Michael Douglas and the Truth about HPV

The actor Michael Douglas recently set the media atwitter with his announcement that his battle with throat cancer could be attributed to Human Papillomavirus (HPV), which he purportedly told a U.K. newspaper that he contracted through oral sex. Whether or not his statement was accurate (and his spokesman certainly disagrees!), his announcement brings due attention to a serious public health issue.

HPV, which is the most common sexually transmitted disease (STD) in the United States, is linked with genital warts and cervical cancer. In fact, HPV is the ONLY known cause of cervical cancer – over 99 percent of all cases of cervical cancer are attributable to HPV. But, many people don’t know that HPV is also linked with other health risks, including oropharyngeal (tongue, tonsil, and pharynx) cancer, penile cancer, and anal cancer.

According to the CDC, an estimated four out of five women in the United States are infected with HPV by age 50, and four out of ten women ages 14 to 59 currently have HPV.

Adolescents and young adults are at particular risk for contracting HPV, due to the higher numbers of sexual partners, fewer long-term committed relationships, and less consistent condom and contraceptive use that happen at these ages. Case in point: about three-quarters of all new HPV infections occur during adolescence and young adulthood, and research suggests that roughly one-third of teenage and young adult females currently have HPV. Many health experts consider males “carriers” of HPV due to their lower known risks associated with HPV, but it is estimated that a substantial number of young men have HPV as well. Men can transmit the virus to future sex partners, even if they are asymptomatic.  Thus, males are an important group to target in the fight against HPV, too.

The bad news is that HPV is not curable. However, preventative measures (such as pap smears for women, which can detect cancerous cells) and successful treatments for genital warts and other complications of HPV,  make regular screening for HPV an important part of young men and women’s sexual and reproductive health. Currently, there are no HPV tests for males (although the presence of genital warts or cancerous cells can indicate infection with HPV), but ensuring that female partners are screened can help identify those at risk.

The good news is that several years ago, the Food and Drug Administration (FDA) approved two different HPV vaccines for adolescent girls and young adult women, which protect against some of the most common strains of HPV and the strains most commonly linked with cervical cancer. The FDA also recently approved one of the vaccines for boys and young men. The vaccines, which come in three doses spread three months apart, can be costly, but they are also covered by most insurance plans – public and private. Notably, the American Academy of Pediatrics recommends the HPV vaccine for all adolescents – girls and boys. Importantly, the vaccine is MOST effective before adolescents become sexually active (and thus risk exposure to the four strains of HPV against which the vaccine protects). And adolescents and young adults should remember that condoms can also offer protection against HPV, when used during oral, anal, and vaginal sex.

At present, researchers have identified more than one hundred strains of HPV. In most cases, people with HPV do not develop any health problems and the virus often goes away on its own. For example, around 90 percent of women who contract an HPV infection test negative for HPV after two years. The numbers are even more promising for men.

Nonetheless, HPV represents a serious health risk, and the number of young women and men who have been vaccinated remain strikingly low. In 2010, for example, less than half of adolescent girls ages 13 to 17 had started the 3-dose vaccination, and a substantial portion of them did not complete all three doses. Of course, given that the HPV vaccine is the first of its kind (that is, the first vaccine for a virus for which the only known route of transmission is through sexual contact), it is understandable that some families may have concerns about vaccinating their child. Families and individuals should talk with their pediatricians, primary care physicians, or gynecologists to see if the weigh the risks and benfits of this vaccine and take a fact-based approach when deciding whether or not to vaccinate. For more information, visit the CDC website on HPV.