Summary:
Human papillomavirus (HPV) is the most common incurable STD in the United States. Those concrened with public health should strongly encourage the only guaranteed method of conquering this epidemic — sexual abstinence until entering into a lifelong, monogamous marrage with an uninfected partner.
The United States is in the midst of a sexually transmitted disease (STD) epidemic. We have the highest STD rate in the developed world, and a higher rate than some developing countries.
Human papillomavirus (HPV) is the most common incurable STD in the United States, with as many as 24 million Americans currently infected.[1]
By comparison, between 650,000 and 900,000 Americans are infected with HIV, the virus that leads to AIDS.[2]
HPV has been linked to over 90 percent of all invasive cervical cancers,[3] and is the #2 cause of cancer deaths among women, after breast cancer.[4] Approximately 16,000 new cases of cervical cancer are diagnosed each year, and 5,000 women die annually from this disease.[5]
When condoms are used properly and consistently, which only occurs between 5 and 40 percent of the time, they still serve as ineffective barriers against STDs.[6] Condoms, whether used correctly and consistently or not, do not prevent the spread of HPV.[7]
Federally funded sexual health organizations and the Centers for Disease Control, however, continue to promote condoms as effective STD barriers. They briefly mention sexual abstinence as a tool for STD prevention, before campaigning for the “consistent and correct” use of condoms as sufficient STD deterrents.
Those concerned with public health should strongly encourage the only guaranteed method of conquering this public health epidemic – sexual abstinence until entering into a lifelong, monogamous marriage with an uninfected partner.
THE EPIDEMIC
In 1960, there were only two significant STDs, syphilis and gonorrhea. Both are easily curable bacterial infections. Today, after the sexual revolution and the significant cultural decay in which it played a part, there are at least 25 STDs. According to the Kaiser Family Foundation, “Since 1980, eight new sexually transmitted pathogens have been recognized in the United States alone.”[8] The Institute of Medicine reports, “Approximately 12 million new [cases of] STDs, 3 million of them among teenagers, occur annually.”[9] [ed. This statistic was from 1997. Presently, there are at least 18.9 million STD cases per year.]
In addition to curable bacterial STDs, there are several viral STD infections that cannot be cured. An estimated 56 million Americans have an incurable viral STD other than HIV, such as genital herpes or human papillomavirus (HPV). That is more than one in five Americans. “STDs represent a growing threat to the nation’s health and national action is urgently needed,” wrote Institute of Medicine Doctors Thomas Eng and William Butler. “Women and infants bear a disproportionate burden of STD-associated complications.”[10]
The Medical Institute of Sexual Health (MISH) estimates that 33 percent of all women are infected with HPV.[11] The people most at risk for this disease are college and high school students.
The University of California at Berkeley found that almost half of its female students were infected with HPV. In some studies, “up to 15% of sexually active teenage women have been found to be infected with HPV, many with the strain of this virus that is linked to cervical cancer.”[12]
Penny Hitchcock, D.V.M, chief of the sexually transmitted diseases branch of the National Institute of Allergy and Infectious Diseases’ (NIAID) Division of Microbiology and Infectious Diseases, said, “The incidence of HPV infection in sexually active young college women is alarming. Furthermore, we currently have no effective way to prevent infection.”[13]
In a 1988 Time magazine article, Dr. Stephen Curry, of the New England Medical Center in Boston, commented on HPV, “This virus is rampant. If it were not for AIDS, stories about it would be on the front page of every newspaper.”[14] Thanks in part to this underreporting by the media, most Americans have never even heard of this STD. In a recent Kaiser Family Foundation survey, only 11 percent of teens aged 15-17 and adults aged 18-44 could name HPV as an STD, and only 30 percent of them were aware that HPV is incurable.[15]
In an article about identifying the risk of cervical cancer, the Washington Post reported, “[W]ithout HPV infection, the disease [cervical cancer] virtually never develops. Researchers calculated that by itself, the HPV test was somewhat better than a repeat Pap smear for identifying women with cancer or precancerous changes in the cervix.”[16]
WHAT IS HPV?
Human papillomaviruses are a collection of more than 100 types of viruses that tend to cause warts, or papillomas, on various parts of the body. More than 20 types of HPV are incurable STDs that can infect the genital tracts of both men and women. They can cause genital warts, which are the most obvious manifestation of HPV and indicate a clinical infection. Only 1 in 100 people infected with HPV experience genital warts, however. Most of the time, HPV infections are subclinical or asymptomatic, that is, there are no visible symptoms.
Subclinical HPV infection is detected by abnormal Pap (papanicolaou) smears or microscopic lesions. Asymptomatic HPV infection, the most common, is the presence of the virus in apparently normal tissue. Most people infected with HPV do not know it.
The virus can lie dormant on the cervix for as long as 20 years before cervical dysplasia (precancerous cells) is detected. Some strains of HPV are considered low-risk (HPV-6 and HPV-11) and some high-risk (HPV-16 and HPV-18), but both can cause cervical dysplasia. To further exacerbate the problem, there are no practical screening tests available for subclinical and asymptomatic HPV infection, so it can be difficult, and with some strains impossible, to diagnose.
Even when HPV is detected, current medical tests are unable to discover the type, or types, of human papillomavirus a woman has or the probability of her developing cancer. Doctors, at this point, do not know which HPV-infected women will end up with pre-cancerous or cancerous cells. It is certain, however, that one out of every 50 American women will be diagnosed with cervical cancer.[17]
It is also certain, as mentioned above, that almost all cervical cancer in the United States is caused by HPV.[18] While it is impossible to estimate how contagious high-risk HPV is compared with low-risk HPV, 2.5 million women are infected each year with at least one strain of the virus. Scientists estimate that between 30 and 75 percent of all sexually active adults are already infected with HPV. [19]
WHY DON’T CONDOMS STOP THE SPREAD OF HPV?
Human papillomavirus differs from other STDs in its method of transmission; it is not spread from one person to another through the exchange of bodily fluids. Rather, it spreads through skin-to-skin contact.
Since HPV is a regional, multicentric disease, it infects the entire genital area: the penis, scrotum, vulva and surrounding areas. Condoms do not cover the scrotum, nor most of the other areas that can be infected with the virus. There also tends to be contact between the anogenital skin of the partners before a condom can be correctly placed on the penis.
“No known effective barrier exists that will protect the vulva or prevent vulvar transfer of the virus,” according to Barbara S. Apgar, M.D., M.S., clinical associate professor of family practice, University of Michigan Medical School.[20]
Adds Mary E. Verdon, M.D
., of the Am
erican Academy of Family Physicians, “In the 1970s, it was demonstrated that a single sexual contact with a person infected with external genital warts carries about a 60 percent chance of transmission.”[21] However, there are several different strains of HPV that do not cause genital warts; therefore, transmission can occur without the presence of any visible symptoms. These strains are more likely to be cancerous.
WHAT DO MEDICAL DOCTORS SAY ABOUT CONDOMS AND HPV?
Doctors know that condoms are useless against HPV.
· “Condoms appear to provide little, if any, protection against HPV, one of the most common STDs in America today and one that causes cervical cancer.”[22] Medical Institute for Sexual Health.
· “Condoms can prevent the spread of many diseases, but not HPV. HPV is found on all the genital tissues, and a condom on the penis usually will not prevent transmission of HPV.”[23] Louisiana State University Medical Center.
· “Human Papillomavirus, thought of as the ‘seed’ of cervical cancer, is a regional rather than localized disease, and its infectivity is not contained by condoms.”[24] John V. Dervin, M.D., associate specialist in radiology and assistant clinical professor, University of California, San Francisco.
· “[S]everal studies have shown that condoms do not protect against this virus (HPV).”[25] Kenneth L. Noller, M.D., professor and chairman, department of obstetrics/gynecology, University of Massachusetts School of Medicine; past chairman of the American College of Obstetricians and Gynecologists Committee on Gynecologic Practice; and past president of the American Society for Colposcopy and Cervical Pathology.
· “Condom use is of little or no value in protecting patients from papilloma infection.”[26] Thomas V. Sedlacek, M.D., chairman, department of gynecology, Graduate Hospital, Philadelphia.
· “Condoms are useless in preventing HPV transmission, because the virus is spread by cells that are shed onto the scrotum, which then comes into contact with vulvar skin.”[27] Michael Campion, M.D., director of gynecologic endoscopy at Graduate Hospital, Philadelphia.
Now, contrast the facts above with the publicity below:
WHAT DO FEDERALLY FUNDED SEX EDUCATION ORGANIZATIONS SAY ABOUT CONDOMS AND HPV?
Despite the evidence, people and organizations supposedly dedicated to public health are pushing condom use as an effective deterrent to the spread of STDs, including HPV. They fail to adequately communicate that condoms do not work against HPV; nor do they promote abstinence until marriage as the only way to stop this potentially deadly disease. Keep in mind that 74 percent of teenagers agree with the statement, “If Americans had higher moral standards STDs would not be the problem they are today.”[28]
Sharon Stone, film actress and research campaign chairwoman of the American Foundation for AIDS Research (AmFAR), at a United Nations panel discussion on youth and AIDS on December 1, 1998, said, “I believe that if you truly, truly love your children, you need to supply condoms in a place in your home, at a quantity that makes it a nonjudgmental situation for them to have them. I mean, put 200 condoms in a box in some place in the house where everybody isn’t all the time so that your kids can take them.”[29]
Other such statements include the following:
AMERICAN SOCIAL HEALTH ASSOCIATION
· “Studies have shown condom use can lower the risk of acquiring HPV infection. For these reasons, condoms should play an important part in any new or non-monogamous sexual relationship.”[30] Sandra Ackerman, “HPV Myths and Misconceptions,” American Social Health Association, 1998.
· “Can condoms protect me from HPV? Condoms do not give complete protection against HPV because they do not cover all genital skin. But with a new partner, condoms are useful to protect both of you from most other STDs. Many people are shocked or upset when they find out they have HPV. But HPV does not have to mean a big change in your life. The most important step is to get help by talking with your health care provider, getting a yearly Pap test [sic], and taking care of yourself.”[31]
SIECUS – SEXUALITY INFORMATION AND EDUCATION COUNCIL OF THE UNITED STATES
· “Condoms are up to 99.9 percent effective in reducing the risk of STD transmission when combined with spermicide.”[32]
PLANNED PARENTHOOD OF WESTERN WASHINGTON
· “Because the virus that causes the genital warts is contagious, abstinence or the use of condoms during intercourse is recommended.”[33]
· “How can you avoid spreading Genital Warts? To decrease the spread of Genital Warts: Seek medical advice and evaluation if symptoms are present. Share information, both printed and verbal, with your partner(s). Partners with obvious warts may also choose to seek treatment. Always use a latex condom.”[34]
TEENWIRE, PLANNED PARENTHOOD OF FEDERATION OF AMERICA (“SEXUALITY AND RELATIONSHIP INFO YOU CAN TRUST FROM PLANNED PARENTHOOD FEDERATION OF AMERICA”)
· “Condoms Work – If you’re lucky enough not to have a genital HPV infection now, make sure you stay that way. Genital HPV infections can spread even when the infected person hasn’t shown any symptoms. Your partner could seem perfectly fine and still infect you. Remember that genital HPV is usually spread by vaginal and anal intercourse – abstinence is your key to remaining totally safe, but using a condom can help cut down on the chances for transmission.”[35]
· “You can have a fulfilling sex life no matter what infection you may have – if you act responsibly and use protection every time.”[36]
WHAT DOES THE CENTERS FOR DISEASE CONTROL AND PREVENTION SAY ABOUT CONDOMS AND HPV?
The Centers for Disease Control and Prevention (CDC) is a government organization responsible for tracking the spread of communicable diseases and developing strategies for containment. Although an estimated 24 million Americans are already infected with HPV, the CDC does not report the number of HPV infections, nor does it offer specific means for prevention. Other than HIV, the CDC is required to report only syphilis, gonorrhea and chlamydia rates. All three are curable, bacterial infections.
When discussing the dangers of STDs and their prevention, the CDC groups all STDs together, including HPV. It recognizes that abstinence until marriage to an uninfected partner is the only guaranteed way to prevent the spread of all STDs, yet it still suggests “consistent and correct” use of condoms as a viable method of prevention:
· “Refraining from having sexual intercourse with an infected partner is the best way to prevent transmission of HIV and other STDs. But for those who have sexual intercourse, latex condoms are highly effective when used consistently and correctly.”[37]
· “Even when used correctly, condoms aren’t perfect, CDC acknowledges, comparing them to other important safety enhancing behaviors like wearing seatbelts and bicycle helmets. Imperfect as they are, condoms can significantly reduce the rates of unintended pregnancies and sexually transmitted diseases.”[38]
· “When used consistently and correctly, latex condoms are very effective in preventing a variety of STDs, including HIV infection. Multiple studies have demonstrated a strong protective effect of condom use.”[39]
· “A primary strategy for decreasing the spread of human immunodeficiency virus (HIV) and other sexually transmitted diseases is to increase the rate of condom use among at-risk persons.”[40]
· “Recommended Prevention Strategies. Abstaining from sexual intercourse is the most effective HIV prevention strategy. For individuals who are sexually active, the following are highly effective: Engaging in sexual activities that do not involve vaginal, anal, or oral intercourse. Having intercourse only with one u
ninfected part
ner. Using latex condoms correctly from start to finish with each act of intercourse.”[41]
· “Prevention through avoiding exposure is the best strategy for controlling the spread of sexually transmitted disease (STD). Behavior that eliminates or reduces the risk of one STD will likely reduce the risk of all STDs. Abstinence and sexual intercourse with one mutually faithful uninfected partner are the only totally effective prevention strategies. Proper use of condoms with each act of sexual intercourse can reduce, but not eliminate, risk of STD. Condoms are not always effective in preventing STD. Failure of condoms to protect against STD is probably explained by user failure more often than by product failure.”[42]
In March 1999, the House Commerce Subcommittee held a hearing on cervical cancer with the CDC and the National Cancer Institute. Dr. Ronald Valdiserri of the CDC’s National Center for HIV, STD, and TB Prevention said that “the causal association between persistent genital HPV infection and cervical cancer is similar to that between cigarette smoking and lung cancer.” In response, subcommittee chair Rep. Tom Coburn (R-Okla.), who is also an M.D., pointed out, “The CDC says, ‘don’t smoke,’ but does nothing to promote sexual abstinence.”[43]
In an interview with the Kaiser Family Foundation’s Daily Report, Tom Coburn M.D., said that although “there is no study that shows that HPV is helped by condoms,” the CDC still tells people condoms provide protection against the disease. He said, “There is no safe sex when it comes to HPV. We’re in an epidemic of [HPV]. The CDC knows about this epidemic. They should have studies on it, but they don’t. They’re behind the curve and they know they’re behind.”[44]
HPV POLICY PROPOSALS
We can no longer ignore the HPV epidemic. With knowledge of the prevalence of HPV, its link to cervical cancer and condoms’ inability to protect against the transmission of this disease, the following proposals should be implemented:
1. Congress should require the CDC to conduct studies on the nature and effects of HPV. The CDC should also be required, as it is with other STDs, to report on HPV transmission rates.
2. Condom manufacturers should be required to include a warning on their packages that alert people to condoms’ ineffectiveness in shielding against HPV transmission.
3. A public health campaign, organized by the CDC, should be launched to heighten public awareness of HPV and to shatter the myth that condoms provide protection against the disease.
CONCLUSION
As public health organizations promote condoms, HPV infections increase, and the cost for treatment of all STDs mounts.
Ten billion dollars per year is spent treating selected major STDs, other than Human Immunodeficiency Virus (HIV). Including HIV, the cost for treating STDs rises to $17 billion a year.
All Americans share this expense through higher health care costs and taxes.
Considering the physical and financial toll that STDs, such as cancer-causing HPV, are taking on society, we must ask why abstinence until marriage is not being taught as the only foolproof method to stop this epidemic – and why condoms are being sold as “safe sex” to unsuspecting youngsters.
[Perhaps the word “sold” is the key. To some groups, money is more important than the health of our young people.]
END NOTES
1. Letter dated March 8, 1999, from Richard Tompkins, Ph.D., director of education and research, Medical Institute for Sexual Health, to Lisa Sanchez and Lakita Garth.
2. CDC Update, “Condoms and Their Use in Preventing HIV Infection and Other STDs,” Feb. 1996 (http://www.cdc.gov/nchstp/hiv_aids/pubs/facts/condoms.htm).
3. “Human Papillomavirus and Anogenital Cancer,” The New England Journal of Medicine 338, No. 13 (March 26, 1998), www.nejm.org/public/1998/0338/0013/0921/1.htm.
4. “The Tip of the Iceberg: How Big Is the STD Epidemic in the U.S.?” The Henry J. Kaiser Family Foundation, December 2, 1998, www.kff.org:80/archive/repro/policy/std/std_qa.html.
5. Institute of Medicine: Division of Health Promotion and Disease Prevention, The Hidden Epidemic – Confronting Sexually Transmitted Diseases, Thomas R. Eng and William T. Butler, eds. (Washington, D.C.: National Academy Press, 1997), www2.nas.edu/HPDP/21f6.html, quoted in “Human Papillomavirus,” Slide 26 of “Sexual Health Today,” a slide presentation prepared by the Medical Institute for Sexual Health.
6. J. Thomas Finch, M.D., “How Effective Are Condoms in Preventing Pregnancy and STDs in Adolescents?” Medical Institute for Sexual Health, July 1997, pp. 4-11.
7. “Condom Sense: Is It Enough?” Medical Institute for Sexual Health, June 1997.
8. “Sexually Transmitted Diseases in the United States: Exposing the Epidemic,” The Henry J. Kaiser Family Foundation, November 20, 1996, www.kff.org:80/kff/library.html?document_key=80anddata_type_key=100.
9. The Hidden Epidemic – Confronting Sexually Transmitted Diseases, op. cit.
10. Ibid.
11. “Listing of Sexually Transmitted Diseases,” Medical Institute for Sexual Health, 1994, www.w-pc.org/sexuality/std.html.
12. “Sexually Transmitted Diseases in the United States: Exposing the Epidemic,” op. cit.
13. “Sexually Active Younger Women Are at Higher Risk for Infection with Human Papillomavirus,” News Release, National Institutes of Health, National Institute of Allergy and Infectious Diseases, February 11, 1998.
14. “Condoms Ineffective against Human Papilloma Virus,” Sexual Health Update, Vol. 2, No. 2, Medical Institute for Sexual Health, April 1994.
15. “National Survey of 15 to 17 Year Olds: What Teens Know and Don’t (But Should) About Sexually Transmitted Diseases,” The Henry J. Kaiser Family Foundation /MTV/ Teen People, March 1999.
16. Susan Okie, “Test Helps Pinpoint Risk of Cervical Cancer,” The Washington Post, May 28, 1999.
17. House of Representatives Concurrent Resolution 64, March 5, 1999.
18. Okie, op. cit.
19. Michelle Boorstein, “Sexual Virus HPV Poses Dilemma,” Associated Press, Jan. 29, 1998.
20. Barbara S. Apgar, M.D., M.S., clinical associate professor of family practice, University of Michigan Medical School, Ann Arbor, Mich., “Do condoms provide full coverage against human papillomavirus?” Consultant 36, No. 4 (April 1996): 656.
21. Mary E. Verdon, M.D., American Academy of Family Physicians, American Family Physician 55, No. 5 (April 1997): 1813.
22. “Condom Sense: Is it Enough?” op. cit.
23. “HPV and Cervical Dysplasia Patient Information,” Louisiana State University Medical Center, Midland Family Physicians-LSUMC Family Medicine Patient Education Home Page, 1996, http://lib-sh.lsumc.edu/fammed/pted/hpvmid.html.
24. “Condoms Ineffective against Human Papilloma Virus,” op. cit.
25. Ibid.
26. Ibid.
27. Ibid.
28. “National Survey of 15 to 17 Year Olds: What Teens Know and Don’t (But Should) about Sexually Transmitted Diseases,” op. cit.
29. Andrew Selsky, “Worldwide Call to Action against AIDS,” Associated Press, Dec. 1, 1998.
30. Sandra Ackerman, “HPV Myths and Misconceptions,” American Social Health Association, 1998.
31. “FAQs About Human Papillomavirus (HPV),” American Social Health Association, www.ashatd.org/faq/hpvfaqs.html.
32. “The Truth about Condoms,” Sexuality Information and Education Council of the United States (SIECUS), www.siecus.org/pubs/fact/fact0011.html.
33. “Genital Warts,” Planned Parenthood of Western Washington, www.ppww.org/warts.htm.
34. Ibid.
35. “STIs: Genital Warts,” by “Joyce,” Teenwire, www.teenwire.com/warehous/articles/wh_19981201p048.asp.
36. “I Think I Have a Sexually Transmitted Infection,” by “Catherine,” Teenwire, www.teenwire.com/yikes/articles/yi_19981201p004.asp.
37. “Condoms and Their Use in Preventing HIV Infection and Other STDs,” CDC Update, February 1996.
38. “Condoms: barriers to bad news,” FDA Consumer, March 13, 1998, p. 22.
39. “Sexually Transmitted Diseases,” Centers for Disease Control and Prevention Office of Women’s Health, November 24, 1997.
40. “Contraceptive Method and Condom Use Among Women at Risk for HIV Infection and Other Sexually Transmitted Diseases – Selected U.S. Sites, 1993-94,” Centers for Disease Control MMWR [Morbidity and Mortality Weekly Report] 45, No. 38 (September 27, 1996): 820-823.
41. “HIV/AIDS Prevention Facts about Condoms and Their Use in Preventing HIV Infection and Other STDs,” Centers for Disease Control and Prevention, February 1996.
42. “Perspectives in Disease Prevention and Health Promotion Condoms for Prevention of Sexually Transmitted Diseases,” Centers for Disease Control and Prevention MMWR 37, No. 9 (March 11, 1998): 133-137.
43. Lee Sanchez, “Cervical Cancer: House Hearing Raises HPV Reporting Issues,” Daily Report, Kaiser Family Foundation, March 16, 1999, www.kff.org.
44. Ibid.
IS99F1
[http://www.frc.org/get.cfm?i=IS99F1; July 1, 2005, by Heather Farish & Yvette Schneider]