Human Papilloma Virus
This paper is about a sexually transmitted viral infection called the Human Papilloma Virus. The Human Papilloma Virus or HPV is part of a group of a hundred related viruses known as papillomaviruses because certain types are a well-known cause of papillomas or warts (National Cancer Institute, 2010). There are different types of HPVs including those which have carcinogenic properties. I chose this topic because a close friend of mine has the disease. Since I did not possess any knowledge about it, I decided to take this opportunity to educate myself about the virus. From my research, I have found that the most interesting components of this topic can be divided into symptoms, transmission, treatments, and prevention.
There are several variations of HPV and most of these variations can be differentiated from their symptoms. Types of HPVs are differentiated by the different areas where they may occur. These areas can be on the hands and feet or the throat or the genital area. Of the hundreds of types that have been identified, a number over 30 is contracted through sexual means and can be spread through the genitals, mouth, or anus. Even though a person may have the infection he may remain symptomless until the viral infection resolves spontaneously in a few years. However, complications can still occur despite remaining symptomless (National Cancer Institute, 2010).
If however, warts do appear they may be flesh-colored, soft, and moist. If the HPV is of a genital type, genital warts can appear weeks or months after the initial infection. They may also appear in groups that resemble the bumpy texture of cauliflower or may be raised, flattened with varying size. In men the can appear on the penis or scrotum while women can have it vulva and cervix as well as the inside and the area around the anus and the vagina. Such warts have also been known to appear on the thigh and groin. It should be noted however that despite the appearance of these warts, such HPV types are low risk. The high-risk types can be identified using a pap smear and have been known to cause cancer within the areas mentioned previously as well as in the mid-portion of the throat known as the oropharynx. If the woman is pregnant accumulation of warts can cause difficulties in urination or even obstruct the birthing process. In rare conditions infants, born to mothers with HPV warts can have them in their throats causing a life-threatening respiratory complication (National Institute of Allergy and Infectious Diseases, 2010).
As mentioned before HPV is primarily spread through sexual contact through oral, anal, or vaginal intercourse. Skin contact during the aforementioned activities can also transmit the disease. It is estimated that at least 66% of individuals who have sexual contact with infected parties, whether they show symptoms or not will develop papillomas within 3 months (National Institute of Allergy and Infectious Diseases, 2010).
In the United States alone, an estimated 6 million HPV transmissions occur each year. HPV is the most common cause of cervical cancer in the United States (National Cancer Institute, 2010). The prevalence of HPV in the United States according to a study among women in the 14 to the 59-year-old range was found to be 26.8%. They also found that the risk factor for contracting HPV increased with each age from 14 to 24 years with the highest prevalence in the 20 to 24-year-old range (Dunne, et al., 2007 ).
A supposition has been made that almost all women will have an HPV infection at some stage in their lives. However, few of them will progress to developing cancer. HPV infections that do not resolve for years are the only types that can lead to cervical cancer. In 2009, women over eleven thousand were diagnosed in the United States and it is estimated that at least four thousand will die from cervical cancer. This disease strikes half a million women worldwide every year and claims over twenty-five thousand lives (National Cancer Institute, 2010). It is perhaps particularly unjust that the majority of viral infections occur in women rather than men (Henderson, Yasgur, & Warshowsky, 2002).
A study by Oriel regarding the transmission of virus sexually found that sixty percent of the sexual partners in the study acquired warts though it is not known whether the type contracted caused cancer (Monsonégo, 2006). The most likely way suggested to prevent infection from HPV is a long-term monogamous sexual relationship with a partner who has not been infected. The use of condoms does not prevent HPV infections, since parts that are not covered during intercourse can contract the virus. Vaccines such as Gardasil and Cervix have now been sanctioned by the United States FDA to minimize the spread of HPV. These two vaccines primarily target HPV types 16 and 18 which have been identified as the major causes of cervical cancer. They have also been shown to be effective against other types such as Gardasil which also prevents types 6 and 11 which are known to cause at least 90% of all genital warts while Cervarix may provide partial protection against other types. Studies are ongoing regarding their effectiveness though to date they have been approved for use in males and females 9 to 26 years of age. They have been known to prevent 70% of cervical cancers overall and 90% of genital warts for up to 4 years from the time of vaccination. They are considered generally safe with minimal or no side effects (National Cancer Institute, 2010).
The diagnosis of HPV can be done from visual identification of genital warts or through an abnormal pap smear. The application of vinegar to areas affected by the virus can cause them to whiten as well. One of the newer tests being employed is the HPV DNA chip method which a study has shown has more sensitivity and a greater predictive and thus more effective than current cytological methods employed through pap smears (An, et al., 2003).
In Henderson’s regarding promotion of prevention of HPV he writes, “This would have been the case even if HPV were just one virus. But because it’s a family of viruses with a variety of effects at a variety of bodily sites, and its effects are so profoundly connected with other risk factors, writing this book became even more daunting.” (Henderson, Yasgur, & Warshowsky, 2002) While Monsonégo writes “Since the 1970s, population wide-screening programs were implemented in many western countries, and this further accelerated the decline in the incidence and mortality of cervical cancer, despite an increasing incidence of precursor lesions over the same period. These data impressively demonstrated how successful early detection and prevention programs for cancer may work.” (Monsonégo, 2006)
In my opinion, these two quotes show a major difference of opinion in the scientific community regarding the effectiveness of controls against cervical cancer. While the prevalence of the disease may still be high, the fact that only a percentage of these women progress to full-blown cervical cancer may not necessitate the research necessary to find an applicable solution to this problem. In turn, only a section of the scientific community may view this virus as a major threat to society.
Though genital warts can disappear without treatment, the growth of warts in certain locations may indicate their removal. In this case, there are several ways in which they can be removed. It can be done through the application of a cream or an antimitotic solution. Additionally, Trichloroacetic acid (TCA) can also be used in its removal. Freezing, burning, or laser treatment are primarily used in the removal of smaller warts. Larger warts that do not respond to treatment may have to be removed surgically. In the case of pregnancy removal of these warts is essential though not all therapies are indicated due to risk factors for birth defects. If the child is born with warts in his throat laser surgery is indicated to remove them. It must be mentioned that though warts can be treated, this does not treat the virus itself and can cause a resurgence of warts to appear after treatment. Some health providers may prescribe alpha-interferon an antiviral to treat warts, though it is not effective against HPV or wart resurgence (National Institute of Allergy and Infectious Diseases, 2010).
Henderson says regarding the enormous prevalence of the high-risk form of the disease in women “How unfair that this virus should cause such extensive damage to women while leaving men relatively unaffected! There is some measure of truth to your perception. HPV seems to be an equal-opportunity infector, but not an equal opportunity afflicter. Still, men can also be seriously affected.” (Henderson, Yasgur, & Warshowsky, 2002) While Monsonégo shows in his books how studies have proven that “Among men aged 18-24, HR-HPV’s were slightly more prevalent (18.4%) than LR-HPV’s (15.2%).” (Monsonégo, 2006). In my opinion, this information shows how even though men may not be susceptible to the cancerous effects of HR-HPV’s or high-risk HPV’s the fact that they can act as carriers without symptoms for years further shows the danger posed by this disease especially in the case of women with multiple sex partners. And the number of men who are susceptible to the HR-HPV infection is no indication of the true prevalence of this disease in men.
These factors show me that even though there may be vaccinations available to counteract the disease in both males and females along with tests to show the presence of the disease. The primary focus of these tests is towards the identification and prevention of the disease in women rather than men. While this is understandable due to its detrimental effects nonetheless the fact that men can be such effective carriers of the disease necessitates that research is done to diagnose and counteract the virus especially of the high-risk sub type in men as well.
To summarize the Human Papillomavirus despite its relatively low presence in the public consciousness is a terrifying disease that must be guarded against especially by women. The importance of HPV vaccinations especially when considering multiple sex partners is thus completely warranted and future treatments towards curing this virus are sorely needed due to its widespread prevalence and cancer-causing characteristics. However, the focus on women as the primary patient to be treated can only be detrimental to the species as a whole. The male carrier state is an equally dangerous factor that must also be taken into account if this disease is ever to be stopped. As always though scientific research, as well as public opinion, will lead the way in this matter.
An, H. J., Cho, N. H., Lee, S. Y., Kim, I. H., Lee, C., Kim, S. J., et al. (2003). Correlation of cervical carcinoma and precancerous lesions with human papillomavirus (HPV) genotypes detected with the HPV DNA chip microarray method. Cancer Volume 97 Issue 7, 1672-80.
Dunne, E. F., Unger, E. R., Sternberg, M., McQuillan, G., Swan, D. C., Patel, S. S., et al. (2007 ). Prevalence of HPV Infection Among Females in the United States. The Journal of the American Medical Association Issue 297, 813-819.
Henderson, G. S., Yasgur, B. S., & Warshowsky, A. (2002). Women at risk: the HPV epidemic and your cervical health p.1-3, 106, 158. New York: Avery Publishing.
Monsonégo, J. (2006). Emerging issues on HPV infections: from science to practice p.1, 20, 30. Basel, Switzerland: Karger Publishers.
National Cancer Institute. (2010). Human Papillomavirus (HPV) Vaccines. Web.
National Institute of Allergy and Infectious Diseases. (2010). Human Papillomavirus (HPV) and Genital Warts. Web.