Sunday, August 11, 2013
Go To Health: Human Papilloma Virus and Its Consequences
Cervical cancer, detected by regular Pap smears before it becomes serious, is caused by a sexually transmitted virus. Nuns and lesbians don’t get cervical cancer if they never have intercourse with men. Condoms offer some protection. Were you ever told this when you (or your partner) went for a Pap test? These facts were ignored for years by the medical profession and popular culture – perhaps because of the discomfort people feel about discussing the nitty-gritty of sex, perhaps because of ignorance. The papilloma virus (HPV) that causes cervical cancer can also cause cancers of the vagina, vulva, penis, anus and throat. Cervical cancer is the most common of these problems, but the number of throat cancers from HPV are now on the rise. The actor Michael Douglas made headlines recently when he told a British newspaper that his throat cancer had come from performing oral sex.
Cancers of the base of the tongue, tonsils and walls of the pharynx are becoming more common. A decade ago, people with head and neck cancers were smokers or heavy drinkers. Now only 20% are smokers or drinkers, and the other 80% have cancers caused by an HPV infection. This year an estimated 14,000 people in the US will be diagnosed with head and neck cancers; most of them will be between 40 and 50 years old, and 3 out of 4 will be men, according to Dr. Robert Haddad of the Dana Farber Cancer Institute. Haddad talks about ‘an epidemic’ of HPV–related head and neck cancers. If oral sex is a factor, the predominance of men may be because vaginal fluid has more virus than the surface of the penis.
There are two vaccines available against HPV infection – Gardisil and Cervarix. These vaccines protect against many of the some 100 strains of HPV, including the high risk strains HPV-16 and 18 which are a known cause of cervical, throat, anal and vaginal cancers. A study supported by the National Cancer Institute has just been published which showed that sexually active young women in Costa Rica had 93% protection against infection with HPV types 16 and 18, after receiving immunization with Cervarix.. Although the study did not include men, it is believed that they would get the same protection with this vaccine.
The Gardisil vaccine was approved by the FDA and the CDC (Centers for Disease Control) for girls ages 9-26 in 2009, and for boys in 2011. Cervarix has also received FDA approval, and may be even more effective. The vaccine is given by 3 injections over 6-12 months. There has been controversy about these vaccines because of reports of serious reactions after injection, but careful studies by the CDC do not show that these reports are valid. Most side effects consist of pain, redness, and swelling at the injection site, and occasional fainting, fatigue, headache, muscle pain, gastrointestinal symptoms, and joint pain.
Women are advised to continue having Pap tests for cervical cancer even after vaccination, as the vaccines are not effective against all strains of HPV. Men and women should know they should not ignore difficulty swallowing or feeling/seeing a lump in the throat or on a tonsil. Seek medical attention promptly if this occurs. Sexually active people should also be aware of many other types of sexually transmitted disease, including HIV/AIDS, syphilis, gonorrhea (rapidly becoming drug resistant), Chlamydia, Herpes et al. Condoms are very helpful but not foolproof for prevention. The birth control pill and IUD are highly effective against pregnancy but do nothing to prevent STDs.. Have you ever wondered why sex scenes in movies and television never involve a discussion of these potential problems? Is it still that controversial? We have calorie counts on some menus, and dire (small print) warning on cigarettes. But nothing is said about sex. Young women in college are initiating hook-ups without emotional involvement so they won’t get derailed from their independent careers. The recent NYTimes article (7/12/13) about this did not mention STDs or birth control. Go figure.
Sadja Greenwood, MD, MPH -->