Tags
health, HPV, human papilomavirus, prevention, safer sex, sexual health, STD, STI, vaccination
Have you had sex? Do you intend to have sex in the future? Did you answer “yes” to either of these questions? If so, read on.
As we all know from our highly inefficient public school sex ed class, engaging in sexual intercourse bears a risk of contracting cooties sexually transmitted infections (STI). Unlike your sex ed teacher, I’m not going to show you numerous images of disease-ridden genitals[1] Today I want to talk about the importance of vaccination, condom use, and regular check-ups to the prevention of HPV.
HPV, human papillomavirus, is a sexually transmitted infection that has over 40 strains and is responsible for genital warts and certain kinds of cancer. It is extremely common. More than 50% of sexually active adults will have HPV at some point in their life. According to CDC, 79 million Americans are currently infected with HPV[2]. Fun fact: HPV is so common (how common is it?) that OB/GYNs do not recommend telling your partner(s) you have it. For a further discussion of HPV disclosure protocol, read this Jezebel article.
low-risk HPV causes genital warts, high-risk HPV can cause cancer
So What’s the Big Deal?
HPV is a huge public health issue. It is the leading cause of cervical cancer, with 70 percent of cases being linked to two high-risk strains. Eighty-five percent of cases of anal cancer are caused by HPV-16. HPV can infect the vulva, vagina, cervix, anus, rectum, penis or scrotum. It can also lead to cancers of those areas.[3].
What makes matters worse, not only is HPV very common, but the high-risk strains (the ones that cause cancer) often have no symptoms. There is NO CURE for HPV. Currently, there is no approved treatment for HPV. Anyone who has had sex can contract HPV. If you had sex once, or with only one partner and even if you practiced safer sex, if your partner was not a virgin, you can still get HPV. This is because, like herpes, what matters is a contact with the infected area, and transmission can happen through skin-to-skin contact. Oh, and did I mention there is no HPV test for men?
So far, HPV sounds pretty serious: a lot of people have it, condoms are not 100 percent effective in preventing transmission, the “C” word is very scary, and your male partners do not know their status. However, the matters are not as hopeless as I made it seem so far, there is a very simple solution to this public health crisis – vaccination. Paired with consistent condom use and regular check ups for women, vaccination can help eradicate high-risk HPV strains.
The Good News
Women
Getting regular Pap smears is essential for HPV detection and cervical cancer prevention. HPV can cause cervical cells to undergo pre-cancerous changes. If these are detected early, the small patch of cells is easily removed, preventing larger problems and expensive treatment down the road. There are two approved HPV vaccines on the market: Gardasil and Cervarix. According to National Cancer Institute[4]:
Both vaccines are highly effective in preventing infections with HPV types 16 and 18, two high-risk HPVs that cause about 70 percent of cervical and anal cancers. Gardasil also prevents infection with HPV types 6 and 11, which cause 90 percent of genital warts
Vaccination is most effective when done before the first sexual encounter. The vaccine is covered by most insurance plans up to age 26. So, if you’re near that age cutoff and still haven’t been vaccinated, make the appointment with your doctor as soon as possible. Likewise, if you’re at risk of losing your health insurance, do not delay.
Men
There is no approved HPV test for men. That doesn’t mean, however, that HPV is undetectable. In women, HPV infects a relatively small area – the cervix, while any cell on the entire area of the penis can be affected, so there is no practical way to test men. One study of 1160 men from Brazil, Mexico, and the United States, found HPV prevalence to be 65 percent[5]. Sixty five percent of study participants carried some strain of HPV! So, if you’re a sexually active male living in one of these countries, there is a 65% chance you have HPV and there is no way for you to know for sure (aside from participating in a study).
So what can a man do to protect his partner(s)? Fortunately, Gardasil is approved for males ages 9-26. If you fall into that age bracket and you have not been vaccinated, please do so. Even if you are older than 26, consider getting the vaccine anyway, as older individuals have a higher risk of developing cancer and lower chance that the HPV will clear up on its own.
The Role of Condom Use
Condom use is essential to transmission prevention. According to a study in the New England Journal of Medicine, consistent condom use reduces the risk of infection by 70 percent[6].
Women whose partners used condoms for all instances of vaginal intercourse during the previous eight months were 70 percent less likely to acquire a new infection than were women whose partners used condoms less than 5 percent of the time, after adjustment for the number of new partners and the estimated number of previous partners of the male partner.
Since men do not know their HPV status, and HPV has no symptoms, please consider using condoms even if you’re in a long-term monogamous relationship. (This is especially true if you and/or your partner are not vaccinated against HPV.) Don’t be too quick to discount this advice as unnecessary or unrealistic, because not all monogamous relationships are as monogamous as you’d like to think (Surprise!!! Honey, I got you a gift that keeps on giving!).
*Note: condoms are not the only thing you can use to lower your risk of infection. Refer to articles by other editors here, here, here, and here.
What if I Already Have HPV?
If you had been diagnosed with HPV, fear not, it is not really that bad. Try to lead a healthier life style and avoid immune-suppressants. This might be a good time to stop smoking[3] and curb your alcohol use. There is a good chance your immune system will be able to deal with it. Get a Pap test once every 6 months to catch any cellular abnormalities early. Talk to your doctor about the things you can do to lower your cancer risk.
If you’re not vaccinated, get vaccinated. Remember, there are over 40 strains and you can get infected with more than one. The vaccine protects you from the most dangerous strains. It is still worth getting, even if you’re already infected.
Continue using condoms both for your and your partner’s protection. I cannot stress this enough.
Recap
- HPV is very common
- Both men and women can get vaccinated
- Condom use significantly reduces the risk of transmission
- Regular Pap and cerivcal exams help prevent cancer
Click on the image to enlarge. Reminder that you don’t have to be straight or have penetrative sex to contract HPV. For a hot example of safer sex and glove use read this. Drawn by Katie Diamond.
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[1]For the love of everything you hold dear, do not, I repeat DO NOT google image HPV
[2] CDC HPV Fact Sheet http://www.cdc.gov/std/hpv/stdfact-hpv.htm
[3] NCI http://www.cancer.gov/cancertopics/factsheet/Risk/HPV
[4] NCI HPV Vaccine http://www.cancer.gov/cancertopics/factsheet/Prevention/HPV-vaccine
[5] Human papillomavirus infection in men residing in Brazil, Mexico, and the USA. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3495064/
[6] Condom Use and the Risk of Genital Human Papillomavirus Infection in Young Women http://www.nejm.org/doi/full/10.1056/NEJMoa053284#t=articleResults
Ok, if there’s no approved HPV test for men, how are doctors able to figure out the statistic that 65% of men have HPV? I mean, if they can test 1160 men for HPV for the purposes of a study, should they also be able to test for HPV in all men?? Am I missing something here?
Thank you for asking. There is no PRACTICAL way to test for HPV in men because the doctor would have to test ALL the skin cells on the shaft of the penis. “The test is unpleasant for many men – it involves using something akin to a metal nail file to scrape skin cells from a man’s penis – and is not quite as sensitive or specific of a test as the HPV test is for women.” I guess most providers and men decide that the cost outweighs the benefit. They only do it for research until they find a better way to detect HPV in men. Does that answer your question?
Read more at Men’s Health: http://blogs.menshealth.com/sex-professor/qa-is-there-really-no-hpv-test-for-men/2010/11/17/#ixzz2YNNsIZAO
Very cool stuff- I wish everyone was this knowledgeable about HPV! FYI, virgins can have HPV as it can be transmitted during birth (although this is not common), and breast milk can also carry HPV which could potentially infect a breastfeeding infant. http://journals.lww.com/pidj/Abstract/2008/06000/Human_Papillomavirus_DNA_Detected_in_Breast_Milk.15.aspx
Wow, thank you for letting me know. This is fascinating! The more reason to de-stigmatize HPV and make the vaccine mandatory.
Exactly!
Also, virgins can have HPV if they engage in any genital-to-genital contact with a partner, even if there’s no penetration. So if you’re not-so-dry-humping, you’re still putting yourself at risk.
Yes, I think the vaccine should be mandatory. That said, I wouldn’t present it as “the solution.” It’s only a vaccine for a couple of strands. And by the way, it takes 3 shots over a period of 6 months, so don’t wait. And please, don’t try to present a false sense of security from the virus.
I don’t think people take STDs seriously enough. Or at least, they don’t take safety measures seriously enough. And certainly not as seriously as the stigma is taken. I have only had unprotected oral sex with one partner, 2-3 times over a short period of time. I have not had sex many times total, and I have never had genital-to-genital sex. I just got tested for the first time ever, and I have Herpes 1, probably of the genital region. I was told that the blood test results indicate I’ve had a lesion in the past, and I’ve had something in the pubic area, but not orally, so I’m pretty sure what that means. And I probably contracted it from oral sex.
My partner and I never discussed STDs until after the first time we had unprotected sex. This partner later told me they chose not to have protected sex based on the “odds.” They said they and their primary partner had had the general STD test and didn’t have anything, and he hadn’t had any partners since then.
Well, one thing I found out from a previous partner is that Herpes 1 is usually not tested for unless you specifically ask for it. So when I had a test, I asked to be tested for this. The nurse told me this is usually not tested for so as not to alarm the general population since 50% of the population has it, and since a blood test cannot tell whether Herpes 1 is located in the mouth or genital region. Well, I think this is fucked up, because I later found out (too late) that the partner I had unprotected oral sex with was tested for everything… but Herpes 1. He didn’t even know that not testing for this was a thing. If 50% of the population has it, this is an epidemic that should be treated as such, but the medical community does not. Oral herpes is considered to be insignificant, but genital herpes carries great stigma and (if I understand correctly) can be more painful… although for me it has not been painful.
Of course, it was also foolish of me to have the unprotected sex in the first place. But let me tell you – this is a collective problem. Because not one of my other several partners asked me about STDs before we had sex, and they were all more experienced than me. Not one of them talked to me about STDs at any point except the one who told me about the non-testing of Herpes 1 – which was brought up because said partner was getting tested. And that was the only time we talked about it. My first two partners + the one I suspect I contracted Herpes 1 from never so much as mentioned safe sex – in fact, we didn’t even talk about sex, period. The one partner I did talk to about STDs did discuss safe sex with me, but we barely discussed STDs over several months of sexual relationship. The only other time I discussed sex with that partner was after telling them I had unprotected oral sex, and then suddenly they’re alarmed and ask me to tell them whenever I have unprotected sex. I believe this alarm was expressed solely out of a desire for self-protection and not at all out of a concern for me. Which I think is pretty much how everyone views STDs, at least until they contract one. It’s someone else’s disease. I’m guilty, too.
I actually don’t think Herpes is necessarily as big of a deal as people make it, but of course no one wants it in part because it can get in the way of intimacy. And the stigma. But it can weaken the immune system.
I think everyone should be tested for STDs as part of sex ed. Maybe it would get people to take the risks more seriously. I also think that everyone should be tested for Herpes 1, and it’s really unfortunate that it’s not tested, merely out of concern for alarming people… because this is just promoting the spread of an extremely common virus. Telling people over and over “get tested” but then never testing for one of the most common STDs, which has no cure, is a serious problem. And it’s clearly, totally possible to contract the virus from oral sex if the other person has oral herpes. I think referring to HSV-1 as oral herpes and HSV-2 as genital herpes is a misnomer. They can both be contracted in both areas. Considering how many people I’ve made out with (countless) compared to how many I’ve had unsafe oral sex with (1), I’m surprised I contracted it genitally instead of orally if HSV-1 is supposedly “oral herpes.”
Also, this can be confusing when reading up on STDs:
HPV = human papilloma virus
HSV-1 = herpes (simplex virus) 1
HSV-2 = herpes (simplex virus) 2
Part of my problem is that I’m just not very assertive, and I’m shy. That makes talking about sex difficult. General shame around sex makes talking about sex and STDs difficult. Not testing for HSV-1 is misleading. The notion that you can only spread herpes if you have sores is highly misleading, especially considering that the best time to spread the virus is right BEFORE outbreak.
And most of the time, people don’t even tell their partners about their status. Or ask about their partners’ status. I never had a partner ask me about my status, not one. And these are all college-educated people, some of them youth educators and one of them a sex educator. Do not be fooled – most people are not very safe about sex, and very few people are even interested in talking about STDs.
Oh, another thing I learned while reading up on STDs is that HIV can be contracted through the mouth, if the partner with HIV has bleeding gums. Which is not that uncommon, especially among folks older than 40. When I learned this, I decided to get tested for HIV as well and thankfully was negative.
The good news is that if you have HSV-1 (and there’s at least a 50% chance you do if you’re sexually active) orally, you’re very unlikely to contract it genitally, and vice versa, although you can still contract HSV-2. But that’s good to know in case I want to have oral sex – I’ll have to ask my partners if they have HSV-1 (50% chance), because then we’re safe. But it does cut me off from 50% of potential oral sex partners, as well as those who don’t know their status, and there’s a good chance they don’t since most don’t get tested for it. Thankfully, it seems I don’t actually care that much about oral sex anyway, and I don’t have genital-genital sex, so it doesn’t affect me as much as it could. But anyone who has HSV-1 or a partner with HSV-1, regardless if it’s oral or genital, should not be having unprotected oral sex – ever – if they want to be completely safe (and it can still be contracted even if condoms are used).
As for how my potential sex partners will take this information, I don’t know yet as I literally have not done anything but think about this since I obtained the news today.
Also, according to Wikipedia, HSV-1 genital infections are increasing.
“researchers estimate that HSV-1 is responsible for up to half of all new cases of genital herpes.”
“Women have a greater risk of being infected after sex with an unprotected partner than men do — about 1 in 4 women have HSV-2, compared to 1 in 8 men. Estimates of how many Americans are infected range from 20% – 30%.”
http://umm.edu/health/medical/altmed/condition/herpes-simplex-virus#ixzz2cSCrLYPs
Sorry, that first comment was probably more alarming than it should have been… I haven’t had time to fully process this.
Haha, that’s ok. It is a lot to process 🙂
Yeah, I was definitely expressing too much alarm about it there. The part about never having oral sex didn’t quite make sense. Everyone should be assumed to have both HPV and HSV, given the prevalence rates, until proven otherwise. However, 80% of people with HSV don’t know they have it, or something like that. And most people are asymptomatic, but there’s a 10% chance of getting it on any given day from an asymptomatic person, so the odds increase very quickly with multiple exposures to an infected person.