Tag Archives: case report

STD Awareness: Human Papillomavirus Grabs Headlines

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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 →

Gardasil and Fertility

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girlsThere is currently a lot of fear about vaccines out there, and if you pay attention to the news, you’ve probably caught a whiff of it. This panic was launched by a 1998 Lancet article authored by Andrew Wakefield, who claimed that the MMR vaccine causes autism. Much ink was spilled unpacking that fiasco, but, in a nutshell, Wakefield falsified data and conducted unethical, invasive procedures on children, and was consequently stripped of his medical license. Researchers couldn’t duplicate his findings, The Lancet retracted his article, and Wakefield was thoroughly discredited.

One case report asserting a link between Gardasil and premature ovarian failure was authored by an anti-abortion activist.

But vaccine fears still linger. For example, there are some scary stories floating around about Gardasil, the vaccine that protects against the four most common strains of human papillomavirus (HPV), the sexually transmitted virus that can cause genital warts or certain types of cancer. These stories include claims that it has caused premature ovarian failure leading to infertility. About 57 million doses of HPV vaccines have been given in the United States, however, and in such a large group there are going to be some unexplained phenomena. Without good evidence, we can’t jump to the conclusion that a vaccine caused them.

According to the Centers for Disease Control and Prevention, the most common Gardasil side effects are fainting; dizziness; nausea; headache; fever; hives; and pain, redness, or swelling at the injection site. These reactions aren’t considered to be serious, most people don’t experience any of them, and they’re only temporary. However, while surfing the Internet or scrolling through your Facebook wall, you might have come across claims that Gardasil causes infertility — specifically, premature ovarian failure in girls and young women. What should you make of these horror stories?

A couple of medical journals have described unexplained ovarian failure in four patients who also received HPV vaccines. Medical journals publish many kinds of articles, and a “case report” is a description of one or a few patients’ experiences. Unlike an article that summarizes the results of a rigorous scientific study involving hundreds or thousands of subjects, a case report might just highlight an unusual situation. They aren’t considered to be sources of “definitive” statements about much of anything. Nevertheless, in 90 percent of patients with premature ovarian failure, doctors can’t find clear genetic or physiological causes for the condition, making it an interesting topic for a medical journal to cover — and ripe for speculation. Continue reading →