Silent Invaders

As the human papilloma virus becomes more common, education and research are needed to prevent its spread
Sunday, November 21, 2004 | 12:00 a.m. CST; updated 2:16 p.m. CDT, Thursday, June 26, 2008

Each year, thousands of Americans are unknowingly infected with a potentially fatal sexually transmitted disease, the human papilloma virus. Unknowingly, because the virus may not become externally visible until it’s too late.

Strains of the human papilloma virus can live undetected in a woman’s cervix and man’s penis for years. Left untreated in women, the virus can evolve into cervical cancer. It accounts for 80 percent of American cervical cancers per year, according to the federal Centers for Disease Control and Prevention. In men, the virus can cause penile and anal cancer.

At MU, the virus is the most commonly spread sexually transmitted disease among students, according to student health officials.

The number of cases at MU and nationwide is difficult to track because HPV is not only one of the deadliest sexually transmitted diseases but also one of the hardest to detect.

The CDC estimates that 5.5 million Americans are infected each year, with 20 million already carrying the disease.

Many carriers don’t even know they have HPV and spread it to their sexual partners, said Susan Even, executive director of MU’s Student Health Center.

Once a carrier is infected, the virus can take three to six months to become visible — sometimes in the form of genital warts. Other strains, however, grow silently, radically converting cervical wall cells into larger, abnormal cells with darker nuclei. Left unchecked, these cells multiply until they develop the capacity to spread deeper within the cervix.

“The wart virus is present in all kinds of secretions,” Even said. “So, even people who are religious about using condoms can still contract it from sexual partners because it only needs to have skin contact to be transmitted.”

Recent studies, however, show an HPV vaccine to be highly effective in preventing the spread of the virus.

A study conducted by pharmaceutical company Merck & Co. and the University of Washington found that only seven out of 775 female participants given the vaccine contracted the virus.

“Hopefully, we’ll be able to give teenage girls this vaccination before they become sexually active,” Even said. “It might not prevent all warts, but not all warts are implicated in cervical cancer.”

Merck is also conducting a study in 34 countries of a vaccine it hopes will prevent the spread of genital warts. Results will be released next year.

Until then, regular pap smears and pelvic exams are the best way to detect the virus in women, said Brenda McSherry, director of health services at Stephens College.

She worries that misinformation about the differences between pap smears and pelvic exams can lead to the continued spread of sexually transmitted diseases.

“Women think that when they’re getting a pap smear that STD testing is routinely done,” McSherry said. “That is not always the case.”

A pap smear only tests for cell changes and early signs of cervical cancer unless a woman asks for an HPV culture test. A pelvic exam includes other sexually transmitted disease tests. Women must ask what tests are being administered because only chlamydia and gonorrhea are standardly given, McSherry said.

“Couples can tell the other, ‘I was tested, and they said I was fine,’ but HPV and herpes are difficult to test if there isn’t a wart, lesion or abnormal cells visible,” she said.

Research conducted at the University of Massachusetts Medical School supports McSherry’s concern. The study found that two-thirds of the teenage females thought a Pap smear was the same as a pelvic exam.

Only three of the 111 teenagers surveyed knew that a Pap smear was not the same as a pregnancy test, a test for sexually transmitted diseases or a pelvic exam.

“The Pap smear to them is the whole gynecological exam, so they’re thinking they don’t need gynecological care for a few years after having sex,” said Diane Blake, the study’s author.

Z.A. Dalu, a former 20-year consultant for the St. Louis Health Department, questions why ailments such as heart disease, hypertension and diabetes receive large research grants and media attention when sexually transmitted disease infections are more prevalent.

“Our culture is in denial and fails to accept the responsibilities necessary to prevent the spread of disease,” said Dalu, who is conducting research on a herpes vaccine for women. “We need to add to the sexual knowledge of individuals that a condom doesn’t give full protection against many STDs like herpes and HPV.”

Sandra Handley, a nurse practitioner at the University of Missouri-Kansas City student health center, agrees that more public education is needed.

“It is harder and harder for providers to give advice about viral STDs because it keeps changing, and we don’t have good testing techniques,” she said.

Although women have routine checkups through pelvic exams and Pap smears, men’s options are far more limited. There is no such test for men, Dalu said.

HPV in men will often not show any symptoms other than those with strains that elicit genital warts. Even then, many of those genital warts grow on the inside of the penis.

“Men tend not to come in to get health care and so don’t get tested,” Even said, referring to the MU Student Health Center. “We are working on developing more marketing and public education.”

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