First spotted on MSNBC:
"We found that there is a high proportion of men who have genital HPV infections. At enrollment, it was 50 percent," said Giuliano, whose study appears online in the journal Lancet.
Read that again. Half of men had genital HPV infections at enrollment in the study. They're not saying these men simply had it at some point in their lives and cleared it. Half of those men were testing positive for at least one type of HPV on day one. And the high rate of HPV was true across all age groups for guys. Also, "[w]hereas risk of HPV decreases with increasing age in women, men seem to have a stable risk for acquiring new HPV infections throughout their life." (Purchase the full text here.)
The distinction is important. Other studies have estimated that there's a good chance that most people - both genders included - will have HPV at some time in their lives. This new study is saying something unique about men, because this is talking about males at this very moment - not at some point within a lifespan, but right now.
Aside from the 50% prevalence on day one, the study also reflects that over 1500 new infections were contracted during the study. It's possible to have more than one strain at once. If you get a new strain, it's a new infection.
What else makes men different? Well, it appears that once guys contract HPV, they hold on to the virus for a longer time. In other words, their bodies don't clear the virus as easily as women can - assuming they clear it at all:
"What is different is men seem to have high prevalence of genital HPV infections throughout their lifespans." She said it appears that women are better able to clear an HPV infection, especially as they age, but men do not appear to have this same ability.
Remember, number of lifetime partners is the #1 risk factor for getting HPV. In light of that, everyone should have a look at this part of the study:
Clearance of oncogenic HPV infection decreased in men with a high number of lifetime female partners
and
Men who had sex with more than 50 female sexual partners were 2.4 times more likely to have a cancer-causing HPV infection than men who reported having only one or no sexual partners.
(Ahem - consider that alongside this information.)
One last thing. The men in this study all got tested for HPV. Yes, you read that correctly - although there is currently no FDA approved test for men in a clinical setting, when it comes to research, it's a different story. It's how the researchers were able to say that half of the men had HPV at enrollment.
At each visit, three specimens of penile and scrotal cells were obtained from the coronal sulcus, glans penis, penile shaft, and scrotum for the detection of HPV DNA and for HPV genotyping.
And then we have the bigger picture. The purpose of this study was to inspire the development a cost effective model for vaccinating men. It speaks volumes for why we have to change the way we think about HPV. It's not just scary for women, it's scary and a problem for men too. And it's the responsibility of both genders to be on the lookout for it, to get vaccinated, and to be aware of their status so we can make this virus a thing of the past. HPV causes serious health problems for men and women.
The first thing, and the easiest thing people have to do: get Gardasil.
And the second thing that has to change that's just as important: testing for HPV in men needs to be made available outside of a research setting, period. There's no good reason why not. Why isn't it? No clue, but maybe it's just the myth that it doesn't affect men, so it's not their problem, so there's really no utility in having a test for men, because apparently, you know, knowing your HPV status is useless information. Reason begs to differ. Men deserve to know for the same reason that women deserve to know: so that they can protect themselves and their partners.
Not necessarily. A pap smear and the HPV test are two different things. The HPV test is run from the same sample that a pap is, but it's a separate test. The pap smear itself isn't looking for the HPV virus, it's looking for cancer, cell abnormalities, and infections - in other words, it's looking for symptoms - not just of HPV, but of all kinds of problems.
It's entirely possible to have a normal pap (no symptoms in the visible/tested area) and still have HPV. Having a normal pap just means that those particular sample cells looked normal when viewed microscopically. It's also important to remember, a pap won't indicate cancer in , say, your mouth - or anywhere else HPV causes problems - because it's only testing one area of your body. See Part 1, Misconception #1 for a breakdown of where else HPV can affect your body.
On the flip side: having an abnormal pap doesn't always mean you do have HPV, either, which shows why it's important to get tested and to follow up to find out for sure what's going on. Up to 10% of paps showing abnormalities are false positives. Check out this excerpt from an article entitled "Should We Abandon Pap Smear Testing?" by Dr. Richard DeMay:"At the individual level, if a healthy woman were screened every 3 years from age 18 through her mid-70s, for a total of 20 Pap smears, and the false-positive rate were 5%, there is an almost 2 in 3 chance (64.2%) that she would experience at least 1 false-positive result.4,6 (If screened every year, for a total of 60 Pap smears, there is approximately a 95% chance of at least 1 false-positive result.)"
Hormonal and bacterial changes, yeast infections, recent sexual activity, and other harmless things can cause a pap to be abnormal as well.
This is Post #9 in the series, Debunking HPV Myths. For other parts of the series, click here.
No. They're. Not.
People make this mistake all the time. Drives me nuts.
Keep 'em separate: the thing that we're looking for (HPV) and the effects that thing can have (symptoms). You can have the thing without seeing the effects. In other words, you can have the virus and not have symptoms. You can even transmit the virus without symptoms. This is why it matters whether you've been exposed, guys and gals. This is why it matters that you ask for the test, gals. The fact that it's present and the fact that it is or is not doing something to your body are two different things.
The moment you're exposed to HPV is simply the time that the virus enters your body. Again, the HPV test looks for the virus, not the symptoms. You don't start showing symptoms immediately, because symptoms take various amounts of time to develop. The virus has to invade your cells, replicate, and take over - which doesn't happen immediately. Some people will show symptoms within weeks or months after exposure (even pre-cancerous lesions can come on really fast, like they did for me), and for others, it can take years.This is Post #8 in the series, Debunking HPV Myths. For other parts of the series, click here.
I hear about people who love to talk about condoms as an ultimate solution to everything. Yes, condoms might help to a degree. Studies even suggest that condoms can actually help people "clear" the virus once someone already has it (and note that clearing is defined in different ways within the mentioned studies).
But look at the numbers. The potential for protection that condoms provide is not good, statistically speaking, because condoms aren't designed for preventing the spread of HPV. They're designed for preventing pregnancy. The probability that you will still get HPV even if you use a condom every time you have sex is unacceptably high. If condoms failed that much at preventing pregnancy, people wouldn't use them for that purpose nearly as often as they currently do.
According to the CDC’s Report to Congress: Prevention of Genital Human Papillomavirus Infection:
The available scientific evidence is not sufficient to recommend condoms as a primary prevention strategy for the prevention of genital HPV infection.
And: Rep. Dave Weldon (R-FL) and family physician, said this at the hearing:
The scientific evidence is clear that condoms provide little protection from
infection by HPV. Yet agencies and organizations are fighting to keep that
fact from the public.
So hey there, this is reality speaking: Unless you wear a wetsuit as a condom, it's impossible for a condom to serve as a barrier for all the skin that can transmit HPV during sexual contact. Keep in mind that you don't have to have penetrative sex to get HPV, either. The virus can be transmitted through oral sex, use of sex toys, and any type of skin-to-skin contact, so even lesbians are at risk. And ask yourself this: do you wear a condom when you're intimate but not having intercourse?
This is Post #6 in the series, Debunking HPV Myths. For other parts of the series, click here.
In some cases HPV does stay dormant for a long time, but it absolutely doesn't have to. In younger females, it's been observed that precancerous lesions can come on aggressively and rapidly. I, for example, went from no HPV and years of back-to-back perfectly normal paps to HPV positivity and CIN3 in less than a year's time. (CIN3, and HSIL — which stand for grade 3 cervical intraepithelial neoplasia and high-grade squamous intraepithelial lesions, respectively — are precursors to cervical cancer.)
Not only are lesions like these aggressive, but they "are common early events among women with incident HPV infection" and, interestingly, "the interval between incident HPV-16 or HPV-18 infection and biopsy-confirmed CIN grade 2–3 appears to be relatively short."
How short? According to a study by Winer et al.,
Contrary to the theory that prolonged infection is necessary for progression to high-grade neoplasia [11–13], our results support the hypothesis that HSILs are often an early manifestation of HPV infection in young women. Half of the incident cases of biopsy-confirmed CIN grade 2–3 in our study occurred within 14 months of an incident HPV infection.
And what about warts? They show up even faster:
The median time between detection of incident HPV-6 or HPV-11 infection and detection of genital warts was 2.9 months (IQR, 0–5.7 months).
Something to think about, no?
This is Post #3 in the series, Debunking HPV Myths. For other parts of the series, click here.
Strains are a major source of confusion, even for some medical doctors and others in the health industry. Some basic questions for this blog: Are there different strains of HPV? (Yes! Many!) What do the strains do? (Depends on which strain.) Can you have more than one strain of HPV at once? (Absolutely.) Which strains are the most common? (High risk types 16 and 18.) Does Gardasil help if it only covers four strains? (Yup, and read on for explanation.)
Let's kick things off with the statements of a commenter going by the screen name Dr Williams, whose full name is probably Dr. Mark Williams, which we know thanks to another genius who replied to him by first name repeatedly. Do you think this is the guy? Anyway, it all began with Dr Williams proudly proclaiming his medical background:
First of all, let me start by saying I am not afraid to hide behind some screen name. My name is Dr. Williams, M.D.
Oh yes, and this is important:
Alan and I have been best friends since we met our freshman year in college.
While Dr Williams was discussing whether Dr. Alan Evans had warts, he went off on 
a bizarre tangent about "the cancer causing kind" of warts. Say what? This statement he made regarding the visual diagnosis of "cancer causing" warts versus "the bumpy strand" is something to behold:
He does not have warts. And even if he did, there is no way by looking at them to tell if they are the cancer causing kind. I guess a future conversation may be.. [sic] "so, do you have warts?", [sic] um [sic] yes." what [sic] genotyps [sic] are they, the cancer causing kind or just the bumpy strand?" ummmm... [sic] I don't know.
No, really. Is this a joke, in more ways than one?
It's common knowledge that the strains of HPV that cause genital warts do not cause cancer. This isn't information you have to dig for or have a medical degree to know; it's plastered everywhere. Cancer-causing strains and warts-causing strains are two different things. And you can definitely have more than one strain at a time.
Keep in mind that Dr Williams made these statements after directing everyone else to get as edumacated as he is on the subject of low risk strains by visiting CDC.gov.
I hope people took his advice on that one point and read the CDC website, because on a page labeled "basic information," the CDC comes right out and obliterates his nonsense about "cancer causing" warts in one sentence:
The types of HPV that can cause genital warts are not the same as the types that can cause cancer.
It's a good story, but I digress. It'd take a chapter of a book to fully explore the bitter, factually incorrect, facially inconsistent and puerile ravings contained within the comments and e-mail correspondence (oh yes, he sent me e-mails too - another time, perhaps?) from Dr Williams.
Here's a second commenter whose ignorance is worth learning from: rosiejr1. Notice that rosiejr1 also claims to know a thing or two about STIs thanks to her line of work with the CDC, so you had better listen up! Or not.
I am a CDC Rep at a local health department in TN, which is top ten for ALL STD's. [sic] Obvoiusly [sic] the courts had some medical experts in it, but [. . .] only one strain can cause cervical cancer.
Rosie is scary uninformed. HPV is a family of viruses. There are many strains — almost 200 that we know of so far — and like I said, different strains do different things. We're mainly talking about the ones transmitted via intimate contact. There are roughly 40 of those. This group can be divided into two types: high risk and low risk. As discussed before, high risk strains can cause cancer. Low risk strains can cause warts.
So let's get down to pointing out the incorrect information that this supposed 'CDC Rep' is carelessly broadcasting to the masses: Does just one strain cause cancer like rosiejr1 said? Um, no. To simplify things to the point of seroius inaccuracy is unacceptable — especially after bragging about how she's in the medical field, so that people will buy what she's saying.
HPV isn't simple, so don't try to make it simple. To give you an idea of how many strains of HPV can cause cancer, the Hybrid Capture II High Risk HPV test looks for 13 different high risk (e.g. cancer-causing) types — 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68. It tests for the most common types, but that's not all of them. For example, there are at least two more well-known high risk types not included in that test: 73 and 82. There's also a test for low risk types, which looks for 5 different strains : 6, 11, 42, 43, and 44. And once again, that's not all. Examples of other low risk types not included in the test are 54, 61, 70, 72, and 81.
The HPV vaccine known as Gardasil protects against four distinct strains: two high risk strains (strains 16 and 18, which together cause 70% of all cervical cancers), and two low risk strains (strains 6 and 11, which together cause 90% of all genital warts). Those four strains cause the vast majority of the most common health problems caused by HPV, which is why it makes sense to get the vaccine. You'd think someone who works as a "CDC Rep" would know that much simply from experience, maybe while talking to people about Gardasil or something in her day-to-day work. But you'd be wrong. Maybe you should be worried, too.
UPDATE: The FDA approved Gardasil to help prevent anal cancer caused by HPV, the vast majority of which is, in fact, caused by HPV.
This is Post #2 in the series, Debunking HPV Myths. For other parts of the series, click here.
