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 -->

HPV – Who Knew All it Could Do?

-->

HPV – the Human Papilloma Virus – has been known for years to be the main cause of cervical cancer in women. There are over 40 types of HPV that are transmitted by direct skin to skin contact during vaginal, anal and oral sex, and most do not cause disease.  However, infection with certain viral types,  mainly but not exclusively  HPV 16 and 18, can cause cervical cancer if not treated. This is why the Pap test is so important for women who are or have been sexually active, with men or with women.  The Pap test is a procedure in which cells are scraped from the cervix and looked at under a microscope. The Pap test can detect abnormal cells before they become cancerous, and early treatment in the doctor’s office can get rid of the problem. However, some women don’t know about the need for regular pelvic exams, or can’t afford them. There were 4,200 deaths from cervical cancer in the US last year.  Cervical cancer is a very serious problem in developing countries which cannot afford to do Pap screening. 

Some subtypes of HPV can also cause cancers of the vulva, penis, anus and the mouth and throat.  Sexually transmitted HPV type 16 causes about 85% of anal cancers according to the National Cancer Institute. The risk for anal cancer is much higher in gay and bisexual men than heterosexual men.  Women who have anal sex are also at greater risk.

Condoms, which help to prevent pregnancy and HIVAIDS, can prevent HPV infection by about 70% if used every time.  Skin to skin transmission can still occur outside of the condom.  Still  - condom use is important with new partners.   The good news is that most HPV infections are cleared by the immune system in a few years and never cause a problem.  However, some people don’t clear the virus, and their infections remain. 

In recent years there has been an increase of cancers of the throat and base of the tongue, caused by HPV 16.  Previously known risk factors for throat cancer included smoking and alcohol, but throat cancers are now seen in younger people who don’t smoke or abuse alcohol. Throat cancers from HPV are more commonly seen in men, but women are also affected.  Oral sex is considered to be a major predisposing factor.  The increase in throat cancer is considered serious, because it can be hard to detect early.

Since most people do have genital and oral sex, how can we view this threat and deal with it?  Prevention and early detection are vitally important.  This would include:

*consistent condom use with new partners, even with oral sex.  This may seem unlikely, especially for teenagers trying to do the right thing to avoid pregnancy.  However, they should be informed about the problem.

*Make sure your children get the HPV vaccine, Gardasil or Cervarix – given in 3 shots over 6 months.  Both are effective in preventing infections that cause cervical cancer.  Gardasil is believed to prevent more HPV types, those that cause cancer of the anus, vulva and vagina.  HPV vaccination is recommended by the Centers for Disease Control for 11 and 12 year old girls, and girls and women age 13 through 26 who have not been vaccinated.  Gardasil has been found to be safe and effective for males age 9-26.  Vaccinating a boy with Gardasil will help his partners, and also help him to prevent oral cancer.  The cost of the vaccine is about $130 per dose - $390 for the series.  Most health insurance plans cover the cost, and the Vaccines for Children program may be able to help.

*Pap tests are still important for women, even if vaccinated, because the vaccines do not prevent about 30% of HPV types that can cause cervical cancer.

*Being in a faithful relationship with one partner, limiting the number of sex partners, and choosing a partner with few prior sex partners can be helpful.   However, it is not always possible to know if a partner or oneself is currently infected with HPV. 

*Early detection of cervical, vaginal, vulvar and anal cancer can be done by regular medical examinations, self exams, and alertness to anything that feels like a persistent sore or abnormal growth. 

*Early detection of cancers of the mouth and throat can be done by regular visits to the dentist and dental hygienist, who should look for abnormalities in the mouth and throat, including hidden areas at the back of the tongue.   Everyone should be aware of symptoms such as a persistent sore throat or mouth sore, a feeling of a mass in the throat, a lump in the neck, or difficulty swallowing.  

Check it out!

* Keep your immune system strong by getting enough sleep, exercising moderately, eating healthy food (lots of vegetables!), and avoiding tobacco, dangerous drugs, and excess alcohol.

Our venerable sage Ben Franklin told us:  An ounce of prevention is worth a pound of cure.  Let’s follow his advice. 

Sadja Greenwood, M.D., MPH  back issues on this blog