Thanks to new treatments to prevent cervical cancer and the public information campaign accompanying it, people are talking about the human papilloma virus (HPV). We can check to see if women are infected with HPV and we can offer many of the women with this infection a vaccine to prevent cervical cancer.
What we can’t do is give our patients a good coherent story that makes sense to them regarding how they became infected with the virus. We tell our patients that HPV is a sexually transmitted disease. Then we say that we can’t culture for the virus in men, and we don’t treat it in men. But it’s OK to continue to have sex with the partner who may have infected them after they have been treated. It is difficult for a person to wrap their minds around having unprotected sex with an infected and untreated partner. With 90% of all women said to be positive for the virus, was it all sexually transmitted?
Needless to say this creates a lot of stress for the patients involved. If it is sexually transmitted, then shouldn’t both partners be treated? And if a person does not plan to be sexually active, does this person have the option of not being treated?
Risk factors for cervical cancer include the presence of HPV, but 10% of women who have never had sex are HPV positive. And why do some people who have the virus develop cervical cancer, while others have no ill effects at all? The answers are still unknown. It is my feeling that the virus is normal flora in the body, but may be sexually activated.
One thing has become clear about HPV: There is an association between HPV and cervical cancer, and that association can be blunted by giving at-risk patients a vaccine.
We need to encourage our patients to get vaccinated, and be honest with ourselves and our patients about what we truly know about this problem, and what is an educated guess.
Tyler Cymet, DO
Section Head, Family Medicine Sinai Hospital of
Baltimore; Assistant Professor of Internal Medicine,
Johns Hopkins School of Medicine, Baltimore, Md