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Last week, Dr. Anayda DeJesus-Cruz delivered some very unpleasant news to a new patient.

After an abnormal pap smear result, and a positive HPV (Human Papillomavirus) test, an in-office cell biopsy revealed warts on her cervix.

The patient, a 17-year-old high school student, had contracted a sexually-transmitted virus that, had it gone undetected, could have led to serious health problems, including the possibility of cancer.

"We have to say to patients, this is not because you are promiscuous or a bad person," DeJesus-Cruz, who practices at the OBGYN group of Attleboro, said. "It's because you're sexually active."

HPV, by most estimates the fastest-growing sexually-associated disease in the United States, has been the subject of national debate since the Federal Drug Administration approved Gardasil, the vaccine that protects against the virus's four most common strains, including the two that account for 70 percent of the nearly 10,000 new cases of cervical cancer in this country each year. It also protects against the two strains that cause 90 percent of genital warts. The vaccine, touted by some as the biggest breakthrough for public health in decades, has met considerable resistance - from groups that worry it will increase sexual activity among teenagers, parents who fear the vaccine's long-term effects and those who worry that it's hefty, $400 per patient price tag will prohibit many from getting it.

Last week, Gov. Deval Patrick announced his intention to offer Massachusetts girls between 9 and 18 the vaccine for free, without making it mandatory, as part of his public health care initiative.

The National Health and Nutrition Examination Survey last week published a study that revealed one-third of women under age 24 have HPV - two-thirds more than in previous counts.

DeJesus-Cruz and other area doctors have said that the increased media attention has peaked interest among their patients, who have begun asking for the vaccine for themselves.

"Before, it was like 75 percent had no idea what it was," DeJesus-Cruz said. "Now, it's about that many who have at least heard about it."

Still, many have not heard about it before they find out they have it. Many health care professionals fear that ignorance about the disease and it's label as an STD - sexually-transmitted disease - spark fears about the vaccine.

"Parents don't want to give their kids the vaccine, because it's an STD," she said. "We need to take that label off."

HPV is a sexually-transmitted virus, spread by skin-to-skin contact with infected partners, not by bodily fluids. To become infected your skin needs only to touch the skin of an infected person.

There are more than 100 strains of HPV, and 30 are associated with sexual activity, according to the Centers for Disease Control.

It's so easy to catch that many doctors liken the likelihood of its transmission, a nearly 80-percent lifetime risk, to the risk of catching the common cold. Most women, except those who develop warts, will show no symptoms of the virus and could possibly clear it on their own before they even know they have it, since the virus can take years to show up.

But others will not, and there always is the possibility, DeJesus-Cruz said, that cancer will develop.

Guidelines recommend yearly pap smears, the cervical cancer screening test, for most women. A DNA-specific test for HPV presence is given for all women over 30. The HPV test is usually only given to women under 30 after they show an abnormal pap smear.

A positive HPV test will reveal either low- or high-risk strains. Patients with low-risk strains don't need further treatment, but women with high-risk types, the ones associated with cervical cancer, will undergo a copolscopy, an in-office procedure in which the doctor uses a microscope to cut cervical cells for biopsy.

If the biopsy shows moderate to severe displaysia (abnormal cervical cells), patients undergo a Loop Electrosurgical Excision Procedure (LEEP), which requires local anethesia and a four-week recovery period that can include some uncomfortable, but not serious, cramping and discharge.

After those procedures, patients need to return for follow-up pap smears every three to four months.

Costs associated with those exams and procedures are often too daunting for patients with insufficient or no insurance. DeJesus-Cruz's office has had to send certified letters to patients who need a copolsocopy, and they worry about those who never return for follow-ups.

"They can develop cancer," she said. "It can take up to 10 years to happen, and you never know who is going to get it."

Warts can appear on the cervix and can form on the outside of the vagina and its surrounding skin.

Treatment for warts is painful and expensive. With nearly one million new cases of warts annually in the country, testing and treatment is "very costly," DeJesus-Cruz said.

Warts are removed either through creams, which sting, burn and irritate the delicate genital skin, or are burned off with lasers or removed through surgery.

"It's like you're putting antacid on your skin," DeJesus-Cruz said. "It really burns."

With treatment, most strains of HPV go away over time. DeJesus-Cruz said that when pap smears and HPV tests come back normal, it is suspected the patient's immune system has built up anitbodies to that virus strain, although there is the possibility of reinfection with a different strain or the same strain in cases of patients with immunodeficiences.

Some patients have wart recurrences, and must inform all future sexual partners of the condition, which is mentally and emotionally draining, especially if you're young, DeJesus-Cruz said.

"If you're starting at 16, you're not going to be with one person for the rest of your life," she said. "The longer you are sexually active, the more you are exposed. It really can put a lot of stress on someone."

REBECCA KEISTER can be reached at 508-236-0336 or at rkeister@thesunchronicle.com.