Monday, September 17, 2012

OMG Everyone Has Genital HPV

Ok, so not everyone has genital HPV but unless you've taken a vow of life-long celibacy (which you intend to take seriously) chances are you've already had a genital HPV infection, you have one now, or you'll get one in the future. Before you freak out and run to your nearest STD clinic for treatment, take a deep breath and read this post in its entirety.

HPV stands for human papillomavirus, an extremely common virus that infects skin cells, including cells that line body cavities such as the vagina, anus, and mouth. Of the 100+ types of HPV that have been identified, about 40 are able to infect the genital region. While HPV is the most common sexually transmitted infection, affecting at least 50% of sexually active individuals, it has many characteristics that make it complicated, confusing, and unlike other STIs.

To begin with, the outcomes of genital HPV infection are highly variable. Most people with HPV are asymptomatic, will never know they are infected, and will eventually rid themselves of the virus through the defenses of their own immune system. Those are the lucky folks. Some types of HPV result in the development of genital warts while other types cause cellular changes that over time can lead to the development of cancer. In fact, HPV is responsible for nearly all cases of cervical cancer. Speaking of cervical cancer, if you haven't read The Immortal Life of Henrietta Lacks, please stop reading this and proceed to your nearest bookstore immediately. It's that good.

How people become infected with HPV is rather clear: skin-to-skin contact including contact with mucous membranes. That means anyone who is rubbing their naked body on anyone else's naked body is at risk for genital HPV infection. It doesn't matter what your sexual orientation is or what type of specific sex acts you partake in (sorry kids, dry humping won't keep you HPV-free). Barrier devices such as condoms and dental dams can decrease the risk of HPV transmission but the virus can still be spread to or from areas that the device doesn't cover.

What remains rather murky regarding HPV transmission is when exactly people are contagious and how long people can be infected before displaying evidence of the virus. Also, it is completely possible to be infected with more than one type of HPV. These factors make it nearly impossible to tell how long a person has been infected, who they were infected by, and whether they are at risk for infecting their current or future partners.

Even if you are one of the aforementioned lucky folks, it does not mean that the person you share your HPV with will be so lucky. Different strokes for different folks in the world of HPV. Fortunately, prevention against four of the particularly nasty HPV types is now available in the form of a vaccine. The HPV vaccine Gardasil provides protection against HPV types 6, 11, 16, and 18 and is approved for use in females and males ages 9-26. HPV types 6 and 11 cause approximately 90% of genital wart cases, while HPV 16 and 18 are responsible for most cases of HPV-related cancers. Vaccinating against HPV provides a dramatic reduction in risk, for both yourself and your lover(s). And yes, preteens should be vaccinated before they are sexually active in order to save them the agony of genital warts or an HPV-related cancer. Will vaccinating against a STI cause children to run out and have sex (yes, this is actually a debate to some people)? You tell me - does vaccinating against chickenpox cause kids to run around looking for playmates covered in chickenpox since they are now protected from their oozing pox blisters?

For those of us who have aged beyond 26 or who may have acquired one or more types of HPV prior to vaccination, don't despair! There have been many advances in science and medicine that have allowed HPV-related cancers to become increasingly preventable. Just because you have one of the high-risk (cancer-causing) strains of HPV does not mean you have, or will get, cancer. If you follow your doctor's recommendations for routine health screenings, such as for Pap smears*, the early cellular changes that MIGHT eventually result in cancer, can be monitored and treated before any cancer develops.

HPV may be the most common sexually transmitted infection but there is plenty you can do to decrease its potential harm. Don't let HPV catch you with your pants down!

*While cervical Pap smears are routine for anyone with a cervix, anal Pap smears are not nearly as common. Anyone who frequently has anal sex, particularly MSM (men who have sex with men) who engage in anal receptive sex, should find a medical provider who is educated in LGBT health, or at least willing to become educated, and inquire about anal Paps for detection of HPV-related cellular changes. Paps are not fun but anal cancer is far worse.

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