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A “Silent” Epidemic
Author: Amanda Dean
December 9,2010

Abstract:
HPV, also known as the human papilloavirus, is the most common sexually transmitted disease. In fact, most men and women are infected with HPV at some time in their lives. There are approximately 100 types of HPV. Some HPV types only infect the genital area and may cause warts; some cause mild changes in cervical cells that do not turn into cancer, and some cause changes that may become cervical cancer if present for many years. The types of HPV that are found in the genital areas are usually passed on during sexual contact. Most people who become infected with HPV do not even know they have it. Fortunately, there is a vaccine available that may prevent contacting the virus. A person may find out that they have HPV by having a Pap smear done or by a DNA HPV test. If you are infected there are treatments availbe but there is no cure for HPV.

Introduction:
I chose to do my research on HPV because it is now the most common sexually transmitted disease. Approximately 20 million people are currently infected with the virus in the United States. It is estimated that at least 50 percent of sexually active men and women will acquire genital HPV infection at some point in their lives. Also, friends of mine have suffered from HPV and had no idea that they were infected. It was a traumatizing experience for them to contract this infection without knowing what it was.

Discussion
So, What is HPV, Really?
HPV is the human papillomavirus and there are currently 100 known strains. HPV can cause anything to warts on your hands, feet, and genital area to cancer of the head, neck, anal, penile, and cervical regions. Most HPV infections have no signs or symptoms. Therefore, many are unaware that they have it and can transmit the disease to others (Levine 89)
Who gets HPV?
Anyone who has ever had sexual relations has a high chance of being exposed to this virus, but only a small number of women infected with HPV develop cell changes that need to be treated. In almost all cases, the immune system will keep the virus under control or get rid of it completely. However, if HPV infection does not go away over many years, there is a greater chance of developing cell changes that may lead to cervical cancer. (Levine 100).
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http://www.nlm.nih.gov/medlineplus/hpv.html


The Controversy: Different Viewpoints Regarding the HPV Vaccine:
http://www.youtube.com/watch?v=31Irc8CHK0c
Gardasil is the only human papillomavirus (HPV) vaccine that helps protect against 4 types of HPV. In girls and young women ages 9 to 26, Gardasil helps protect against 2 types of HPV that cause about 75% of cervical cancer cases, and 2 more types that cause 90% of genital warts cases. Today, most of us would agree that vaccines have been an amazing thing for mankind. Yet, when it comes to introducing another vaccine the community has doubts. Are there side effects? What precautions should we take? There are two HPV vaccines now available in the world markets. Only Gardasil has been approved for the U.S. The other, Cervarix, is awaiting FDA approval. These vaccines are preventative and do not treat HPV. The vaccine does not contain any infectious part of HPV thus it cannot cause cancer. When you get the shot, three doses are required to develop adequate immunity. They are effective against those strains that are predominantly responsible for the majority of cervical cancers (Huh, 481).
Proponents to the Vaccine:
As much as parents want their children to practice abstinence until marriage they realize that in a society where nearly 50 percent of girls and boys are sexually active before high school, total abstinence may not be practical. Therefore, they are in agreement to take the necessary steps to protect their children from possible repercussions of sexual activity. Others say that the vaccine increases promiscuity. However, the vaccination protects you from only one of many sexually transmitted diseases so it should not change the precautions people take. The next argument is that drug companies developed the HPV vaccination for profit and not in the best interest of customers. However, drug companies have the ability to continue to sell their drugs as profit in order to continue research to keep the human race healthy (Krishnan, 5)


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Opponents of the Vaccine:
Opposition to the vaccine is based on the premise that it endorses and encourages sexual behavior. Also, since HPV is not spread by involuntary behavior but rather by voluntary sexual behavior people believe the choice should be a parental one not a governmental one. Also, pharmaceutical companies are still making billions of dollars from advocating the vaccine. People wonder, if the purpose of the vaccine is really to prevent a common sexually transmitted disease, why are only women being vaccinated? Several moral and religious groups believe that the HPV vaccine will contribute to the decay of our society’s moral values. Another decision to be made is should the vaccine be mandated or should it be a choice? (Krishnan 7)

HPV Transmission and Natural History
HPV, which comprises of more than 100 different viruses, has been around for centuries. HPV is transmitted by vaginal or anal intercourse, oral sex, nonpenetrative sex (foreplay) and nonsexual methods as well. Both men and women can get it and pass it on to their partners. HPV is a silent disease and can be contracted through a partner, remain dormant, and be transmitted to the next pratner without symptoms. In women HPV is more common. More than 50 percent of college-age women are found to have an HPV infection. The transmission of the virus in men is still not understood. There is no cure for HPV(Brewer, 275).

Risk Factors and Testing: Knowledge is Power
Risk Factors That “Fire” the Infection
The most significant risk factor that increases your chances of acquiring an HPV infection is your sexual behavior (Kelly 310)
  • Early age at first intercourse
  • Having multiple sex partners
  • Having a sexual relationship with someone who has had multiple partners
  • Sexual contact with infected partner
  • Frequency of sexual intercourse
  • Unprotected vaginal or anal intercourse
  • Protected vaginal or anal intercourse- no barrier methods can completely protect against HPV transmission because HPV is primarily transmitted through skin-to-skin contact.
  • Skin-to skin contact
  • Oral sex
Risk Factors That “Add Fuel to the Fire”
  • A weakened immune system
  • Stress
  • Medications
  • HIV infection
  • Poor Diet
  • Substance abuse
  • Increasing age
  • Pregnancy and women with many children
  • Smoking- increases your risk of cervical cancer


Testing:

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After going over the risk factors of HPV the next step to discuss is how to get tested for HPV. You can receive a Pap test. The Pap test is perhaps the most effective cancer screening method. The Pap test detects abnormal cell changes in the cervix that may be caused by HPV. You should get a Pap test at age 21. One of the pitfalls of the Pap test is that it can be misread as normal even though cancer cells are present. On the other hand, a test could be read as abnormal when there are no cancer cells present. Another test you can have done is a HPV DNA test. There is now an increasingly growing interest in the potential use of HPV DNA testing in cervical cancer prevention programs. Unlike pap tests that look for abnormal cell changes the HPV DNA tests detect genetic material of the virus and can tell if a woman has high-risk HPV types. The test has a sensitivity of greater than 94 percent. There are two reasons the HPV DNA test is administered. One is a primary screening along with a Pap smear in women 30 and older. The second is if women have an abnormal Pap smear result and are over 20. This test is more for older women, since younger women’s HPV can clear on their own. For men, there are no current HPV tests (Krishnan, 45).
Outcomes for testing:
· Negative HPV, Normal Pap Test- best outcome
· Negative HPV, Abnormal Pap Test-low-risk HPV or false positive
· Positive HPV, Normal Pap Test- high risk HPV type
· Positive HPV, Abnormal Pap Test- worst outcome may be asked to do a colposcopy(cervix examined using a bright light)

Cancer, Warts and HPV: How to treat the Problem
HPV infections can cause a variety of disease, ranging from warts to cancers in both men and women.
Genital Warts
This is the most common, however, not all persons infected with HPV acquire genital warts. You can get genital warts, or warts can appear on the hands and feet. Genital warts are caused by sexual activity and can be spread by skin-to-skin contact during vaginal, anal and rarely oral sex (Krishnan, 51).
Treatment-
Surgical methods:
Simple excision-cutting with scalpel
Electrocautery-burning the warts
Cryosurgery- freezing the warts with liquid nitrogen
Laser therapy- using an intense light to remove warts.
Nonsurgical methods:
Various cream and gels such as Aldara and Condylox.
It is important to know that once the warts are removed, that does not mean the virus is gone.

Cervical Cancer-
Cervical Caner is the most serious manifestation of HPV infections. Cervical cancer occurs when abnormal cells break through the basement membrane of the cervical lining and invade underlying tissue. There are very few symptoms for cervical cancer; one includes abnormal bleeding (Krishnan, 68).
The treatment for cervical cancer depends on:
  • The stage of the cancer.
  • The size of the tumor.
  • The patient's desire to have children.
  • The patient’s age.
Men With HPV
The overall prevalence rate of HPV infections among sexually active men is high. Prevalence rates in men range anywhere from 20 to 72.9 percent based on factors such as age, race or ethnicity, circumcision status, tobacco smoking, and sexual orientation. Circumcised men have a lower rate of HPV infections. Men should be equal players in reducing the viral load on society. When vaccines become available for men, they will only serve as an additional layer to the preventative strategies adopted to lessen HPV infections (Brewer 280).

http://www.youtube.com/watch?v=DStwXsmZ3OE

Sources Cited
Brewer, Noel, Terence Ng, Annie-Laurie McRee, and Paul Reiter. "Men's Beliefs About HPV-related Disease." Journal of Behavioral Medicine, 33.4 (2010): 274-281.
Huh, Warner, Mark Einstein, Thomas Herzog, and Eduardo Franco. "What is the Role of HPV Typing in the United States Now and in the Next Five Years in a Vaccinated Population” Gynecologic Oncology, 117.3 (2010): 481-485.
Kelly, Bridget, Amy Leader, Danielle Mittermaier, Robert Hornik, and Joseph Cappella. "The HPV Vaccine and the Media: How Has the Topic Been Covered and What Are the Effects on Knowledge About the Virus and Cervical Cancer?." Patient Education & Counseling//, 77.2 (2009): 308-313.
Krishnan, Sobha. The HPV Vaccine Controversey Sex, Cancer, God, and Politics: A Guide for Parents, Women, Men, and Teenagers. Connecticut: Praeger Publishers, 2008. Print.
Levine, Arnold. Viruses. 37. New York: Scientific American Library, 1992. 87-103. Print.