HPV is like the Joe Lieberman of STDs—irritating and displeasing, but probably not disastrous. Both have a peculiar propensity to cause fear and confusion. Where is the Democratic Party going? What are those bumps down there? We know there is something sketchy about HPV but we’re not quite sure what, mainly because most of us don’t know what the hell it is. Nonetheless, human papillomavirus, HPV, was most likely not one of the STDs/STIs you talked about in your high school health class and since Wesleyan has no safer sex program, you might still be in the dark, even if, god forbid, you got a case of the ‘lloma (like “the clap” for gonorrhea, I think “lloma” is more fun than “HPV”). Beginning this semester, Dr. Davis Smith and the Davison Health Center are initiating an HPV education/awareness program, beginning with this Wespeak. I have been nominated their HPV go-to boy. Don’t assume anything.
Let’s begin with some stats, facts and demystification. If you are a sexually active college student, you have most likely had or have HPV, and you will most likely never know you had it. Around 20 million people in the United States have HPV and about 75% of people between 15 and 49 have contracted genital HPV. It is probably the most common STD among young adults. There are between 70 and 100 strains of the virus, 30 of which are transmitted sexually. So now you know you probably have it—unless you’re not having sex, not that there’s anything wrong with that—what is it and what can you do about it?
HPV is a virus that can cause genital warts but is more often undetectable and usually causes some degree of dysplasia- abnormal cell growth. So when someone has genital warts (condyloma) they have HPV, but when they have HPV they probably do not have genital warts. Genital warts are not a party in your pants but they’re not horrific. They can be flat, bumpy, pinkish, moist, small, big and cauliflower-like and are found generally around the vagina, vulva, penis and anal area-especially among men who have sex with men. Although visually disconcerting, warts are generally innocuous but can cause tenderness, irritation, and bleeding. If you have some wartiness going on you should consult your primary care physician. Genital warts often go away on their own, but can be removed by topical treatment (cream), freezing or burning them off, or by surgical excision. However, because current treatments target warts rather than the virus itself, recurrence rates are high. Even when you pick a booger there’s a whole lot more left in your nose. Nonetheless, removing the warts probably decreases the likelihood of transmitting that strain to another person.
Interestingly, it is the strains of HPV that do not cause genital warts that are more worrisome in the long run. Some of these sub-clinical (microscopic) strains can cause acute dysplasia and, if unchecked, can develop into genitally-associated cancers, including cervical cancer and more rarely, anal and penile cancer. Although most HPV cases do not transform into cervical cancer, most cervical cancer cases arise from HPV—about a dozen sexually-transmitted types of HPV are classed as high-risk (having the potential to cause cervical cancer). For women and trans folks who have vaginas, regular Pap tests screen for cervical cancer and abnormal cell growth and development. One study showed that most women who do have cervical cancer did not get regular screenings—so get your Pap test! If the result of the Pap is abnormal, an HPV DNA test can be used to identify whether or not high risk HPV is present. If it is present, more aggressive evaluation and treatment (colposcopy and excision or obliteration) are usually recommended.
Sub-clinical infection and its associated treatment and diagnosis in the anal and penile area are more ambiguous. Sub-clinical HPV can often be detected by application of acetic acid, biopsy, colonoscopy, or cytology but treatment is not recommended unless the infection causes a certain high-degree of abnormal cell development. Rates of anal and penile cancer are much lower than those of cervical cancer, and sub-clinical HPV usually clears within two years.
What can you do? The only way to definitively not get HPV, like all STDs/Sties, is to not have sex or engage in any genital contact. Additionally, practice safer sex—condoms are not just for HIV and pregnancy. Although HPV is transmitted from skin to skin and condoms, unless full-body, are therefore not greatly preventative of external-genital infection, they do afford protection from internal infection: women who do have sex with condoms are less likely to get cervical cancer than those who don’t. But safer sex is more than just latex—talking with your partners, learning their sexual history, and being honest about yours, can also reduce the likelihood of contracting HPV and keep you aware of what you’re getting yourself into—if you’re going to play the field (with others who play the field) at least know the risks. Also, sub-clinical infection may be just as transmittable as genital warts, so even if the person you’re fooling around with doesn’t have warts they can still transmit HPV.
HPV is not the end of the world but it is an infection that people know shockingly little about. Good links to look at include www.ashastd.org/hpvccrc,which is comprehensive with special attention to cervical cancer, and www.cdc.gov/nchstp/dstd/HPVInfo.htm which is a little less personal but informative. In the upcoming months there will be an HPV awareness/education workshop. If you have any questions or want to help with campus awareness, feel free to email me at jfischel@wesleyan.edu or Dr. Smith at pdsmith@wesleyan.edu. Be safe and be educated.
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