HPV:
The STD of a New Generation
- By Amanda Hess
Lifestyle Editor, GOOD
A brief American cultural history of sexually transmitted disease: The "Greatest Generation" faced propaganda posters warning sexually active patriots of syphilis and gonorrhea. In the '80s, Time magazine declared herpes the "new scarlet letter" for people having casual sex. Then the AIDS crisis hit, and in the '90s-defining film Reality Bites, even Janeane Garofalo's straight white girl agonized over the results of an HIV test. But as AIDS is increasingly coded culturally as a poor person's problem, the dominant conversation surrounding sexual health has focused on the human papillomavirus, the sexually transmitted infection that most people don't even know they have.
In recent years, the ways that HPV is transmitted, treated, and talked about has shone a light on America's developing cultural attitudes toward sex. HPV is not AIDS, and it can't even be our generation's red "A"—in many people, HPV has no symptoms. Instead, the spread of HPV among sexually active youth has quietly revolutionized our cultural script surrounding sexual stigma.
Thanks to HPV, just about everyone has a sexually transmitted infection these days. About 20 million Americans are currently infected with one or more strains of the virus. Six million more are infected each year. If you have sex, you're more likely than not to get it before you die. Forty percent of women will contract it within just 16 months of their first vaginal intercourse. And the virus' proliferation has complicated Americans' moral judgments concerning sexual activity. The ubiquity of HPV has democratized sexual stigma—the virus infects people of all races, classes, and sexual orientations. If contracting a virus from sex is the norm, it makes it more difficult to dismiss people with STIs as moral degenerates or irresponsible sluts.
At the same time, the proliferation of HPV among young people has stoked longstanding fears over sexually promiscuous youth. There is no cure for HPV, and even the rules of '90s "safe sex" no longer apply—even with condoms, certain strains of HPV can be transmitted through the skin. The virus clears from most bodies within a couple of years without a trace, but in others, it will develop into genital warts or slowly convert cervical cells into cancer. Every year, 12,000 American women develop cervical cancer, and 4,000 women die from it. But strangely, fears over HPV's spread exploded only after Gardasil, a vaccine that can prevent common wart and cancer-causing strains of the virus, hit the market in 2006.
Arguably, both the pharmaceutical companies that developed the vaccine and the evangelical Christians who oppose it have contributed to the hysteria surrounding the virus. After the CDC recommended Gardasil for all girls and women ages 11 to 26, the prospect of routinely vaccinating girls against STIs before they even become sexually active sparked a political firestorm. Some conservatives claimed that protecting girls from a virus that will almost certainly affect them later in life could in fact encourage them to get busy earlier. And last week, Republican presidential hopeful Rick Perry added fuel to the fire when he reversed his previous support of administering Gardasil to every 6th grade girl in Texas. Today, fewer than half of all girls in the United States receive the vaccine.
But Gardasil developer Merck has also fanned the flames. Guli Fager, a sex educator at the University of Texas at Austin, told me that while Gardasil is effective in preventing some cancer-causing strains of the virus, it doesn't protect against all of them, and it doesn't eliminate the need for condom use or regular Pap tests. The HPV vaccine is "like using seven airbags at once," Fager says—it's nice, if you can afford it.
But well-situated women already have a couple of effective cancer-preventing tools in their arsenal. Condoms do help to prevent HPV from infecting the cervix, and regular Pap screenings are highly effective in curbing HPV's transformation to cancer. That means that the virus is most dangerous to women who have reduced access to preventative care or don't have the power to negotiate condom use with their partners. Every woman is at risk of contracting HPV, but certain women may be more likely to actually die from it. In the years to come, how cultural commentators negotiate that divide will help inform our generation's views on sex, shame, and just as importantly, class.
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Genital HPV Infection - Fact Sheet
What is genital HPV infection?
Genital human papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). There are more than 40 HPV types that can infect the genital areas of males and females. These HPV types can also infect the mouth and throat. Most people who become infected with HPV do not even know they have it.
HPV is not the same as herpes or HIV (the virus that causes AIDS). These are all viruses that can be passed on during sex, but they cause different symptoms and health problems.
What are the signs, symptoms and potential health problems of HPV?
Most people with HPV do not develop symptoms or health problems from it. In 90% of cases, the body’s immune system clears HPV naturally within two years.
- But sometimes, certain types of HPV can cause genital warts in males and females. Rarely, these types can also cause warts in the throat -- a condition called recurrent respiratory papillomatosis or RRP.
- Other HPV types can cause cervical cancer. These types can also cause other, less common but serious cancers, including cancers of the vulva, vagina, penis, anus, and head and neck (tongue, tonsils and throat).
The types of HPV that can cause genital warts are not the same as the types that can cause cancer. There is no way to know which people who get HPV will go on to develop cancer or other health problems.
Signs and symptoms of HPV-related problems:
Genital warts usually appear as a small bump or groups of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. Health care providers can diagnose warts by looking at the genital area during an office visit. Warts can appear within weeks or months after sexual contact with an infected partner—even if the infected partner has no signs of genital warts. If left untreated, genital warts might go away, remain unchanged, or increase in size or number. They will not turn into cancer.
Cervical cancer usually does not have symptoms until it is quite advanced. For this reason, it is important for women to get regular screening for cervical cancer. Screening tests can find early signs of disease so that problems can be treated early, before they ever turn into cancer.
Other HPV-related cancers might not have signs or symptoms until they are advanced and hard to treat. These include cancers of the vulva, vagina, penis, anus, and head and neck. For signs and symptoms of these cancers, see www.cancer.gov
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RRP causes warts to grow in the throat. It can sometimes block the airway, causing a hoarse voice or troubled breathing.
How do people get HPV?
HPV is passed on through genital contact, most often during vaginal and anal sex. HPV may also be passed on during oral sex and genital-to-genital contact. HPV can be passed on between straight and same-sex partners—even when the infected partner has no signs or symptoms.
A person can have HPV even if years have passed since he or she had sexual contact with an infected person. Most infected persons do not realize they are infected or that they are passing the virus on to a sex partner. It is also possible to get more than one type of HPV.
Very rarely, a pregnant woman with genital HPV can pass HPV to her baby during delivery. In these cases, the child can develop RRP.
How does HPV cause genital warts and cancer?
HPV can cause normal cells on infected skin to turn abnormal. Most of the time, you cannot see or feel these cell changes. In most cases, the body fights off HPV naturally and the infected cells then go back to normal. But in cases when the body does not fight off HPV, HPV can cause visible changes in the form of genital warts or cancer. Warts can appear within weeks or months after getting HPV. Cancer often takes years to develop after getting HPV.
How common are HPV and related diseases?
HPV (the virus). Approximately 20 million Americans are currently infected with HPV. Another 6 million people become newly infected each year. HPV is so common that at least 50% of sexually active men and women get it at some point in their lives.
Genital warts. About 1% of sexually active adults in the U.S. have genital warts at any one time.
Cervical cancer. Each year, about 12,000 women get cervical cancer in the U.S.
Other cancers that can be caused by HPV are less common than cervical cancer. Each year in the U.S., there are about:
- 3,700 women who get vulvar cancer
- 1,000 women who get vaginal cancer
- 1,000 men who get penile cancer
- 2,700 women and 1,700 men who get anal cancer
- 2,300 women and 9,000 men who get head and neck cancers. [Note: although HPV is associated with some of head and neck cancers, most of these cancers are related to smoking and heavy drinking.]
Certain populations are at higher risk for some HPV-related health problems. This includes gay and bisexual men, and people with weak immune systems (including those who have HIV/AIDS).
RRP is very rare. It is estimated that less than 2,000 children get RRP every year in the U.S.
How can people prevent HPV?
There are several ways that people can lower their chances of getting HPV:
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Vaccines can protect males and females against some of the most common types of HPV. These vaccines are given in three shots. It is important to get all three doses to get the best protection. The vaccines are most effective when given before a person's first sexual contact, when he or she could be exposed to HPV.
- Girls and women: Two vaccines (Cervarix and Gardasil) are available to protect females against the types of HPV that cause most cervical cancers. One of these vaccines (Gardasil) also protects against most genital warts. Both vaccines are recommended for 11 and 12 year-old girls, and for females 13 through 26 years of age, who did not get any or all of the shots when they were younger. These vaccines can also be given to girls as young as 9 years of age. It is recommended that females get the same vaccine brand for all three doses, whenever possible.
- Boys and men: One available vaccine (Gardasil) protects males against most genital warts. This vaccine is available for boys and men, 9 through 26 years of age.
- For those who choose to be sexually active, condoms may lower the risk of HPV. To be most effective, they should be used with every sex act, from start to finish. Condoms may also lower the risk of developing HPV-related diseases, such as genital warts and cervical cancer. But HPV can infect areas that are not covered by a condom - so condoms may not fully protect against HPV.
- People can also lower their chances of getting HPV by being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has had no or few prior sex partners. But even people with only one lifetime sex partner can get HPV. And it may not be possible to determine if a partner who has been sexually active in the past is currently infected. That's why the only sure way to prevent HPV is to avoid all sexual activity.
How can people prevent HPV-related diseases?
There are ways to prevent the possible health effects of HPV, including the two most common problems: genital warts and cervical cancer.
- Preventing genital warts: A vaccine (Gardasil) is available to protect against most genital warts in males and females (see above).
- Preventing Cervical Cancer: There are two vaccines (Cervarix and Gardasil) that can protect women against most cervical cancers (see above). Cervical cancer can also be prevented with routine cervical cancer screening and follow-up of abnormal results. The Pap test can find abnormal cells on the cervix so that they can be removed before cancer develops. An HPV DNA test, which can find HPV on a woman's cervix, may also be used with a Pap test in certain cases. Even women who got the vaccine when they were younger need regular cervical cancer screening because the vaccine does not protect against all cervical cancers.
- Preventing Anal and Penile Cancers: There is no approved screening test to find early signs of penile or anal cancer. Some experts recommend yearly anal Pap tests to screen for anal cancer in gay and bisexual men and in HIV-positive persons. This is because anal cancer is more common in those populations. These tests are not routinely recommended for anal cancer screening because more information is still needed to find out if they are effective.
- Preventing Head and Neck Cancers: There is no approved test to find early signs of head and neck cancer, but tests are available by specialized doctors for persons with possible symptoms of these cancers. [see www.cancer.org]
- Preventing RRP: Cesarean delivery is not recommended for women with genital warts to prevent RRP in their babies. This is because it is not clear that cesarean delivery prevents RRP in infants and children.
Is there a test for HPV?
The HPV tests on the market are only used to help screen for cervical cancer. There is no general test for men or women to check one’s overall “HPV status,” nor is there an HPV test to find HPV on the genitals or in the mouth or throat. But HPV usually goes away on its own, without causing health problems. So an HPV infection that is found today will most likely not be there a year or two from now.
Is there a treatment for HPV or related diseases?
There is no treatment for the virus itself, but there are treatments for the diseases that HPV can cause:
Visible genital warts can be removed by the patient him or herself with medications. They can also be treated by a health care provider. Some people choose not to treat warts, but to see if they disappear on their own. No one treatment is better than another.
Cervical cancer is most treatable when it is diagnosed and treated early. But women who get routine Pap tests and follow up as needed can identify problems before cancer develops. Prevention is always better than treatment. [see www.cancer.org]
Other HPV-related cancers are also more treatable when diagnosed and treated early. [seewww.cancer.org]
RRP can be treated with surgery or medicines. It can sometimes take many treatments or surgeries over a period of years.
Where can I get more information?
CDC’s National Breast and Cervical Cancer Early Detection Program
STD Information
CDC-INFO
Contact Center
1-800-CDC-INFO (1-800-232-4636)
Email: cdcinfo@cdc.gov
CDC National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
1-800-458-5231
1-888-282-7681 Fax
1-800-243-7012 TTY
E-mail: info@cdcnpin.org
National HPV and Cervical Cancer Prevention Resource Center American Social Health Association (ASHA)
P. O. Box 13827
Research Triangle Park, NC
27709-3827
1-800-783-9877
>via: http://www.cdc.gov/std/hpv/stdfact-hpv.htm