HPV vaccine: It's not about sex, it's about cancer prevention
By WENDY ANNE EPSTEIN, M.D.

(Original publication: May 26, 2007)
In a May 22 Community View ("HPV vaccine: Pressure leaves parents confused"), Bob Moffitt gives merit to the argument that mandatory vaccination with the HPV vaccine will encourage "reckless behavior such as sexual promiscuity." Implicit in this argument is that once vaccinated an individual would feel freer to engage in sexual behavior because they felt immune to contracting cancer-causing HPV.

However, human papilloma virus is only one sexually transmitted disease. There is no vaccine for herpes, Hepatitis C, HIV. Implicit in this argument is that sexual contact is necessary to become infected with the cancer-causing strains of HPV, and by avoiding sexual contact one is guaranteed not to contract HPV. Unfortunately, sexual contact is not necessary for the transmission of cancer-causing HPV. Abstinence will not guarantee that your children are protected against developing cervical cancer.

Hand-to-hand contact can transmit cancer-causing HPV. After all, that's how most people get ordinary warts caused by HPV. Most warts do not cause cancer, because most warts on the hands and fingers are caused by non-cancer-associated HPVs. However, cancer-causing strains of HPV, including strains 16 and 18, can also be found on the hands and fingers. Squamous cell carcinoma of the finger is almost exclusively caused by HPV strains 16 and 18, the same cause of 70 percent of cervical cancer. These cancers are potentially very aggressive and can reoccur or even metastasize if not adequately treated.

I have treated several patients that had persistent warts on their hands or fingers caused by cancer-causing strains of HPV. I have seen several women with cancer-causing strains of HPV warts on the fingers that also had atypical Pap smears of the cervix. Since most warts on the hands and fingers are treated without biopsies or special testing to see which HPV strain caused the warts, we don't know what percentage of "ordinary"-appearing warts on the hands are caused by cancer-causing strains of HPV.

Human papilloma virus is the major cause of cervical cancer. Worldwide, cancer of the cervix is the No. 1 cause of cancer death in women. The vaccine, Gardasil, can prevent infection with the two most common cancer-causing strains of the virus.

Perhaps it is unfortunate that Gardasil is marketed solely as a prevention of cervical cancer. HPV strains 16 and 18 cause several other forms of cancers in males and females. HPV strains 16 and 18 can cause cancer of the esophagus, mouth, throat, larynx, tongue, tonsils, rectum, uncircumcised penis and skin.

It is my opinion that our culture continues its basic disdain for female sexual behavior. While the portrayal and consumption of female sexuality is in utmost demand, females engaging in sexual behavior are still morally devalued. Insidiously, under the guise of morality, female sexual behavior is to continue to be punishable by cervical cancer.

Abstinence alone does not guarantee that your children are protected against developing cervical cancer, because sexual contact is not necessary to become infected with cancer causing strains of HPV.

Vaccination with Gardasil should not lull anyone into a false sense of security because it will not immunize against all strains of cancer causing HPVs. One should try to avoid touching another person's HPV-infected skin, be it on their genitals or fingers. The problem is that there is no way to know if someone is infected with cancer-causing HPV unless they know and tell you. Not all HPV-infected skin produces a visible wart. Vaccination therefore is important because it can prevent an infection that you or the person you are touching is unaware that they have.

While practicing dermatology for more than two decades, both in private practice and as a New York University School of Medicine faculty member teaching at Bellevue Hospital, I have witnessed how conservative cultural ideals conflict with actual human behavior. Viruses are apolitical, and so must we be in preventing the cancers they cause.

It is my opinion that all non-infected human beings, irrespective of sex or age, be offered vaccination against certain strains of HPV to prevent cancer.

The writer is a dermatologist, a faculty member of New York University School of Medicine and health officer of the village of Grand View.

Brian,

Having read this as well as every HPV article I come across, I continue to be amazed at how many cancer docs who know something about HPV, don't know very much at all and will tell you "wives tales" instead of facts. I guess it's probably because they, the HPV Community, are hearing new things every day. But it seems that a lot more is known about HPV than is published or at least readily available. Hopefully the HPV Community will collect all HPV knownledge together and make it generally available to the docs that should be aware and put an end to the misinformation pool that exists today.

I talked to a 3rd year intern who wants to finish in oncology in my office last week. He was booking a party for the graduating interns and SOMEHOW we started talking about HPV. He looked me and said there is no way HPV can be contracted orally by kissing. I gave him the name of the public official, the Communicable Disease Director for the Florida Dept of Health, who told me that and I wish I also had had this article as well.

I just get sooooooo frustrated some times.

I don't know how you do this full time Brian.

Just like I got through Nam and cancer.... one day at a time, one obstacle at a time. It helps to have a sense of persistence and a belief that anything is possible, though the connections and opportunities to effect change may not be accessible or obvious to you today. Frustration is tempered with small successes, though it is a a routine part of the process and never more than a day away. Lastly, one phone call or email from someone whose life is better because of the effort, can carry me over days of frustration. A man who wants to to move a mountain starts with a handful of pebbles.... that man works daily not only to pick them up, but to inspire others to help him.

Brian,

Can I tell you i read your last post with tears in my eyes , you are an inspiration you really are ..you are such a strong and dedicated person and while you encourage us all to be strong you let is know we will have our frustrations and bad days. If it wasnt for you and everyone on here I KNOW i would have many more ba then good days! And as far as HPV goes.....THis country is so AFRAID of sex and all that Crap ..I worked for Planned Parenthood for over 2 years and I can,t tell you all the young girls that are being Diag with cervical cancer and genital warts...and now oral cancer..The real truth is ..AMERICA needs to WAKE UP anyhow where sex and sex ed is concerend..they could make a big difference and get over their fear and realize that The vaccine has Nothing really to do with Sex..and saying it is OK to engage ...ughhhhhh so many issues i would love to fight for .hahaha . The awareness of this disease. the vaccine , better sex ed , and many more ..where to begin? where and how do I make someone listen. You starte this website and you educate people all the time ..how did you start ?