In the Dark
How much do you know about HPV?
Tank

I am a 28-year-old woman who has been sexually active for 10 years, and up until last October, I ensured that I was engaging in protected or safe sex. Being an AIDS baby (meaning that I was 6 or 7 when the epidemic hit), protected and safe sex is something that has been drummed into my head long before the idea of the sexual act was even entertained as a reality in my life. As well as preventing unwanted pregnancies, condoms also stop me from getting sexually transmitted infections (STIs), right? Provided, of course, that I don’t sleep with someone that has symptoms of an STI. That’s why condoms make sex safe, right?

Wrong.

There is no such thing as safe sex, or at least, not in the sense that I understood it. Not in the sense of “use a condom and I am safe from getting an STI.” Not in the sense of “use a condom and choose my partners carefully and wisely.” There is only safer sex, and I believe that to be an important distinction. Ultimately we should all know what we are being protected from. Pregnancy, sure. HIV, sure. Chlamydia, Gonorrhea — sure. But what of the other STIs, the incurable, viral infections like HSV (Herpes Simplex) and HPV (Human Papillomavirus)? Condoms are ineffective in preventing the transmission of those, you say? So what does that mean? And what on earth is HPV?

It means that back in October I received some extremely shocking and unwanted news. It means that I was diagnosed with HPV without ever having heard of it before. It means that as a woman who considered herself knowledgeable regarding the inner workings of her body, a woman who considered herself a feminist, I had a particularly nasty wakeup call which informing me of my ignorance and also, that I was harboring certain judgmental opinions about women, sex, and disease.

HPV is the most common STI in this country: 75% of sexually active adults will transmit it at some point in their life. However, only 30% of those infected will ever show symptoms, which is how something gets to reach epidemic status without the majority of us knowing it even exists.

There are around 100 strains of HPV, but only approximately 30 of those affect the genital region. The others affect other parts of the body like the hands and the feet and cause the common wart. Is HPV starting to sound familiar now? HPV has several symptoms: abnormal Pap smears, cervical dysplasia, cervical cancer, and genital warts. We have all heard of genital warts, haven’t we? But who knew that a different strain (and you can have multiple infections of differing strains) of the very same virus caused cervical cancer? Not me, that’s for sure.

In fact, whilst I dutifully had my annual Pap smear, I really wasn’t sure why I was having it. I just knew that you got one to make sure that you didn’t have cervical cancer. I don’t believe I was ever told what caused cervical cancer because I certainly had no idea that it was caused by an STI that was not prevented by using condoms. I mean, if I had known, the information would have put a whole new slant on my attitude towards sex. Every new partner would have represented a 75% chance to catch the precursor to cervical cancer, and on most men, honestly, I think I would have passed.

HPV infects the skin and is therefore transmitted during skin-to-skin contact. A genital HPV infection can be located anywhere in the anogenital region, which is an area far larger than that covered by a condom. In addition, according to some sources, the virus is small enough to pass through a condom, so that leaves us with no surefire way of avoiding it save abstinence. And while many of us do practice abstinence at varying points in our lives, the idea of a life completely free of sex is not something of which the average person would relish.

As HPV is a virus, it means that, like all other viral infections, there is no cure and the best we can hope for, once infected, is to develop an immunity to it. Unfortunately though, because there are numerous strains, we can become reinfected with a new and different strain even if we have developed immunity to another. Since so little is known about HPV, the medical community is unsure as to whether or not we can transmit the virus once an immunity has been developed. They say “possibly,” and so one must always communicate a prior or current HPV infection with a potential or current lover to allow them the choice of taking the risk. Always remember that someone else’s health does not belong to you. The other interesting characteristic of HPV is that while the normal incubation period after infection is 1 to 3 months, it does have an ability to lie dormant in one’s system for up to 10 years.

Up until the Pap smear was invented in the 1940s, cervical cancer was the number one killer of women, and in non-industrialized countries, cervical cancer is still the second most common cancer in women. I don’t think I am exaggerating when I say that the invention of the Pap smear must be one of the most revolutionary acts in women’s health care, as this single test reduced cervical cancer deaths by 75%. Having said that though, over 200,000 women still die each year from cervical cancer and over 450,000 new cases of it are diagnosed. Cervical cancer and HPV are a very real and very dangerous health issue for women. So why do we not know about it?

One of the major problems with this infection is that, for the most part, it is asymptomatic. It is also a misogynistic virus, in that it is primarily an issue for women, as penile and anal cancers that can result from it are far, far rarer than cervical cancer. For the most part, if men do show symptoms, it is from one of the low risk (meaning non-cancerous) strains that cause genital warts. For women though, the high risk (meaning cancer causing) strains can attack our cervix and lead to abnormal Paps, dysplasia, and cancer.

It is therefore vital that as soon as women become sexually active, we become regular in our Pap testing. Having a high-risk strain of HPV does not have to lead to cancer, provided the virus is caught early on when any damage caused by it can be reversed. In addition, we need to be vigilant in keeping our general level of health as high as can be. Which means not smoking (don’t moan, I just quit a 15-year addiction after receiving my diagnosis), eating a balanced diet, and keeping drug and alcohol consumption to a minimum.

Then, on top of the health risks accompanying HPV, you also have to deal with the emotional distortions of coming to terms with having an STI. After my initial diagnosis, I felt shattered by barbs of shame, dirtiness, guilt, and a sense of being unlovable. I looked at myself and wondered if this meant I was a whore, and I questioned my previous decisions and sexual encounters. I was buying into dogmatic belief structures that polarize women into the virgin / whore category. I was either clean, virginal, and good, or dirty, sluttish, and bad. I am, of course, neither, but the shame of contracting an STI definitely permeated my initial experience after diagnosis, making everything feel a lot worse than it truly is. Once I realized that having HPV says no more about me than having asthma does, I was able to speed along my emotional healing to come to a place where HPV was a part of me but did not define me in any way at all.

Since coming out of the HPV closet, so to speak, I have found that I have numerous friends with HPV or HSV. Without my speaking so freely about my condition, I never would have known. With the knowledge of being among others in similar situations comes a cleansing of sorts — you are not alone and this is a part of normal life for a lot of people. It is not bad luck or an attack of bad karma; this is just a risk of engaging in sexual activities, protected or not. I believe that a lot of the trauma of experiencing an STI can and will be removed once people actually start talking about it. By keeping the silence we are, consciously or unconsciously, subscribing to the idea of sex as shameful and something to be hidden, and while these ideas have proved tenacious so far in our culture, they are ideas that need to be eradicated in order for us to grow as a whole.

Owing to the nature of HPV and its potential severity for women, I do have a very strong, import laden desire to inform as many women as possible about this virus. It is this notion which has primarily driven me to be so forthright with my communications regarding my diagnosis. Since it seems practically impossible, if we choose to be sexual beings, for us to avoid this virus, what we do need to do is raise awareness about it. So, when other women find themselves in my situation, they need not go through the feelings of devastation that accompany the prognosis of an STI. They simply move forward in the direction of health.

For more information:

http://www.ashastd.org/hpvccrc/
http://www.cervicalcancercampaign.org
Joel Palefsky, M.D., What Your Doctor May Not Tell You About HPV and Abnormal Pap Smears