Google Answers Logo
View Question
 
Q: HPV testing for men ( Answered 4 out of 5 stars,   5 Comments )
Question  
Subject: HPV testing for men
Category: Health > Men's Health
Asked by: malcolm11-ga
List Price: $200.00
Posted: 03 Sep 2005 20:38 PDT
Expires: 03 Oct 2005 20:38 PDT
Question ID: 564071
Hello,


I am a single man who recently (several weeks ago) slept with someone
who I found out had been infected with HPV -- in particular, one of
the "high-risk" strains that can lead to cervical cancer in women. 
She had first been exposed about nine months earlier.

I have had no obvious symptoms of anything.  However, men often do not
show symptoms of HPV, so I may still be a carrier.  It seems likely --
HPV is easily transmitted, and we had intercourse three times without
protection -- but I just don't know.

This is a really frustrating situation.  Before this, I've been
"clean."  Now I need to talk to any potential partners about the
possibility I have "high-risk HPV" so they can educate themselves and
decide whether or not to take the risk.  Talk about putting a damper
on a romantic evening.

HPV can be spread through all gential-area skin-to-skin contact, so
condom usage with future partners wouldn't fully mitigate the risk.


I see three ways of dealing with this situation:

1) Tell any potential partner about my situation, and accept the
inconvenience of having to have a period of weighty discussion and
deliberation before sex.

2) Do not tell any potential partner about my situation and expose
them to the risk.  I only consider this a morally acceptable option if
the risk of passing them the virus and developing cervical cancer is
sufficiently small.  One in one million, for example, would be
sufficiently small -- most people accept that kind of risk every day
when they get in a car and risk getting in a serious accident.  Not
sure exactly what an accepable risk threshold is for me.

3) Get tested for HPV, potentially discovering that I do not have the virus.


My questions are:

- How can a man get tested for HPV?  My research has indicated that
there are no commercially available, FDA-approved tests to detect HPV
in men.  So how about non-commercially-available -- perhaps in a
research setting?  Or non-FDA-approved -- in another country?  Any
other ways to get reliably tested?

- Do you see any options I am missing?


Bonus question, not required for payment but may earn a tip up to $50+:

- What are the approximate odds that a person whom an individual in my
situation has intercourse with will develop cervical cancer due to the
fact that we had intercourse?  Consider factors like condom usage with
the original partner and the new partner, length of time since my
original HPV-carrying partner had obtained the virus, etc.


Thank you!
Answer  
Subject: Re: HPV testing for men
Answered By: crabcakes-ga on 05 Sep 2005 13:10 PDT
Rated:4 out of 5 stars
 
Hello Malcom11,

   I?ve tried to break my answer up into categories, following your
questions, but because the information overlaps, this was not entirely
possible. I hope you find the answers to all your questions contained
in my answer. If not, please request an Answer Clarification, before
rating, and I will be glad to assist  your further.

Question 1)
============ 

 How can a man get tested for HPV?  My research has indicated that
there are no commercially available, FDA-approved tests to detect HPV
in men.  So how about non-commercially-available -- perhaps in a
research setting?  Or non-FDA-approved -- in another country?  Any
other ways to get reliably tested?

---
   You are correct, there are no FDA approved tests available for male
HPV. The current thinking seems to be that since it is so difficult to
test men, coupled with the fact that HPV rarely causes disease in men,
that women should bear the brunt of taking care of their own sexual
health.

However, some doctors do utilize the presently available tests for
women, on men, for informational purposes. Some sperm banks utilize a
PCR test to test sperm for HPV, and there are some experimental
serological tests being researched. I have found a few research
labs/clinics where you may be able to be tested.

I would first recommend visiting a urologist, who can examine you, and
using the old standard, an acetic acid test, look for even tiny signs
of infection. A urologist, particularly one who specializes in
sexually transmitted diseases, will know the best way to collect a
sample and where to send your sample for HPV testing. Ask your family
doctor for a referral, call Planned Parenthood, or look in the phone
book for urologists who specialize in men?s sexual health in the
physician section.

Have you considered  getting tested for HIV, herpes and other STDs
such as chlamydia and gonorrhea, syphilis! I don?t mean to alarm you,
but STDs are know to travel together! Co-infection is not uncommon!
??there is evidence suggesting that the higher prevalence of HPV among
HIV-seropositive women reflects persistence or reactivation of
pre-existing HPV infection rather than recent acquisition of new
infection (Palefsky 1999).?
http://www.rho.org/html/cxca_keyissues.htm#role

The Acid test - Literally! 
http://sextrans.bmjjournals.com/cgi/content/abstract/68/2/90


?Genital warts often do not have symptoms of pain or irritation. To
look for warts, a health care provider may put acetic acid (vinegar)
on the genitals. This causes the wart to turn white and makes it
easier to see, especially if viewed through a magnifying lens, such as
a colposcope. However, the vinegar can sometimes cause other skin
changes to be highlighted.  ?
http://www.indiana.edu/~health/hpv.html


 ?Most of the time, males will not have any symptoms or health risks,
such as cancer, with the "high-risk" types of HPV. We recommend that
sexual partners be examined by a physician. If warts are found on
examination, the partner can be treated. If warts are not found, the
male may still carry HPV but show no signs of it. HPV prevention
strategies include maintaining integrity of the skin, maintaining a
healthy lifestyle (proper nutrition and exercise to keep the immune
system strong), cessation of smoking and the consistent use of condoms
during sexual intercourse.?
http://www.ameripath.com/healthcare/womenshealth/hpv.htm

?Keep in mind it is rare for ?high-risk? HPV to lead to cancer. In
2005, for example, the American Cancer Society estimates only about
1,750 cases of anal cancer will occur with men and that penile cancer
will account for approximately 0.2% of all cancers in males.?
http://www.ashastd.org/learn/learn_hpv_men.cfm

?How are men screened for HPV?
Men are typically screened clinically with a visual inspection to
check for lesions (such as warts) ? there is no specific way to test
directly for HPV in men that is approved for clinical use. Researchers
are looking at ways to better screen men, but the current lack of
testing options for males can be very frustrating.?
http://www.ashastd.org/hpv/hpv_learn_men.cfm


?PCR testing for HPV DNA can detect as few as 500 viral particles per specimen.
The negative predictive value of this test is estimated to be greater
than 99.9%: if a patient?s HPV test result is negative for high-risk
HPV DNA, the chance she harbors high-grade dysplasia or carcinoma is
less than 0.1%.

In addition, PCR testing is highly specific for the detection of HPV. The natural
course of high-risk HPV infection involves an indeterminate period of latent
infection, frequently followed by dysplasia and then carcinoma.
Consequently, some patients in the latent infection period may test
positive for HPV but show no current abnormalities on biopsy.
Large-scale evaluation will clarify the number of patients with
high-risk HPV infection who later develop dysplasia or carcinoma;
presently, studies suggest that this percentage will be very high.
Accordingly, patients with highrisk HPV infection should be followed
more closely than HPV-negative patients, as abnormalities are more
likely to develop.?
http://labguide.fairview.org/newsletters/LF0301.pdf


?Study: Detecting Human Papillomavirus DNA in Men  
A study presented at the Human Papillomavirus 2002 International
Conference in Paris evaluated methods for detection of genital human
papillomavirus (HPV) DNA in men. In this study, samples were obtained
from three consecutive groups of 10 men attending a sexually
transmitted disease clinic by use of (1) a saline-wetted Dacron swab
alone, (2) a saline-wetted cytobrush, or (3) emery paper (600A-grit
Wetordry Tri-M-ite; 3M) abrasion followed by a saline-wetted Dacron
swab. By use of a polymerase chain reaction-based assay, 45% of
emery-paper samples were found to be positive for -globin, compared
with 23% of swab-alone and 0% of cytobrush samples. Subsequently,
emery paper and saline-wetted Dacron swabs were used to obtain penile
shaft, glans, foreskin, and scrotum samples from 318 male university
students. Urine samples were also obtained. Of 1323 samples tested,
1288 (97%) were found to be positive for -globin. HPV DNA was detected
in samples from 104 men (33%): 24% from the penile shaft, 16% from the
glans, 28% from the foreskin, 17% from the scrotum, and 6% in urine.
The HPV prevalence was similar for circumcised and uncircumcised men.
Testing multiple sites increased the number of men for whom HPV DNA
was detected.
Bethany A. Weaver et al. Evaluation of Genital Sites and Sampling
Techniques for Detection of Human Papillomavirus DNA in Men. JID
2004;189:677-685.?
http://www.idcronline.org/archives/may04/news.html


?Most of the time, males will not have any symptoms or health risks,
such as cancer, with the "high-risk" types of HPV. We recommend that
sexual partners be examined by a physician. If warts are found on
examination, the partner can be treated. If warts are not found, the
male may still carry HPV but show no signs of it. HPV prevention
strategies include maintaining integrity of the skin, maintaining a
healthy lifestyle (proper nutrition and exercise to keep the immune
system strong), cessation of smoking and the consistent use of condoms
during sexual intercourse.?
http://www.ameripath.com/patients/wh/hpv.htm

??We?d always assumed that if there were no lesions on the penis, then
were was no infection. Now we know that?s not the case,? said Roger
Pierson, director of the Reproductive Biology Research Institute on
campus. Even after washing the sperm, the virus remained detectable in
all but two of 27 HPV-positive sperm samples. This suggests the virus
is bound to the membrane of the sperm and that sperm washing does not
eliminate the risk of HPV transmission to recipients, Pierson said.?
http://www.usask.ca/events/news/articles/20000615-2.html


How soon after exposure to HPV will symptoms appear?
?Warts typically appear within 3 weeks to 6 months after sexual
contact with an infected person, but they can also take years to
appear. This time period makes it difficult to track the infection as
it's passed from one partner to the next.?
?Most men with HPV don't have any symptoms and so diagnosing HPV in
men is difficult. Since there is no treatment for asymptomatic HPV,
most men are not treated. It is possible for men to think they have no
symptoms when they actually do. Sometimes a medical provider can see
small warts that have gone unnoticed, particularly if they are right
inside the opening of the penis.
Men and women should stop having sexual contact as soon as they know
or think they have genital warts and they should seek treatment
immediately.?
http://www.brown.edu/Student_Services/Health_Services/Health_Education/sexual_health/sti/hpv.htm


?Human papillomavirus (HPV) is the main etiologic agent of anogenital
cancers, including cervical cancer, but little is known about the
type-specific prevalence of HPV in men. Participants were men aged
18-70 years attending a sexually transmitted disease clinic. Penile
skin swabs were assessed for HPV DNA using polymerase chain reaction
with reverse line-blot genotyping. Of 436 swabs collected, 90.1%
yielded sufficient DNA for HPV analysis. Men with inadequate swab
samples were significantly more likely to be white and circumcised
than men with adequate swab samples. The prevalence of HPV was 28.2%.
Oncogenic HPV types were found in 12.0% of participants, nononcogenic
types were found in 14.8% of participants, multiple types were found
in 6.1% of participants, and unknown types were found in 5.9% of
participants. The most prevalent subtypes were nononcogenic 6, 53, and
84. HPV positivity was not associated with age. These results indicate
that HPV infection among men at high risk is common but that
characteristics of male HPV infection may differ from those of female
infection.?
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12660920&dopt=Abstract


?Two studies from the Netherlands may suggest that consistent condom
use can speed the regression of human papilloma virus (HPV)-related
lesions on the cervix and on the penis and shorten the time it takes
to clear HPV infections. The researchers believe that their findings
add to the evidence that condoms can be a useful tool in the
prevention of HPV-related cancers, though some experts consider the
issue still unresolved.

Researchers from VU University Medical Center in Amsterdam and Albert
Schweitzer Hospital in Dordrecht described their results in two
articles in the International Journal of Cancer (2003;107:804?810 and
811?816). Both studies involved long-term (8 to 10 years) monogamous
heterosexual couples in which the women had cervical intraepithelial
neoplasia (CIN).?
http://caonline.amcancersoc.org/cgi/content/full/54/2/69


?HPV DNA was detected by PCR in 23 of 27 (85%) specimens from patients
attending the GUM clinic for treatment of genital warts and in one of
two specimens from patients attending the clinic for other conditions.
By Southern blot, nine (33%) of the 29 specimens from GUM clinic
patients were HPV DNA-positive. HPV DNA was detected by PCR in 43 of
104 (41%) of specimens from males attending the ACU, whilst 70 of
these tested by Southern blot hybridisation were all negative for HPV
DNA. CONCLUSIONS--The data suggest that urethral HPV infections, as
indicated by the presence of HPV DNA in semen, are prevalent in males
with and without genital warts.?
http://sextrans.bmjjournals.com/cgi/content/abstract/67/3/207


?Background: A possible reason for the failure to detect human
papillomavirus (HPV) DNA in asymptomatic men who are likely to be
infected is the sensitivity of the detection methods.
Goal: The goal of this study was to identify a method for sampling the
anogenital skin of men that was simple and well tolerated and that
would permit the detection of asymptomatic or subclinical HPV
infection, which is thought to occur commonly in sexually active men.
Study Design: Swabs of genital skin and urine from men at high and low
risk of infection with types 6 and 11 were tested for HPV by
polymerase chain reaction.
Results: These specimens had a low sensitivity for HPV detection,
often because inadequate material was collected on the swab.
Conclusion: Noninvasive sampling of genital skin to identify
individuals with subclinical HPV infection remains a challenge. Future
studies should involve the use of more abrasive sampling devices (such
as cytobrushes), perhaps combined with some type of soap to dislodge
more epithelial cells.?
http://www.stdjournal.com/pt/re/std/abstract.00007435-200303000-00014.htm;jsessionid=Dbxa9o9JEMcOGfXar7Dpni96YMfo4bYl5LxpC2xhuAtmzjUPL6K4!1389088241!-949856145!9001!-1

?The most accurate method of detecting an HPV virus infection is DNA
testing. DNA is the genetic material present in all living cells. Each
HPV viral type has its own unique DNA. Samples of genital skin cells
can be collected & tested for the viral DNA. However, not all
infections can be found even with these sophisticated tests, nor can
DNA testing find all the viral types. That means it is impossible to
be 100% sure if or which HPV infection is present.?
http://www.sexualhealth.com/article.php?Action=read&article_id=83&channel=15&topic=109

?Cell mediated immunity and the HLA system may play key roles in
preventing or facilitating chronic HPV infection. Currently, these are
areas of intense research activity, and it is expected that the
function of the immune system with regards to HPV infection and
disease development will be better understood and elucidated in the
next few years (McDougall, Galloway, & Daling, 1996; Rader, 1996).?
http://www.phac-aspc.gc.ca/publicat/cjhs/cjhs4.html

?It is important to dispel potential misconceptions that patients may
have about HPV. For example, many patients will need, and be comforted
by, information about the high prevalence of HPV, the generally benign
natural history of most HPV infections, and the relatively low risk of
subsequent genital cancer if management guidelines are followed. Many
patients will assume that they have acquired HPV from their current
sexual partner. While this may be the case, patients should be
informed that due to the sometimes very long incubation time before
lesions appear, the presence of HPV does not necessarily imply that
the infection was acquired from the current partner or that the
partner has been unfaithful. Although there is a high probability that
the current partner is also infected, there is no proven benefit from
examining partners.?
http://www.phac-aspc.gc.ca/publicat/cjhs/cjhs4.html


?Little is known about how HPV affects men, Giuliano said, although
the virus is common.
An estimated 30 percent of young American women and men are infected. 
The virus has been associated with anal cancer and penile cancer, a
rare disease in the United States. Some strains also can cause genital
warts.
Still, HPV usually isn't a problem for men, who are less likely to
show symptoms than women, Giuliano said.?
http://health.tbo.com/health/MGB56P0NN4E.html


 ?In 95% of the urethral-coronal sulcus samples, the [beta]-globin
gene was detectable, indicating adequacy of the specimen for DNA
amplification; however, only 14% of the urine specimens had detectable
[beta]-globin. Removal of inhibitors by DNA purification in a sample
of subjects produced [beta]-globin amplification, but no increase in
human papillomavirus DNA positivity was detected. Human papillomavirus
DNA was not detectable in penile-urethral swab samples in any of the
subjects who reported not having engaged in sexual activity but was
present in 43% of men who reported sexual activity, a strong
indication of the sexual transmission of human papillomavirus.
Conclusions: Human papillomavirus is a common sexually transmitted
infection among Mexican males, and urine sample specimens cannot
adequately detect the presence of this infection in males.?
http://www.stdjournal.com/pt/re/std/abstract.00007435-200105000-00007.htm;jsessionid=DbvLjPQsfQSiowzMVoYM1deC7j4CnkUg1mdkJZO6MbdMUXvluhxC!1971627109!-949856144!9001!-1


?A series of 122 males at high risk for development of human
papillomavirus (HPV) infection were prospectively studied with
simultaneous urethral brushing cytology and ViraPap, to establish
their relative sensitivity and specificity in relation to the
diagnosis of HPV infection in the urethral canal. The prevalence of
disease in this high-risk population was 10 percent. The sensitivity
of DNA hybridization was determined to be 67 percent, with a 100
percent specificity, as compared with a 25 percent sensitivity of
cytologic analysis. Physical examination alone had a 75 percent
sensitivity. Physical examination with ViraPap urethral analysis
identified all patients with urethral HPV-associated disease. These
results indicate that clinical examination alone misses one quarter of
the HPV-involved patients.?
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2164271&dopt=Citation

**Note, Vira-Pap is no longer manufactured.
http://www.dcla.com/prof_hpv.html

One Canadian study found that 53% of infected men tested positive for
HPV by using the PCR method on their sperm.
?We detected HPV DNA in the sperm cells of 24 of 45 subjects (53%)
with past or current HPV infections in contrast to three of 40 healthy
subjects (8%) (P < .001). Overall, PCR detected HPV in 21 of 32
subjects (66%) with identifiable lesions and six of 53 (11%) without
them (P < .001). Swim-up washings of all 27 prewash sperm cells with
HPV reduced cellular HPV DNA below detectable levels in only two
cases.?
http://www.greenjournal.org/cgi/content/abstract/97/3/357


 ?The virus can exist throughout most of the anogenital area
(including areas not covered by male condoms). Although treatment
strategies are available for the genital warts sometimes caused by
HPV, no therapies exist to eliminate the underlying infection (Koutsky
et al. 1999; PATH/Outlook 1998). It is not entirely clear that barrier
methods of protection against STIs are effective in protecting women
from cervical cancer. A number of studies have found barrier methods
to be protective (Grimes et al. 1995; Coker et al. 1992; Thomas et al.
1996), including one study that found condom use significantly reduced
the risk of acquiring genital warts (Wen et al. 1999). Other studies
have not found a significant association between use of barrier
methods and cervical cancer prevention (Hildesheim et al. 1990). HPV
DNA also has been detected on the fingertips of persons with genital
warts, suggesting a potential for transmission of HPV infection by
finger-genital contact (Sonnex et al. 1999), although this may be an
unlikely route of transmission (Mindel and Tideman 1999). Researchers
also are beginning to focus on the possible role of men who may be
acquiring high-risk HPV from frequent contact with sex workers and
transmitting the infection to their wives (Thomas et al. 2001).
Results from pooled data from IARC's seven case-control studies shows
a strong association between circumcision and a reduced risk of penile
HPV and subsequent cervical cancer in female partners (Castellsague et
al. 2002).?
http://www.rho.org/html/cxca_keyissues.htm#role


?Few studies are currently available where serum HPV antibodies have
been analysed in children.1,19,20 When HPV 16 peptides are used, the
detection rate of serum HPV antibodies is much higher (24?33%) than
with virus-like particles (VLPs) of HPV 16 (3?15%). The seroprevalence
is also related to the number of VLPs tested. The preliminary results
from our Finnish HPV Family Study indicate, however, that
seroconversion to both low-risk and high-risk HPV types can be
detected already at the age of 6 to 12 months.?
http://www.sogc.org/scc/english/newsletters/documents/HPVToday-April05.pdf


==============================
Possible Places to be Tested:
==============================

Cancer Research Center of Hawaii is conducting research on male HPV.
This site was last updated in February, 2005, so you will need to
contact them to see if the study is ongoing yet. ?Currently, there is
no medical standard for HPV testing in men. Consequently, HPV testing
is not offered as a part of routine medical care in Hawaii or anywhere
else (and is not covered by medical insurance). We test for HPV in men
for research purposes only. Our male HPV study will be analyzing HPV
DNA by taking swab samples from the penis and other sites.?
http://www.hawaii.edu/hpv/partner/eligibility.html

There is no closing date posted on the site. Here is contact information:
http://www.hawaii.edu/hpv/partner/contactus.html



University of Saskatchewan
For more information contact:

Dr. Femi Olatunbosun
Chair, Obstetrics, Gynecology and Reproductive Sciences 
University of Saskatchewan
(306) 966-8033

Roger Pierson
Professor, Obstetrics, Gynecology and Reproductive Sciences 
University of Saskatchewan
(306) 966-4458

Kathryn Warden
Research Communications Officer
University of Saskatchewan
(306) 966-2506
http://www.usask.ca/events/news/articles/20000615-2.html


These resources may have suggestions on how to get tested:
American Social Health Association (ASHA)
P.O. Box 13827
Research Triangle Park, NC 27709
(919) 361-8400
(919) 361-8425 (fax)
www.ashastd.org

American Cancer Society (ACS)
1599 Clifton Rd. NE
Atlanta, GA 30329
800-ACS-2345
(404) 329-7530
www.cancer.org

National Center for HIV, STD, & TB Prevention
Centers for Disease Control and Prevention
Atlanta, GA 30333
nchstp@cdc.gov
www.cdc.gov/nchstp/od/nchstp.html
Toll-free voice information: 888-232-3228
CDC STI Hotline: 800-227-8922


?The potential value of anal cancer screening is confirmed in studies
by Dr Sue Goldie of the Harvard School of Public Health and Dr Joel
Palefsky of the University of California at San Francisco. Their
research was published respectively in the American Journal of
Medicine in 2000 (108:634-41) and in the scientific magazine AIDS in
1998 (12:495-503) - and reported on BBC Online News, 9 November 2000.?
?It depends on how you define anal cancer. Anal HPV infection can lead
to cancer in the anus, rectum and perhaps even the lower colon. Your
department's statistics appear to refer to cancer that is strictly
localised in the anus only (as opposed to the rectum and lower colon).
This means the figures do not record all cancers that arise from anal
HPV infection.?
http://www.petertatchell.net/health/analcancer.htm


You MAY be able to be tested at Brigham and Women?s Hospital, an
affiliate of Harvard University, in Boston, MA
http://healthgate.partners.org/browsing/browseContent.asp?fileName=32308.xml&title=Human%20Papillomavirus%20(HPV)%20Testing
Contact Information
https://www.brighamandwomens.org/forms/contactus.asp


================
Cervical Cancer:
================

I?m assuming when you say the type of HPV your female friend has is
?high risk? for cancer, that it is HPV-16 or HPV-18, as they are the
most pathogenic strains. HPV-31 and HPV-33 types are considered as
possible carcinogens. Other types are considered to be less likely to
cause cancer.

?The types of HPV that cause abnormalities on the cells of the cervix,
(usually Types 16,18 and 31 and several others) cannot be seen with
the naked eye.   Although infection with these "Intermediate/High
Risk" HPV types is common  it rarely turns into anything serious in
healthy young women who don't smoke.  Most of the time the virus will
either become suppressed or be made dormant by the body's immune
system or perhaps, even cleared, so that it cannot be detected.
Studies show that this usually occurs in 12 - 24 months.?
http://www.health.arizona.edu/webfiles/health_services_womens_health_pap.htm


?Cervical cancer occurs when cells on the cervix grow in an abnormal
way. The human papillomavirus (HPV), the sexually transmitted disease
which can cause genital warts, is a precursor to cancer of the cervix.
Have regular Pap tests to check for this condition as it can be fatal.
There are different treatment options available, however they can
impact your ability to have children in the future.
When cervical cancer is detected at its earliest stage, the 5-year
survival rate is more than 90 percent.?
http://www.epigee.org/health/cervical.html 


 ?Patients with SIL (squamous intraepithelial lesions, which are
precancerous) are infectious and may remaininfectious after treatment.
Fully eliminating transmissibility in these patients is not possible,
but condom use substantially reduces the risk of transmission, but
does not eliminate it entirely.  The transmission that does occur with
condom use relates to the virus being shed from subclinical infection
on squamous epithelial sites not covered by a condom. There is a myth
that HPV can fit through condom pores. The reality is that latex
condoms are essentially non-porous.  The only condoms with pores large
enough to transmit the virus are ones made of sheep gut, which are not
widely used.
http://www.stacommunications.com/journals/pdfs/diagnosis/dxdecember02/womenhealthcare.pdf


?Cervical cancer strikes fewer women than it once did, but among women
younger than 50, the disease has actually become more common. That
fact, reported by the American Cancer Society, is especially
disturbing because cervical cancer is largely preventable.?
?Carcinoma of the cervix is one of the most common malignancies in
women, accounting for 15,700 new cases (6 percent of all cancers) and
4,900 deaths in the United States each year. However, since the
implementation of the Pap smear in the 1950s, the number of deaths due
to cervical carcinoma has decreased by over 70%.2 Clearly, the Pap
smear is an excellent screening tool for detecting high grade cervical
lesions and preventing cervical carcinoma.?
http://labguide.fairview.org/newsletters/LF0301.pdf


?It is estimated that 400,000 women develop cervical cancer each year,
including nearly 13,000 Americans. Deaths from cervical cancer have
declined in the U.S. as more women now receive annual Pap smears. The
American Cancer Society estimates that approximately 4,600 Americans
die from cervical cancer each year. When detected early, the chances
for successful treatment and survival are high. The 5-year survival
rate for early invasive cervical cancer is approximately 91%. The
overall 5-year survival rate for all stages of cervical cancer is
around 70%, and for pre-invasive cervical cancer, the 5-year survival
rate is nearly 100%.?

?MYTH: If you have HPV, you will get cervical cancer.

FACT: Although HPV is very common, cervical cancer is not. The virus
usually disappears on its own in a few months without causing any
problems. In fact, studies show that 70 percent of new HPV infections
in young women disappear within one year, and as many as 91 percent
disappear within two years.7 However, it's important not to be
complacent. Only persistent infections ? more commonly found in women
30 or older ? can lead to cervical cancer if pre?cancerous cell
changes caused by HPV are not detected and treated early. In fact, it
is estimated that women who have HPV are more than 200 times more
likely to develop cervical cancer than those who don't have the virus.


MYTH: There is no particular value in finding out your HPV status,
since there isn't anything you can do about it anyway.

FACT: There is a lot you and your doctor can do if you are HPV
positive. Recent guidelines recommend that if your Pap test is normal,
but your HPV test is positive, your doctor should re?test you in six
to 12 months.9 If the infection persists (the HPV test is again
positive), the next step is an exam called a colposcopy, in which a
device allows the cervix to be better visualized using magnification,
followed by a tissue biopsy if the cells appear abnormal. If the cells
are found to be pre?cancerous, treatment can be initiated immediately
? ensuring the best outcome possible (cancer can almost always be
prevented before it occurs).?
http://imaginis.com/womenshealth/news/news2.26.01.asp



?In fact, among couples in which the man was uncircumcised and had at
least six sex partners, the risk of his partner getting cervical
cancer was more than double that of partners of circumcised men with
multiple partners. Uncircumcised men were three to five times more
likely to be infected by the human papillo-mavirus (HPV), which they
may then pass on to their partners through sexual intercourse. This
virus can cause genital warts in both men and women and has been
linked to cervical cancer. Doctors aren't certain why being snipped
protects against HPV infection, but they suspect that the inside
surface of the foreskin is more vulnerable to infection than other
penile skin.?
http://www.findarticles.com/p/articles/mi_m1264/is_7_33/ai_94384245


?CONCLUSION: Most young women with a positive HPV test will become
negative within a 24-month period. Persistent positive tests with
oncogenic HPV types represented a significant risk for the development
of HSIL. However, we found that most young women with persistent
positive HPV tests did not have cytologically perceptible HSIL over a
2-year period. Factors thought to be associated with the development
of HSIL were found not to be important in HPV regression.?
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&list_uids=9506641&dopt=Citation


 ?Women can also prevent cervical cancer in a more basic way. Many of
the risk factors for the disease?early or multiple pregnancies, first
intercourse at an early age and previous infection with human
papillomavirus (HPV), herpes, gonorrhea or syphilis?are directly
related to sexual activity. In fact, cervical cancer in many instances
can be considered a sexually transmitted disease (STD). Many cases of
cervical cancer can be prevented in the same way as other STDs.?
http://www.sjmed.com/Scripts/library/article.asp?artid=81&catid=6


?So why is it helpful to know if a woman has HPV? "It is incredibly
important. If you know you have HPV, then regular screening becomes
much more important so that you can prevent cervical cancer.?
http://dms.dartmouth.edu/news/2001/17jul2001_harper.shtml

?Since 40 million Americans have HPV and most strains are harmless,
testing for HPV is not beneficial unless Pap smears produce unclear
results. Research also shows that the majority of women who are
diagnosed with cervical cancer did not receive annual Pap smears to
screen for the cancer.
The Digene Corporation?s Capture HPV test has been approved by the
U.S. Food and Drug Administration (FDA) since 1999 and costs
approximately $50. Around 15% of women with unclear Pap results
currently receive HPV testing. The recent NCI study results will be
discussed at two upcoming conferences and may change guidelines for
how women with unclear Pap results are evaluated.?
http://imaginis.com/womenshealth/news/news2.26.01.asp


==================================================================
1) Tell any potential partner about my situation, and accept the
inconvenience of having to have a period of weighty discussion and
deliberation before sex.
==================================================================

I  lean towards Option Number One, regardless of the chances. (And I
get the impression you are a very conscientious gentleman). I say this
also because you have been exposed to the more virulent strains of
HPV.  Even if the risk were one in a billion, It seems that advising
any potential partners is the right thing to do. A woman should have
the right to determine the risk she is willing to take. While the risk
IS low, for one person to cause another to spend the rest of their
life  being hyper-vigilant of their cervical health should be the call
of the woman. Consider too that if you infect a woman, she may infect
another man, who may infect another woman! You may want to share the
following information with your female partners. I feel sure if the
conditions were reversed you would want your partner to tell you,
before engaging in sex, so you could make the decision yourself.



?Open and clear communication between partners is an essential part of
an intimate and trusting relationship. Informing your partner that you
have HPV shows your concern for your partner's health and respect for
his or her feelings. Disclosure can strengthen the emotional bond
between you and your partner while dispelling any myths or
misinformation.?
http://www.phac-aspc.gc.ca/publicat/epiu-aepi/std-mts/hpv_e.html

?Although HPV is a treatable and manageable infection, it is not
curable. Once a person has contracted HPV, he or she carries the virus
for life. Having HPV can mean several different things because there
is a great deal of variety in the manifestation of the virus. If you
have been diagnosed with HPV, that probably means that you experienced
either visible genital warts or, for women, found out from your pap
smear that you had irregular cervical cells due to HPV. A person who
receives treatment for genital warts may or may not have a visible
recurrence. Someone with subclinical HPV may or may not develop
genital warts. Some types of HPV may cause cervical cell dysplasia, a
pre-cancerous condition, in women. One of the reasons that regular pap
smears for women are so important is that HPV has been shown to be
associated with an increased risk for cervical cancer. Not all forms
of HPV cause genital warts. There are more than 50 other types of HPV
that are not sexually transmitted and cause warts on the hands and
feet.?

?If you are currently in a relationship, finding out that you have HPV
often can be cause for a lot of questions and suspicion. It is
important to understand that the sudden appearance of HPV in a
monogamous relationship does not necessarily mean that one partner has
been unfaithful. Many people who have HPV are unaware that they are
infected. Some people carry the virus, never show any noticeable
symptoms, but are capable of infecting others. It is also possible for
people to carry the virus for a significant amount of time with no
symptoms, and then later develop detectable symptoms (warts or
irregular cells).
It is important to help your partner find the answers to the questions
he or she has about HPV.

This will help him or her become comfortable with HPV as well as make
an informed decision about how he or she wants to proceed. If you
decide to get treatment, it is important to remember that treatment of
genital warts does not always prevent transmission of the virus.
Recurrences of warts are thought to be due to reactivation of the HPV,
not to re-infection from a sexual partner.
If you haven't already been using condoms, you and your partner may
decide that you want to. Your partner may decide that condoms are not
necessary. Whatever you decide, it is important that each of you has
enough information and time to make the decision that is most
comfortable for both you and your partner.
How do I talk to my future partners?

Talking to your partners can be one of the most challenging parts
about living with HPV. Because even with treatment and the use of
condoms it is possible to transmit the HPV virus, you need to tell all
partners before you have sex.
Telling someone you are interested in that you have HPV can be
difficult and embarrassing. Initiating this conversation takes a lot
of courage, and in the beginning, you may feel awkward. Try to keep in
mind that you are doing your partner a big favor by letting him or her
know that you have HPV. You would want to know if it was the other way
around, wouldn't you? By talking to your partner about HPV before you
have sex, you are showing this person how much you trust and respect
them. Your partner will most likely appreciate honesty and concern for
their well being.? Please read the entire article, which I cannot post
here in its entirety. (Copyright laws)
http://www.shs.unc.edu/library/articles/hpv.html


?If you and your partner had already discussed this, you'd probably
just relax and enjoy the experience. But if you've not talked it
through and you do go ahead with sex, be prepared for an experience
that is less than perfect.
In this age of AIDS?when the stakes can be life and death?open
communication with a lover before you have sex is imperative. Of
course, talking about sexual issues is never easy. But it's less
difficult when you take the time to get to know your partner and not
rush into sex.?
http://healthgate.partners.org/browsing/browseContent.asp?fileName=14531.xml&title=Let's%20Talk%20About%20Sex%20(and%20STDs)


?There are two main situations in which one person might have to tell
a partner that the first person has a sexually transmitted disease.
The first person has an incurable STD (such as HIV, herpes, or HPV)
and needs to tell a new partner before engaging in any sexual
behavior. One of the two people finds out that he or she has an STD
(curable or incurable) during an existing relationship. In both of
these situations, it can be frightening to tell a partner for the fear
of rejection. However, finding the best way to communicate this
information to a partner may help the partner be more understanding,
no matter how he or she finally reacts to it.?
http://www.soc.ucsb.edu/sexinfo/?article=stds&refid=020

 ??It is now agreed that 100 percent of cervical cancer is caused by
HPV,? says Saslow. ?The actual number is about 99.7 percent, but it is
thought that the 0.3 percent is due to failure of testing rather than
the absence of HPV.? The vast majority of genital HPV infections cause
no symptoms and go away on their own. But genital HPV remains a public
health concern because persistent infection with certain high-risk
types can cause cervical cancer.17?18
http://www.arhp.org/healthcareproviders/onlinepublications/healthandsexuality/cervicalcancer/revealing.cfm


Tell her, especially if she is Latina or African-American! ?Scientists
know that the most common sexually transmitted disease, the human
papillomavirus, causes cervical cancer, especially in Hispanic women.?
http://health.tbo.com/health/MGB56P0NN4E.html

?Race: The American Cancer Society estimates that African-American
women are twice as likely to die of cervical cancer than the U.S.
national average. Hispanics and American Indians also have higher than
average death rates from cervical cancer. Researchers believe these
population groups, as well as women with low economic statuses, are
less likely to receive annual Pap smears. Pap smears increase the
likelihood that cervical cancer will be detected at pre-cancerous or
very early cancerous stages when treatment is most successful.?
http://imaginis.com/cervical-cancer/risk_factors.asp


==============
Bonus question
==============
- What are the approximate odds that a person whom an individual in my
situation has intercourse with will develop cervical cancer due to the
fact that we had intercourse?  Consider factors like condom usage with
the original partner and the new partner, length of time since my
original HPV-carrying partner had obtained the virus, etc.


   Women who take oral contraceptives, smoke, are overweight, in a low
socio-economic group, had a mother who took DES, have already had
previous cervical dysplasias, or have or have had hepatitis are more
prone to developing cervical cancer from HPV exposure. Arriving at a
hard numbers would be impossible to estimate considering all the
variables.

?It has long been observed that certain tissues and organs are more
resistant to disease than others. For example, vaginal, vulvar and
penile cancers are uncommon and usually occur later in life than
cervical cancer (Kurman, 1994; Maymon et al., 1994). However, personal
susceptibility is an important factor for these malignancies, since
vaginal and vulvar cancers occur more frequently in women who already
have a history of cervical dysplasia and cancer (Kurman, 1994).?
?Women of low socio-economic means and recent immigrants from
countries where cervical screening is not well developed are at high
risk for cervical cancer (Parboosingh et al., 1996). Cervical cancer
is more common and may be more aggressive in women infected with HIV
(Maiman, 1994; Northfelt, 1994; Palefsky, 1991).?
http://www.phac-aspc.gc.ca/publicat/cjhs/cjhs4.html


Apparently people made the connection between sexual activity and
cervical cancer as long ago as the late 1800s. The clues leading to
this conclusion were the realization that women whose husbands
traveled a lot were more likely to die of cervical cancer, while nuns
and virgins did not.

?Even though HPV is considered a cause of cervical cancer, only one
out of 1,000 women with HPV develops invasive cervical cancer (ACOG,
2000). 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?
http://www.plannedparenthood.org/pp2/portal/files/portal/medicalinfo/sti/fact-HPV-virus.xml


?There is little reason to carry out HPV testing in males.
Transmission of HPV from female to male partners usually does not
result in consequential disease (i.e., neoplastic) in the male. The
female is at a greater risk of malignancy because of the unique
anatomy of the cervix with its ever-dynamic transformation zone,
resulting in an area of very high vulnerability to neoplastic
transformation.  HPV is equally prevalent in males and females, but
the vulnerability to cancer is very different.?
http://www.stacommunications.com/journals/pdfs/diagnosis/dxdecember02/womenhealthcare.pdf

?What exactly causes a person to develop cervical cancer? Studies have
shown that cancer of the cervix has been associated with the Human
Papilloma Virus (HPV). Also any behavior that raises the risk of
getting HPV increases the risk of the cancer emerging later. Risky
behaviors include early sex, multiple partners or even a single
partner who has multiple partners. Smoking too, is considered a risk
factor associated with the development of HPV.
 
It is also argued that the complex, and still poorly understood
relationship between an individual?s genetic profile and the
environment in which they live is key to how a person develops cancer,
how the cancer affects individuals, and how they respond to particular
cancer therapies. Despite the many unanswered questions about cervical
cancer and its causes, women worldwide deserve access to services that
can safely, effectively and affordably prevent cervical cancer.?
http://www.hsc.mb.ca/nursingpractice/may_04.htm


?Decades of studies have confirmed that cervical infection by
high-risk HPV types is a precursor event to cervical cancer. The
natural history of cervical cancer as a continuous single disease
process progressing gradually from mild cervical cervical
intraepithelial neoplasia (CIN1) to more severe degrees of neoplasia
and microinvasive lesions (CIN2 or CIN3) and finally to invasive
disease has been the basis for diagnosis, therapeutic measures, and
secondary preventive strategies (48). It is plausible that high-risk
HPV infection occurs early in life, may persist, and, in association
with other factors promoting cell transformation, may lead to a
gradual progression to more severe disease.?

?The risk of progression of mild dysplasia to severe dysplasia was
only 1% per year, while the risk of progression of moderate dysplasia
to severe dysplasia was 16% within 2 years and 25% within 5 years.
Nonetheless, it is agreed that early detection and subsequent early
treatment of HPV in precancerous lesions can prevent progression to
cancer (109). As mentioned above, HPV cannot be cultured in the
laboratory from clinical specimens and immunologic assays are not
adequate for detection of HPV infections. The primary diagnostic tools
have been cytology and histology. Recently, molecular methods to
detect HPV DNA sequences in clinical specimens have been introduced.?

?Following treatment of noninvasive intraepithelial neoplasia lesions
by any technique, there is always a potential risk of leaving
dysplastic cells behind. Recurrence rates as high as 31% with a mean
time to recurrence of 11.9 months have been reported following loop
diathermy procedures in immunologically normal patients (43). Patients
with positive margins had a higher recurrence rate (47%) than did
those with clear margins (26%).?
http://cmr.asm.org/cgi/content/full/16/1/1#EPIDEMIOLOGY


?According to the World Health Organization and the National
Institutes of Health, HPV is the cause of virtually all cases of
cervical cancer. Studies have confirmed a strong, causal link between
HPV and cervical cancer that is independent from other risk factors. A
study published in the Journal of Pathology (Aug. 19, 1999) documented
that HPV is present in virtually all cervical cancers (99.7%).
Furthermore, a study published in the New England Journal of Medicine
(November 1999) confirmed that persistent HPV infection causes
cervical cancer and that a test for high?risk HPV can predict the risk
of cervical cancer among women with normal Pap results.

Almost 100 types of HPV have been identified. Twenty?three of these
are present in the genital tract with approximately a dozen key types
associated with cancer and considered "high?risk." Persistent
infection with these high?risk types is required for cervical cancer
to develop.
However, HPV infection alone is not sufficient to induce an immediate
carcinoma since malignant tumors develop only after HPV?induced
lesions persist for several years.2 The epithelial lining of the
anogenital tract is the target for infection by the mucosotropic HPV
viruses3. Progression from infection to a tumor is facilitated by
chemical or physical mutagens that may affect both viral and cellular
functions. After exposure to HPV, events in the viral life cycle are
initiated, with specific activity regulated by the factors responsible
for the host's immune response.

HPV infection can be latent for many years. Most women will clear an
HPV infection within 9?15 months. However, women with persistent
high?risk HPV infection are 300 times more likely to develop HSIL?
http://www.digene.com/healthcare/healthcare_testing_01.html

?By the time an HPV related problem occurs, most regular sex partners
are already infected.   Determining who passed the virus to whom is
usually not possible unless one of the partners was a virgin. 
Partners are likely to share the same virus and reinfection with the
same type of HPV is thought to be unlikely.  Unless a male partner has
the type of HPV that causes genital warts, thus, has visible genital
warts there is no test for a man that is equivalent to the Pap test. 
Regular sex partners can continue with their usual sexual practices.
Condoms should be used, of course, with new partners. As stated
before, however, condoms will not always provide protection from HPV.?
http://www.health.arizona.edu/webfiles/health_services_womens_health_pap.htm


Depending on the type of HPV, an active infection can progress to one
of two extremes:
	Abnormal cervical cells "resolve spontaneously", which means that
the infection becomes inactive and poses no significant threat to
health. An inactive infection can become active again for reasons not
clearly understood.
	Abnormal cervical cells can slowly progress to cervical cancer.
Studies show that in cases of women with cervical cancer, over 90%
test positive for HPV.
http://www.phac-aspc.gc.ca/publicat/epiu-aepi/std-mts/hpv_e.html
?Adenocarcinoma of the cervix, although less common than squamous
cervical cancer, is also associated with oncogenic HPV, most notably
type 18 (Bosch et al., 1995). HPV-DNA has also been identified in
other anogenital invasive cancers and their precursors; these include
squamous cancers originating in the vulva, vagina, anus and penis
(Kurman, 1994; Mayeaux, Harper, Barksdale, & Pope, 1995; Maymon et
al., 1995; Palefsky, 1995).?
http://www.phac-aspc.gc.ca/publicat/cjhs/cjhs4.html

?Cervical cancer is highly associated with HPV strains 16 and 18.
Ninety percent of cervical cancers contain HPV DNA (usually HPV 16,
18). The vulva, vagina, penis and anus also can be affected by these
carcinogenic strains.
In the US, the disease occurs in 8/100,000 patients. The introduction
of Pap smears greatly reduced the rate of the disease (Some say by
70%). In developing countries, where Pap smears are not available,
rates of cervical cancer are really high.?


?How is HPV speculated to cause cancer?
HPV DNA integrates into the host genome.
The proteins E6 and E7 are produced from the resultant DNA.
E6 binds and degrades p53 (a tumor suppressor gene).
So what? Normally, if the cell DNA is damaged, p53 is in charge of
stopping the cell cycle so the DNA can be repaired. Now, if the DNA is
altered, the cell keeps replicating. The mutation rate of the cell
increases!
E7 binds and degrades retinoblastoma (another tumor suppressor gene).
Hm, sounds familiar. Retinoblastoma normally keeps the cell from
growing too fast or responding to growth stimulators. This inhibitory
factor is now lost!
And so, without these two mechanisms to slow down cell growth and
prevent mutation. . .
Malignant Transformation Occurs!?
http://www.stanford.edu/group/virus/papova/HPV.html

?How do I cope with an HPV infection?
Once you have been treated for HPV, the most important thing you can
do for your health is to continue to have regular check-ups. If you
have been recently diagnosed and treated, you will need more frequent
exams to be sure that the warts have been removed. After a successful
treatment men and women should continue to examine their genitals
regularly to check for warts and to have annual physical exams to
check for any new warts or growths that you can't see. Women should
also receive annual Pap smear tests to identify any cervical cell
changes.

As with other viral infections, you're less likely to experience
genital wart recurrences if you take care of your health. This means
that you want to maintain a strong immune system by eating right,
getting exercise, getting enough sleep, managing your stress, and
avoiding alcohol, tobacco, or other illegal drugs. Maintaining a
healthy lifestyle will decrease the chances of recurrences, and in
time, most people stop having any recurrences.

Being diagnosed with HPV does not mean that you can't have sex ever
again! It is important to communicate with your sex partner(s) and
give them information about HPV to make informed decisions about
sexual activity. Telling a partner that you have HPV, or any other
type of STI, can be a difficult and challenging experience. Some
partners may react by needing some time to think about how this
affects your relationship. Some partners may have a lot of questions,
might want to get tested themselves, and might make the decision not
to have sex for a while. It's completely normal to feel frustrated,
depressed, angry, or guilty about having HPV -- most people diagnosed
with an STI have the same concerns. But by taking care of your health,
practicing safer sex, and informing yourself and your partners, you
are taking all the necessary steps to minimize the risk of recurrences
and transmitting the virus to others.?
http://www.brown.edu/Student_Services/Health_Services/Health_Education/sexual_health/sti/hpv.htm

?Studies suggest that whether a woman will develop cervical cancer
depends on a variety of additional factors that act in concert with
cancer-associated HPV types in the process that leads to cervical
cancer. The primary immune response to HPV infection is cell mediated;
therefore, conditions that impair cell-mediated immunity such as renal
transplantation or human immunodeficiency virus disease increase the
risk of acquisition and progression of HPV (19, 28, 117). The upstream
regulatory region of HPV contains sequences similar to the
glucocorticoid responsive elements that are inducible by steroid
hormones such as progesterone (the active component of oral
contraceptives) and dexamethasone. Long-term use of oral
contraceptives is a significant risk factor for high-grade cervical
disease according to some studies but not in others (1, 16). Cervical
cancer risk also seems to be independently influenced by other
variables including current smoking and parity (1). Local immune
suppression induced by smoking and the mutagenic activity of cigarette
components have been demonstrated in cervical cells and may contribute
to persistence of HPV or to malignant transformation similar to that
seen in the lung (87, 121, 128). It appears that smoking is the most
important risk factor independent of HPV infection for higher grades
of cervical disease (1). Smoking shows little or no relationship to
low grades of cervical disease. Multiple pregnancies were a
significant independent risk factor among women with histopathologic
evidence of HPV infection in biopsy specimens and among women with
moderate- to high-grade cervical disease. In women with mild cervical
disease, only the presence of high-risk HPV infection was a
significant risk factor. Other factors such as alcohol consumption and
diet have not been well established.?
http://cmr.asm.org/cgi/content/full/16/1/1#EPIDEMIOLOGY


?Some studies,17 but not all,18 have pointed to a lower risk of
cervical cancer in women whose sexual partner is circumcised. In this
study, the risk of HPV DNA in circumcised men was only one fifth of
the risk in uncircumcised men, and this could not be explained by
other variables such as number of partners and age. Thus, our results
may suggest that the female partners of circumcised men are less
exposed to cervical cancer because these men are less likely to be
infected with HPV.?
http://sextrans.bmjjournals.com/cgi/content/full/78/3/215

?Study Design: We conducted a literature review and meta-analysis of
the effect of condom use on the prevention of genital warts,
subclinical HPV infection, cervical intraepithelial neoplasia (CIN),
and invasive cervical cancer (ICC).
Results: Among 27 estimates from 20 studies, there was no consistent
evidence that condom use reduces the risk of becoming HPV
DNA-positive. However, risk for genital warts, CIN of grade II or III
(CIN II or III), and ICC was somewhat reduced.

Conclusions: Available data are too inconsistent to provide precise
estimates. However, they suggest that while condoms may not prevent
HPV infection, they may protect against genital warts, CIN II or III,
and ICC.?
http://www.stdjournal.com/pt/re/std/abstract.00007435-200211000-00018.htm;jsessionid=Dcd1JwyImWoPCzFp7gCsgkWxdo5byJuu44kSeQ1wxIe6axCF9wM9!1389088241!-949856145!9001!-1


?Is HPV preventable?
Using condoms every time you have sex can help reduce the risk of HPV.
Be aware, however, that condoms do not cover all of the genital skin,
so they are not 100 percent effective in protecting against the spread
of HPV. A person with genital warts should not have sex until the
warts are removed. This might help reduce the risk of spreading HPV.

Women should have regular pelvic exams and Pap tests to look for
abnormal changes in the cervix that might be pre-cancer. Men and women
should stop having sexual contact as soon as they know or think they
have genital warts, and they should seek treatment immediately.?

?How is HPV related to cervical cancer?
Certain strains of HPV can cause changes in the cells of the cervix, a
condition called cervical dysplasia. If untreated, dysplasia can
progress to cervical cancer. HPV is almost always the cause of
cervical cancer. However, just because a woman has HPV or cervical
dysplasia does not necessarily mean she will get cervical cancer.

Regular Pap tests are the best protection against cervical cancer. The
test can detect almost all pre-cancerous changes and cervical cancer.
Cervical cancer is almost always preventable or cured if pre-cancerous
changes are detected and treated early, before cancer develops. Before
age 30, HPV infection is transient (self-limiting). By age 30,
detection of HPV during Pap smear screening can be used to help
determine the appropriate interval for screening. The absence of
high-risk HPV types indicates that a woman is at low risk for
developing cervical changes related to the risk of cervical cancer. In
this case, the interval of Pap test screening might be every three
years. Most women will still need a yearly exam by their physicians to
complete the remaining screening tests needed.
If a woman tests positive for high-risk HPV types, her health care
provider will perform yearly Pap tests to check for any cell changes
that might be pre-cancerous or that need to be treated.?
http://www.clevelandclinic.org/health/health-info/docs/3800/3808.asp?index=11901&src=news


?Epidemiological studies in virginal and Human Papillomavirus
(HPV)-negative women clearly indicate that sexual intercourse is
virtually a necessary step for acquiring HPV as detected by HPV DNA
and serum antibodies testing. Genital HPVs are predominantly sexually
transmitted. As with any other sexually transmitted infection (STI)
men are implicated in the epidemiological chain of the infection.
Acting both as "carriers" and "vectors" of oncogenic HPVs, male
partners may be important contributors to the risk of developing
cervical cancer in their female partners. Although more rarely than
women, men may also become the "victims" of their own sexual behavior
and of their own HPV infections, and a fraction of infected men are at
an increased risk of developing penile and anal cancers, two tumors
that are strongly related to infection by the same HPV types that
cause cervical cancer.?

?More recently, data from the Swedish Family Cancer Database showed
that husbands of women with in situ or invasive cervical cancer had an
excess risk of anal cancer, a recognized HPV-related cancer.27 Anal
cancer was also increased as a second primary cancer in women with
cervical neoplasia.28 Of special interest is also the excess risk
found in husbands of cervical cancer patients of both tonsilar cancer
and cancer of the tongue, supporting the currently emerging evidence
that HPV may be etiologically involved in a fraction of these
tumors.29
All together these studies provide thus indirect evidence that: a)
cervical and penile cancers share a common infectious etiology, b)
both men and women contribute to the transmission of an infectious
agent, and c) both men and women may become cancer victims of this
viral infection.
Stronger evidence of the male role has been provided by formal
case-control studies comparing either direct histories of sexual
behavior or clinical evidence of HPV-related lesions in male partners
of women with and without cervical cancer.2,13,30-32 Zunzunegui and
colleagues showed, for instance, that as compared to unaffected women,
women with cervical neoplasia were five times more likely to be
married to a man who had had more than 20 sexual partners.30 In
another study, women who were the sole sexual consorts of men with
pre-existing penile condyloma showed an increased risk of cervical
neoplasia.33 Barrasso and colleagues also reported a high prevalence
of HPV-related penile neoplasia in the sex partners of women with
cervical neoplasia.34?

?The lack of association between most male-related variables and
cervical cancer risk found in high-risk countries could be explained
by the fact that in these populations HPV is such a widespread
infection that hampers case-control studies to discriminate subjects
at a higher risk. In these populations, women's having sexual contacts
with an even limited number of male partners place them at a high risk
of acquiring cervical HPV infections and subsequent cervical cancer.
HPV DNA detection in the penis of adult men, even if high, is still a
poor reflection of lifetime exposure to HPV. Other biological markers
of lifetime sexual promiscuity in men such as seropositivity to
Chlamydia trachomatis have proved to better discriminate men's
partners at a high risk of cervical cancer, not only in populations at
low risk,2 but also in populations at high risk of cervical cancer.13?

: Our current understanding is that men who have had multiple sexual
partners or who are carriers of HPV DNA may be vectors of high-risk
HPV types, placing their sexual partners at a high risk of cervical
cancer. The key question though is how men acquire the virus in the
penis in the first place. It is now well established that penile HPVs
are predominantly acquired through sexual contacts. Sexual contacts
with prostitutes play an important role in HPV transmission and sex
workers may be an important population reservoir of high-risk HPVs.
Through sexual intercourse with high-risk women, HPVs enter the penis
which can then be transmitted to the current stable partner or to
subsequent sexual partners. Men are thus the vectors of oncogenic HPV
types that are usually found in cervical carcinomas. Circumcision is
also likely to modulate the risk of penile HPV acquisition, the risk
of transmission to the partners as well as the long-term risk of
cervical cancer.?
http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0036-36342003000900008


?I shall limit my remarks to HPV since it is (1) the most prevalent
STD, (2) very high numbers of college students are infected and (3) it
can lead to cervical cancer in a minority of cases. But it must be
emphasized here that nearly all cervical cancer is caused by HPV.
Moreover, in the United States, more women die from cervical cancer
than die from AIDS!

College women frequently suffer along the lines of the following two scenarios. A
young woman may acquire HPV and develop cervical changes discovered on a Pap
smear. When cells are rapidly mutating toward cancer, her gynecologist
may recommend surgery to remove a large portion of the cervix. Later
this leads to more difficulty in conceiving?
http://www.dailyfreepress.com/media/paper87/news/2005/02/01/Opinion/Truly.Safe.Sex.One.Doctors.Case.For.Abstinence-847877.shtml


?Condoms provide some protection against viruses such as human
papilloma virus (HPV) and herpes simplex virus (HSV), that infect the
general genital area (CDC, 2004). The Centers for Disease Control and
Prevention recommend condom usage as a way to reduce the risk of both
infections (CDC, 1998). Since HPV and herpes viruses 'shed' beyond the
covered area, however, condoms do not provide as complete protection
as they do for other pathogens, but two recent Dutch studies have
found that condom use promotes the regression of HPV lesions in women
and men, as well as the clearance of HPV infection in women
(Hogewoning, et al., 2003; Maaike, et al., 2003).

Condoms can significantly decrease the risk of infection. Condom use
directly correlated with a lower risk of herpes infection in Costa
Rican women whose partners wore condoms (Oberle, et al., 1989). A
subsequent study also found that condoms were highly effective at
reducing the rate of infection in women who had sex with men infected
with herpes (Wald, et al., 2001). Failure to use condoms has been
shown to be among the most significant risk factors for pre-cancerous
conditions related to certain types of HPV (Wang & Lin, 1996).

Unlike HIV, most HPV and HSV infections do not have catastrophic
health consequences. In general, they are not as dangerous as HIV or
chlamydia, which condoms can more successfully prevent. HIV infection
is considered fatal, and chlamydia and gonorrhea can result in
infertility or permanent disability (Friedman, et al., 1998; Howell,
et al., 1998; OWH, 1997).?
http://www.plannedparenthood.org/pp2/portal/files/portal/medicalinfo/birthcontrol/fact-truth-condoms.xml


?If my Pap is atypical and I test positive for HPV, what are the
chances that I have a high-grade lesion?
Answer: About 10-20%. But that does not mean you have cancer. With
proper medical follow-up (keeping your appointments) your chances of
developing cervical cancer will be very close to 0%.?
http://www.cdphe.state.co.us/pp/womens/pdf/HPVPamphlet.pdf

?Most cervical cancers arise at the squamocolumnar junction between
the columnar epithelium of the endocervix and the squamous epithelium
of the ectocervix. At this site, there are continuous metaplastic
changes. The greatest risk of HPV infection coincides with greatest
metaplastic activity. Greatest metaplastic activity occurs at puberty
and first pregnancy and declines after menopause. HPV infection is
most common in sexually active young women, 18 to 30 years of age.
There is a sharp decrease in prevalence after 30 years of age.
However, cervical cancer is more common in women older than 35 years,
suggesting infection at a younger age and slow progression to cancer.
Persistence of infection is more common with the high-risk oncogenic
HPV types and is an important determinant in the development of
cervical cancer.?
http://cmr.asm.org/cgi/content/full/16/1/1#EPIDEMIOLOGY



Don?t count on spermicidal foams to reduce the risk of transmission:
?Spermicides and STDs
Spermicides with N9 were originally thought to prevent the spread of
certain STDs. This belief was based on research done in the 1980s that
showed nonoxynol-9 was able to demobilize gonorrhea, chlamydia,
trichomoniasis, herpes simplex virus and HIV. However, these tests
were done in laboratories, not on people. While further research did
hint that spermicides could help reduce the transmission of STDs,
current studies suggest otherwise.

The latest studies investigating N9?s ability to combat STDs has shown
that spermicides do not offer any protection against sexually
transmitted diseases. In fact, in certain cases, it could even
increase a person?s risk of contracting an STD since it can cause
sores in the vaginal and rectal lining thereby facilitating an
infection.

Condoms containing nonoxynol-9 have not been shown to be any more
effective at protecting against pregnancy and STDs than condoms
without spermicide. Moreover, because of the increased risk of HIV
infection, it is strongly advised against using condoms that contain
spermicide during anal sex. While abstinence is the most effective way
of preventing HIV and other STDs, if you do choose to be sexually
active, it is necessary to use condoms as they will help to reduce
your risk of STD infection.?
http://www.epigee.org/guide/spermicides.html


?Barrier contraceptives, which have been successful in reducing
transmission of most sexually transmitted diseases, do not appear to
be effective in preventing HPV infection. Vaccines against HPV
infection are being developed, and early clinical trials are in
progress.  Preliminary trials of the vaccine in women with invasive
cervical cancer have demonstrated that the vaccine elicits antibody
production, but more definitive study is needed. Another promising
avenue of research is the development of spermicidal agents effective
against this virus.?
http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/97vol23/23s6nat/23s6g_e.html

?Spermicidal foams, creams, and jellies have not been proven to
protect against HPV and genital warts.?
http://kidshealth.org/parent/infections/bacterial_viral/genital_warts.html


Additional Reading:
===================

?This article presents a review of psychosocial factors associated
with the primary and secondary prevention of cervical cancer. Current
research evidence convincingly links the presence of the human
papillomavirus (HPV) to the development of cervical cancer suggesting
that bringing together knowledge from the Papanicolau smear screening
and HPV infection research may help formulate a new approach that
bridges primary and secondary prevention strategies. Bringing together
these 2 areas of research involves an understanding of the
psychosocial factors that underlie both. This review will specifically
focus on 3 areas of psychosocial research: (1) sexual behaviours
associated with HPV infection; (2) knowledge, attitudes and beliefs
associated with Pap smear and HPV screening; and (3) the role of the
medical provider in facilitating prevention activities.?

The entire content of this article can be purchased for $18.76
http://www.ingentaconnect.com/content/rsm/std/2000/00000011/00000011/art00002

Personal Stories
http://www.yoshi2me.com/stories/kerry.html

http://www.yoshi2me.com/stories/annamarie.html

http://www.yoshi2me.com/stories/iris.html

Previous Google Answers: 
http://answers.google.com/answers/threadview?id=402719

http://answers.google.com/answers/threadview?id=308647

http://answers.google.com/answers/threadview?id=553232

http://answers.google.com/answers/threadview?id=438685

http://answers.google.com/answers/threadview?id=308647


There you go! I sincerely hope you can get tested i order to give
yourself some peace of mind! Take care, and ask for a clarification,
if any part of this answer is unclear, or if I have repeated
information you already had.

Sincerely, Crabcakes
     


Search Terms
=============

Subclinical HPV + males
HPV + detection + males
HPV detection research + Men
Research testing + HPV + men
PCR + HPV + men
DNA testing + HPV + men
Spermatozoa testing + HPV
Urine testing + HPV
HPV detection research males
Epidemiology + HPV
telling your partner + HPV
risk contracting HPV
spermicidal foams + STDs
cervical cancer risk + HPV exposure
malcolm11-ga rated this answer:4 out of 5 stars and gave an additional tip of: $20.00
crabcakes,

Thank you for the thorough answer.  Hopefully I'll be able to get
tested.  Take care.

Comments  
Subject: Re: HPV testing for men
From: crabcakes-ga on 16 Sep 2005 19:25 PDT
 
Thank you Malcolm11, for the generous tip!

Sincerely, Crabcakes
Subject: Re: HPV testing for men
From: jimstix-ga on 07 Dec 2005 17:03 PST
 
I'm delighted to find such thorough information relating to my exact situation.

malcolm11 ... were you ever able to get tested? how? where? by whom?

this information is highly valuable to me. if i am out of line let me
know, but i'll do pretty much anything to figure this out, seeing that
the woman i love will not come near me unless i'm certain i don't have
a disease.

(i relate quite painfully to what you said: "Now I need to talk to any
potential partners about the possibility I have "high-risk HPV" so
they can educate themselves and decide whether or not to take the
risk.  Talk about putting a damper on a romantic evening." )

thanks in advance for any further info at all!!
-nearly desparate
Subject: Re: HPV testing for men
From: malcolm11-ga on 07 Dec 2005 19:10 PST
 
Hey jimstix,

I don't have great news for you, but here is some info/insights.

I talked to my doctor.  He initially said there was no way to do
testing, but I later mailed him some web links alluding to male
testing, and after some digging, he did find a test he could use for
me.  The downside is that it is only certified for females, and so
while the reliability rate for men is probably "high" it is not
something he considered a reliable enough basis upon which I should
modify my behavior (e.g. disclosing the situation to a potential
partner).

I opted to get tested anyway, as even if it couldn't give me a "clean
bill of health" I would hopefully be able to offer a lighter shade of
gray.  FWIW, I came out negative.

So, I'd recommend talking to your doctor.  My doctor works at a pretty
good medical facility and is highly available to his patients, and
even I had to push to get him to find out about this test.  So it
might take some work.

Note there is a female vaccine coming out later in '06 for some of the
bad HPV strains, I believe 16 and 18.  Do some web searches and you'll
find it.  If you have a long-term potential partner then maybe this
will help.

IMO -- if you and your potential partner are interested in a serious
long-term relationship, I'm surprised HPV is such a huge issue for
her.  Even IF you did catch HPV and IF it's a bad strain and IF it
causes pre-canceous devleopments for her -- cervical cancer is
basically 100% preventable with regular gyn checkups and proper
preventive care -- she will discover this if she does the web
research.

The whole situation has been quite frustrating.  It is very confusing.
 The medical community seems very concerned about maintaining high
ethical standards in some ways ("it's not a certified test! you can't
assume it's accurate! don't modify your behavior!"), but there seems
to be no information, literature, or tests for men in this situation,
as if they're just expected to ignore the risk they may carry a
dangerous virus... wtf?  I have sort of given up on getting any sort
of concrete, solid, resolution.

Best of luck.
Subject: Re: HPV testing for men
From: jimstix-ga on 08 Dec 2005 09:20 PST
 
malcolm.. wow thanks for the quick reply!

*sigh* .. no surprises. :\

except about that vaccine! that's really interesting! i'll definitely
look into that.

I've been trying to get in touch with the doctors/labs at a couple
local hospitals to find out of they have any access to the Digene
Hybrid Capture test (which i've been reading about and yea, it's
currently only for women)... and I thought that maybe I could talk
someone into using the methods described in that article, from the
Brown University publication, quoted in the above paragraphs... maybe
they could "try" something a little "unorthodox" and duplicate those
methods, which to me seemed pretty conclusive.

I don't care what they have to do to me to get strong test results.
scrub my penis with sandpaper for skin samples? if it works, do it.
now.

the issue with my lady-friend is that we've JUST started things off,
but before things got physical i told her about this. she's had some
frightening relationships and i don't blame her for being a bit of a
scaredy cat. hopefully she'll calm down though and allow me to show
her some research.

(and, a little off-topic, truthfully i'm not sure if she's interested
in super long-term with me haha)

again, thanks for the correspondence, malcolm11 ... i'll post any news
i find on getting tested.

best wishes!
-hopeful
Subject: Re: HPV testing for men
From: malcolm11-ga on 12 Dec 2005 08:20 PST
 
good luck man, on all fronts!  and do please let me know if you find
any special info.

Important Disclaimer: Answers and comments provided on Google Answers are general information, and are not intended to substitute for informed professional medical, psychiatric, psychological, tax, legal, investment, accounting, or other professional advice. Google does not endorse, and expressly disclaims liability for any product, manufacturer, distributor, service or service provider mentioned or any opinion expressed in answers or comments. Please read carefully the Google Answers Terms of Service.

If you feel that you have found inappropriate content, please let us know by emailing us at answers-support@google.com with the question ID listed above. Thank you.
Search Google Answers for
Google Answers  


Google Home - Answers FAQ - Terms of Service - Privacy Policy