DR DOBSON www.TheCitizensWhoCare.org HPV Response to Dr. James Dobson It was shocking to read the headline in Saturday's (1/7/06) Pilot "HPV Epedemic Plagues Young People" by Dr. James Dobson. He implies that HPV is very serious and causes far more deaths among women in the US than HIV. He also stated that research conducted at UC Berkeley 15 years ago found 47 percent of the tested female students carried the virus and that "Every one of them will suffer painful symptoms for the rest of their lives and some will die of cervical and uterine cancer." He goes on the say that he objects strenusously to the campaign to get young people to have "protected sex." By trying to discredit the effectiveness of condoms for risk reduction, he uses alarmist and misleading information about this very common, and usually benign, sexually transmitted infection. He concludes with the statement that "Abstinence before marriage is the only way to go," in an attempt to scare all sexually active people, and especially young people who haven't become sexual yet, to join the sexually repressed. Now, I'm not against promoting abstinence or lifelong monogamy but if abstinence is taugh without also teaching about sex, the dangers and the enjoyments, then it borders on sexual abuse for by withholding appropriate information about sex or providing misleading or untruthful information, that, in itself, can be a form of sexual abuse. So, let's talk about the actual facts: HPV is the most common sexually transmitted infection in the U.S. with up to 20 million Americans currently infected. There are around 100 viral types of HPV and about one third of these are associated with sexually transmitted genital infections. Some research also suggest that genital HPV can be transmitted through nonsexual routes via inanimate objects such as towels or underwear Dr. Dobson is correct when he says that there is currently no "cure" for genital HPV infection but in almost all cases, the immune system will keep the virus under control or get rid of it completely without medical intervention. In fact, the study Dr. Dobson sites followed the college women for three years. 43 percent tested positive for HPV at some piont over the study period but the average duration of HPV infection was only eight months and 70 percent of the women cleared their HPV infections within one year through the natural immune process. Only 9 percent continued to be infected after two years. The American Cancer Society says that it is rare for "high-risk" HPV to lead to cancer. And, the median age of diagnosis for cervical cancer is 48 years. While HPV is considered a cause of cervical cancer, only one out of 1,000 women with HPV develops invasive cervical cancer. Most HPV infection never leads to the development of cervical cancer, even in the absence of medical intervention and treating precancerous cervial lesions detected by Pap tests has greatly reduced the rate of invasive cancer. Among the ages 15-49, 75% will have a genital HPV infection. While this may make it seem like HPV is an epedemic among sexually active women and men, it is reassuring to know that these infections most often remain asymptomatic and symptoms, if they occur, are usually manageable. Equally reassuring is the fact that condom use is likely to reduce the risk of infection. A side-bar. If you get HPV, and you've ever had sex with more than one person in your life, don't start accusing your partner. The virus can remain undetected in either one of your bodies for a life time. However, if either of you have leisions or genital warts at any time, it is best not to have contact with the area and to see a medical professoinal ASAP. Realize that most people are exposed to one or more HPV types in their lifetime, and most will never even know it because they will not have visible symptoms. It is important for partners to understand the "entire picture" about HPV so that both people can make informed decisions based on facts, not fear or misconceptions. Don't believe me? Then check out www.iwannaknow.org/links.html This web site gives you answers to your questions about sexual health and sexually transmitted diseases. Then there's the Center for Disease Control and Prevention at www.cdc.gov/std/HPV/STDFact-HPV.htm , the National Institutes of Health at www.niaid.nih.gov/factsheets/stdhpv.htm and the American Social Health Association, which deals specifically with HPV and other sexually transmitted infections. It is at www.ashastd.org/hpv/hpv_learn_fastfacts.cfm Let's stop using fear to misinform people about sex. There's no reason to fear sex. And, knowing the realistic risks and preventive measures before hand will go a long way to experiencing a long and healthy sex life, whenever you choose to start. Gordon Clay Web Master healthstuff.us and Menstuff.org   Short Version Editor: It was shocking to read the headline in Saturday's Pilot (1/7/06) "HPV Epedemic Plagues Young People" by Dr. James Dobson. He implied that HPV causes far more deaths among women than HIV. He also stated that 47% of college women surveyed carried the HPV virus and that "Every one of them will suffer painful symptoms for the rest of their lives and some will die of cervical and uterine cancer." What he didn't say is that the average duration of HPV infection in those women was eight months and 70 percent were clear of their infections within one year. Furthermore, the American Cancer Society says that it is rare for "high-risk" HPV to lead to cancer. The actual facts: HPV is the most common sexually transmitted infection in the U.S. with up to 20 million Americans currently infected. There are around 100 viral types of HPV and about one third of these are associated with sexually transmitted genital infections. Some research also suggest that genital HPV can be transmitted through nonsexual routes via inanimate objects such as towels or underwear. Among 15-49 year olds, 75% will have a genital HPV infection. While this may make it seem like an epedemic, it is reassuring to know that these infections most often remain asymptomatic as our immune system takes care of them and symptoms, if they occur, are usually manageable. While Dobson is against encouraging "young people to have 'protected sex'", it's equally reassuring that condom use is likely to reduce the risk of infection. Let's stop using fear to misinform people about sex. Knowing the realistic risks and preventive measures will go a long way to experiencing a long and healthy sex life. Don't believe me? Check out www.iwannaknow.org/links.html Gordon Clay Web Master healthstuff.us and Menstuff.org Other resources: The Center for Disease Control and Prevention at www.cdc.gov/std/HPV/STDFact-HPV.htm The National Institutes of Health at www.niaid.nih.gov/factsheets/stdhpv.htm The American Social Health Association, at www.ashastd.org/hpv/hpv_learn_fastfacts.cfm   In their efforts to discredit the effectiveness of condoms, right-wing ideologues who want to institute sexual abstinence until marriage as a standard for all Americans have instigated an alarmist and misleading public policy and media campaign about very common, and usually benign, sexually transmitted infections — the human papilloma viruses (HPVs). State and federal legislative bills have been introduced, misinformation has been disseminated, and lawsuits have been threatened to inspire public doubt about condom use and unnecessary alarm among the many sexually active women and men — as many as three out of four — who have been infected with this extremely common, and most often harmless, infection (Cal. SB 977, 2001; Cates, 1999; "House Approves...", 2000; Leishman, 2001; Schneider & Cirmo, 2000). While a handful of sexually transmitted HPVs can cause a variety of conditions that can lead to dangerous cancers if they remain untreated, it is a gross and dangerous exaggeration to typify HPV as a "dreaded virus" and safer-sex, public health messages advocating condom use as a "conspiracy" ("House Approves...", 2000). This fact sheet will give sexually active women and men the facts they need to understand the real nature of HPVs, what conditions HPVs cause, how those conditions can be effectively managed, and how one may reduce one's own risk of becoming infected. Human Papilloma Virus (HPV) is a common infection that affects skin and mucous membranes, and is the cause of warts. Some types cause warts in the genital area — others cause common skin warts in other areas such as the hands or feet. Approximately 100 viral types of HPV have been identified, and about one third of these are associated with sexually transmitted genital infections (Koutsky & Kiviat, 1999). HPV has affected humans for thousands of years — ancient Greek and Roman medical records described genital lesions consistent with genital warts and associated them with sexual activity (Jay & Moscicki, 2000). Today HPV is the most common sexually transmitted infection in the U.S. — yet 70 percent of Americans have never heard of it (Jay, 2000; KFF, 2000). Up to 20 million Americans are currently infected with sexually transmitted HPV, and it is estimated that 75 percent of reproductive age women and men have been infected with genital HPV at some point in their lives (Cates, 1999). The highest rates of genital HPV infection are found in adults between the ages of 18 and 28 (Koutsky, 1997). HPV is also prevalent among people with immunosuppressive disorders, such as HIV (Koutsky & Kiviat, 1999). HPV is believed to be widespread across racial groups and to have very little variation in prevalence across regions in the U.S. (CDC, 2000). HPV is so common, in fact, that it is considered a virtual marker for having had sex (Boonstra, 2004). Some research also suggests that genital HPV can be transmitted through nonsexual routes, via fomites — inanimate objects such as towels or underwear — but more research must be conducted to examine these modes of transmission (Carson, 1997; Keller, et al., 1995; Stevens-Simon, et al., 2000). Although there is currently no "cure" for genital HPV infection, most cases are transient and clear themselves without medical intervention (CDC, 2001; Elfgren, et al., 2000; Ho, et al., 1998). One study designed to determine the natural history of genital HPV infection followed college women for three years (Ho, et al., 1998). HPV was detected using a sensitive DNA test that detects small amounts of HPV, even when there are no symptoms present. While there was a high rate of HPV infection (43 percent tested positive for HPV at some point over the study period), the average duration of HPV infection was eight months. Repeated HPV DNA testing showed that 70 percent of the women cleared their HPV infections within one year through the natural immune process, and only nine percent continued to be infected after two years. Another study conducted in Sweden supported these findings, with a five-year clearance rate of 92 percent (Elfgren, et al., 2000). In both studies, the viral type of HPV was a major determinant in the duration of infection, with types 16, AE7, 61, 18, and 73 having the longest average duration (Elfgren, et al., 2000; Ho, et al., 1998). HPV and Cancer It is estimated that in 2004 there will be about 10,520 new cases of invasive cervical cancer in the United States, which will result in about 3,900 deaths (ACS, 2003). median age of diagnosis for cervical cancer for all races is 48 years Today, certain types of HPV have been established as causal agents in the development of the cellular changes that may lead to cervical cancer (Janicek & Averette, 2001). Large studies have found that HPV is present in more than 93 percent of cervical cancer tumors (NCIa). HPV 16 is responsible for about 50 percent of cervical cancers. HPV 18, 31, and 45 account for another 30 percent of cases. Other HPV types are associated with the remaining 20 percent of cases Even though HPV is considered a cause of cervical cancer, only one out of 1,000 women with HPV develops invasive cervical cancer Most HPV infection never leads to the development of cervical cancer — even in the absence of medical intervention — and treating precancerous cervical lesions detected by Pap tests has greatly reduced the rate of invasive cervical cancer HPV appears to be necessary, but not sufficient, to the development of cervical cancer. Besides HPV type, researchers believe there are several cofactors that may contribute to the development of cervical cancer. These may include smoking, HIV infection, diet, hormonal factors, and the presence of other sexually transmitted infections, such as chlamydia and/or herpes simplex virus 2 Certain types of genital HPV are also now considered to be a cause of most cancers of the vagina, vulva, anus, and penis. Although each of these cancers occurs less frequently than does cervical cancer, taken together they equal nearly half the number of cases of cervical cancer in the U.S. (Eng & Butler, 1997). The average age for diagnosis of these cancers is significantly later than for cervical cancer. The median age of diagnosis for vaginal cancer is 67 years and 70 years for vulvar cancer. Anal cancer is typically diagnosed at 66 years of age for women and 63 years for men, and the average age of diagnosis for cancer of the penis is 66 years (Kiviat, et al., 1999). As is the case with cervical cancer, HPV 16 and HPV 18 are most often associated with vaginal, vulvar, anal, and penile cancers (Eng & Butler, 1997). An association has also been made between HPV and oral, head, and neck cancers, although further research needs to be conducted to establish a causal relationship (Mork, et al., 2001; Schwartz, et al., 1998). Men are three times more likely than women to develop head and neck cancers (HPV Treatment and Prevention Resource, 2001). Abstinence or lifelong monogamy are the most effective ways to avoid HPV infection. However, for most sexually active women, the most important preventive measure women can take to protect themselves from developing cervical cancer is having regular Pap tests Avoiding skin-to-skin contact with someone with HPV is the most effective strategy to prevent HPV infection. And although condoms may not eliminate the risk of transmitting HPV, the CDC recommends them for risk reduction . The claims of condom-use opponents who suggest that condom use leads to increased numbers of HPV infections are false and alarmist. Condom use cannot be blamed for the high prevalence of HPV infection or the incidence of cervical cancer among women in the U.S. While HPV is endemic among sexually active women and men in the U.S., it is reassuring to know that these infections most often remain asymptomatic and symptoms, if they occur, are usually manageable. Equally reassuring is the fact that condom use is likely to reduce the risk of infection. To reduce the risk of developing the most dangerous conditions associated with HPVs, women and men who are sexually active should have periodic physical checkups including evaluation of any symptoms of sexually transmitted infections. Sexually active women should be sure to have routine Pap tests as well. ©2007-2023, www.TheCitizensWhoCare.org/brookings/dobson.html