The Guide to Getting It On (110 page)

— Sexually Transmitted Infections —

Those That Condoms Aren’t As Effective In Preventing

Human Papilloma Virus (HPV): The Strains That Cause Genital Warts

Human papilloma or HPV is one of the sexually transmitted infections that condoms might help prevent but not with any degree of certainty. HPV is a virus that lives in the flat cells on the surface of the skin and on the moist mucosal membranes in the body. These include the urethra (peehole), vagina, cervix, penis, anus and throat.

There are at least 120 types or strains of human papilloma virus. While many of the HPV strains cause no symptoms, others can cause warts, like the warts people get on their hands and feet, or on their genitals, anus and thighs. Some of the HPV strains can cause cancer. The cancer-causing strains of HPV are discussed in separate sections that follow.

Approximately forty of the HPV strains are passed through sexual contact. These can infect the genital areas, including the skin around the vulva, cervix, penis or anus. They can also infect the mouth and throat. Most sexually active people will get HPV at some point in their life. It’s nearly impossible to avoid. It’s also nearly impossible to know who you got HPV from because it usually doesn’t have symptoms. Most people never know they have it. You might have only had sex once ten years ago and still not know you have HPV.

One of the fascinating things about HPV is that 90% of people who have it get rid of it on their own within one or two years. It doesn’t matter if it is one of the strains that causes warts or cancer. Most people’s immune system clears it.

Genital Warts:
About 1% of men and women have genital warts at any given time. Most genital warts are caused by HPV types 6 and 11. Genital warts are usually harmless but potentially gross looking. They are small growths that can sprout up on your genitals or anus.

Genital warts seldom hurt, except maybe your pride. Genital warts can be single or in groups. Some are flat, some are raised, some big, some small. Genital warts pose no health risk to you or your partner unless you have HIV. They won’t turn into cervical cancer.

It is possible to get genital warts from someone who has no warts and no symptoms. HPV is like that. It can take weeks or months for genital warts to show up after you had sex with an infected partner. Women can get genital warts on their vulva, vagina, cervix, anus or thighs. Men can get them on the penis, scrotum, anus or thighs.

Be sure to have a healthcare provider diagnose whether you have genital warts and discuss the treatment options. Unfortunately, treating the warts won’t necessarily make them less contagious.

Treatments to remove genital warts include surgery, medicines and freezing the warts off. One of the treatments is made from an extract of green tea. It is the first botanical to be approved as a prescription drug in the US. None of the treatments for genital warts work better than the others, although one type of treatment might be better suited to your particular situation. Another treatment strategy is to not have the warts treated and see if they go away on their own. Sometimes they do, sometimes they don’t.

If you want your warts removed, you can have a healthcare provider do it or you can use a home treatment. Current over-the-counter products for genital wart removal include podofilox and salicylic acid. There may also be homeopathic remedies. A pharmacist should be able to help you find whatever over-the-counter products are available if that’s what you decide.

Whether you or your healthcare provider remove the genital warts, the chances are good they will return and you will need to do more treatments.

If you currently have genital warts, you should tell a partner about them and avoid having sex until the warts are gone or removed. However, it’s not yet known how long a person can pass on genital warts after the warts are gone. So once the warts have come and gone away, no one knows if you should tell a future partner that you formerly had them. Talk to your healthcare provider about this.

Note: Some healthcare providers will apply a 3% to 5% solution of acetic acid to the skin of your genitals to see if you are HPV-infected. This is not a specific test for HPV and is not recommended.

Human Papilloma Virus (HPV): Strains That Cause Cancer

Cervical Cancer:
While the vast majority of HPV strains do not cause cancer, there are a couple of stinker strains that do. Cervical cancer is caused by HPV—mostly strain 16 and 18. What’s fascinating is that a lot of women will be infected with these strains of HPV, but their immune systems will clear the infections in an overwhelming majority of women. So there are other factors or cofactors that cause the infection to remain or be persistent in a small minority of women. And even then, less than 20% of women under the age of 55 who have a persistent infection with a carcinogenic strain of HPV will go on to develop cervical cancer.

So an important question is “What causes an infection to go from persistent to cancerous?” Smoking is a significant factor, but women who have never smoked can also get cervical cancer. So there must be something that causes the cancer switch to be thrown: perhaps there’s a genetic tendency in your family toward one type of cancer or another, perhaps it’s environmental or anything else that impacts a woman’s immune system. There is still much that we don’t know about cervical cancer.

Fortunately, women can protect themselves from getting cervical cancer by having routine pap smears and getting treatment if necessary. That’s because it can take a long time for cervical cancer to develop and the cells on the cervix usually show warning signs. This is why it’s so important to get pap smears. If a pap smear is unclear or irregular, a woman needs to follow up as recommended. If abnormal or precancerous cells are found, those areas can be cleared with cryotherapy or freezing. This will prevent the cancer from forming.

Anal Cancer, Vulvar Cancer, Vaginal Cancer, Penile Cancer:
These are rare cancers that are also caused by certain strains of HPV, particularly #16 and #18. One of the problems with these cancers is there are no methods to detect them early. Once they get bad enough to send the person to the doctor, they are often far along and can be difficult to treat.

Certain Oral Cancers:
Cancer of the Tonsils and Cancer of the Back of the Tongue: Please see the section on oral sex and HPV-positive cancer that follows.

HPV Vaccines:
There are currently two HPV vaccines. One was designed to protect against the two strains of HPV that cause cervical cancer, HPV # 16 and HPV #18. The second vaccine was designed to protect against the HPV strains that cause genital warts in addition to cancer. Unfortunately, we don’t yet know for sure if the vaccines will fulfil their promise of eliminating cervical cancer. We won’t know that for another decade or two. However, it’s now been almost ten years since the first group of human test subjects were vaccinated, and the vaccines appear to be performing as expected, which is encouraging. On the other hand, women will still need to get Pap smears, and whether a woman is vaccinated or not, most cervical cancers can be prevented with routine gynecological care. If you are under the age 26 and are interesting in taking the HPV vaccines, speak with your healthcare provider.

Oral Sex and HPV-Positive Oral Cancer?

Years ago, researchers discovered that strains 16 and 18 of the human papillomavirus caused most cervical cancers. They also found that women who had a greater number of sexual partners had a higher risk for getting cervical cancer. So when researchers recently discovered that cancer of the tonsils and cancer of the back of the tongue could be caused by HPV as well as by smoking and drinking, they started asking questions about sexual behavior. As it turned out, some of the studies showed that people who had the oral cancers that were associated with HPV had a higher number of oral sex partners than people who didn’t get these cancers. So it seemed reasonable to claim that oral sex was the cause of HPV-positive oral cancers. Researchers also noticed that the HPV-positive oral cancers, although uncommon, were on the rise. This matched nicely with the idea that oral sex must be the cause, because oral sex has become increasingly popular during the last fifty years.

A headline-grabbing oral-sex panic was in the making. Captions such as the following from CBS News in 2011 were becoming common: “Oral sex now main cause of oral cancer” followed by “What’s the leading cause of oral cancer? Smoking? Heavy drinking? Actually, it’s oral sex.” It wouldn’t be long before an exuberant HPV-oral cancer researcher would be releasing advisories to the media that parents should warn their children about the dangers of oral sex.

What the media forgot to mention is the average age of people who are diagnosed with HPV-related oral cancer is sixty-one years. This means it will be thirty-five to forty-five years before today’s teenagers start getting oral cancer—if they get oral cancer, which very few will. The chances of a teenager being killed in a car wreck during the next thirty years are almost a million times greater than the chances he or she will die from oral cancer during that time.

The media also forgot to report that billions of people have had oral sex with multiple partners, yet only a tiny percent have gone on to have an HPV-positive oral cancer. Clearly, something else is involved besides just oral sex. Otherwise, oral cancer would be the most common cancer on the planet instead of being one of the most uncommon.

Contrary to the reader-grabbing headlines, we don’t yet understand what leads to persistent HPV infection in the throat and mouth, and we don’t understand why a very small group of people who do get persistent oral HPV infections will go on to develop oral cancers. We also don’t know why men get HPV-related oral cancers at a much higher rate than women. Fortunately, oral cancer is an uncommon cancer, being number 14 on the list of cancers that women get and number 8 on the list of cancers that men get. And a significant percent of these cancers are caused by tobacco and alcohol rather than HPV. This will continue to be the case as long as people smoke, drink, and chew tobacco. Unfortunately, oral cancers can be devastating regardless of the cause.

According to the National Institute of Health, while HPV is certainly involved with some of the oral cancers, we don’t know yet how it’s involved, as we do for cervical cancer. This is a different story than has been presented in the media. As for the role of oral sex, one of the latest studies concludes: “...oral sexual contact in the form of both oral-oral and oral-genital contact could play a role in the transmission of oral HPV.” That’s the most we currently know. It will probably be years before we know the rest of the story.

Genital Herpes

Herpes is a virus, not a bacteria. There is no cure for it, although antiviral drugs can help with the symptoms. Condom use can reduce the risk of transmitting herpes by half, and antibiotics are totally ineffective against herpes.

Genital herpes is transmitted through sexual contact including intercourse, oral-genital contact, and rubbing naked genitals together. Seventy percent (70%) of new herpes cases are transmitted by someone who shows no obvious symptoms. Most genital herpes symptoms are mild. They are easy to miss.

Many people who get herpes fly into a panic when they are first told, thinking it’s the end of their sex lives. Before we get into the nuts and bolts of herpes, please take the following section to heart.

Herpes in Perspective — It’s Not Leprosy!

Many people know that cold sores or fever blisters in the mouth are a form of herpes, but they assume that genital herpes is so much worse. Yet these two forms of herpes are very similar—and the symptoms each causes are also similar. So why do we need special dating sites for people who have herpes in the crotch, but not for people who have herpes in the mouth? Why the added stigma for genital herpes?

On the website of the American Social Health Association, it says that most of the 50 million Americans who have genital herpes do not even know they have it. According to the CDC, most individuals with genital herpes have very mild signs that they don’t even notice. Yet people behave as if genital herpes is a terrible disease. Perhaps that’s because it shows up below the belt as opposed to above.

This is not to minimize the impact of genital herpes. The symptoms can be severe for some people. So if you know you have it, you need to inform a potential partner before you have sex. And if you don’t have herpes, try to protect yourself from getting it. But if you are searching for perspective, the same should be true for oral herpes.

Oral herpes resides in a part of the body that is much closer to the brain than genital herpes. Some researchers are starting to worry about a possible connection between oral herpes and Alzheimer’s. As upset as people are about genital herpes, no one has ever suggested it could someday cause you to lose your mind.

So please, if you find out you have genital herpes, keep it in perspective. Learn all you can about it. Stay healthy. And try to keep it in perspective.

The Different Types of Herpes

Herpes Simplex Virus 1: Oral Herpes
The most common form of herpes is Herpes Simplex Virus 1 (HSV1), which causes cold sores on the lips, nose, chin and other parts of your face. People usually get HSV1 during childhood and most symptoms go unnoticed because they are minor. About 56% of people over age 14 in the US display evidence of a previous HSV1 infection when their blood is tested.