This is the sixth of 6 guest posts on infectious causes of chronic disease.

By Ousmane Diallo

I was dumbfounded when I read this news article relating HPV to the increase of lip and oral cancers because of oral sex.

It reminded me my younger years, as a med student, debating with my professor of psychology the fundamentals of Freudian psychoanalysis, the Id, the Ego and the Super-ego. It was a rather philosophical debate more than anything else, a combination of religious and cultural reciprocal statements of beliefs. At that time, we were exposed to the new French “sexual education” magazine called Union, borderline Playboy and X-rated. Even though we were colonized for one hundred years, sang the Marseillaise at elementary school, believed like the Koran that we were the descendants of the Gallic people, Fellation and Cunulingus amounted to blasphemy; even French kisses were of an oddity. As a true disciple of Freud, my professor believed that our Islamic beliefs system enmeshed with the weight of African ancestral traditions were at the cornerstone of the decadence of African societies, the social disconnect with the desire of every individual to be free from the yoke of group. No wonder why, he said, we were seeing more and more drug addiction (mostly Marijuana), schizophrenics, histrionics and all the ills of proto-modern, transitional, societies. The main thing was that humans needed to free themselves from society, break the ego free from the super-ego or at least limit its nefarious effects on the development of man’s personality. Only by using the old Marxist exercise of criticism on Taboos could we, as humans, attain Nirvana, Felicity, Bliss or Paradise, “here on Earth and not over there in Heaven” (Karl Marx, 1883). The only thing I could utter was that if he really believed that man should only follow his desires, mate as he wished and how he wanted to, and behave like animals, then let him be aware of God’s wrath; “He will strike humanity with unknown diseases”, quoting the religious text. Instead of good grades, I earned a nickname “Ayatollah”.

(More after the jump…)

The problematical introspection now is less out of a religious concern or morality than for public health. In the evolutionary process, “man has earned the right to live among billions of unseen organisms” to paraphrase Morgan Freeman in “the war of the worlds”, developing a biological equilibrium based upon the basic framework of the epidemiological triad “Host, agent, and environment”. In every single portion of his body, a truce is declared, a mutual checks and balance applied among ‘natives’ and ‘aliens’. Natives cells are regenerated intelligently on an unfailing biological clock and ‘aliens’ germs are participating to preserve that equilibrium, to the ecological benefit of all. Now, let me use recent rhetoric to better explain myself: if illegal immigrant germs were to colonize a new area, its legal resident germs will become the first line of defense, destroying the invaders for their sole benefit and that of the host. The breaking of the first line will disrupt the equilibrium and the result manifests itself as diseases. The theory of equilibrium seems to apply mostly to bacteria and not viruses, the ultimate invaders.

HPV is particular among other viruses in the sense that it is specific to the human species, to an organ or type of cells called epithelial cells, the superficial lining and non dividing cells of the skin or mucous membrane. There are over 90 different types of HPV, which are differentiated by their DNA sequences. Very small, 20 times smaller than Herpes, consisting of very simple machinery, a double stranded DNA, and like all viruses, HPV uses the host to regenerate itself but does not either integrate the host genome or ‘kill’ the cell. Therefore, the generation of cancer does not seem to result from a mutation of the cell genome, but the inhibition of certain proteins involved in the suppression of cell growth and the DNA repair is demonstrated. The introduction of the HPV types (16 & 18) that cause cervical cancers into the cell lining of the oral mucosa, known to be structurally very similar to the cervix and fragile as demonstrated by Dr. No-Hee Park, is just a call for disaster. The other types of HPV, low risk types, are already present in the buccal area, the new subtype will only elude the defense mechanisms and rapidly infect the basal cell of the mucosa and start replicating. Viral genesis of cancers is more and more discussed as the etiology of cancers. New sources of infection will certainly come from neo-colonization, transfer of germs from one medium to another, one carrier to a new, rather than de-novo mutation of viruses.

As the battle ground of billions of cells and germs, man is also ‘spirit’ trying out, seeking new adventures to quench his thirst for thrills, and searching for a reason to exist. History teaches us that orgies, sodomy, and others “French” sexual behaviors (as opposed to Victorians) were practiced long before the birth of moral codes and civilization, long before any systematic collection of data, and certainly HPV has been around for millennia along with the other plagues, now forgotten relics of the European past but still a threat to African lives, Hansen, Koch, Pallidum to name a few hallmark names. Since HPV vaccine has been announced to be readily available to females and perhaps males, I have been feeling like Omar Khayyam, the 11th century Persian poet drunk with his quatrains:

Rejoice my young friend and lover,
Receive deeply my gift of life,
Fear no Heavenly wrath or viruses,
For we have discovered vaccines

Dr. Ayatollah

Ousmane Diallo is a physician from Senegal seeking a PhD in infectious disease epidemiology at the University of Iowa. After obtaining his master in Public Health in 2005 from St. Louis University, he joined the Iowa Department of Public Health, where he works as an epidemiologist in injury and substance abuse prevention.

Works cited

Karl Marx, Contribution to the Critique of Hegel’s philosophy of Right, 1844.

Zur Hausen, Pappillomavirus infection: a major cause of human cancer. Biochim Biophys Acta Rev Cancer 1996; 1288: F55-78. PubMed Link.

Scully C. Oral squamous cell carcinoma; from a hypothesis about a virus, to concern about possible sexual transmission, Oral Oncology, 2002. PubMed link.