Sexually Active? Read This

It’s an STD epidemIc that not enough people know about. The human papillomavirus is common, potentially deadly—but also preventable.
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It’s an STD epidemic, but one that not enough people know about: human papillomavirus, or HPV. Unlike other sexually transmitted diseases, some forms of this one can cause cancer.

In fact, an estimated 12,000 women get cervical cancer or other genital cancers from HPV each year, experts say, and about 7,000 men get head, neck and anal cancers from it.

“The incidence of HPV-related head and neck cancers is growing exponentially,” says Bryant Lee, M.D., an otolaryngologist at Saint Barnabas Medical Center. “Smoking and drinking used to be the major causes, but HPV will soon outpace these.” The reason, he says, is that oral sex has become more common, especially in the younger generations. Men develop head and neck cancers about four times as often as women do, he says.

The good news is that, when caught early, HPV-related cancers are often quite curable. The better news is that they are preventable.

VACCINES THAT COULD
SAVE YOUR LIFE

The Food and Drug Administration has approved two vaccines to prevent HPV infection: Gardasil and Cervarix. Both 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.

The vaccines are most effective if given before infection, so they are recommended before sexual activity begins. However, they may also be appropriate for adults who have been monogamous or have had few partners, says Dr. Denehy. Gardasil, approved in 2006, is for both males and females ages 9 to 26, while Cervarix, approved in 2009, is only for females ages 10 to 25.

The vaccines are usually administered in three separate doses spread over a six-month period. Side effects, as with many vaccines, may include some pain and swelling at the injection site and a mild fever, but rarely anything more than that.

“Both vaccines are very safe and efficacious,” says Uzma Hasan, M.D., a pediatric infectious disease specialist at Saint Barnabas Medical Center. “There is a strong push to vaccinate for HPV.”

Types of HPV

According to the Centers for Disease Control and Prevention, about 79 million americans, most in their late teens and early 20s, are infected with HPV. Each year, about 14 million people become newly infected. But many more are also infected and don’t know it.

More than 150 different types of HPV exist, and about 40 types can be passed through sexual contact. Most are harmless, cause no symptoms and are successfully fought off by the immune system in a year or two. “Perhaps 95 percent of all women are exposed to some type of HPV,” says Thad R. Denehy, M.D., a gynecologic oncologist at Saint Barnabas Medical Center.

Some kinds of HPV cause genital warts in both men and women. But about a dozen types of HPV cause cell abnormalities that become cancerous, Dr. Denehy says. About 70 percent of cancers come from two specific subtypes.

HPV infection is the major cause of cervical cancer. Happily, treatments for women are less drastic today than they used to be, according to Dr. Denehy. “Thirty years ago, most women with an abnormal Pap smear had a hysterectomy,” he says. “Recent research shows that mild or moderate dysplasia [cell abnormalities] can be treated more conservatively and in many cases resolves on its own. Often there is no need to remove tissue.” If the disease progresses, surgery is recommended.

As for HPV-caused head and neck cancers, Dr. Lee says cure rates for these cancers are much better, at each stage of the disease, than for traditional head and neck cancers.

Prevention, of course, is the best way to avoid these and all STDs. “Limit exposure to the virus—that’s the true takeaway,” says Dr. Denehy. “I tell my patients, ‘Condoms all the time, every time, until you get married.’ That’s not a perfect solution either, of course, but it’s still sound advice.” Women should also see their ob/gyn regularly for routine exams. Men should be aware of any lumps in their mouth or neck area, according to Dr. Lee. “If a lump doesn’t go away in a week or two, I am concerned about it,” he says. “It should be evaluated by a doctor.”

Both doctors also argue strongly in favor of the HPV vaccine. (See “Vaccines That Could Save Your Life,” at side.) “If we pretend that safe sex is all you need,” says Dr Lee, “We are putting our heads in the sand.”—D.L.

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