Mandatory HPV Vaccine Moves Forward in Iowa

Lynda Waddington

Only two steps remain in Iowa's legislative quest to require insurance companies to provide coverage of vaccinations for the human papillomavirus, the major cause of cervical cancer.

Only two steps remain in Iowa's legislative quest to require insurance companies to provide coverage of vaccinations for the human papillomavirus, the major cause of cervical cancer.

The proposed bill was passed by an 81-16 vote of the Iowa House last week and referred to the Senate Human Resources Committee. All 16 House members opposing the measure were Republicans, six of them women.

Tuesday morning, the Senate committee, chaired by Assistant Majority Leader Joe Bolkcom, D-Iowa City, approved the measure and sent it on to the full Senate floor. The bill will need to pass through the Senate — something that is considered likely — and will need to be signed by Gov. Chet Culver. The law would take affect for third-party payment provider contracts, policies or plans delivered, continued or renewed in the state after Jan. 1, 2009.

"Cervical cancer is preventable," Bolkcom said. "The HPV vaccine is the best defense. This bill will ensure that health insurers make the HPV vaccine available and affordable to Iowa women. I expect the Senate to approve this bill soon."

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The bill, the successor to HSB 566, is supported by the Iowa Osteopathic Medical Association, Child and Family Policy Center, the Iowa Academy of Family Physicians, the Family Planning Council of Iowa, the Iowa Coalition Against Domestic Violence, Planned Parenthood of Greater Iowa, the Iowa Medical Society and the American Cancer Society. It is opposed by Golden Rule Insurance, the Iowa Christian Alliance and Iowa Right to Life.

For the most part, insurance companies — many of which already provide coverage for the vaccine — have remained neutral about the bill.

"Really this is about the state making a long-term commitment to women," said Kyle Carlson, staff attorney for PPGI. "This is the state saying that it is going to prevent cervical cancer as a matter of policy rather than leaving it to market forces."

Genital HPV infection is a sexually transmitted disease that is caused by human papillomavirus, a group of viruses that includes more than 100 different strains. The disease is spread by genital contact. All types of HPV can cause mild Pap-test abnormalities that do not have serious consequences. Roughly 10 out of the 30 identified genital HPV types can lead to development of cervical cancer.

In June 2006, the first vaccine developed to prevent cervical cancer and other diseases in females caused by HPV was recommended by the Centers for Disease Control and Prevention. The vaccine protects against four HPV types, which altogether cause 70 percent of cervical cancers and 90 percent of genital warts. The vaccine was subsequently approved by the Food and Drug Administration for use in girls and women between the ages of 9 and 26. The vaccine is given through a series of three shots during a six-month period.

While there is no doubt the vaccination could save the lives of girls if it is provided before they become sexually active, social conservatives have argued that immunizing teens could encourage sexual activity and provide a false sense of protection against other sexually transmitted infections.

"I think we can reassure [those who worry about promiscuity] that there isn't a cause-effect relationship," said Dr. John Seffrin, chief executive officer of the American Cancer Society. "To put it in another way, the threat of getting cancer has not prevented people from engaging in sexual activity. More importantly, we've found that if you want people to take up an effective measure, you don't ram it down their throat. You provide it and educate people."

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

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A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.

News Politics

Senate Democrats Object to Contraception Limits in Blocking GOP Zika Agreement

Christine Grimaldi

“Republicans don’t want to treat Zika as an emergency and they don’t want to expand access to birth control," Sen. Barbara Mikulski (D-MD) said in a statement. "It begs the question: Will they be willing to pay the costs associated with every child born in this country with Zika-related birth defects?”

Democrats in the U.S. Senate Tuesday temporarily blocked a $1.1 billion GOP-engineered agreement to combat the Zika virus amid objections to the strings attached, including restrictions on contraceptive access.

Their Republican counterparts needed 60 votes to end debate and proceed to a vote on the measure. The 52-48 vote fell short of that threshold.

The Zika aid is part of a sweeping conference report (H. Rept. 114-640) that also provides fiscal year 2017 military construction and veterans affairs funding. The U.S. House of Representatives passed the conference report last week in a largely party-line vote with few Democrats on board. Prior to the vote, Democrats involved in negotiations had refused to sign off on the plan, which would limit contraceptive services in the United States and Puerto Rico and falls short of the Obama administration’s $1.9 billion request for emergency supplemental Zika funding.

As Rewire reported last week, the Republican agreement limits women to obtaining contraceptive services from public health departments, hospitals, and Medicaid Managed Care clinics. This could prove particularly challenging for women in Puerto Rico, a sprawling territory with few such options. Republicans would also prohibit subgrants to outside groups “that could provide important services to hard-to-reach populations, especially hard-to-reach populations of women that want to access contraceptive services,” according to a Democratic summary.

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Senate Majority Leader Mitch McConnell (R-KY) took to the Senate floor to argue that the Republican agreement actually provides “more resources for women’s health services” through the three options.

“It’s really puzzling to hear Democrats claim to be advocates for women[’s] health measures when they are the ones trying to block the Zika legislation and its critical resources to protect women’s health,” McConnell said.

Senate Appropriations Committee Vice Chairwoman Barbara Mikulski (D-MD), however, criticized Republicans for effectively prohibiting contraceptive services between many women and their doctors or primary care clinics.

“I know the issue of birth control is difficult for some, but we know that Zika has terrible consequences for women and babies,” Mikulski said in a statement. “Republicans don’t want to treat Zika as an emergency and they don’t want to expand access to birth control. It begs the question: Will they be willing to pay the costs associated with every child born in this country with Zika-related birth defects?”

The Centers for Disease Control and Prevention concluded that Zika causes microcephaly, an incurable neurological disorder that impairs brain and skull growth in utero, as well as other severe fetal brain defects. Advocates have said the virus underscores the urgent need for better contraceptive access, particularly since Zika can be sexually transmitted.

Online requests for abortion medications have spiked in Latin American countries that issued warnings to pregnant people about Zika-related complications yet outlaw or restrict the health care, according to a recent New England Journal of Medicine study.

A White House spokesperson June 23 said that President Barack Obama would veto the funding package in its current form. McConnell will attempt to bring up the Republican agreement after the Senate returns from its July 4 recess, according to a leadership spokesperson.

Senate Minority Leader Harry Reid (D-NV) and other party leaders in the chamber called for a new round of Zika talks.

“The conference report includes a restriction that would limit funding for providers of birth control services—a backdoor way of restricting care from women’s health providers like Planned Parenthood and family planning centers that would have serious consequences for women’s health,” they said in a letter to McConnell and House Speaker Paul Ryan (R-WI).