HPV is a silent epidemic. According to the CDC’s Manual for the Surveillance of Vaccine-Preventable Diseases (4th Edition, 2008), “Genital human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, with an estimated 6.2 million persons becoming newly infected every year” (1). “Approximately 20 million Americans are currently infected with HPV. As many as half of these infections are among adolescents and young adults, ages 15 through 24 years of age.” (2) There is a 50% chance that sexually active people will contract HPV. (2) If this CDC estimate isn’t grotesque enough, consider the morphology of genital warts. Or how about the fact that HPV causes 70% of cervical cancer cases (3) that strike nearly half a million women each year worldwide, claiming a quarter of a million lives (4). The worst part is that HPV is transmitted by skin contact (1) so a condom won’t save you!
Female Vaccine
Thankfully in 2006, the vaccine Gardasil was FDA approved for females aging 9 to 26. According to the Merck website, “Gardasil is the only cervical cancer vaccine that helps protect against 4 types of human papillomavirus (HPV): 2 types that cause 70% of cervical cancer cases, and 2 more types that cause 90% of genital warts cases.” (5) This was a feat for Merck pharmaceuticals as well as public health and more than 50 million doses have been delivered globally (6). The vaccine was well promoted and the existence of this female vaccine is now common knowledge in the US. But did you know that in October 2009, the vaccine was also approved for males?
Male Vaccine
As of October 16, 2009, Gardasil was approved for “boys and men 9 through 26 years of age for the prevention of genital warts caused by HPV.” (7). Yet as of December 16, 2009 no one is talking about it. Planned parenthood wont give the vaccine to guys. The medieval style student health service website at SDSU (aka ‘STD-SU’) has no mention of it, nor is it searchable (8). The student health service website at UCSD (aka ‘the smart ones’) has no mention of it, nor did search results turn up anything about the vaccine for males (9). I finally decided to go to my normal UCSD clinic to get the vaccine and I was met by surprised looks. None of the doctors had any real knowledge of it, and I was apparently the second guy to ever get the vaccine at the extremely busy clinic.
I can’t begin to tell you how ridiculous all of this is.
1. Even if you don’t have symptoms, you need to get vaccinated. Most infections are asymptomatic and transient (10). This means it is possible to contract it and not even know about it. Add a 6-8 month asymptomatic incubation period to this equation, and its hard to figure out exactly who the virus even came from. The passive nature of this disease is perhaps the mechanism behind its prevalence. It leads one to wonder how most of the women, who bear the worst of HPV’s effects, contracted this disease in the first place? Perhaps they got it from guys who don’t even know they have it, much less where they got it. And although 90% your immune system clears it in 2 years, we’re really not sure if the virus is gone forever or just hiding (1). Reoccurrence difficult to explain because of this ‘dormancy’ hypothesis and the fact that it so damn common.
2. If the virus affects both sexes, then why are aren’t both sexes getting vaccinated? Men and women get this virus from each other. Males need to be vaccinated just as much as females.
3. If the age range is mainly 15 through 24, why aren’t our schools and universities actively promoting it? Hell, they might as well be hiding it at this rate. And why the heck is it not available at planned parenthood for the community?? This is inexcusable.
Finally I conclude that HPV is a silent epidemic that is the number one STD in the US, mainly affecting college-aged men and women, and is easily preventable by a newly FDA approved vaccine. I can only ask that the data I have presented you speaks for itself and that universities and local governments respond with vigilance by actively promoting the vaccination of students and other citizens (of both sexes).
The Facts:
Epidemiology
Genital human papillomavirus (HPV) is the most common sexually transmitted infection in the United States (1)
There is a 50% chance that sexually active people will contract HPV (2)
Approximately 20 million Americans are currently infected (2)
6.2 million persons are newly infected every year (1)
Half of infections in the US are among adolescents and young adults, ages 15 through 24 years of age (2)
HPV
Transmitted by skin contact (1) (a condom won’t save you)
There are more than 100 strains of HPV (5)
>30 HPV strains are sexually transmitted (11)
40 HPV strains infect humans and most infections are asymptomatic and transient (10)
Viral strains 6 and 11 are responsible for 90% of genital wart cases (5)
Viral strains 16 and 18 are responsible for 70% of cases of cervical cancer (5)
Gardasil protects against all 4 strains (5)
Cervarix only protects against strains 16 and 18 (6)
Immunity
In 90% of cases, the body’s immune system clears HPV naturally within two years (2) (we think)
Cervical Cancer
Most cases of cervical cancer occur in women aging 20-50 (12)
US cervical cancer mortality: was once the #1 cause of female cancer mortality, but declined 74% 1955-1992 because of pap smears (4)
US cervical cancer diagnoses: 11,270 (12)
US cervical cancer deaths: 4,070 (12)
US cervical cancer 5 year survival rate: 71% will survive (12)
Worldwide cervical cancer mortality: cervical cancer is the 2nd biggest cause of female cancer mortality worldwide
Worldwide cervical cancer diagnoses: 510,000 (13)
Worldwide cervical cancer deaths: 288,000 (nearly 80% in developing countries) (13)
Other cancers that can be caused by HPV (statistics for US):
3,700 women who get vulvar cancer (2)
1,000 women who get vaginal cancer (2)
1,000 men who get penile cancer (2)
2,700 women and 1,700 men who get anal cancer (2)
2,300 women and 9,000 men who get head and neck cancers (2)
rarely, respiratory tract warts in children (10)
HPV may play a role in the development of some oropharyngeal cancers (1)
Sources:
1
CDC’s Manual for the Surveillance of Vaccine-Preventable Diseases (4th Edition, 2008)
http://www.cdc.gov/vaccines/Pubs/surv-manual/chpt05-hpv.htm
Genital human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, with an estimated 6.2 million persons becoming newly infected every year.
Weinstock H, Berman S, Cates W, Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health 2004;36:6–10.
2
Approximately 20 million Americans are currently infected with HPV. Another 6 million people become newly infected each year.
As many as half of these infections are among adolescents and young adults, ages 15 through 24 years of age.
HPV is so common that at least 50% of sexually active men and women get it at some point in their lives.
In 90% of cases, the body’s immune system clears HPV naturally within two years.
http://www.cdc.gov/STD/HPV/STDFact-HPV.htm
3
HPV types 16 and 18 together cause about 70 percent of cervical cancers
Munoz N, Bosch FX, Castellsague X, et al. Against which human papillomavirus types shall we vaccinate and screen? The international perspective. International Journal of Cancer 2004;111:278–285.
Schiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S. Human papillomavirus and cervical cancer. The Lancet 2007; 370:890–907.
4
Persistent HPV infections are now recognized as the major cause of cervical cancer. In 2007, it was estimated that 11,000 women in the United States would be diagnosed with this type of cancer and nearly 4,000 would die from it. Cervical cancer strikes nearly half a million women each year worldwide, claiming a quarter of a million lives. Studies also suggest that HPVs may play a role in some cancers of the anus, vulva, vagina, and penile cancer (cancer of the penis) (2).
http://www.cancer.gov/cancertopics/factsheet/Risk/HPV
Parkin DM. The global health burden of infection-associated cancers in the year 2002. International Journal of Cancer 2006; 118:3030–3044.
5
GARDASIL is the only cervical cancer vaccine that helps protect against 4 types of human papillomavirus (HPV): 2 types that cause 70% of cervical cancer cases, and 2 more types that cause 90% of genital warts cases. GARDASIL is for girls and young women ages 9 to 26.
http://www.gardasil.com/hpv/index.html
6
The panel’s decision could open up a large market for Gardasil maker, Merck, which has been approved to market the vaccine in the U.S. to females ages nine to 26 since 2006 and has distributed more than 50 million doses globally.
http://www.scientificamerican.com/blog/post.cfm?id=fda-panel-approves-gardasil-hpv-vac-2009-09-09
7
Vaccination in boys and men 9 through 26 years of age for the prevention of genital warts caused by HPV types 6 and 11
http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM094042
8
SDSU
http://www.google.com/search?q=HPV&hl=en&lr=&ie=ISO-8859-1&as_sitesearch=shs.sdsu.edu
9
UCSD
http://studenthealth.ucsd.edu/searchresults.shtml?cx=011691032548729733085%3Af79iinv_riq&cof=FORID%3A11&q=HPV+vaccine+men#845
10
Of the more than 40 types of HPV that infect human mucosal surfaces, most infections are asymptomatic and transient.
http://www.cdc.gov/STD/HPV/STDFact-HPV-vaccine-hcp.htm
11
http://www.cdc.gov/STD/HPV/STDFact-HPV-vaccine-hcp.htm
Human papillomavirus is the name of a group of viruses that includes more than 100 different strains or types. More than 30 of these viruses are sexually transmitted
12
http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_cervical_cancer_8.asp
about 11,270 new cases of invasive cervical cancer will be diagnosed. about 4,070 women will die from cervical cancer.
13
Human Papillomavirus (HPV) causes cervical cancer, and is the second biggest cause of female cancer mortality worldwide with 288 000 deaths yearly. About 510 000 cases of cervical cancer are reported each year with nearly 80% in developing countries
http://www.who.int/vaccine_research/diseases/hpv/en/
