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HPV (human papilloma virus) - Ambar
November 28th, 2005
10:14 pm

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HPV (human papilloma virus)
Since I've had two requests for the paper, it's behind the cut. My personal conclusion, incidentally, is that HPV is nothing to be concerned about if you are female and you have an annual Pap test. Most HPV infections have no noticeable symptoms and are cleared by the body. A few strains cause visible warts. A few strains cause cervical (and possibly other) cancer. The Pap test will catch any cancerous changes in time for treatment. There are treatments for genital warts, which may or may not make them regress faster than they would anyway. There are no treatments for HPV per se, which is also the case for most viruses.

As the paper was written for a women's studies class, it doesn't touch on HPV in men much at all. Start with the references and spread your search out from there.


Human Papilloma Virus (HPV) and Women’s Health



What is HPV?



Human Papillomavirus (HPV) is a large and diverse family of viruses that infect the skin and mucous membranes, causing “a variety of benign proliferations” such as warts and epithelial cysts. [zur Hausen, 1996] Over 100 types are known. [Webmd 2005(1)] HPV is being investigated for association with a number of different cancers, but it is most reliably linked as a cause of at least 90% of cervical cancers, as well as more than 50% of other anogenital cancers. [zur Hausen, 1996] Some 70% of cervical cancer cases are attributed to just two strains of HPV (type 16 and 18). [Lancet 2004]

HPV may be the most common sexually transmitted disease (STD) in North America. [Webmd 2005(2)] There is no treatment for the virus as such. Most women infected with HPV will clear the infection on their own without medical treatment within six to eighteen months, although they can be reinfected with different strains of the virus. [Webmd 2005(2)] Some strains cause genital warts, and these warts can be treated (although they will usually regress on their own). However, the strains linked with cervical cancer rarely cause visible warts.

Prevention of HPV and Cervical Cancers



According to the most currently available recommendations from the Centers for Disease Control and Prevention (CDC), the most reliable way to prevent HPV infection is sexual abstinence, followed by monogamy with an uninfected partner. [CDC 2002] However, even a monogamous woman can be at risk for HPV infection if her partner has other partners. According to the CDC [CDC 2005], most sexually active adults will have an HPV infection at some point in their lives, but will not know because there are no visible symptoms and the infection goes away without causing any problems.

[Male] condom use is associated with a decline in HPV-related diseases (genital warts and cervical cancers), but condoms do not cover all the areas which can be shedding the HPV virus, so they are not a reliable method of prevention. [CDC 2005] I could not find any studies on HPV and the female condom. Several studies suggest that the rates of HPV infection in lesbians who report no sexual contact with men are similar to rates of HPV infection in other women. While this is not direct proof of sexual transmission between women, it is suggestive, and the unanimous recommendation is that lesbians should have cervical health screenings at the same frequency as other women. [Marrazzo 2004]

Detection of HPV and Cervical Cancers



Current CDC recommendations are that women should receive an annual Pap screening, starting three years after they become sexually active, or at age 21, whichever comes first. [CDC 2005] However, there is considerable discussion about the most effective way to prevent cervical cancer in other parts of the world where fewer medical resources are available. This article [Schiffman, Castle 2005] in the New England Journal of Medicine argues that between 65 and 76 percent of cervical cancers could be prevented by use of a DNA-based screening test at 35 years of age, and again at 40, with appropriate treatment for women who show evidence of cervical intraepithelial neoplasia (precancerous cellular changes in the cervix).

A DNA test for HPV is commercially available (http://www.thehpvtest.com/). In response to this, the CDC has reiterated their recommendation for (in order) abstinence, monogamy, and annual Pap screenings. Is this simply a conservative response to a new technology, or is this part of the current governmental policy which pushes abstinence?

Future Directions: an HPV Vaccine



In November of 2004, a study of an HPV vaccine was published in The Lancet (a respected British medical journal). The study used 1100 women aged 15-25, in North America and Brazil. It showed that among the women who received 3 doses of the vaccine, the vaccine was 100% effective in preventing infection with HPV type 16 or 18 (the only two types the vaccine can prevent; but which account for some 70% of all cervical cancers). The results were surprisingly good. A larger-scale trial (involving some 15,000 women) is currently under way. Experts predict the vaccine may be commercially available in five years.

Even when the vaccine is commercially available, it will only be of use to women who have not already been infected with HPV type 16 or 18. Recommendations being discussed are to vaccinate girls ages 10-12, before they become sexually active, in order to make best use of the vaccine. Even then, regular screening for cervical cancer (whether using the Pap test, the DNA HPV test, or some other form of screening) will be necessary in order to detect and prevent cervical cancer which may be caused by other strains of HPV.

Conclusions



Contrary to the scaremongering propagated by some anti-sex groups [Planned Parenthood 2005], primary infection with HPV is not usually a major health concern. While cervical cancer is certainly a concern, it can be prevented by the CDC-recommended annual Pap test.

References



New England Journal of Medicine. 2005 Nov 17;353(20):2101-4. “The promise of global cervical-cancer prevention.” Schiffman M, Castle PE.

Biochimica et biophysica acta. 1996 Oct 9;1288(2):F55-78. “Papillomavirus infections--a major cause of human cancers.” zur Hausen H.

Webmd.com. 2005 [1]: http://www.webmd.com/hw/health_guide_atoz/sth149953.asp “Human Papillomavirus (HPV)”

Webmd.com. 2005 [2]: http://www.webmd.com/content/article/85/98738.htm “Cervical Health”

Lancet. 2004 Nov 13-19;364(9447):1757-65. “Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: a randomised controlled trial.” Harper DM, Franco EL, Wheeler C, Ferris DG, Jenkins D, Schuind A, Zahaf T, Innis B, Naud P, De Carvalho NS, Roteli-Martins CM, Teixeira J, Blatter MM, Korn AP, Quint W, Dubin G; GlaxoSmithKline HPV Vaccine Study Group.

Centers for Disease Control and Prevention. 2002: http://www.cdc.gov/STD/treatment/6-2002TG.htm#HumanPapillomavirusInfection “2002 STD Treatment Guidelines”

Centers for Disease Control and Prevention, 2005: http://www.cdc.gov/STD/HPV/DearColleagueMarch-21-2005.pdf “Open letter from John M. Douglas, Jr., MD., Director, Division of STD Prevention on HPV testing and cervical cancer screening.”

Emerging Infectious Diseases. 2004 Nov;10(11):1974-8. “Barriers to infectious disease care among lesbians.” Marrazzo JM.

Planned Parenthood. 2005 http://www.plannedparenthood.org/pp2/portal/files/portal/medicalinfo/sti/fact-HPV-virus.xml “HPV: The Most Common Sexually Transmitted Virus”

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From:gconnor
Date:November 29th, 2005 07:14 pm (UTC)
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Well done, and thanks for posting.
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