STD Awareness: The Good, the Bad, and the Ugly

Sexually transmitted diseases (STDs) have been with us since the dawn of time — or at least since the dawn of sex. And, as we continue to hone our approach to preventing and treating them, STDs will always grab headlines, whether the news is bad or good.

The Good

Can the HIV epidemic be stopped?

For more than a decade, AIDS, the illness caused by HIV, was seen as a death sentence. It wasn’t until the mid-’90s that antiretroviral drugs kept the virus in check, prolonging lifespans for people with access to these medications and transforming the infection into a chronic disease. Now, those dreaming of an end to HIV are seeing reasons for optimism. No, a cure isn’t in the works — but many researchers believe we can end the epidemic through prevention.

Ending HIV transmission will take money and an efficient health care infrastructure, but we have the tools to do it. It starts with expanding access to HIV testing — an estimated 15 percent of Americans with HIV are unaware of their status. The next step is to ensure that everyone testing positive has access to antiretroviral drugs. When used correctly, these medications keep viral levels so low that the chances of transmission are virtually nonexistent. More recently, medications called PrEP — pre-exposure prophylaxis — enable people without HIV to protect themselves from infection. Condoms, of course, are a time-tested prevention tool. Gathered together, we have a pretty mighty arsenal. Here in the United States, we could stop HIV transmission in its tracks in just a handful of years. Of course, people all around the world will need access to testing and treatment to halt this scourge on a global level. Continue reading

STD Awareness: Can Older Adults Receive the HPV Vaccine?

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

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

STD Awareness: Herpes in the Headlines

Two separate stories about herpes have popped up in recent headlines, and the news isn’t good. A “citizen-scientist” injected an untested herpes treatment live on Facebook, sidestepping preliminary studies on safety and effectiveness. Meanwhile, research into a promising herpes vaccine was shut down as the extent of one scientist’s severe ethics violations came to light. Both stories show that there is a strong demand for ways to prevent, treat, and cure herpes — and both are case studies in the wrong way to bring such therapies to market.


Unscrupulous researchers may take advantage of people with stigmatized infections like herpes.


Herpes is a sexually transmitted virus that can cause “outbreaks” of painful genital sores. Afterward, the virus goes dormant in the nerve cells, hiding from the immune system. In some people, the virus can “wake up” to cause temporary flare-ups of symptoms. Given how common this virus is, a preventive shot could help a lot of couples discuss their herpes status without as much fear of judgment and stigma.

While someday an effective herpes vaccine might be developed, recent headlines have been unfortunate examples of scientific experimentation gone horribly wrong.

Citizen-Scientists Doing it Wrong

On February 4, at a biohacking conference, Aaron Traywick took off his pants in front of an audience and injected his thigh with a syringe containing a never-before-tested herpes treatment — a type of gene therapy, a treatment that alters a patient’s DNA by inserting genes into their cells. Frustrated by the testing that pharmaceutical companies must do, and the regulations they’re saddled with, he thought his startup company could leapfrog over these steps and go straight from the lab to human testing, using himself as a guinea pig. In addition to the alleged herpes “cure” that Traywick injected himself with, his company makes a similar herpes vaccine, which they hope will prevent herpes infections in those who don’t have it. 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