STD Awareness: Can the HPV Vaccine Prevent Head-and-Neck Cancer?

Photo: Heather Hazzan, Self Magazine

The HPV vaccine Gardasil protects against human papillomavirus, a prolific virus that causes many types of cancer. In fact, although it was initially approved to prevent cervical cancer, the most common HPV-associated cancer is head-and-neck cancer. Last month, Gardasil 9 was finally approved for the prevention of head-and-neck cancer.

That certainly took long enough! We’ve known for a long time that HPV is behind the epidemic of head-and-neck cancers, and we’ve known that the HPV vaccine guards against infection with this virus. With HPV causing more head-and-neck cancers than any other HPV-associated cancer in the United States, this approval was long overdue.

Bearing the Burden of HPV


Gardasil 9 is now approved for the prevention of head-and-neck cancer, shining a light on this epidemic.


Although its routine use in boys and men has been recommended since 2011, the HPV vaccine is still primarily thought of as a “girl’s vaccine,” invaluable for its ability to prevent cervical cancer. For the first few years of its existence, Gardasil was only FDA-approved for girls and women, and since then it has struggled to escape its gendered connotations. While this new FDA approval doesn’t change who is eligible to receive the vaccine, it does shine some awareness on head-and-neck cancer, and gives parents more evidence that this anti-cancer vaccine is important to give to sons, not just to daughters.

Head-and-neck cancers can strike anywhere from the lips to the larynx, or voice box, and up into the sinuses and nasal cavity. According to the Centers for Disease Control and Prevention, an estimated 11,300 U.S. men are diagnosed with head-and-neck cancer every year, compared to 2,200 U.S women. Continue reading

From HPV to Cancer to Dry Mouth

Despite what a lot of people might think, oral sex is sex — not “third base,” not “everything but” — carrying with it the potential for both pleasure and disease transmission. That includes oral transmission of human papillomavirus (HPV), which can lead to head-and-neck cancer (aka oral cancer, aka oropharyngeal cancer). Unfortunately, because so many of us have a lax attitude toward it, fewer people take precautions when engaging in oral sex, and are less likely to use condoms or dental dams.


A head-and-neck cancer epidemic is striking younger people, spurred by HPV.


Head-and-neck cancer — which can strike anywhere from the lips to the larynx, and up into the sinuses and nasal cavity — is caused by several risk factors, chief among them oral infection with HPV. When HPV causes head-and-neck cancer, it usually occurs at the base of the tongue, at the back of the throat, in the tonsils, or in the soft palate.

HPV can be spread by most sexual activities, including vaginal, anal, and oral sex, as well as by rubbing genitals together. Although HPV is most famously associated with cervical cancer, it’s actually driving more cases of head-and-neck cancer in the United States.

It’s Oral, Head, and Neck Cancer Awareness Week — a time to learn about how head-and-neck cancer has changed over the years, what consequences it can have for survivors, and how it can be prevented in the first place.

A Changing Patient Profile

In 2017, scientists reported that oral HPV infections with cancer-causing strains of the virus are five times more common in men than in women, and that, likewise, HPV-associated head-and-neck cancers are more likely to strike men. That same year, researchers also reported that, in the United States, head-and-neck cancer among men has surpassed cervical cancer among women. As the years pass by, head-and-neck cancer rates are expected to continue to skew even more heavily toward the male population. Continue reading

STD Awareness: The HIV Epidemic at Home

In the United States, we understand HIV — the virus that causes AIDS — using a common narrative, one that gives us the impression that its deadliest chapters belong in decades past or distant places. It goes like this:

The disease emerged in the 1980s, cutting down young gay men in their primes and blindsiding scientists as they scrambled to unravel the virus’ mysteries. While AIDS initially whipped up mass hysteria among the general public, LGBTQ folks demanded equality, pushing to find treatments and a cure. AIDS activism and scientific research eventually led to the development of antiretroviral drugs, which tamed the plague by turning a death sentence into a chronic disease. Now, with the right medication, people with HIV can live long, healthy lives. The hysteria has died down, as most people realize viral transmission is preventable, and the infection is manageable.

One thing hasn’t changed, however: Just as it was in the 1980s, AIDS is still thought of as a disease of the “other.” Back then, it was a disease of gay men, a population cruelly marginalized by the general public. Today, it’s thought of as a disease of sub-Saharan Africa, where HIV prevalence is highest.

That narrative, however, doesn’t tell the whole story. Right here in our own backyards, the HIV epidemic continues to spread in the face of chilling indifference from those not affected. African-American MSM — men who have sex with men, who may or may not self-identify as gay or bisexual — have an HIV prevalence that exceeds that of any country in the world. In Swaziland, for example, 27 percent of adults are living with HIV/AIDS, but if current transmission rates hold steady, half of African-American MSM are projected to be diagnosed with HIV in their lifetime. Instead of taking this projection as a wake-up call to invest in lifesaving health policies, however, state and federal responses are poised to let it become a self-fulfilling prophecy.

Contrary to racist and homophobic stereotypes, data show that black MSM aren’t more likely to engage in risky sexual behavior, use drugs and alcohol, or withhold their HIV status from partners. So why are they burdened with higher HIV rates? The answer lies beyond mere behavior, embedded in policies and practices that disproportionately harm people based on race, sexuality, and geography. Continue reading

STD Awareness: Transgender Men and Cervical Health

Healthy cervical cells as seen under a microscope. Image: National Cancer Institute

Just one month ago, headlines screamed that the Centers for Disease Control and Prevention (CDC) received a list of “banned words” from the Trump administration. One of those words was transgender, raising the alarm that the current president might be eyeing policies that would further marginalize the trans population and harm their health. (Other forbidden words include fetus, evidence-based, and vulnerable.) Some have argued it wasn’t Trump policy per se, but self-censoring on the part of the CDC to protect their budgets from being slashed by legislators hostile to transgender rights, abortion rights, science, people of color, and poor people.

In any case, refusing to use words like transgender can have grave consequences for trans health. If the CDC can’t reference the trans population when requesting money for services and studies, they will be hobbled in their ability to serve that population’s needs.


Recommendations for cervical cancer screening are the same for anyone with a cervix, whether trans or cisgender.


January is Cervical Health Awareness Month. Anyone who has a cervix can develop cervical cancer — including transgender men who have not had their cervixes surgically removed. In observance of the month, and in defiance of directions to avoid the word transgender, today we’ll discuss the importance of cervical health in trans men — and why taxpayer-funded entities like the CDC and the National Institutes of Health must be able to study and serve this population.

Transgender men (or trans men for short) are individuals born with female reproductive organs, but who identify as male. Likewise, cisgender women were born with female reproductive organs and identify as female. Both trans men and cisgender women were born with cervixes, and wherever a cervix exists, the possibility of cervical cancer exists. Continue reading

STD Awareness: Is HPV Now a “Men’s Disease”?

Human papillomavirus, or HPV, is most notorious for causing cervical cancer — making it, in many people’s minds, a “women’s disease.” But this gender-blind sexually transmitted virus can cause cancer in any cell it infects, and is associated with cancers of the cervix, anus, vagina, vulva, penis, and mouth and throat — aka oropharyngeal cancer.

While oropharyngeal cancers used to be caused mostly by tobacco, as people quit smoking an increasing proportion is caused by HPV. In the 1980s, only 15 percent of oropharyngeal cancers were caused by HPV, but nowadays the virus is behind 70 percent of them. A 2011 study predicted that the number of HPV-positive oropharyngeal cancers will surpass cervical cancers by 2020.


HPV is rapidly gaining prominence among men.


It’s only 2017, but we’re ahead of schedule. Earlier this year, researchers reported that, in the United States, oropharyngeal cancer is more common among men than are cervical cancers among women — and oropharyngeal cancer rates are increasing in the male population, while they are relatively stagnant among women. These rates are projected to continue climbing, which will skew oropharyngeal cancer even more heavily toward the male population. But, in the public’s imagination, HPV is most well-known for its association with cervical cancer — while most people haven’t even heard of oropharyngeal cancer.

Oropharyngeal Cancer and HPV

Oropharyngeal cancer can strike the inside of your mouth and throat. Risk factors include tobacco (including cigarettes, snuff, and chewing tobacco), marijuana use, alcohol, and oral infection with HPV. HPV can be spread by most sexual activities — including vaginal, anal, and oral sex, as well as “French kissing” and rubbing genitals together. There are many strains of HPV, which come in two main categories: low-risk HPV, which can cause genital warts; and high-risk HPV, which can cause cancer. Continue reading

STD Awareness: The Surprising Sexual Transmission of Non-STDs

What is a sexually transmitted disease, or STD? If someone catches their partner’s cold during sex, is that cold an STD? According to the Office on Women’s Health, an STD is “an infection passed from one person to another person through sexual contact.” Unless the cold was passed through sexual contact, rather than mouth-to-mouth contact, it would not be considered an STD. Others say that, for an infection to be considered an STD, its sexual transmission must make it significantly more common in the population. So, a disease like the common cold would probably be just as common even if people never had sex.


MRSA, meningitis, and the virus that causes pinkeye can be transmitted sexually.


However, there are some infections, such as hepatitis C or bacterial vaginosis, whose status as official STDs is controversial. While researchers argue with one another over where to draw the line between an STD and a non-STD, let’s take a look at some bacteria and viruses that can be transmitted sexually, even though they’re not officially categorized as “STDs.”

MRSA: Methicillin-Resistant Staphylococcus aureus

MRSA bursting out of a dead blood cell. Image: Frank DeLeo, NIAID

MRSA bursting out of a dead blood cell. Image: Frank DeLeo, NIAID

You’ve probably heard of MRSA, which is pronounced “mersa” and stands for methicillin-resistant Staphylococcus aureus — a strain of bacteria that is resistant to every antibiotic in the penicillin family, as well as others. S. aureus, or “staph” for short, is the same bacteria responsible for TSS, or toxic shock syndrome, which has most infamously been associated with the use of highly absorbent tampons. But mostly, staph is a common cause of skin infections, which could be deadly in the pre-antibiotic era, but these days usually don’t raise too many eyebrows.

Unfortunately, with the emergence of MRSA, which is difficult to treat with the usual drugs, we might once again have to worry about minor skin infections blossoming into life-threatening conditions. Additionally, MRSA has found a way to hop from person to person via sexual contact, and sexually transmitted MRSA has been documented in both heterosexual and MSM (men who have sex with men) populations. Untreated, it can lead to a form of gangrene in which tissue blackens as it dies. Continue reading

STD Awareness: Human Papillomavirus Grabs Headlines

Human papillomavirus, or HPV, is the most common STD out there — a fact made even more aggravating by the absence of a good test for it. Sure, Pap testing can detect cellular abnormalities triggered by HPV, and the HPV DNA test can find evidence of infection. But it’s not a definitive test — a negative Pap/HPV DNA co-test doesn’t rule out the possibility that you carry the virus. Ditto for the anal Pap test — which most people haven’t even heard of anyway!


There are more compelling reasons to vaccinate boys against HPV — and not-as-compelling reasons to think Gardasil could protect against skin cancer.


The lack of a good diagnostic test makes the HPV vaccine an even more valuable asset. If we can drive the virus to extinction through aggressive vaccination campaigns, our limited diagnostic abilities become a moot point. And recent headlines have given us reasons to love the HPV vaccine even more.

HPV and Men

Many people think of HPV as a women’s issue, as the virus causes cervical cancer, and for a long time, boys and men weren’t even targeted for vaccination. But HPV is everyone’s issue — genital warts don’t care what gender you are, and cancer-causing strains of HPV cause most cases of anal cancer, penile cancer, and oropharyngeal cancer. Recently, a large, first-of-its kind study published in JAMA Oncology analyzed penile swabs provided by 1,757 men to figure out how common HPV is in this population. (While there is no FDA-approved test for diagnosing male patients with HPV, scientists can still collect swabs for research purposes.)

The results: 45.2 percent of American men ages 18 to 59 carry genital HPV — for a total of nearly 35 million adult males. HPV carriers can transmit the virus to sexual partners through vaginal, anal, or oral sex — or even just rubbing genitals together, as the virus is spread by skin-to-skin contact. Furthermore, a quarter of men are infected with cancer-causing strains of HPV. And, while the female population sees a peak in HPV infections in their early 20s, men’s HPV prevalence increases with age. While 28.9 percent of men 18 to 22 years of age carried HPV, 50.8 percent of them carried it by the time they were 28 to 32 years of age, and 59.7 percent of 58- and 59-year-olds were carriers. Continue reading