STI is one of the scariest acronyms out there. Along with the phrase “sexually transmitted infections” comes thoughts of discomfort, shame and fear. But as sexually active adults, we have to realize that “you can never say safe sex, you can only say safer sex,” says Dr. Liana Clarke, a specialist in vaccination for HPV, or the Human Papiloma Virus. HPV is a fairly new addition to the STI group, one that’s been somewhat shrouded in mystery, with various Web sites offering disparate statistics on the virus. “HPV is the common cold of STIs,” says Dr. Clarke. It seems like no one is safe from this most common STI, that’s also associated with cervical cancer and warts. ESSENCE.com spoke with Dr. Clarke about how to prevent the scariest effects of HPV and talked to sexual health expert Dr. David Bell to get a better understanding the STD that more than half of us will contract in our adult lives.
DR. DAVID BELL ON HPV: ESSENCE.com: Please explain how common HPV is. DR. DAVID BELL: HPV is the most common sexually transmitted infection. At least half of all sexually active individuals will contract HPV.
ESSENCE.com: Is it true that part of the reason why it’s so common is that it can be dormant for a long time and spread from partner to partner with no signs? DR. BELL: It’s not necessarily that it lies dormant. It’s just
asymptomatic.
ESSENCE.com: Should a woman be worried about HPV if she can’t detect any of its symptoms? DR. BELL: Actually the types that don’t cause any physical symptoms or any visual symptoms, those are actually the ones that are most associated with cervical cancer. The ones that are visible are mostly just a nuisance. They primarily manifest into genital warts.
ESSENCE.com: What makes the advance quicker in some patients rather than others? Does the virus advance faster in women than in men? DR. BELL: How fast any one person gets an infection differs from one person to another. One of the factors that sometimes is talked about as far as why women develop the warts faster is because of the types of cells that are in the female genitals. The vaginal mucosa–they’re moist and less keratinized [meaning they have less of a protective layer]–that can possibly allow easier transmission of the virus.
ESSENCE.com: What are your thoughts on recent recommendation for young women to wait until age 21 to begin pap screenings? Why would this be recommended if women age 16 to 26 are at highest risk for contracting the virus? DR. BELL: I’m not an expert on the guidelines, but I am aware of the basis. HPV is very common, but it also, especially in early ages, doesn’t necessarily stick with the person. It can be a transient infection that doesn’t necessarily cause cancer. The large majority of young people that are exposed to HPV usually clear it on their own.
ESENCE.com: This goes against what a lot of people have been taught about HPV and genital warts. DR. BELL: Even messages on the internet don’t keep up with the knowledge that we have on HPV. A lot of sites say, once you have HPV, you have it for life. That’s not true. However, as long as you have the virus in your skin, you are potentially infectious.
ESSENCE.com: Is it easy to detect genital warts on a man? DR. BELL: It’s important to know that males don’t have the test for HPV. The exam for genital warts is a visual exam for a male.
ESSENCE.com: What about for women? Should we be worried that our doctors are not being thorough enough when looking for HPV? DR. BELL: Overall it’s ingrained in women’s health. So it’s a standard part of taking care of a woman.
ESSENCE.com: Do genital warts always look the same? DR. BELL They can mimic a number of types of bumps. Usually you can detect them visually, but sometimes they require biopsy.
ESSENCE.com: The idea of contracting an STI is always scary. Due to its commonness and its ability to clear itself, is HPV really a scary STI? DR. BELL: Any time you use the word cancer, it’s scary and its association with cancer
is scary. In the United States, cervical cancer isn’t as high as it is in developing countries. However, African American women do have a 50 percent higher risk than White women. The warts are primarily a nuisance because of the transmission and the way it looks, it carries a lot of anxiety and personal upset.
DR. LIANA CLARKE ON THE HPV VACCINE: ESSENCE.com: Please explain the different strands of HPV in relation to cervical cancer and genital warts. DR. LINA CLARKE: There are at least 20 to 40 HPV types that affect the genitals. 15 to 20 types have been associated with cervical cancer. HPV 16 and 18 account for at least 70 percent of all cervical cancers–the vast majority of cervical cancer. There are other types, but their impact is very low. There are about 20 HPV types that are associated with genital warts. Types 6 and 11 are the types that tend to cause 90 percent of genital warts.
ESSENCE.com: How does the HPV vaccine work? DR. CLARKE: It’s basically the same premise of any vaccine. But, it is a virus-like antigen with particles that have been grown and synthesized. So you’re not actually getting injected with the virus. It looks like an empty HPV shell with no DNA. Your body will mount an immune response against that antigen. And then your body is primed to say, “OK, now we have seen this. If we see this again, we’re prepared for it.”
ESSENCE.com: We always hear about Gardasil as the HPV vaccine. Are there other HPV vaccines out there? What are they like? DR. CLARKE: There is another vaccine called Cervirex, which is a bivalent vaccine. It covers HPV 16 and 18 the two types associated with cervical cancer. Gardasil is a quadrivalent vaccine. Not only does it protect against types 16 and 18 it also protects against types 6 and 11–the types that cause genital warts. Putting those together reduces risk of cervical cancer and other cancers.
ESSENCE.com: The HPV vaccine is recommended for women under 26. What happens if you’re over 26? Should you not get the vaccine? DR. CLARKE: The data on women over 26 has been submitted to the FDA. That study hasn’t been released to the public yet. The FDA will only let us market a product in the age group which we’ve tested it. Ages 16 to 26 is where we tested how effective the vaccine was. Those are the most common years that people contract HPV. There is more serial monogamy in the adolescent to young adult phase.
ESSENCE.com: If you’ve already been exposed to one or more types of the HPV strands protected by Gardasil, is the vaccine still recommended? DR. CLARKE: Very few people are exposed to all four vaccine types, so for the vast majority, it is beneficial to still be vaccinated.
ESSENCE.com: Is there anything else you’d like to add? DR. CLARKE: The point that has to be made is that people of color have a higher risk of cervical cancer. Nobody has established the reason for that, but we have a target on our back. We need to recognize, as a group, as an ethnicity, because of our risk, we need to be more understanding of ourselves and we need to be very, very in touch with how to protect our kids from HPV.
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