HPV: “We don’t know.”

The human papilloma virus (HPV) is the most common sexually transmitted infection, and there is a lot of information and misinformation about it floating around.  Recently, I had an illuminating discussion with a gynecologist who claimed to be up on the latest research, and her basic answer to a pile of interesting questions was, “we don’t know”.  This seems a little ridiculous, given that the CDC claims that “at least 50% of sexually active men and women acquire genital HPV infection at some point in their lives”.

There are two types of strains of HPV: high risk (which can cause cervical cancer in women) and low risk (which can cause genital warts in both men and women).  There are at least 40 different strains of (genital) HPV.  90% of infections (of either type) can be “cleared” without intervention by a healthy individual within two years, again, according to the CDC.  HPV can also cause penile cancer (in men) and anal cancer (in both men and women presumably, but more commonly in men for behavioral reasons).  There is no treatment for HPV itself, only the related diseases (warts and cancers).

As far as transmission, condoms were thought to perhaps lower the risk of HPV.  However, HPV can infect areas not covered by a condom.  A doctor once claimed to me that it’s way too squirrely of a virus to even worry about condoms (which nearly floored me).  There is a vaccine out that is recommended to be given to girls at age 11-12, or females who missed that vaccination but are 26 years or under.  It protects against the four most common strains of HPV (two high risk, two low risk).   The vaccine is looking good in trials for men, but has not yet been approved for them; some are getting it anyway.

The old state of the art testing and diagnosis used to be a pap smear for women every year.  If an abnormality of the cells was detected, it would be assumed that the woman had HPV, and she would be followed with repeated, more frequent, pap smears to see if her body could clear the abnormality on its own or whether it needed treatment (destroying or removing the affected cells, generally).  There was no test for men.

The current state of the art testing has changed.  Pap smears are generally still done once a year (although this may change at some point).  A new DNA test has been created, which is also done every year for women.  The DNA test currently tests for nine of the most common high risk varieties.  It does not distinguish between them, so if both you and a partner are diagnosed with HPV, there is no way to tell if you have the same strain or not.  It does not test for any of the low risk strains.  Supposedly it used to, but that turned into a patient management nightmare: there is no way to treat low-risk HPV other than removing visible warts (and if there aren’t any visible ones, there’s nothing to be done).  This “made the patients nervous”, so they stopped the tests.

The DNA test is not recommended to be performed for three years after a positive result on a given patient, since if it shows positive again, they don’t know if they are seeing the original virus recurring, the original virus not yet quiescent, or an entirely new infection.  Instead, they keep doing followup pap smears, and as long as the cells look ok, it doesn’t matter as far as they are concerned.  They throw up their hands entirely at thinking about it from a transmission perspective.

Men cannot be tested for it for PIV sex.  This creates lots of mysteries even among disease transmission for the straight, mostly monogamous crowd.  Men can also not be vaccinated against it yet although trials are going on to see if the vaccine used on women is effective on them.

HPV can be gotten anally or orally in addition to genitally.  These types (allegedly) do not respond to the vaccine as well, or to treatment, although they have been studied even less then the genital versions, are much more rare.  Outside of the men-having-sex-with-men community, doctors generally do not test for this (and are not equipped to do so).

They think that HPV never actually completely goes away, it just gets down to a low enough viral load that they declare it “cleared” (their words) or “quiescent” (mine).  Whether or not it can flare up again on its own at any point down the road is unknown.  Also unknown is whether or not it can be trasmitted in this state.

Definitely more questions than answers.

4 Comments

  1. Such timing! Gardasil for men was just approved by the FDA.
    http://www.bloomberg.com/apps/news?pid=20601103&sid=aA60zcLRsbKQ

  2. […] completley else; the fact that we know nothing or very little about HPV (human papilloma virus). Poundcake explains it very clearly and it is indeed important to keep updated about all of these things. I […]

  3. I recently had the gardasil shot, and heard rumors that it really isn’t that great in terms of what “we’re up against” in terms of HPV.

    I do remember they warned me it contained yeast, and honestly it felt like peanut butter going into my arm. It was three separate shots, all hurt like hell, and made my arm feel numb-ish.

    Part of me wonders if there is severe enough concern about this virus, and how much of the correlation for cervical cancer is there. It’s been troubling not to be able to find actual studies or journal articles in regards to the studies, but of course I might be looking in the wrong places.

  4. thanks for this. the study of hpv does seem to unearth more questions than answers. since i’ve been defined as having it and then “cleared” i am closely observing all the bullabaloo around vaccinations and such. i don’t put much…err…any stock in vaccinations as i believe they actually attack the immune system not support it but again, thanks for this article and for the collections of thought provoking writings, in general.


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