I haven't seen this question addressed in this forum (although I am a new member). If one's partner has an HPV+ tumor, can he/she currently infect a partner who doesn't show (and has never shown - e.g., no abnormal pap smears)any evidence of HPV 16?

There is no absolute answer to your question since there is so much unknown at this time. It is possible to have had an HPV positive lesion, and later to be HPV negative, I know since that is how I am. So the best guess is that the immune system can find some way to deal with the virus and eliminate it, or it goes dormant in a manner that is undetectable. If it can be transmitted when it is dormant (if this even happens) is unknown. Just remember that lots of people become HPV16 positive and do not develope a malignancy.

Sophia,

Since I tested + for HPV 16 I have tried to find out as much as I could about the virus that tried to kill me. It's been frustrating to say the least.

I have been told many things by doctors that should know, such as:

HPV is highly contagious, even more so than HIV;

One doesn't have to have sex to get HPV;

You can transmit HPV by kissing an orally infected person; and,

You can get it by touching the skin of someone that has the HPV virus present on their skin even if no warts are visable.

Again, these came directly from doctors who one would think should know these things.

I've read as many articles on HPV as I have come across, which aren't many and I am surprised how much they know about how the HPV virus manipulates the cells into turning canerous.

I have equally been surprised that not all "docs in the know" say the same things about HPV and I'm surprised that not all docs that should know basic HPV stuff do know as much as I think I know about HPV and mostly I'm surprised at what is not known about HPV given what is known about HPV.

For instance, they don't know why the majority of immune systems deal with HPV and some don't;

They don't know how the virus goes dormat and what triggers it to become undormat. I don't even know if dormat is the correct work because I had one doc tell me that my immune system may have "dealth" with the HPV virus but some other contributing factor, like stress, may have caused my immune system to say "drop the leash on my HPV and it ran wild";

They don't know if HPV+ SCC killed by current Tx will stay killed; and

They don't know if current cancer Tx will kill actively present HPV virus or just the cancer converted cells.

I have been married to my wife for 18 years and she didn't test positive for HPV so I either gave it to her and her immune system took care of it or she has it and it's dormat and undetectable. Maybe I got it from her and her immune system took care of hers and mine didn't? I'm sure there may be other explanations I'm not aware of yet.

If you find out anything of value please pass it on.

Thanks, Brian and David for responding. I actually thought I knew a fair amount about HPV (I've written about women and STDs) and one of my doctoral students conducted her doctoral dissertation on college-age women's perceptions of gardasil and factors that contribute to planning to get the vaccine. What I didn't know until recently was the harm that can come to men (more often than women) in terms of oral cancer. I know that info is on the NCI site but I don't recall it being discussed in terms of the gardasil debate, etc. Of course now I have read Maura Gillison's research and that of others. I have learned that boys/men can get gardasil in several countries that have laws that say that availability of vaccines, etc. cannot discriminate by gender. Given what my husband is going through, I would be extremely upset if I had a son who could not get gardasil. I am so grateful that our daughter was in the age range to be eligible and she has already been vaccinated. If I learn anything new I will pass it on to the board.

Sophie,

I testified before the Florida House this spring when they were considering the Gardasil" bill which would have guarenteed the vaccine free to those girls that couldn't afford it entering the 7th grade and parents could "opt out" of the vaccine for any reason whatsoever simply by signing a form and that bill failed to get the required votes due to a republican party belief that morals should not be taught in school.

I have been on my soapbox ever since trying to bring public awareness re HPV in all sexes. If I think I know little about HPV, believe me the public including doctors, other than a select few, KNOW NOTHING. Until they do, ignorance will prevail.

Hi --

We were on vacation, now back....

Just to add a bit to the discussion -- the vaccine currently in trial at Hopkins is a therapeutic vaccine, that is, designed to be given to people who have an HPV-caused cancer. The theory is that it will stimulate the person's T-cells to destroy the virus. Right now it is being tested only on people who have had successful treatment for an HPV+ cancer (both oral and cervical) and are considered cancer-free, since it is not yet a substitute for proven effective treatments for those with active cancer. It has been successful in animal trials, which is an good thing but no guarantee it will do the same for humans. So still many years off...

The focus on immune boost is because people who have had an HPV+ cancer have demonstrated that for some reason their immune system was not effective in eliminating the virus initially (Dr. Gillison and others estimate that 80% of us get infected with high-risk HPV within 4 years of becoming sexually active, however most of us shed the virus and in those who do not, only a smaller percent actually develop cancer.) The time-line for this is uncertain but Dr. Gillison again has said that 10-15 years (or even more) after initial infection is not out of the question. Thus the futility of trying to figure out where it came from. Plus the fact that (as was posted above) the doctors cannot rule out infection by oral contact (read "kissing") etc. HPV, including the high-risk strains, are ubiquitous.

The way the first phase of this vaccine trial works is that there are four cohorts (dose levels) of the vaccine -- no placebo arm -- and the trial started with the lowest dose. Each cohort must receive their 4 vaccinations and be followed up for several months to be sure there are no side effects before the next higher dose is given. At this time I believe the final cohort is about to start. (And not all are men, I think there is one or maybe two women in the oral cancer arm). After all cohorts are finished, then the blood and sera samples taken throughout will be analyzed. Was there an immune boost against HPV-16 and if so, was it dose-dependent? The blood and sera are also being tested for "markers" -- i.e., genetic fragments -- of HPV. If there is a positive response then a Phase II trial will be designed, and I am not sure what this will look like.

Why is this important? -- in HPV+ cancers the p53 gene, which regulates cell repair and cell death, is only disabled by the HPV oncogene. (In contrast, cancers caused by smoking usually have mutated or abnormal p53 genes). What happens if the virus is eliminated? A recent study took HPV+ cancer cells in vitro (cell culture) and used an RNA probe to disable the HPV oncogenes. 90% of the cancer cells died within 48 hours. Thus there is reason to think that if the virus can be eliminated, the cancer will also be controlled. Or, at the minimum, it would be another powerful "bullet" against the disease.

I think that in Australia and at least one other country boys as well as girls can receive Gardisil. I know many doctors who deal with oral cancer feel that boys should also be vaccinated. It is too bad when ignorance stands in the way of improved health.

One other thing, there was a Swedish study which showed a slightly increased rate of oral cancer in men whose wives had cervical cancer. Have the reference somewhere...

Unfortunately despite the publicity over the HPV study last May, a lot of of doctors are still unaware of this link. Our RO told us he had two new tonsil cancer patients, both young men, non-smokers -- both HPV+ -- and the oncologists who diagnosed them had never heard of this.

Gail

Hi, everyone,

I have a close friend (an MD) who is a lab chief/head at NCI with a focus on cervical cancer. She told me that a major reason Gardisil was developed with 2 strains of HPV that can cause cervical cancer (which makes sense) and 2 strains that cause venereal warts is that the goal/hope was to eventually make this available for boys/men and that they thought it would be a tough sell for boys/men and their parents if Gardisil just protected against the cervical cancer-causing strains. In other words, boys/men would be less concerned about getting a vaccine if they did not see a direct benefit (e.g., preventing venereal warts).

I have read that 90% of all HPV oral cancer is caused by HPV strains 16 and 18 which should be reason enough to get the male population's attention.

Unfortunately that knowledge hasn't found it's way into main stream America and that's why I keep pounding on doors. I'm just one person but it will take many more just like me to crack that egg.

David is correct, most oral cancers caused by HPV are HPV-16, some are HPV-18 and a few, other "high-risk" strains. Thus Gardisil would probably help and I know Dr. Gillison and her colleagues think so, since they say so in their May New England J. of Medicine paper on HPV and head/neck cancer.

Gail