Beyond Protection: Papillomavirus

College students are inundated with warnings about HIV and chlamydia, but one common and potentially life-threatening sexually transmitted disease (STD) goes largely unnoticed.

Human papillomavirus (HPV), more commonly referred to as genital warts, is one of the most widespread STDs and can also lead to cervical cancer. What many Harvard students may not know is that HPV cannot always be prevented with the use of condoms.

HPV at Large

In several studies conducted with college women, nearly half tested positive for HPV. It is estimated that 10 million American women have active viral infections and perhaps 10 percent of them have diseased tissue as a result. Papilloma is associated with 95 percent of cervical cancer cases.

Cervical cancer kills 5,000 American women a year, and in countries where women do not have easy access to Pap smear tests, papillomavirus-related cervical cancer is the number one cause of cancer-related death.

Of the more than 50 different strains of HPV, some only cause warts, but others have been conclusively linked to pre-malignant and malignant growths in the cervix.

Two genes in the virus, E6 and E7, attach to proteins that regulate cell division and deactivate them. HPV causes the cells to grow wildly and also destroys the mechanisms that would normally fix the problem.

The first noticeable cellular difference in the cervix is subtle change in the shape of cells as they begin to enlarge. Later, the standard arrangement of cells gets destroyed as diseased cells begin to grow out of control.

Early diagnosis is important, and women are recommended to get annual Pap tests, where cells that line the cervix are gently scraped off and examined under a microscope.

The problem, however, is that Pap tests are not always accurate. The results can be skewed due to human error in spreading the samples on slides and in reading the results. Since each of the hundreds of thousands of cells needs to be examined, abnormal cells are often missed. It is estimated that 20 to 40 percent of lesions are missed.

A recent study has shown that testing for HPV directly is more effective in predicting cancer than a Pap smear alone, but tests are not yet widely available.

Prevention

What makes HPV particularly frightening is that there is no way to prevent it other than abstinence. Condoms to prevent transmission through bodily fluids, once thought to be enough, no longer are. The virus can live in outer skin cells and even in dead cells for a short time, then be transmitted to a partner.

Recent legislation from the House Commerce Committee has called for the Food and Drug Administration (FDA) to label packages with a warning that condoms may not prevent the transmission of HPV.

Additionally, though men do not face the same threats from HPV, they are capable of carrying and transmitting the disease without knowing.

At Harvard

In an informal poll of 50 Harvard students, none knew that HPV could be spread while condoms are used. Nor did any know that it is conclusively linked to cervical cancer.

"The fervor around HIV and AIDS is much higher," says David S. Rosenthal '59, director of University Health Services. "HPV is less understood by students and the College. I think it's one of those abstract things that people don't think about."

According to Rosenthal, most of the education about HPV, like other STDs, is done through peer groups like Peer Contraceptive Counselors.

Although students come in with HPV, it is fortunately not especially rampant at Harvard, Rosenthal said. College, however, is a time when some students may be initially infected.

"The emphasis is that it's just like alcohol in that there is a delayed effect. Contact with HPV can be a precursor to cervical cancer," Rosenthal says. "Women need to have routine Pap smears.

"You still need to be sure to have anything diagnosable treated early because it can eventually have to do with cancer," he says.