STD Awareness: HPV Testing vs. the Pap Test

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

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

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

Some Good News About Three Sexually Transmitted Viruses

Scientists are hard at work finding ways to improve your health!

With so much bad news emblazoned across headlines in every newspaper you look at, the world might seem like a gloomy place. So let’s take one depressing subject — disease — and peel away the sad outer layer to find silver linings of optimism.

When it comes to infections, a lot of us blame one thing: germs, also known as “bugs” — “pathogens” if we’re fancy. Some people might not think of infectious diseases as being that big of a deal — after a round of antibiotics, you’ll be on the mend. Unfortunately, antibiotics only work for bacteria, but a lot of diseases are caused by other types of germs — for which antibiotics are no match. One type of germ is called a virus, and they can’t be cured. Sometimes they can be prevented with vaccines or treated with drugs. For example, the major strains of human papillomavirus (HPV) can be prevented with a vaccine called Gardasil, herpes simplex virus can be suppressed with antiviral drugs, and HIV can be controlled with antiretroviral drugs — but none of these infections can be cured. HPV is usually defeated by the immune system, but herpes and HIV are with you for life.

But it’s not all bad. Around the world, individual scientists have picked their “favorite” viruses and are devoting their lives to finding better prevention strategies, better treatments, and even cures. Let’s check in with some of the latest headlines touting the successes of science.

New Hope for a Herpes Vaccine

A herpes vaccine would be a blockbuster — given how common this sexually transmitted infection is, a preventive shot could help a lot of couples discuss their herpes status without as much fear of judgment and stigma.

Herpes might cause an “outbreak” — unpleasant symptoms that include genital sores — but afterward the virus goes dormant in the nerve cells, hiding from the immune system. In some people, the virus can come out of its dormancy to cause flare-ups of symptoms, but once it’s had its fun it retreats back to the nerve cells.

Earlier this year, media reported on a promising new candidate for a herpes vaccine. Using a completely different strategy than previous, failed herpes vaccines, the researchers behind this breakthrough targeted the part of the virus that allows it to hide from our immune systems. If this vaccine works as hoped, recipients will be able to mount an immune defense when exposed to the virus, blocking it from establishing a permanent home in nerve cells. It might even suppress outbreaks in people who already have herpes. Continue reading

STD Awareness: The Next Generation of Gardasil Is Coming!

noisemakersIt’s January, which means it’s time to festoon our surroundings with streamers, throw around the confetti, break out the noisemakers, and shout Happy Cervical Health Awareness Month!

And, in 2015, we have something huge to celebrate: Last month, the Food and Drug Administration (FDA) approved Gardasil 9, the next-generation HPV vaccine, which provides broader protection than the current version. Next month, the new and improved vaccine will start to be shipped to health care providers, and the Advisory Committee on Immunization Practices is expected to give the Centers for Disease Control and Prevention the green light to recommend the vaccine, after which insurance plans and the Vaccines for Children program should start covering it.


The newest version of Gardasil protects against the seven strains of human papillomavirus that together cause 90 percent of cervical cancers.


Why is this news so exciting for people who care about cervical health? Because, while the current version of Gardasil, which debuted in 2006, protects recipients from the two HPV strains that cause 70 percent of cervical cancers, Gardasil 9 will protect against seven strains of HPV that collectively cause 90 percent of cervical cancers. On top of that, both versions of Gardasil protect against the two HPV strains that are together responsible for 90 percent of genital warts.

Gardasil 9 has been shown to be highly effective in clinical studies, and it is safe to use, which means Gardasil just became an even more potent weapon against cancers caused by HPV. Not only that, but vaccination against HPV will also reduce the frequency of precancerous lesions, which are cellular abnormalities that can be treated before progressing into full-fledged cancer. Less pre-cancer means less time, money, and anxiety spent dealing with followup procedures after an abnormal Pap test, for example. Continue reading

STD Awareness: Gardasil and Males

menIt’s Men’s Health Month, and yesterday was the last day of Men’s Health Week, which means we’re going to look at a men’s health issue that is usually ignored: the impact of human papillomavirus (HPV) on the male population.

You’ve probably heard of HPV in discussions about cervical cancer and Pap testing. But HPV doesn’t care about gender, and is perfectly content to invade cells in anyone’s genital tract, mouth, throat, or anus. In males, HPV can cause genital warts as well as anal, oropharyngeal (mouth and throat), and penile cancers.


HPV will cause more oral cancer than cervical cancer by 2020.


The good news is that most HPV infections can be prevented by a vaccine called Gardasil, and you don’t need to be female to get it. However, few males are actually getting the HPV vaccine: In 2012, 20.8 percent of U.S. males 13 to 17 years of age had received at least one dose of the HPV vaccine, but only 6.8 percent completed the three-dose series.

Gardasil Is for Everybody: Good News from Australia

This huge disparity in promoting Gardasil to female patients rather than male patients has real-world consequences. In Australia, girls have been vaccinated with Gardasil since 2007, covered by their national health system. Four years into the program, genital wart rates fell by 93 percent in females less than 21 years of age. Even though males weren’t being routinely immunized, genital wart rates fell by 82 percent among heterosexual males in the same age group. That’s because their female partners had received the vaccine, which had the effect of protecting much of the male population. That might sound pretty nifty, but the female-only vaccination policy left out gay and bisexual males, whose genital wart rates saw no corresponding decline. Continue reading

Is Pap Testing Better Than HPV Vaccination?

Good news: The decision to be vaccinated for HPV or receive regular Pap testing isn't either/or. Image: Andy Newson

Good news: The decision to be vaccinated for HPV or receive regular Pap testing isn’t either/or. Image: Andy Newson

It’s January, which means that it’s Cervical Health Awareness Month! If you have a cervix, there are two big things you can do to protect its health: get vaccinated against human papillomavirus (HPV) before becoming sexually active, and receive regular Pap testing after becoming sexually active. When you take both of these steps, you can maximize what modern medicine has to offer. However, some people think you can just do one and ignore the other. Are they right?

You’ve probably heard of HPV, which causes genital warts and certain cancers. This virus has the dubious honor of being the most common sexually transmitted pathogen — some call it “the common cold of STDs.” According to the Centers for Disease Control and Prevention, “HPV is so common that nearly all sexually-active men and women get it at some point in their lives. This is true even for people who only have sex with one person in their lifetime.”


HPV isn’t just the “cervical cancer virus” — it’s a jack of all trades that can trigger cellular abnormalities all over the body.


One of the cancers most commonly caused by HPV is cervical cancer. In fact, when Gardasil, the most popular HPV vaccine in the United States, made its debut, it was marketed as a “cervical cancer vaccine,” despite the fact that HPV can cause other types of cancer. Nevertheless, a vaccine that could protect against such a common and potentially dangerous virus was good news indeed. However, some critics were quick to point out that cervical cancer is rare in the United States, thanks to widespread access to Pap testing, an effective screening procedure that can catch cellular abnormalities when they are still in their “precancerous” stages, allowing them to be treated before progressing to cancer.

For those of us planning to receive regular Pap testing, is vaccination really necessary? Likewise, if we’ve been vaccinated against HPV, do we really need regular Pap tests? Let’s examine both questions separately. Continue reading