Human Papilloma Virus (or HPV for short) is getting almost as much airtime these days as the President—and that’s saying a lot. Every time you open your browser window or flip open the New York Times, there’s another article about the potentiality of transmission, or a new disease that’s now been connected with the STD, or a treatment or cure that’s in the works. Unfortunately, because of the nature of HPV, there are a lot of “maybe” statements about it—and many people don’t know what to believe, or how (or even if they should bother) to try to protect themselves. So let’s take a look at some of the facts about HPV:
Fact 1: HPV is a collection of over 70 different specific viruses. Each virus has its own properties, which means that not every type will cause every potential symptom of the disease. The high-risk virus types—known as 16, 18, 31, and 45—are most strongly associated with cancer; other types of the virus are responsible for genital warts, and still others seem to have no effect on the body at all.
Fact 2: HPV is not well understood by either the general public or by medical researchers and clinicians. It’s only in the past twenty years that the majority of what we know about HPV has been discovered; there are new findings every year (most recently, the discovery that many oral cancers can be traced back to the Human Papilloma Virus). Unfortunately, this lack of information about HPV means that very few people—on either side of the medical divide—have a clear picture of what it is, and how to prevent its spread.
Fact 3: The great majority of sexually active adults have been exposed to at least one strain of HPV. In fact, a 1997 study showed that 74% of Americans—that’s three out of four, for those of you mathematically challenged folk out there—have had HPV at some point in their lives. In fact, because the virus doesn’t always cause symptoms, it can remain in the body for weeks, months, or even years without detection.
Fact 4: Most types of HPV virus are relatively benign. In fact, as we mentioned above, the majority of strains of the virus have little to no effect on the body; even those that cause genital warts do not raise the inherent risk of cancer. The good thing is that, assuming that one’s immune system is healthy, the body will be able to fight off HPV infection fairly well on its own. The bad thing is, without regular health care checks, there’s no way to tell if your body isn’t doing the job.
Fact 5: HPV can be transmitted by skin-to-skin contact. This means that a condom won’t necessarily protect you—any skin that touches the genital area of another person can transmit the disease, including labias, scrotums, and perineums. It also means that HPV can be transmitted by oral sex as well. Your best bet is to continue to use a condom, since it also protects you from other STDs.
Fact 6: HPV can cause genital warts. Genital warts are, in and of themselves, not dangerous; while they may obviously be unpleasant from an appearance standpoint, or may be uncomfortable depending on their location, they’re very rarely indicative of cancer. They can be removed in your doctors office, but simply removing them doesn’t mean that you no longer have an active HPV infection.
Fact 7: HPV can cause cervical cancer and anal cancers. The high-risk strains of HPV have a strong correlation with cervical and anal cancers. These cancers can be almost totally prevented by having annual cervical and/or anal Pap smears. In fact, the overwhelming majority of diagnosed cervical cancer cases are found in women who have not had a Pap smear in over five years. Basic annual health exams will discover cellular abnormalities (called “dysplasia”) early enough for it to be treated in the doctor’s office, far before it ever becomes a serious health risk.
Fact 8: HPV can cause oral cancers. Recent studies have shown that some oral cancers (particularly those of the throat and/or tonsils) have genetic markers that identify them as having been caused by HPV. This means that while oral sex has often been regarded as safer for everyone involved, the “head giver” is risking their health a bit more than we previously thought.
Knowing all of that, how do we respond to it on an individual basis? First of all, we evaluate our own risk. Factors like multiple sex partners and less-safe sexual practices (like not using barriers for sexual contact) will increase our risks, in general. Obviously, the only 100% way to prevent HPV is total abstinence (and yes, this includes mouth sex and bootie sex, for those of you that often don’t count that as “real sex”). However, you probably wouldn’t be reading this page if you wanted to remain abstinent, now would you?
The next thing you’ll want to do is talk to your partner (or partners, if you’re involved intimately with multiple people) about HPV. Print out a copy of this article for them, or send them the link to it, so that you’re both working with the same basic knowledge. Talk about how much of a health risk you believe HPV to be; if your immune system is compromised (such as through an immunodeficiency disorder or because of medication that suppresses your body’s immune response) then HPV may be a more significant health risk than it would be for others. In addition, if you have had a partner recently who has had a run-in with HPV, especially one of the cancer-causing varieties (they may have had an abnormal pap smear, which is the usual tip-off of an HPV infection), you’ll want to re-evaluate your own safety precautions with other partners, as you may very well be carrying the virus.
Due to the relative ease of infection, as well as the high number of people already infected, it may be unrealistic to expect that you will go through your entire life without being exposed to at least one strain of the virus. It may also be unrealistic to expect that a new partner is clean, even if they’ve had very few other partners. Many people choose to use barriers for particular sexual acts, such as penetrative sex (including oral sex); some people feel that given their own risk assessment, the use of barriers specifically to prevent HPV transmission isn’t important. You, and only you are responsible for your own health, and you and your partner have a responsibility to each other's health to talk about the potential problems that HPV can cause and determine what activities are safe and what are not worth the risk.
Regardless of how you decide to manage your HPV risk, there are a few simple steps that you can take to ensure that HPV doesn’t have the chance to ruin your health:
1. Consider getting an HPV vaccination. Gardasil ™ is the primary vaccine on the market currently, and is recommended for girls and women aged 9-26; the goal of the age range is to vaccinate young women before they become sexually active, thus preventing more potential problems. Gardasil™ only works on four types of the HPV virus—types 16 and 18, which account for 70% of cervical cancer cases, and types 6 and 11, which cause 90% of genital warts. This means that it is not a catch-all preventative. It’s certainly not a cure, either—vaccines work by causing your body to manufacture antibodies that defend against initial infection, not by killing the virus that’s already residing in your body. The FDA is currently evaluating whether the vaccine should be approved for use in young men—which seems obvious, since HPV infections also happen in men as well as women—and many doctors and health clinics are willing to vaccinate women over the age of 26 if specifically requested. Vaccination is not an easy decision, but thankfully there is a lot of information on the internet and available from your physician or gynecologist about the pros and cons of vaccination.
2. Maintain a regular schedule of checkups, particularly if you’re sexually active (and no, the gender of your partner[s] doesn’t matter!). Pap smears should happen at least once every three years, and should happen more often if you engage in sex with multiple partners or if you’ve had an atypical pap smear. Unfortunately, many doctors do not suggest anal Pap tests to their patients who engage in anal sex, and because of the societal shame about ass play most of us don’t fess up to our doctors about it, so the burden is on you to ask for it.
3. Practice safer sex, without making excuses. “She looked clean” or “I didn’t see anything wrong with his dick” isn’t a good reason to skimp out on the condoms or dental dams. If HPV isn’t worrying you, there are a dozen other reasons out there to keep having safer sex (namely HIV, Herpes, Syphillis….do I need to continue?). Negotiate safer sex practices before you go to bed with someone, and go prepared with your own 'Trick Kit' of lube, gloves, condoms, and dental dams.
4. Stay healthy. Not only is it good for the rest of your sex life (who wants to have to bow out of a hot, nasty sex session because they’re exhausted after three minutes?), it also helps your immune system to remain in tip-top shape. Additionally, there has been a link between smoking and HPV infection when it comes to cervical cell abnormalities, so if you’re a smoker, there’s another reason to consider quitting.
5. Stay informed. The clinical knowledge about HPV is growing by leaps and bounds each year. Keep up to date with the latest in safer sex information to see if there are new treatments available, or better suggestions on how to stay healthy. Unfortunately, there are so many types of HPV and so many routes of transmission that the medical community has more unanswered questions than they have answers, but inroads are being made.