Menstuff® has compiled the following information on the Human
Papillomavirus Virus. E-Mail
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HPV Overview
Human papillomavirus (HPV) is the name of a group of viruses that
infect the skin. There are more than 70 different types of HPV.
Certain types of HPV cause warts on the hands or feet, and other
types can cause warts on the genitals. But some people never have
warts they can see and many never get warts, so most people with HPV
do not know they have it. About 30 of these types are sexually
transmitted and cause genital HPV. Some types of genital HPV may
cause genital warts, while other types of genital HPV are linked to
abnormal cell changes on the cervix (detected through Paps).
Background Information
Human papillomavirus (HPV) is a sexually transmitted disease that
is highly prevalent, yet often misunderstood. Recent scientific
advances have established that certain types of HPV can cause
cervical cancer. However, this cancer can almost always be prevented
through regular screening and, if needed, treatment of abnormal cell
changes. The challenge is to provide focused, much-needed education
about HPV without causing undue fear.
Approximately 5.5 million new cases of sexually transmitted HPV occur in the U.S. each year, with at least 20 million people estimated to be currently infected. Direct annual medical costs for treating symptoms of HPV infection in the United States are estimated at $1.6 billion and the cost of the cervical cancer screening program (Pap smears) is $5 billion - $6 billion every year. Because research linking genital HPV and cervical cancer is relatively new, there is considerable confusion among patients, medical professionals, policy makers and the general public as to the best counseling, screening, treatment and prevention practices. Additionally, while anal and penile cancers are uncommon, HPV can put men at risk for these cancers, so care should be taken not to leave them out of these equations.
The majority of Americans are unaware of the link between certain types of HPV and cervical cancer: in one national survey, 70 percent of women were unable to name the cause of cervical cancer, and 76 percent had never heard of HPV. Additionally, fewer than half of clinicians responding to a Centers for Disease Control and Prevention (CDC) survey in 2004 were aware of differences between "high-risk" and "low-risk" HPV types. Exciting new technologies and research findings have advanced the capacity to conduct better HPV and cervical cancer screening, diagnosis, and treatment. Yet, their role in clinical management is often misunderstood.
This lack of clarity, coupled with discomfort surrounding issues related to STDs and limited provider time for counseling/patient education, contribute to what is often perceived by patients as inadequate and inconsistent information and advice. Misinformation and overly frightening views about genital HPV abound. Many patients are puzzled or angry that they were unaware of HPV and their personal risk for acquiring the virus. Many are frustrated by the difficulty of finding clear, accurate, up-to-date information and counseling about a potentially life-threatening condition.
Among policy makers, the misinformation and confusion surrounding HPV has fueled discussion. In 1999, Congress debated whether to require screening and reporting for HPV, condom labeling, and warnings on educational materials about HPV and other STDs. Overall, federal funding in HPV research and treatment is limited in scope and remains poorly funded.
There is a clear public health need for ASHA's National HPV &
Cervical Cancer Prevention Resource Center to serve as a
comprehensive resource for the public, patients, providers, and
policy makers. Increased awareness about HPV and cervical cancer
prevention will reduce unnecessary deaths from this preventable
cancer.
HPV Vaccine
for Your Daughter
Parents should demand full answers about this vaccine's use (high
effectiveness in the 27-month study, but no long-range studies have
been done), just as they do any other health procedure. But,
regardless of whether you'd support mandated or optional vaccines,
use this
issue as a teaachable moment for you and your daughter.
She needs to know that sexually transmitted diseases and infections
are a reality for millions of girls and boys. Honest discussion of
all the possible side effects of sexual activity - from pregnancy to
STDs and relationship issues - is the best way to prevent, not cause,
physical and emotional harm from early sexual activity. (Related
issue: Abstinance Failure.)
General STD information is accessible via www.iwannaknow.org
for teens.
The emotional toll of dealing with HPV is often as difficult as the medical aspects and can be more awkward to address. This may be the area where you feel most vulnerable, and the lack of clear counseling messages can make this even more stressful, especially where relationships are concerned.
We regularly receive questions about what to tell either a current
or future sex partner about HPV, for example. The better educated you
are about HPV, the easier it is to give partners the information
needed to answer common questions. Use the information in this
section (and elsewhere on ASHA’s Web site) to give yourself a
good foundation of knowledge.
Prior to discussing things with a partner think about addressing any of your own questions or issues about HPV. This is to help establish your own comfort level and is where knowledge really does equal power. One of the most important aspects of coping with HPV, and helping partners develop a good understanding of the virus, is getting factual information and avoiding myths and hype.
It may also be a good idea to have resources to which you can direct a partner, so you know they turn to trustworthy sources for information. In addition to this information, see our links page for more sites with HPV information
First, remember that having HPV does not mean you have done anything wrong. As mentioned above, most sexually active people are likely to be exposed to HPV at some point, though most never have visible symptoms and remain unaware. Having HPV simply means you, like so many others, have been exposed to a common virus. It is not a reflection on you, your character, or your values, and conversations with partners should not be viewed as making a “confession” or offering an “apology”.
With a new relationship it may be good to date for awhile and allow aspects of the relationship besides sex to develop as you get to know one another and become closer.
HPV types:
There are over 100 types of HPV, about 30 of which are primarily associated with anogenital skin and sexual transmission. Of these types, some can cause genital warts (“low-risk” HPV) while others may cause abnormal cell changes, most commonly of the cervix (“high-risk” HPV).
HPV Latency:
It can take weeks, months, or even years after exposure to HPV before symptoms develop or the virus is detected. This is why it is usually impossible to determine when or from whom HPV may have been contracted.
A recent diagnosis of HPV does not necessarily mean anyone has been unfaithful, even in a long-term relationship spanning years.
Medical Impact:
The medical risks of genital HPV do exist and should not to be overlooked, but a key point is that for most people, HPV is a harmless infection that does not result in visible symptoms or health complications.
Very few cases of “high-risk” HPV will lead to cervical cancer, for example, primarily because the immune response is usually able to suppress the virus before cancer develops. In some cases, HPV may cause cell changes that persist for years, and the cells can eventually become cancerous if not detected in time. However, regular screening (such as Pap tests) can almost always find abnormalities so they can be treated, if needed, before cancer occurs.
Some other cancers associated with “high-risk” HPV
include those of the anus, penis, vagina, and vulva. These cancers
are not common and are very rare in industrialized nations,
however.
Most sexually active couples share HPV until the immune response
suppresses the infection. Partners who are sexually intimate only
with each other are not likely to pass the same virus back and forth.
When HPV infection goes away the immune system will remember that HPV
type and keep a new infection of the same HPV type from occurring
again. However, because there are many different types of HPV,
becoming immune to one HPV type may not protect you from getting HPV
again if exposed to another HPV type.
Current partners are likely to share HPV, but this may be difficult to prove. Testing options for HPV are limited and most cases are never diagnosed.
Pap tests, for example are not specific screening for HPV; they are designed to detect abnormal cell changes of the cervix.
HPV DNA testing is not currently approved to test infection status. HPV tests are approved for clinical use with women as 1) follow-up with unclear Pap test results or 2) as primary screening for those over age 30.
Screening for men usually consists of a visual inspection to look for lesions (such as warts). Some health care providers apply an acetic wash (vinegar) as a means of highlighting lesions, but this is not a specific test for HPV and may lead to overdiagnosis.
Most cases of HPV, in either gender, remain unconfirmed
clinically.
Will I be able to transmit HPV after treatment?
Much remains unknown about HPV transmission when symptoms (lesions such as warts or cell changes) aren’t present, so experts cannot fully answer this question. However, studies show that in most cases a healthy immune system will be likely to clear, or suppress, HPV eventually. Some cases may persist for years and result in recurrent lesions, but this is not the norm. The bottom line is that most who have genital HPV DNA detected in research studies eventually test negative, often within a year or two.
Many researchers and clinicians do believe “subclinical”
HPV (virus may be in skin cells but no lesions are present) is less
likely to be transmitted than when warts or cell changes are
detected, probably due to a reduced viral load, and subsequently
think it is reasonable to say the chances of transmitting virus years
after the last clinical episode (where lesions were detected) will
become increasingly remote over time. This is not easy to prove and
the lack of a solid “yes or no” answer is frustrating.
Still, HPV does not seem likely to always be active.
A partner might have questions you may not be able to answer. ASHA
may be contacted by E-Mail
for help or visit their HPV
Chat Room
weekdays from 5pm-6pm, ET.
Oral Sex Can Add to HPV Cancer Risk
The study, which appears in this week's New England Journal of Medicine (NEJM), shows that men and women who reported having six or more oral-sex partners during their lifetime had a nearly ninefold increased risk of developing cancer of the tonsils or at the base of the tongue. Of the 300 study participants, those infected with HPV were also 32 times more likely to develop this type of oral cancer than those who did not have the virus. These findings dwarf the increased risk of developing this so-called oropharyngeal cancer associated with the two major risk factors: smoking (3 times greater) or drinking (2.5 times greater). HPV infection drives cancerous growth, as it is widely understood to do in the cervix. But unlike cervical cancer, this type of oral cancer is more prevalent in men.
HPV is ubiquitous. Of the 120 strains isolated from humans — about 40 of which are in the mouth and genital tracts — Merck's recently FDA-approved vaccine, Gardasil, protects against four: HPV-6 and HPV-11, which cause warts; and HPV-16 and HPV-18, which cause about 70% of cervical cancers. Similarly, according to the study, HPV-16 was present in 72 of the 100 cancer patients enrolled in the study. Between 12,000 and 15,000 new cases of oropharyngeal cancer are diagnosed each year, and about 3,000 people die from it. "It is a significant health issue," says Dr. Robert Haddad, clinical director of the Head and Neck Oncology Program at the Dana-Farber Cancer Institute. Haddad says that public awareness of the HPV virus needs to be just like that of HIV because the virus causes multiple types of cancer.
The study's findings bring to light a part of the debate over HPV vaccination and treatment that is often overlooked: the elevated risks of cancer that being HPV-positive has for men. According to Johns Hopkins' researcher Dr. Maura Gillison, who worked on the study: "When you look at the cancers associated with HPV in men — including penile cancer, anal squamous cell carcinoma, oral cancers — it's very close to the number of cases of cervical cancer that occur in the U.S. in women every year. We need to adjust the public's perception... that only women are at risk."
In his practice, Haddad has seen an increase in the number of younger people developing this cancer, people in their 30s and 40s. He attributes it in part to a "change in sexual behavior over the last decade." He says: "The idea that oral sex is risk-free is not correct. It comes with significant risks, and developing cancer is one of them."
Gardasil has become a vaccine rock star, but vaccines to fight HPV are still in their infancy. Another study in this week's NEJM points out that while the preventative vaccine works 98% of the time to protect girls not yet infected with HPV-16 and HPV-18, the vaccine is only 17% effective against cancer precursors overall. These findings could undercut the argument ensuing in more than 15 states to make the vaccine mandatory for young girls.
Gardasil and some vaccines in clinical trial are preventative, but drug companies such as MGI Pharma are studying therapeutic vaccines to treat those already infected with the virus. "We need to come up with better vaccines — and we need to study them in men," says Haddad. Gardasil has not been tested against oral HPV, but Dr. Douglas Lowy, laboratory chief at the National Cancer Institute, says that there is every reason to think that, in principle, "the vaccine should be able to have an impact on oral cancers attributable to HPV." Lowy says that the next studies might start with a look at the rate of acquisition of oral HPV in those who are vaccinated and those who aren't.
"There's no question that the debate needs to go further than
where it is now," says Haddad. "Men are carriers and that is one way
of transmitting this virus."
Source: www.time.com/time/health/article/0,8599,1619814,00.html
Gardasil photo
For me, the decision to take her wasn't difficult. Gardasil, which was approved by the FDA last June, protects against four strains of human papillomavirus (HPV). Two are believed to cause 70% of cervical cancer, which strikes about 11,000 U.S. women a year. The other two strains cause 90% of genital warts--so the vaccine is a twofer.
The American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) have recommended Gardasil for girls at age 11 or 12, though it may be given any time from ages 9 through 26. The idea is to deliver protection before or not long after their "sexual debut." About 40% of girls become infected with HPV within two years of becoming sexually active. By age 50, 80% of women have had the virus at some point, though many have no symptoms, and only a small percentage of infections lead to cancer.
My pediatrician's office has been doing a brisk business in Gardasil, but a lot of parents are deeply uncomfortable with it. Texas Governor Rick Perry found that out last month when he tried to make the vaccine mandatory for girls entering sixth grade, an idea that many Texans felt contradicted the state's abstinence-only message in sex education. Since then, Merck, which makes Gardasil, has stopped lobbying states to require the vaccine for school. No other vaccine mandated for school targets a microbe that is spread mainly through sex.
To me, protecting my child from cancer outweighs any reluctance to ponder her sexual future. "But some parents are totally in denial," says my longtime pediatrician, Dr. Marc Wager of New Rochelle, N.Y. It's his practice to discuss the vaccine when parents bring a daughter for a checkup at 11 or 12. But he doesn't force it on those who resist, and he's willing to edit his discussion of HPV transmission for those who don't want a child to hear it.
Alice managed to tolerate our brief discussion of HPV without rolling her eyes. While explaining, Wager slipped in the needle--an old distraction trick that worked. "I didn't really feel it," said Alice.
"You were brave," said Wager. "Most girls say it stings more than most shots."
And it stings the wallet too. Alice will have to return for a second dose in two months and a third four months after that. The vaccine costs $120 a dose. Luckily, most private insurers are covering Gardasil, so I'll be out just $25 for each of the three visits. Kids without coverage can get the vaccine free through the federal Vaccines for Children program.
As with any new vaccine, there are plenty of unknowns about Gardasil. The CDC's Advisory Committee on Immunization Practices recently studied 542 reports on side effects out of 2.1 million doses given. Most were minor and expected: pain at the injection site, fever, dizziness and fainting. "Any procedure involving a needle has a risk of fainting," says Dr. John Iskander of the CDC's immunization safety office, which recommends waiting in the doctor's office for 15 minutes after any shot. Another unknown: how long the protection will last and whether a booster will be needed. Merck says its studies so far show that protection lasts at least five years.
My next challenge: persuading my 18-year-old daughter to go for
the shots. "Better hurry," warns Wager with a twinkle. "You'll want
to get it in before she's off to college."
Source: www.time.com/time/magazine/article/0,9171,1597467,00.html
HPV Web sites and cervical cancer prevention
800.ACS.2345
800.ACS.2345Source: www.ashastd.org/hpv/hpv_learn_fastfacts.cfm
* Correction, 2/23/2007: It had been stated that "all women who develop cervical cancer have had a human papilloma virus (HPV) infection." According to the U.S. National Institutes of Health, HPV infection is the primary risk factor for cervical cancer, but other risk factors include a high number of full-term pregnancies, use of oral contraceptives, and smoking. This error has been corrected.
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