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

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: 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

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

STD Awareness: Does Gardasil Have Side Effects?

Teen_GroupIn 2006, a vaccine called Gardasil made its debut. Its ability to protect against two of the most widespread strains of human papillomavirus (HPV) means that it doesn’t just protect against an infectious disease — it protects against cancer, too. A persistent HPV infection can trigger cell changes that could lead to cancers of the mouth, throat, cervix, vulva, anus, or penis. Gardasil also protects against two additional strains of HPV that cause most genital warts.


The most common Gardasil side effects are fainting, dizziness, nausea, headache, fever, and hives, as well as possible pain, redness, or swelling at the injection site.


Cervical cancer is not as common in the developed world as it once was, thanks to an effective screening test. The Pap test catches “precancerous” cell changes, allowing the precancer to be treated before it develops into full-fledged cancer. So, while HPV vaccines have the potential to save hundreds of thousands of lives if they can be distributed in countries without widespread access to Pap testing, they have utility in the United States, too. Gardasil has spurred declines in high-risk HPV infections and genital wart incidence among American girls — which means less “precancer” and all the invasive, possibly expensive or painful, treatments that they entail, and a lot fewer genital warts. What’s not to like about that?

Despite this, a lot of people are curious about Gardasil’s side effects. If you enter a few key search terms into Google, you can easily find all kinds of websites warning you of Gardasil’s alleged dangers. So, you might be wondering: Is Gardasil safe?

What are Gardasil’s side effects?

Despite Gardasil’s relatively recent debut, many studies have already been conducted to evaluate its safety — and research continues so that we can consistently reassess its risks and benefits. So far, the consensus is that Gardasil is safe, with very few side effects. According to the Centers for Disease Control and Prevention, the most common Gardasil side effects are fainting, dizziness, nausea, headache, fever, and hives, as well as possible pain, redness, or swelling at the injection site. These reactions are not considered to be serious, some people don’t experience any of them, and they are only temporary. Continue reading

STD Awareness: HPV and Smoking

cigaretteThursday, November 21, is the Great American Smokeout, a day to abstain from smoking — and, one hopes, to quit for good. “That’s great,” you say, “but what do cigarettes have to do with sexually transmitted diseases?”

Good question!

First, let’s talk about HPV. Human papillomavirus (HPV) is known as the “common cold of STDs” — because pretty much every sexually active person will contract it, even people with very few sex partners. Aside from complete abstinence, the best way to avoid an HPV infection is to be vaccinated with Gardasil, which protects against four common HPV strains — two that cause genital warts, and two that cause certain cancers, such as cervical cancer and oropharyngeal cancer. You can further reduce risk by using condoms and dental dams during all sexual activities, limiting sexual partners, and choosing partners who have had few or no previous partners — however, these risk-reduction methods don’t guarantee that you’ll remain HPV-free.


Harmful chemicals from cigarettes can end up in your cervical mucus!


If you’re sexually active, you could have contracted HPV without ever knowing about it. Most infections are asymptomatic (meaning that you never develop symptoms) and transient (meaning that they go away on their own after a year or two). When symptoms do appear, they can manifest as genital warts, penile skin lesions, cervical abnormalities, and signs of cancer elsewhere on the body. And, sometimes, an HPV infection can become persistent, meaning that it doesn’t go away. Luckily, there are steps you can take to decrease risk of developing HPV symptoms, and to increase your chances of fighting off an HPV infection. And one of those things is to quit smoking! Continue reading