How do we get HPV infections, anyway?

One of the weirdest issues to drive the religious right into frothing madness was the discovery of a vaccine against human papilloma virus, or HPV, which would effectively reduce rates of cervical cancer … and it was opposed because it blocked infection with a sexually transmitted disease, and thus would encourage licentiousness. Weird, I know. Their brains don't work right.

Anyway, here's a new twist: investigators have found other non-genital reservoirs of the virus: HPV strains that could cause severe forms of cancer have been found under people's fingernails. Ooooh, yuck, you filthy humans, crawling with viruses and microorganisms and various creepy crawlies … it gives one a little sympathy for obsessive germophobes.

It has to be emphasized, though, that finding the virus in one place does not mean it is transmitted via that place — this may be a completely negligible finding. If transmission is documented, then this could be an important discovery for public health policy, since we could at least tell them we're inoculating their kids against a virus they might get from their priest patting them on the head, rather than just in case their child grows up to be a nasty dirty slut who actually has sex. It's too early to do that, though, and right now this is mainly an opportunity to justify more research into mechanisms of infection with HPV.

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Oh, but HPV is a skin contact transfer virus -- it's not spread by bodily fluids. And that little fact helps to reveal all the hypocrisy and hoaxes of the "abstinence only" people.

P.Z., I have listened to the Texas abstinence-only presentations, and each time the presenter (claiming to be a health professional until I called them on their inaccuracies) said that condoms are ineffective against a high percentage of HPV transmissions (true, because the virus may reside on skin outside the area protected by a condom), and then gone on to extrapolate that the viruses migrate through holes in the condoms (false) and that condoms are also ineffective at birth control (also false), and nearly completely ineffective against HIV (in the only serious study done, condoms were found to be 90% effective in stopping HIV transmission between committed partners where sex was frequent and one partner was known to be infected -- in other words, the things are incredibly effective against HIV).

We already know that HPV transmission doesn't occur from semen or vaginal fluids, and can occur anywhere skin contacts infected and virus-shedding skin. So the vaccines protect against non-sexually-transmitted HPV, too.

HPV is probably the virus your prudish aunt warned you about -- you know, the one you'd get from shaking hands with the self-abusers and sexually active. Only she didn't know it.

It's interesting to drop those facts into a conversation of mothers in Texas insisting they won't let their daughters get the vaccine because it's untested.

In other news, about a week ago, the Texas woman whose testimony in favor of the vaccine, to the legislative committee considering the ban on Gov. Perry's order, was prevented by her becoming too ill before the committee ever got to her, died of the cancer she got from HPV.
http://www.dallasnews.com/sharedcontent/dws/news/texassouthwest/legisla…

Liberal media? Did your newspaper cover it? Your newspaper is a conservative tool . . .

I am pleased to say that here in the UK the government has recently decided that it will set up a vaccination program for all 13 year old girls. The downside is that it probably will not begin until Sept 2008, and maybe not even until 2009. And they have ycet to decide if there should be a "catch-up" program for those girls still at school but over 13. There has been very little opposition to the plan here, apart from a few of the more radical religious groups. We just ignore those though.

By Matt Penfold (not verified) on 01 Aug 2007 #permalink

One thing I've never quite understood: isn't there some value in developing/administering a vaccine to those who are only carriers of the virus (i.e., males)? I understand that, as those who will suffer the consequences of HPV, women have more direct incentive to get a vaccine, but most discussion is around whether to require school-age kids to have this vaccine. Surely males can be included under that umbrella?

Or wouldn't there be any value in vaccinating the carriers as well?

Zadig: IANAHP but... if the virus is transmitted via surface contact, and it can survive *on* the surface, then administering the vaccine to a man is likely to be ineffective, since he will not contract the disease, and any virus on his skin will be - essentially - invisible to the vaccine (unless you administer via a bathtub!). So he'd still be a carrier.

Males are not just carriers -- HPV causes genital warts and sores like cold sores. Males get these, too.

Yes, there is great value in vaccinating males. It stops them from being carriers.

In a more interesting twist on the question, a vaccine has been developed against the malaria parasite. Any mosquito who bites someone who has been vaccinated becomes incapable of carrying the parasite. The ethical and pragmatic difficulty, of course, is that people would be getting the vaccine to benefit others, because it doesn't prevent their getting malaria.

So, should we promote it? Could it help?

and any virus on his skin will be - essentially - invisible to the vaccine (unless you administer via a bathtub!).

You do understand what a vaccine does?

By PMembrane (not verified) on 01 Aug 2007 #permalink

yes - i do understand what a vaccine does. It vaccinates the recipient...

however - if the recipient has spores on the surface of the skin in an area inaccessible to the administerd vaccine then the vaccination will be effectively useless...

I was responding to Zadig re administering the vaccine to males, who are only ever carriers of the virus. A vaccination will make the male immune to the effect of virus (irrelevant since they are already unaffected by the virus).... but not to carrying the virus on their skin.

Zadig,

My understanding is that vaccinating men does nothing to stop HPV transmission, and since men do not get cervical cancer there is no benefit in such a program for them. The reason 13 year old girls are targeted is becuase it seems the vaccine is only effective before exposure to the viruses and at 13 most girls have yet to become sexually active.

By Matt Penfold (not verified) on 01 Aug 2007 #permalink

we're inoculating their kids against a virus they might get from their priest patting them on the head

I'd think the average parent wishing to protect his child's chastity would let that child nowhere near touching distance with a priest.

Of course boys should be vaccinated. I find the term 'carrier' here problematical because it ignores the fact that there is a risk for boys also developing cancer associated with HPV.

By J Aaron Logan (not verified) on 01 Aug 2007 #permalink

Ed @ 5: I did not know that. So would the same condition hold true for boys as girls - that vaccination post viral exposure is largely ineffective .

Re the anti-malaria vaccine - i think if there are no negative side effects, then it *should* be promoted. If we can eradicate the malaria parasite at second hand then at least it will be controlled... and scarce resources can be targetted to those rare individuals who will continue to contract malaria.

yes - i do understand what a vaccine does. It vaccinates the recipient...

however - if the recipient has spores on the surface of the skin in an area inaccessible to the administerd vaccine then the vaccination will be effectively useless...

No, you don't know what a vaccine does.
A vaccination is, to put it in crude terms, a process where one purposely exposes a weakened pathogenic organism, fragments of a pathogenic organism, or a denatured toxin (if we include antivenin) to a person in order to stimulate that person's immune system into recognizing and attacking that particular pathogen or venom in order to prevent the person from becoming ill.
In other words, a vaccine, itself, does not kill anything. A vaccine is simply a way of training your immune system to kill particular pathogens.

HPV under the edges of fingernails has huge significance for sexual transmission. Just as a penis does not only fit in a vagina, nor is it the only limb that fits there. And besides, there's a lot of sex going on between non-bepenised people.

Yes, a vaccine post-infection is ineffective. However, the vaccine is good against several different forms of HPV, including the two that go on to create the majority of cervical cancers. So if the patient has been exposed to one, but not both, then the vaccine may still offer some protection.

Talk to a health professional. (C'mon over to my blog and follow the links to the prescribing warnings and other information:
http://timpanogos.wordpress.com/2007/05/31/voting-for-cancer-against-pr…

This is a serious issue, and it merits serious discussion. HPV is NOT NECESSARILY SEXUALLY TRANSMITTED, and the vaccine protects against all forms of transmission.

Oh, and as with all herpes viruses, the virus infects the skin cells and goes on from there. The vaccine protects all cells in the body, including skin cells. (in response to comment #4)

Males are not just carriers -- HPV causes genital warts and sores like cold sores. Males get these, too.

You're right about the genital warts, but cold sores are caused by the herpes virus. Herpes simplex I (generally) causes cold sores and simplex II (generally) causes genital herpes, but the viruses can be transmitted between the 2 (you can have herpes II on your face or I in the genital area).

By Elizabeth (not verified) on 01 Aug 2007 #permalink

Fundie cultists are just setting their kids up to fail. These people are dumb and sick in the head.

It is amazing just how much these clowns lie. Their ten commandments are really eight. Lying and killing get left out routinely.

I assume the vaccine will be voluntary or with an opt out option. So, don't want the vaccine, don't get it. And if your kid gets cervical cancer, don't complain.

What is the difference between trying to block a cervical cancer vaccine for an STD and outlawing the sale of antibiotics and treatment for STDs such as chlamydia, syphilis, and gonnorhea? Not seeing much difference.

When I had a cervical cancer scare - well before the approval of the vaccine, I'm sad to say - my GYN told me that sexual intercourse was not required for the transmission of the virus that causes cancer. I think her words were, "I've seen a 50-year-old nun get cervical cancer; there's no way of knowing where or when you might have contracted the virus. It might not even have been through sex, and using a condom isn't a 100% guarantee against transmission, anyway."
This didn't actually make me feel any better, but it does suggest that you don't have to be a dirty hoor to get HPV.

And besides, there's a lot of sex going on between non-bepenised people.

And even among exclusively bepenised people, who might contract oral and rectal cancer from HPV.

Males are not just carriers -- HPV causes genital warts and sores like cold sores. Males get these, too.

Not just icky warts and sores. HPV causes penile and anal cancer in men, too. Gay men are five times more likely to get anal cancer than women are to get cervical cancer.

Don't forget exactly how common cervical cancer is, either. Before pap smears became standard for women in the third world, it was one of the most common causes of death for women. To this very day, cervical cancer is the #1 form of cancer in parts of the third world, and is in the top 5 for many others.

This link is useful in answering many of the questions above. It looks like boys aren't getting it yet just because they haven't tested it yet. Same reason why girls aren't getting it until they're at least 9 yrs old. (I always wondered why they didn't just give it to babies like all other immunizations).

http://www.cancer.org/docroot/CRI/content/CRI_2_6x_FAQ_HPV_Vaccines.asp

Thanks, all. That clears things up. It seems that it would be very useful to give the vaccine to males (both to protect them and to reduce transmission), but only after it's tested and approved for said males.

I appreciate the help understanding.

@ raven #17:

I'm not sure that vaccination should be voluntary. There are many other vaccinations that are, while not mandatory, stongly enforced by means of a requirement to be vaccinated to attend a public school. Obviously this won't apply to many fundies, but...

The biggest benefit I can see for vaccination in this case is not so much the protection of the vaccinated individual but the opportunity to greatly reduce the prevalence of the disease itself.

By Brain Hertz (not verified) on 01 Aug 2007 #permalink

here's something else you may not have known about HPV vaccines: my wife, a family physician, mentioned the other day in incredible dismay and frustration, that certain insurance companies (Neighborhood Health I think), are reimbursing physicians for less than the cost of the vaccine. That's right - in order for doctors to provide the vaccine to many of their patients, they have to do so out of their own pocket. I wonder now if this is part of the religious right's plan?

Viral particles under the finger nails ?? I am shocked. How would one get those ? And do nasal membranes have the appropriate receptors for HPV ? Scary.

And Jolya, I am not sure that HPV infections is the only and sole cause of cervical cancer, although I amust admit I am not up ont eh literature. but there are plenty of epithelial cells there that can go haywire without viral transformations.

This is not surprising. I saw a similar result in a study following a cohort of college-age girls that were HPV negative going in. About 10% converted to HPV+ after one year despite never having had intercourse. I suspect it was digital to cervical transmission.

I do not know if the studies have been conducted re: the HPV vaccine specifically, but vaccines -can- be effective as post-exposure treatments. Rabies, specifically, is a great example of an illness treated with post-exposure prophylaxis; one merely has to muster an immune response before the virus reaches one's brain.

@24, that's long been the case, and not just re: HPV vaccine. In my time shadowing for a pediatrician, I found that the majority of his vaccinations - particularly for patients covered by medicare - ended up losing him money. On vaccine-heavy days, he could go home having made perhaps $100 for the day (not counting the cost of other overhead).

And, yes, vaccines ought to be legally mandated. Vaccines do not function merely on a person-to-person basis: one of their most important functions is in providing herd immunity, by destroying the virus' ability to establish circulation in a population. People that do not get vaccinated are not only risking themselves, but everyone around them. If a certain critical mass of people do not have a vaccine (just enough to support the particular virus, according to contagiousness, life cycle, and virulence) you can see it erupt from a few isolated cases to an epidemic. As is the general rule; where the cost to the individual is nil, and the benefit to society large, your "rights" go out the damn window.

I'd slam these fundie idiots over the head with baseball bats, but the Royal Society for Prevention of Cruelty to Baseball Bats might arrest me.

For the fundie loonies you simply have to say: "HPV can affect anybody who has sex; and everybody's mother has had sex."

They will either shut up, or fall into the trap you have laid for them. It would be interesting to try: I wonder how many will say "My mother has not had sex!"

By Justin Moretti (not verified) on 01 Aug 2007 #permalink

My 16 yo daughter is having her HPV booster today at school. The Australian government originally wasn't going to fund it for a year or two, however a consortium of women Members of Parliament from at least three of the political parties put the pressure on to fast track it. I'm happy.

Stantoon: Actualy I did know that - but iuf you actually read my post it recognizes thatvaccination would be irrelevant if you were already infected.... but that it provided benefit if you were not.... but that benefit would not extend to your skin.

When you said 'do you understand what vaccination *does*' I did not understand that you wanted me to state the *mechanism*... I wrote about the *effect* - which was the point of my post. I could have written what you wrote... but what was the point of that - it would not illustrate that vaccination would not affect any spores on the skin - which is the virus' primary vector.

sorry if that was confusing, but posts often are - we generally don't write complete or well-formed statements in these blogs.

;)

And I'd also like to state thanks to everyone else who posted -- much better informed on this (didn't know the same virus similarly affected males, for instance)

I agree with many of the posters above: from a public health perspective if a vaccination is positively beneficial for the greater population with little risk to the individual then it should be compulsory.

"They will either shut up, or fall into the trap you have laid for them. It would be interesting to try: I wonder how many will say 'My mother has not had sex!'"

unfortunately, they simply beomce more absurd. one fundie blogger's reply to a comment like that was: "Good christian women don't get diseases like that because they only have sex with their husbands." When another commentator suggested a husband might cheat on his wife, she blithely replied: "A good christian woman wouldn't marry a man that would cheat on her." i swear, i did not make this up. and this was well before i had heard that HPV can be contracted without sexual contact. which is unfortunate, as i would have loved to see what retarded rebuttal she could come up with for that.

One of the weirdest issues to drive the religious right into frothing madness was the discovery of a vaccine against human papilloma virus, or HPV, which would effectively reduce rates of cervical cancer ... and it was opposed because it blocked infection with a sexually transmitted disease, and thus would encourage licentiousness. Weird, I know. Their brains don't work right.

That's easily understood: The thing that most terrifies fundies is sex without consequences. That explains an awful lot, doesn't it?

My wife recently attended a meeting (she works in the medical field) concerning the HPV vaccine, and the (male)doctor giving the lecture was asked if he had vaccinated his children. He replied that he had vaccinated his daughters (all of his children are pre-pubescent). A nurse quickly asked if he had vaccinated his son. The embarrassed doctor replied that the vaccine was only covered by his insurance for female children.

I live in the USA. It is (if you've never heard of it) an industrialized, modern country. We still don't provide basic medical care to our citizens unless a huge privately controlled bureaucracy deems it cost-effective.
I am often, these days, ashamed of the ignorant assholery of my country.

What a great opportunity! Why not make vaccination a requirement for entry into public schools? Think of the wonderful knock-on effects! The fundies will stay away from public schools - good for the school. Publicly educated non-fundies will tend to 'out-survive' the fundies, gradually improving America's voter base. Good science might one day have a hope in hell of being widely properly taught - yay!

All that PLUS - the fundy-'educated' will tend to die early because regardles of what they say about sex we all know they're doing it and they'll be doing it without the combined benefits of knowledge and protection.

See? Everybody (who matters to your country's future...) wins! ;-)

I was living with a woman back in the early 90's. Her doctor found some possible pre-cancerous lesions on her cervix that had to be lasered off. When I took her in for the appointment, the first thing her doctor did was examine my hands.

Justin @ 29: While it is probably true that everybody's mother has had sex, these days it is possible to conceive a child without sex via such means as artificial insemination. This makes it theoretically possible for a virgin to have a kid sans divine intervention. So, do you have a response for, "Mom went to a clinic and got a sperm sample"?

This makes it theoretically possible for a virgin to have a kid sans divine intervention. So, do you have a response for, "Mom went to a clinic and got a sperm sample"?

Even that may not be enough to prevent serious infectious disease, though. Hansa, the young elephant that died at the Woodland Park Zoo in Seattle a few weeks ago, died from a previously unknown herpesvirus that no one is sure how she contracted, long past the age window where baby elephants are supposedly only vulnerable during.

No one knows how she contracted it, and the possibility that the virus arrived via some of the AI attempts her mother underwent (although Hansa was later conceived the old-fashioned way) can't be ruled out with as little knowledge as we have.

I could have written what you wrote... but what was the point of that - it would not illustrate that vaccination would not affect any spores on the skin - which is the virus' primary vector.

The vaccine prevents the virus from multiplying and erupting on the skin to infect others. Clear now?

tony -I was responding to Zadig re administering the vaccine to males, who are only ever carriers of the virus. A vaccination will make the male immune to the effect of virus (irrelevant since they are already unaffected by the virus).... but not to carrying the virus on their skin.

I think you are misunderstanding what "carrier" means. It doesn't just mean that the pathogen is sitting inertly on the surface of their skin like dandruff, which is what you seem to think it means - a carrier is infected with the virus, has it replicating inside them, and can pass it on to others, but does not show symptoms themselves. A vaccine would indeed stop people being carriers.