Tag Archives: cervical cancer

STD Awareness: How Do I Tell Someone I Have Herpes? Or HPV? Or HIV?

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Image provided by Katie to Vice

Of all the novel ways to jump-start a difficult conversation, presenting someone with a hand-drawn comic about herpes is among the most creative. A couple of weeks ago, Vice shared the story of Katie, a millennial with genital herpes who struggled to find the optimal way to disclose her status to potential partners. In a fit of inspiration, she wrote and illustrated a pamphlet that not only shared her history and status — it also included important stats and other facts about genital herpes, a highly stigmatized and widely misunderstood condition. Her pamphlet has been received well by potential partners, dispelling myths while also lightening the mood during what can be a highly fraught conversation.

Begin your relationship with transparency and respect.

Katie’s struggle is shared by a lot of people with treatable — but incurable — STDs, such as genital herpes, human papillomavirus (HPV), and HIV. (Herpes and HIV stay in the body for life, but 9 out of 10 times HPV will be defeated by the immune system. But sometimes, HPV lingers for years or even life.) Most of us don’t want to disclose too early, when we haven’t yet established trust, but we also might be wary of waiting too long, lest we be accused of dishonesty. And disclosing before it seems like sex is in the cards might seem presumptuous. It can be a fine line to walk.

Whether you design your own comic like Katie did, or try another route, the ability to disclose your STD status to a potential partner is an important communication skill to develop. Healthy relationships are built on a foundation of honesty and respect, and your potential partners need to make their own decisions when it comes to their comfort with possible exposure. To make an informed decision, they must be armed with all the facts — and you can help them! Continue reading →

STD Awareness: The Vaginal Microbiome and Cervical Cancer

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Cervical cancer is caused by human papillomavirus (HPV), which has been nicknamed “the common cold of STDs” — because pretty much every sexually active person will get it at some point. Luckily, that scary stat is poised to change as more people receive the HPV vaccination, which protects against nine major strains of the virus.

HPV jumps easily from person to person, spread by pretty much all types of sexual contact. For most people, the infection clears up within 8 to 13 months, but sometimes the infection develops into a chronic condition, which increases risk for certain cancers — including cervical cancer, but also cancers of the anus, genitals, and throat. Unfortunately, it’s hard to predict if your immune system will vanquish your infection, or if you’ll develop a chronic infection.

Members of the lactobacilli family, keeping vaginas healthy across the globe. Image: Josef Reischig

Luckily, the vagina has some tricks up its sleeve to protect itself from HPV, and some of its best weapons are bacteria. Yep — a healthy vagina isn’t germ-free. To the contrary, it needs lactobacilli and other beneficial microbes to maintain a healthy environment. Bacteria from the Lactobacillus genus produce lactic acid and other chemicals, which help keep dangerous bugs away. Vaginal environments in which Lactobacillus gasseri dominate, for example, are more likely to clear HPV infections. L. crispatus helps trap HIV in a thick mucus, reducing infection risk. Other lactobacilli species secrete chemicals that ward off yeast infections. Sometimes, however, good bacteria lose this turf war, and “bad guys” move in.

The population of microbes that live in your vagina are known collectively as the vaginal microbiome.

University of Arizona researchers in Phoenix performed a “census” of the vaginal microbial communities of 100 premenopausal women. They learned that women who have cervical cancer or precancerous abnormalities have drastically different vaginal microbiomes. Healthy vaginas were generally dominated by lactobacilli, but as cervical health declined, their populations declined, and “bad” bacteria took over. One such bad guy, called Sneathia, was linked to HPV infection, precancer, and cervical cancer.

Which Came First?

Finding a new vaginal “bad guy” was exciting, and Sneathia had previously been linked to other gynecological problems, ranging from bacterial vaginosis to pregnancy complications. But the researchers were looking at a snapshot in time — they didn’t know what came first, the Sneathia or the cervical abnormalities. Were lactobacilli protecting the cervix whereas Sneathia were harming it, or did a chronic HPV infection set the stage for Sneathia to move in and thrive? It’s a real “chicken-and-egg” conundrum. Continue reading →

STD Awareness: Winning One War on Cancer

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Cancer starts with the uncontrolled division of cells.

The developed world is in the midst of a huge nosedive in genital warts and cervical “precancer” — all thanks to the human papillomavirus (HPV) vaccine. This simple shot trains the immune system to defend itself against HPV, a virus that causes genital warts and several types of cancer. Most sexually active people will be exposed to it in their lifetimes — it’s even been nicknamed the “common cold” of sexually transmitted infections.

Gardasil 9 protects against seven strains of HPV that collectively cause 90% of cervical cancers and anal cancers, plus the two HPV strains that are jointly responsible for 90% of genital warts. Vaccination also reduces the frequency of “precancers,” which are cellular abnormalities that can be treated before progressing into full-fledged cancer — meaning less time, money, and anxiety spent dealing with follow-up procedures and treatments.

The HPV vaccine is an anti-cancer vaccine.

The vaccine is safe and effective — and when we say “effective,” we mean it could lead to the eradication of HPV, and with it the cancers it causes. A recent analysis of 66 million vaccine recipients published in The Lancet points to plummeting rates of genital warts and precancer. Among teenage girls, there was an 83% drop in HPV-16 and HPV-18 infections (the two strains of HPV that together cause 70% of cervical cancers) — and cervical precancers were cut in half.

The most dramatic gains were made in countries that offered the HPV vaccine to both boys and girls. Additionally, there were even decreases in the HPV strains that aren’t covered by the vaccine — evidence of “cross-protection,” the phenomenon in which the immune system recognizes close relatives of the viruses it has been trained to attack. Even people who did not receive the vaccine were less likely to catch the virus, simply because their risk was reduced if their partners were vaccinated. Continue reading →

STD Awareness: Can Older Adults Receive the HPV Vaccine?

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female-patient-with-female-doctorWhen the human papillomavirus (HPV) vaccines were introduced, a lot of people were excited about protection from a sexually transmitted virus that could cause cancers, including cervical cancer, anal cancer, and head-and-neck cancer. It wasn’t just any old vaccine, it was a shot that could prevent cancer. Cancer!

In fact, a lot of people were disappointed they were too old to take advantage of an anti-cancer vaccine, which was initially approved for people as old as 26. We were given a lot of reasons why people above that age were “too old,” such as the assumption that anyone older than 26 has probably been sexually active for years and would have already contracted the most common strains of HPV.

While getting vaccinated before becoming sexually active is optimal, the HPV vaccine can still benefit people who have already had sex.

But there are compelling reasons to vaccinate people in their late 20s and beyond. In fact, Gardasil 9 was recently approved for people as old as 45. That’s great news for those of us who missed out on the HPV vaccine the first time around. We might never have had any sexual contact, and therefore were never at risk for catching the sexually transmitted virus. We might have found ourselves widowed or divorced after years or decades of monogamy. We might have been sexually active with multiple partners during that time. Whatever our circumstances, those of us who are 45 or younger can now consider HPV vaccination.

HPV and the “Older” Individual

When Cervarix and Gardasil, the first HPV vaccines, were released, they only protected against two cancer-causing HPV strains, HPV-16 and HPV-18, which are responsible for 70 percent of cervical cancers (Gardasil protects against two additional wart-causing HPV strains). A few years ago, Gardasil 9 hit the market, targeting five additional cancer-causing HPV strains — increasing the chances that even sexually active recipients could be protected from HPV strains they hadn’t encountered. Continue reading →

STD Awareness: HPV Testing vs. the Pap Test

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I love writing about health and medicine, but I hate going to the doctor. I don’t like taking my clothes off for a dermatological exam, I don’t like rolling my sleeve up for a shot, and I don’t like opening my mouth for a dentist. I don’t even like having my blood pressure taken — it gives me the heebie-jeebies, and probably a case of white-coat hypertension too.

For now, pelvic exams are a mainstay — and an important part of cancer prevention.

So when it comes to something even more invasive, like the Pap test to screen for cervical cancer, I’m one of those people pining for a magic wand — a tool that a health care provider can wave over your fully clothed body to detect disease. The Pap test may have transformed a scourge like cervical cancer into one of the most easily detected and treated cancers — and for that I love it — but I still fervently wish for its demise. As long as it’s replaced by something better, of course.

Last month, an article in JAMA inspired a burst of headlines. “HPV test more effective than Pap smear in cancer screening,” said CNN. Or as WebMD put it more succinctly, “HPV Test Beats Pap.” Then, last week, the U.S. Preventive Services Task Force updated their guidelines to recommend that patients 30 and older can forgo the Pap test in favor of HPV testing alone. This news might be welcome to anyone who dislikes regular Pap tests and wishes to avoid stirrups and speculums. Unfortunately, HPV tests aren’t the noninvasive “magic wand” so many of us hope for. From the patient’s perspective, the experience of undergoing an HPV test is no different from the experience of undergoing a Pap test. They both require a pelvic exam — the stuff of stirrups and speculums. Continue reading →

STD Awareness: Eliminating HPV-Related Cancers

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Earlier this month, every major cancer center and organization in the country released a joint statement calling for the elimination of cervical cancer, along with all other HPV-related cancers. The elimination of a large swath of cancers might sound like a tall order — so far, we’ve only eradicated two viruses from the planet: smallpox and rinderpest. And we’re on the brink of getting rid of a third, the virus that causes polio.

But doing away with human papillomavirus (HPV) would herald a new chapter in disease eradication, because HPV causes cancer, meaning that eradicating HPV will eradicate the cancers caused by it. And the good news is we have all the tools we need to wipe HPV off the face of the earth — we just need to use them.

The tools to wipe a large class of cancers off the face of the earth are right under our noses — we just have to use them.

A quick rundown on HPV is in order. It’s the most common sexually transmitted infection in the world, and causes multiple cancers — cervical, head and neck, anal, vulvar, vaginal, and penile. While it’s most well-known for causing cervical cancer, here in the United States it is transitioning away from its old job, causing more head-and-neck cancers than cervical cancers. Nearly all sexually active people will be infected with HPV at least once in their lives, and though only a fraction of infections progress to cancer, its ubiquity means it still causes hundreds of thousands of cancers every year. In the United States, around 41,000 HPV-related cancers are diagnosed annually, while more than 600,000 are diagnosed worldwide. Continue reading →

STD Awareness: Fighting Cervical Cancer Across the World

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Tomorrow kicks off World Immunization Week, a reminder that, just as disease can cross borders, so should our efforts to prevent it. Especially when we have an effective vaccine for one of the world’s top causes of cancer — but the people who need it most are less likely to get it.

Almost 90 percent of cervical-cancer deaths strike women in developing countries, where it is the second-most common cancer among women. In fact, over vast swaths of Africa, cervical cancer is the No. 1 cause of cancer death in women. (In the United States, it doesn’t even crack the Top 10.) While cervical cancer rates are holding steady in the developed world, in the coming decades they are projected to increase sharply in less developed regions.

More than 9 out of 10 cervical cancers strike women in countries with no HPV vaccination programs.

Since 2006 there has been a vaccine for human papillomavirus (HPV), the virus that causes cervical cancer. Unfortunately, while this vaccine is making impressive strides in the developed world, it is almost out of reach in the developing world, where it could save the most lives. To fully realize this vaccine’s potential, it needs to be distributed worldwide — not just within rich countries that can afford it.

Fighting Cervical Cancer in the Developed World

HPV has been nicknamed “the common cold of STDs” — because pretty much every sexually active person will get it at some point. It can be transmitted by vaginal, anal, and oral sex, as well as by rubbing genitals together, even without penetration. HPV can cause cancers of the throat, anus, vagina, vulva, and penis — but is most “famous” for causing cancer of the cervix (the tissue that connects the vagina to the uterus). If you have a cervix, there are two big things you can do to protect its health: receive regular Pap testing after becoming sexually active, and get vaccinated against HPV before becoming sexually active. When you take both of these steps, you’ll maximize what modern medicine has to offer. Continue reading →