Sex Gets Scarier: The Papilloma Virus

By Ilene Springer

The Jewish religion teaches us that our bodies, especially those of women, are holy vessels. This means that we should do everything we can to take care of our physical selves-prevent disease, be discriminate about sexual activity and generally take the necessary steps to maintain vigorous health.

When AIDS became a threat, we were taught about prevention through the use of condoms. The good news about AIDS is that, with common sense about sexual partners, testing before marriage or sex and the proper use of condoms for every sexual encounter before (or outside) of marriage, it's possible to prevent being infected with this lethal disease.

But what do you do about a sexually transmitted disease (STD) that cannot be prevented through the usual means?

There is a sexually transmitted virus called the human papilloma virus (HPV), which can lead to cervical cancer in females and, less often, penile cancer in males. This disease--lurking in the shadow of AIDS-has reached epidemic proportions: It's estimated that ten million American women have active infections, and as many as one-third of sexually active teens are believed to be exposed, according to the AOL Health Channel Newsletter.

It's a catch 22, where we feel held back by fear while wanting to lead full lives. We want to date and meet someone special in our lives, but at the same time, we don't want to engage in risky behavior that could especially render us vulnerable to disease. As we are finding out from this "new" disease--which has actually been around for quite some time, but we are just learning how pervasive and quickly spreading it is--it can be very hard to strike a balance between forming loving unions--and being frightened from having sex with the wrong person. And as we're also discovering, "nice" girls are catching this disease. Most of them are not promiscuous; most have practiced safe sex. It just hasn't worked in this situation.

In a recent article in the New Yorker Mazagine, Dr. Jerome Groopman, staff writer and Harvard professor of medicine, recounts a very troubling case of a college junior who was referred to him because a doctor, during a routine gynecological exam, believed he had found a precancerous growth on the young woman's cervix. Writes Groopman, "She had informed the college doctor that she had had intercourse with only two partners in her life, and never without a condom."

After undergoing a colposcopy-a process in which the gynecologist uses a magnifying instrument to examine vaginal and cervical tissues, the young woman was found to have severe dysplasia of the cervix. Not yet cancer, but close enough that she will have to tested every four months for the rest of her life--or be treated now for the dysplasia, which could involve removal of part of her cervix. Groopman explains that this young woman's problem was caused by the type 16 papilloma virus--"the virulent genital strain that most often leads to cervical cancer." There are about 20 different strains of HPV, four of which have been linked to the development of cancer of the cervix, vulva, vagina and anus. One strain leads to genital warts, which is linked to cervical cancer.

Frightening facts of life--and death According to Groopman and other experts, HPV is the most common sexually transmitted infection in the United States and Europe. Because of the type 16 variant of HPV, about 80 thousand women--mostly in their late teens and twenties--have early cervical cancer; another percentage have cancer that has invaded the cervix more deeply, and each year about 5000 of these women will die. Groopman sadly remarks on another of his patients, a 34-year-old married woman, who died from cervical cancer after extensive surgery, radiation and chemotherapy. The culprit? The papilloma virus, type 16.

What about men who are infected? Infected men can sometimes develop cancer of the penis, but not at the epidemic rate of women developing cervical cancer from the infection. However, an infected man can rapidly spread the disease to women with every sexual encounter. Gay men have a higher rate of infection and cancer of the anus because of anal intercourse. "Among sexually active urban gay men," writes Groopman, "about 60 percent of those who are HIV negative carry the papilloma virus in the anal area."

The most terrifying thing about the infection is that it can't be prevented through regular safe-sex procedures, such as using a condom. "Condoms are unreliable," says Groopman in an interview from his office at the Beth Israel/Deaconess Hospital in Boston, "because the papilloma virus lives in the cells of the outer skin as well as the interior cells lining the vagina, cervix, anus and urethra. Condoms do not cover the entire shaft of the penis and do not block contact with the pubic skin." So foreplay, mutual masturbation and oral sex--in addition to intercourse--can pass along the virus to the vulva and vagina and then up to the cervix.

Another worrisome fact: Few people know when they've been infected because the initial infection seldom produces symptoms. Until recently, just about the only way the virus has been detected is through examination of cells from a Pap smear. But, says Groopman, Pap smears have been known to be highly inaccurate, missing between 20 and 40 percent of infected women. There is now DNA testing specifically for the virus if a Pap smear shows the slightest abnormality. But the doctor must request testing for HPV; it isn't yet a part of normal gynecological exams.

In studies done on infected female students at Rutgers University in New Jersey, the infections lasted about eight months, then subsided. But about ten percent of the students still had an active form of the virus in the vagina and cervix two years later. "These persistent infections were most common with the virulent, cancer-linked types of the virus," writes Groopman.

In general, experts believe that once you have been infected with HPV, you're infected for life; there's no treatment, no cure. If you're lucky, an infection is kept under control by a healthy immune system, but there's no telling when the virus will become active again. There is talk about developing a vaccine for HPV, but it will be difficult to do so because there are so many variants of the virus.

Early detection is key Since there is no realistic prevention for infection by the papilloma virus, the only hope is in vigilant early detection in all sexually active women, says Groopman. Women, engaging in any sexual activity, must go for annual gynecological exams and Pap smears. "If anything comes back suspicious," says Groopman, "the woman should ask her doctor to request the DNA test for the papilloma virus." If she is found to be infected, especially with the more dangerous type 16 or type18 strains, she must set up regular, more frequent check-ups to make sure she is not developing cervical cancer. The good news in all this is that cervical cancer usually takes years to develop; catching it at an early stage is very likely and most often leads to successful treatment. But to catch it, you must first know it could be there.

These are tough days and tough lessons. We want to experience the beauty and pleasure of sex, and not panic. Nor do we want to ignore the risks altogether. But we must understand that if we take risks with our bodies, then we must assume the care and responsibilities that go along with those risks. We must arm ourselves with the information we need to protect ourselves from infection or serious disease. It's the only weapon we have.

For information on upcoming topical solutions that prevent HIV infection and other STD's in women:
Click here: YOUR HEALTH DAILY - NYT SYNDICATE
Click here: When It Comes to Sex, Keep Up the Dialogue
Click here: InteliHealth - Home to Johns Hopkins Health Information:
Click here: Cervical cancer - Preventable and treatable

Ilene Springer writes on health for Cosmopolitan, Ladies' Home Journal, Family Circle and other national magazines. She lives in Brookline, MA with her husband and two children and is editor of JewishHealth.com