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LETTER |
Family Medicine Sinai Hospital of Baltimore Assistant Professor of Internal Medicine Johns Hopkins School of Medicine Baltimore, Md
To the Editor: I would like to commend Paul M. Krueger, DO,1 for overseeing, and Bethany A. Weaver, DO, MPH2,3; Daron G. Ferris, MD4; and Anthony H. Dekker, DO,5 for participating in, the production of a thoughtful and timely March 2006 JAOA supplement on human papillomavirus (HPV) vaccines.
The availability of a vaccine for HPV raises many questions about the virus, including: How is it spread? How does it cause cervical cancer?6
The main question my patients ask when they are given the diagnosis of HPV is "Where did I get the virus?" When they are told that HPV is sexually transmitted, the conversation becomes confusing. If HPV is sexually transmitted, where and when did my patient or the patient's partner become exposed? Should both partners be treated?
Men may be infected with the virus, but we usually do not treat them. Clinical expression of HPV in men is rare, with the exception of genital warts or anogenital cancers that develop in a small number of men who have the virus. And it is not understood why some men are asymptomatic while others have disease progression, though it is known that the disease will develop in men in regions of greater irritation or friction.7
Although we tell people that HPV is sexually transmitted, we also know that HPV can be found in women who have never had sexual intercourse, with one study claiming the rate of HPV infection in virgins is 14.8%.8 And we also know that HPV infection can be transmitted from mother to child.9
In conversion of HPV to cervical cancer, any type of trauma accelerates the process. We also know that T-cell recruitment to the site of HPV infection occurs prior to transformation of the virus into a precancerous or cancerous lesion.10
It is not until after the debut of sexual activity that a person's HPV-related problems appear. It is possible that the physical friction of sexual activity along with the presence of the virus is what activates viral transformation.
References 2. Weaver BA. HPV vaccines: are we closer to preventing cervical
cancer and other HPV-related diseases? J Am Osteopath
Assoc. 2006;106(3
suppl 1): S1. 3. Weaver BA. Epidemiology and natural history of genital human
papillomavirus infection. J Am Osteopath Assoc.2006; 106(3 suppl 1):S2
–S8. 4. Ferris DG. Vaccines for preventing HPV-related anogenital infection
and neoplasia. J Am Osteopath Assoc.2006; 106(3 suppl 1):S9
–S13. 5. Dekker AH. Fostering acceptance of human papillomavirus vaccines.
J Am Osteopath Assoc.2006; 106 (3 suppl 1):S14
–S18. 6. Bailey J, Cymet T. Planning for the HPV vaccine and its impact on
cervical cancer prevention. Comp Ther. In
press. 7. Partridge JM, Koutsky LA. Genital human papilloma virus infection
in men. Lancet Infect Dis.2006; 6:21
–31.[Medline] 8. Pao CC, Tsai PL, Chang YL, Hsieh TT, Jin JY. Possible non-sexual
transmission of genital human papillomavirus infections in young women.
Eur J Clin Microbiol Infect Dis.1993
:12:221
–222.[Medline] 9. Sinclair KA, Woods CR, Kirse DJ, Sinal SH. Anogenital and
respiratory tract human papillomavirus infections among children: age, gender
and potential transmission through sexual abuse.
Pediatrics.2005; 116:815
–825. 10. Jastreboff AM, Cymet T. Role of human papilloma virus in the
development of cervical intraepithelial neoplasia and malignancy.
Postgrad Med J. 2002;78225
–228.
1. Krueger PM. Infections with human papillomavirus: hope for
prevention and guidance for diagnosis and management [editor's message].
J Am Osteopath Assoc.2006; 106(3 suppl 1):inside front cover–S1
.
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