the cells being shed fro the cervix may become problematic.

Q: Why are Pap smears so helpful?
A: The Pap smear has been an invaluable screening program which allows for early diagnosis and treatment of cervical cancer and precancers. The Pap smear is cheap, which allows physicians and other health care providers to make it widely and affordably available to every woman who wants to do a screening test.

Q: How accurate is the Pap smear?
A: The Pap smear is not a very accurate test. The Pap smear only detects an abnormality 70% of the time. If a woman responsibly shows up and gets her Pap smear screenings on the regular prescribed by her doctor, any abnormality that may be present will be detected over time before it has the chance to progress.

Q: Why is it a good test if it is not an accurate one?
A: The Pap test is cheap and widely available so all women can receive regular screening. Repeat Pap smears are frequently performed in order to verify an initially positive Pap smear. Cervical cancers grow slowly and can take over twenty years to grow from the time of the initial infection with the high risk HPV DNA strains, so repeated Pap smears will reliably eventually detect any abnormalities.

Q: What does it mean if the Pap smear is negative?
A: A negative Pap smear indicates that no abnormalities were detected at the point in time when the specimen was collected. In the case that there may be an abnormality present but the Pap smear did not pick it up the first time, the abnormality will most likely be detected on subsequent tests. It is extremely important for a women to show up and get her follow up Pap tests on a regular basis as prescribed by her physician.

Q: What happens when a woman has a persistently positive Pap smear?
A: Persistently positive Pap smears will require a more thorough diagnostic and possibly therapeutic workup by a woman’s health care provider.

Q: Do most positive Pap smear need further workup?
A: Most Pap smears are normal on follow up. 70% of positive Pap smears resolve on their own and become negative in the year. 90% of positive Pap smears resolve on their own without treatment within 2 years.

Q: Why did most abnormal Pap smears become normal on follow up?
A: Most HPV infections are caused by the low risk HPV DNA strains. The abnormalities that these low risk strains cause are transient. Low risk HPV strains have zero percent chance of progressing into a cervical cancer.

Q: Do all abnormal Pap smears caused by high risk strains go into cervical cancer?
A: Many infections caused by high risk strains resolve on their own without treatment. The Pap smears that require the most concern are those that are persistently abnormal after repeat testing.

Q: When is more testing needed?
A: Further testing and evaluation would be needed if a woman has a persistently positive Pap smear after more than one screening.

Q: Can you have HPV but not warts?
A: You can have HPV but not have warts. Genital warts refer to growths that occur outside the body. Abnormal Pap smears in women are caused by an HPV infection on the mucous membranes of the cervix. A woman can have an abnormal Pap smear on her cervix but not have external genital warts, and vice versa.

Q: What other screening methods are available for cervical cancer other than a Pap smear?
A: HPV DNA tests are considerably more reliable than the traditional Pap smear, and are accurate 90% of the time.

Q: What is the preferred method of cervical cancer screening at different ages?
A: Pap smears are the preferred method of screening for women who are under 30 years old. Pap smears are an inexpensive test, and most cervical HPV infections in younger women resolve on heir own. When a woman is over 30 years old and/or has a persistently positive Pap smear, the HPV DNA test should then be considered.

Q: If a woman had the full course of three HPV vaccinations before her first sexual contact, does that mean that she does not need to get screened for cervical cancer?
A: Women need to continue to get screened for cervical cancer regardless of whether or not they received the HPV vaccine. The high risk HPV 16 and 18 strains in the vaccine represent 70% of all of the strains that cause cervical cancer. A women is still susceptible to getting an infection with one of the other high risk strains that cause cervical cancer in 30% of the cases.

Q: What should a woman tell her partner if she finds out that she has an HPV infection?
A: The woman who has an HPV infections needs to let her partner know so that he can go to his doctor to be evaluated as to whether he has an infection.

Q: What kind of a doctor should he go to?
A: Dermatologists and urologists have the greatest amount of experience in his field. He can also ask his family doctor for guidance.

Q: How do I find that type of doctor?
A: You can ask your family doctor or GP (general practitioner) or internist. A woman who is diagnosed with an HPV infection can ask her gynecologist for the name of a doctor who has experience in evaluating the male partner.

Q: What kind of doctor should the woman go to?
A: Women should see their gynecologists for their regular Pap smears. If there a growth on the outside (vulva, groin, thighs, abdomen) the women may choose to have this treated by either a gynecologist or a dermatologist.

Q: What will my doctor talk to me about?
A: Your doctor will explain to you many of the things tha t you want and need to know about this infection. Having an HPV infection can be an emotionally-charged issue. You would most likely feel more comfortable with a doctor who is knowledgeable in this field who can answer your questions thoroughly.