Written: 13 March 2003 for English Writing 2 - Don't Plagiarize!

Silent, But Deadly

Have you ever heard of HPV, human papillomavirus? There are at least 70 known strains that are the cause of common skin warts (plantar warts), genital warts, and the number one type of cancer that kills thousands of women each year internationally, cervical cancer, as well as other cancers. Although researchers suspected cervical cancer was sexually transmitted, HPV wasn't noticed until the 1970s. Since then, there have been many improvements in diagnosis and treatment of dangerous HPV strains, but there is still much to be learned about this virus.

According to the Story of Discovery, researchers noticed a connection between sex and cervical cancer "almost a hundred years ago." The introduction of the Papanicolaou smear test ("Pap smear") in the 1950s by Dr. George Papanicolaou was important in observing and detecting cancerous and tumor-like growths. German researchers finally linked cutaneous and genital warts to HPV in the 1980s. Progress wasn't made until the 1980s in understanding the structure of HPV. They determined that HPV is made of viral proteins, E6 and E7, which target a certain type of cell depending on which strain and cause abnormal growths. Even though they understand what HPV is made of, they still don't understand how it works.

In the 1990s, more studies were done and researchers worked on more ways to detect HPV. Contraceptive Technology Update reports that in March 1999, the Food and Drug Administration approved the "Hybrid Capture II HPV Test, a DNA-based technology that can detect 13 high-risk types of HPV." There has been some debate about the different steps of testing. Articles like, "FDA advisory panel backs HPV test as pap smear adjunct," suggest using both the HPV test and Pap smear as part of the testing regimen. Some medical articles advise screening every three years, while others advise every two years. The age at which to stop regular screening also varies by as much as 10 years, some say 65, others say 75. There are still many differing opinions on diagnosis, such as how often women of certain age brackets should get a Pap smear, and if the smear turns out abnormal, if smear tests should be used to more closely observe the infection.

Realizing the abundance of the papillomavirus, researchers set out to create a way to "solve" this problem by means of a vaccine. The creation of a vaccine would prove to be a difficult one; since HPV cannot be reproduced in laboratory conditions, a crippled version of the virus cannot be used as a vaccine. Miraculously, though, researchers discovered a vaccine for HPV type-16. This strain is the cause of about 50% of HPV-caused cervical cancer. This is a great achievement because this could save many lives. However, it wasn't good enough because there would still be the other 50% of infected women to think about. After working on the vaccine some more, they have created one, the Merck vaccine, which works against 18, 11, and 6, on top of the type-16 strain. These four strains are cause of the majority of cervical cancer cases in women. The vaccine is expected to be available for doctors to use in 2007.

In the 1980s, doctors believed it necessary to treat all patients with abnormal Pap smears. American Family Physician reports that if the results were abnormal, doctors would "immediately perform colposcopy," a cervical biopsy. It was believed that treating the partners of women infected would reduce the chances of recurrence ("Changes" Apgar). They would treat any symptom of HPV because at the time, they thought all HPV strains lead to cervical cancer. Patient Care describes how they used Podophyllin (Podoben), a topical cream, but it has "a high risk of local and systemic toxicity" (Friedman-Kien). Other methods of treatment involve an acid treatment, or excision, which involves either heating or freezing growths and removing them. As a result of over diagnosis based on Pap smear results, a large amount of women were being over treated and suffering immensely because of it.

Today, HPV is only treated if it is a known cancer-causing strain and there are cancerous growths. This is because they've discovered that even though a woman may be infected with a cancer-causing strain, it doesn't always cause cancer. Research has found that oftentimes HPV will go away on its own, although it takes longer for cancerous strains to go away. Genital warts are still treated by excision, topical creams, or acid treatments. American Family Physician says new medicines to treat symptoms of HPV are on the horizon, such as Imiquimod (Aldara) and a gel that is in Phase III testing ("Changes" Apgar).

A standard means of treating genital warts or cancerous HPV has not been established, but new methods are being developed. The Toronto Start Newspaper reported in 1999, that an accident in a lab revealed a certain common detergent chemical found in toothpaste and shampoo, sodium dodecyl sulfate (SDS), inactivates not only HPV, but HIV (Gillespie). Knowledge of this HPV-killing chemical has not yet been harnessed. It is not known if it will even be effective on humans. Articles like "Detergent Kill HIV & Human Papilloma Virus in a Test Tube," in the Toronto Star Newspaper, and "Surprise Discovery of Possible Cancer Protector," in Fox News Online believed, in 1999, research would take less than 10 years to develop and test this new drug.

While the improvement of diagnostics and creation of a vaccine are giant steps toward eliminating dangerous HPV strains forever, we still have a long way to go. Researchers and doctors still debate about diagnostics, there is a complete lack of a means to treat HPV, and there is currently no method of protection. The majority of people don't even know what HPV is. The Journal of the American Board of Family Practice conducted a survey that tested the knowledge of college students on HPV and found that "despite the high [prevalence and serious complications associated with HPV infection, most college students know very little about HPV" (Lambert). Schools teach students that condoms are the end-all-be-all of STD prevention, but this isn't wholly truthful. In fact, Beyond AIDS reports that Tom Coburn, M.D., "called safe-sex messages 'a lie'" ("HPVupdate"). Consultant wrote in 1996, researchers found studies suggesting condoms do not protect against HPV ("Condoms?" Apgar). This is because all that is needed to pass on HPV to another person are infected skin cells; HPV is highly infectious. Since this is a major concern, why then, is it not a major topic taught in sex education classes? What we need is to set standards for diagnosis, treatment, and education. Once these have been established, it would be easier to update everyone. Right now, everything is up in the air and mass hysteria . The vaccine won?t prevent all strains of HPV. We are not safe, yet. We are still vulnerable.

Works Cited

Apgar, Barbara S. "Changes in Strategies for Human Papillomavirus Genital Disease." American Family Physician. 55 (1997): 1545(3). Accessed 16 March 2003.

------- "Do Condoms Provide Full Coverage Against Human Papillomavirus?" Consultant. 36 (1996): 656(1). Accessed 16 March 2003.

Frieden, Joyce. "FDA Advisory Panel Backs HPV Test As Pap Smear Adjunct." Family Practice News. 32 (2002): 30. Accessed 16 March 2003.

Friedman-Kien, Alvin E., and Richard H. Oi, Richard Reid, and Mary Desmond Pinkowish. "Genital Warts: Nuisance or Menace?" Patient Care. 22 (1988): 36(12). Accessed 16 March 2003.

Gillespie, Kerry. "Detergent Kills HIV & Human Papilloma Virus In A Test Tube." Toronto Star Newspaper. 13 February 1999.
http://www.cancer-info.com/detergentkills.htm Accessed 17 March 2003. Accessed 16 March 2003.

"HPV DNA Tests: Studies Target Use for Cancer Screening." Contraceptive Technology Update. 21 Issue 5 (2000): 1. Accessed 17 March 2003.

Lambert, Erika C. "College Students? Knowledge of Human Papillomavirus and Effectiveness of a Brief Educational Intervention." Journal of the American Board of Family Practice. 14 (2001):
Accessed 17 March 2003.

Neergaard, Lauran. "Surprise Discovery of Possible Cancer Protector." Fox News Online. 12 February 1999.
http://www.hivdent.org/drugs1/drugsdopcp0299.htm. Accessed 17 March 2003.

Story of Discovery Preventing Cervical Cancer.
http://plan2000.cancer.gov/resrch_prog/chap6/cervical.htm Accessed 17 March 2003.