Common STI is harder to treat than to prevent

Jiná Ashline
Columnist

I’ve heard a lot recently about HPV, but I don’t really know what it is. I heard that it can cause cancer and that condoms will not necessarily protect you from it. Is that true?
—Hoping for Protection from the Virus

Dear Hoping,

Let’s start at the beginning. HPV stands for Human Papilloma Virus, and refers to a group of common viruses that will infect most people at some point in their lives. According to Baldwin Medical Center, HPV is the most common sexually transmitted infection (STI) seen at Vassar.

There are more than 100 strains of HPV, including types that produce warts on the feet and hands, and about 40 strains that are spread primarily through sexual contact, infecting the vulva, vagina, cervix, rectum, anus, penis and scrotum.

How it spreads

Genital HPV infections spread mainly through vaginal and anal intercourse via direct skin-to-skin contact with someone who is infected. It is important to be aware that in some cases, other kinds of skin-to-skin contact, including sex play, body rubbing and oral sex, may also transmit HPV.
Because the virus spreads through skin contact, latex condoms are not 100 percent effective at preventing HPV. The virus may be present in skin that is not covered by a condom. Even so, condoms can reduce the risk of HPV infection if they are used every time, and condom use has been cited as a factor in lower rates of cervical cancer in heterosexual women.

Symptoms

HPV strains that affect the genitals usually do not have visible symptoms, and most strains seem to have no harmful effects. “Low-risk” types of the virus can cause genital warts, bumps that are usually soft, moist, pink or flesh-colored swellings on the genitals or the area around the genitals, including the thighs. Warts can be raised or flat, one or many, small or large, and they are sometimes cauliflower shaped.

After sexual contact with an infected person, warts may appear within weeks or months, or not at all. “High-risk” types, about 10 of the 40 strains of genital HPV, may cause mild to significant cell changes in the cervix, vulva, anus or penis that very rarely lead to genital cancers if the infection does not go away over many years. HPV strains that cause warts on the hands or feet do not cause genital warts or high-risk cell changes, and vice versa.

Population frequency

According to the Centers for Disease Control (CDC), about 20 million people in the United States have
HPV at any one time, and 10 to 15 million have high-risk types. It is estimated that over 75 percent of sexually active Americans will contract HPV sometime in their lives.

But most people who have HPV are not aware of it because, in almost all cases, the immune system will keep the virus under control or eliminate it completely.

Although most HPV infections are harmless and go away within several months to two years, some will not.

HPV infections that do not go away can “hide” in the body for years without detection, making it nearly impossible to determine exactly when, how or from whom people became infected. For these reasons, HPV infection does not necessarily mean that your partner has been unfaithful.

Detection

Most women are diagnosed with HPV through a Pap test during a routine gynecological exam. Regular
Pap tests can help find very early precancerous conditions, which are easily treated to prevent cancer from developing. Sexually active women should have a Pap test every year.

There is also a test that detects HPV DNA from 10 different cancer-causing strains of the virus. The test is performed at the same time as a Pap, by collecting cells from the cervix. This test is not routine for women under 30 unless they have abnormal Pap results.

There is currently no test designed to find HPV in men. Doctors commonly believe that it is not as important for a man to know if he has HPV as it is to know if he has a disease that HPV causes, such as penile or anal cancer. However, screening tests for these cancers are not often recommended by doctors, so men should check regularly for any abnormalities on their genitals or anal areas.

Some experts recommend yearly anal Pap tests for gay, bisexual, HIV-positive or otherwise immune-deficient men, since anal cancer is more common in these groups. If the test finds any abnormal cells, they can be removed. However, the CDC does not recommend this testing since its efficacy in preventing cancer is unproven.

Treatment

There is no treatment to cure the virus, but treatment is available for the abnormal cell changes and genital warts it causes. Genital warts can be treated with medicine, surgically removed or frozen off.
Treating genital warts, however, does not necessarily lower chances of passing HPV on to a sex partner. If they are not treated, warts may go away on their own, stay the same or grow in size or number. They will not become cancer or affect your health.

Reducing risk

There is an HPV vaccine, commonly known as “Gardasil,” available for women, that is available at Baldwin Medical Center. It is given in three separate injections over six months, and it protects against two types of HPV that cause 90 percent of all genital warts and two more types of HPV that cause 70 percent of all cervical cancer. Studies are currently being done to find out if the vaccine can protect men. The vaccine does not protect against all strains of the virus and does not guarantee you won’t contract HPV.

Safe sex practices are still essential.

You can reduce your risk by practicing abstinence. If you have sex, having a long-term, mutually monogamous relationship can lower your risk of contraction. If long-term monogamy is not possible, try reducing the number of your sexual partners. In addition, having sex play that does not include vaginal or anal intercourse will help reduce your risk.

Also, if you have HPV or a cell abnormality, don’t smoke. Smoking has been shown to increase the chance of cell abnormalities might becoming more severe.

No matter what, if you choose to have sex, use latex condoms or dental dams (for oral sex or analingus) correctly and every time to lower your chance of contracting or passing on HPV.

For more information on HPV and other STIs, check out the Center for Disease Control (cdc.gov), Planned Parenthood (ppfa.org), or the American Social Health Association (ashastd.org). Since it is a new year, think about making safer sex practices part of your healthy living goals so that you can live infection-free in 2008 and beyond.

—Jiná Ashline ’08 is a religion major with women’s studies correlate. She is also president of C.H.O.I.C.E. Each week she will answer a question about sex and sexuality. Send your questions to jiashline@vassar.edu or by dropping a note in Box 2172.