Last month we talked about “Deadly Viruses” (Influenza, D68, and Ebola). This month we will have a frank discussion about another deadly virus — human papilloma virus (HPV). HPV disease is the most common sexually transmitted infection (STI) in the United States, and cervical cancer is known to affect 500,000 women annually worldwide. HPV is spread via skin to skin contact, including sexual intercourse (vaginal or anal), oral sex, and hand to genital contact in women and men. Condoms may not prevent disease, as they do not cover all possible risky areas of transmission. For example, HPV may lurk in uncovered portions of the penis and scrotal area. The risk of HPV disease increases with the number of sexual partners. People who have a weakened immune system are also at higher risk. Human papilloma viruses only affect humans, and there are over one hundred variations (genotypes) of the virus.
HPV is known to cause genital warts (condyloma accuminata) and causes other disease leading to malignancy (cancer) of the cervix, vulva, anus, penis, and oropharynx (throat). Many people have heard of HPV as the main cause of cervical cancer, and HPV is the main reason women are advised to have a Papanicolaou (Pap) test every 3-5 years. Talk to your primary care provider (PCP) about which interval is right for you. Pap tests not only screen for early, premalignant changes in the cervix, but also for the presence of HPV. Pap testing should begin at age 21 and continue through age 65. Regular testing can catch changes in the cervix due to HPV and allow treatment before the changes can lead to cancer. However, as mentioned above, cervical cancer in women is only one of the many threats of HPV — in men as well as women.
Seventy-five to eighty percent of sexually active adults will acquire an HPV infection by age 50. The good news is that HPV disease is largely preventable. In addition to abstinence and safe sexual activity decisions, two vaccines are now available to help prevent infection and its sequelae. These vaccines are targeted toward the most risky types of the virus. The greatest protection against HPV is realized if immunization occurs before an individual becomes sexually active. Gardasil and Cervarix are recommended for girls and women ages 9-26 yrs. HPV is an “equal opportunity virus,” so boys are at risk, too. HPV immunization is advised for boys and men ages 9-21. A common opportunity to discuss HPV immunization with your PCP is during the well visit usually associated with “6th grade shots” at around age 12. Although some parents might not be comfortable discussing safe sex behaviors and problems related to sexual activity with elementary children, doing so along with appropriate immunization can prevent a lifetime of misery or even premature death from cancer. Although not required for school attendance, HPV immunization is recommended by the Centers for Disease Control, the American Academy of Pediatrics, and the American Academy of Family Physicians.
Dr. Fleming is the Medical Director of The Jane Pauley Community Health Center (closely affiliated with Community Health Network). Ideas for this column can be e-mailed to Dr. Fleming at AskDrFleming@gmail.com. Questions for the doctor can also be mailed to Ask Dr. Fleming, 8931 E. 30th Street, Indianapolis, IN 46218. On written correspondence, please include your name and city (names will not be published).