Commentary Sexual Health

Oh! The Drama! Soap Opera Treats HPV… the Wrong Way

Martha Kempner

All My Children takes on the world of STDs with a storyline about HPV that is, unfortunately, more dramatic than it is accurate. 

About a week ago, driving my husband to a doctor’s appointment, I began dreading my time in the waiting room. This doctor often keeps us waiting and the last time we were there, Fox TV was blaring right-wing propaganda from the flat-screen in the corner.  It was during the Gulf oil spill and the talking heads were somehow managing to twist events to blame those who wanted new more efficient energy sources. When they turned to Michael Brown, the former head of FEMA who botched the Katrina recovery so badly, for his expert opinion, I found myself screaming at the TV.  So, I was relieved when this time the receptionists had chosen to force us to watch All My Children instead.  I haven’t watched a real soap opera in over a decade, but I grew up on General Hospital and As the World Turns and would take their silly melodrama over Fox’s asinine analysis any day.  And yet, 20 minutes later, I found myself yelling at that same flat-screen in the corner.

The storyline I watched unfold in a series of two-minutes scenes seemed to go like this: The girl in the pink shirt had had a one night stand with the smarmy guy with the slicked back hair (who I assumed was named Storm, Chase, or Brick).  A pregnancy scare had turned out to be a false alarm but now she was anxiously awaiting results of STD tests. She confided this to a ridiculously blond friend who reminded her it could just be a simple infection and she shouldn’t do anything until she hears from the doctor. Instead of heeding blond friend’s advice, she confronts smarmy guy and they each accuse the other of being the source of the not-yet-confirmed infection. Then, standing with a young doctor in what appears to be a hospital corridor (good for privacy and confidentiality), pink shirt girl is informed in classic soap opera overacting mode “You have [pause for dramatic effect] human papillomavirus!!”

That’s when I started screaming at the TV for its inaccuracies and overreaction. It’s also when it was our turn to see the doctor so I didn’t get to find out what happened next or whether the writers redeemed themselves in anyway.  Here is how explains this ongoing storyline:

In another part of the hospital Amanda tries to process the news that she has HPV. She could have gotten it recently or a long time ago; often the symptoms stay dormant. Cara is gentle but matter of fact as she informs Amanda is at high risk for cervical cancer. Amanda freaks out, but Cara urges her to keep calm until the next test results return. Amanda heads to the Chandler mansion where she confirms to JR that she has HPV. She urges JR to get tested and tell Marissa, but all JR can do is complain that he might lose Marissa. Furious Amanda calls JR  “selfish;” he could at least show some compassion. She could have cancer! JR thinks that Amanda got HPV from a long time ago since he tested clean after Annie left, which means no one has to know about his one-night with Amanda. Frustrated Amanda reminds JR that he has an obligation to tell Marissa and leaves.

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Ah the exclamation points.  While they got a few things right, AMC’s coverage of HPV leaves a lot to be desired.  Here are some things I wished they’d explained better:

HPV doesn’t usually present with symptoms.

As I understood the back story (admittedly not having seen it transpire), Amanda sought STD testing because she had symptoms—she felt something was wrong—and was told that maybe she just had a simple  infection.  Given that set up, I expected her to be diagnosed with Chlamydia or Gonorrhea both of which can cause itching, burning, and discharge in women, though they often have no symptoms. Human papillomavirus (HPV), on the other hand, can cause genital warts or changes to the cells on a woman’s cervix neither of which are things that a woman is likely to actually feel and neither of which would be confused with a simple infection.

It seems like the writers aimed at accuracy with the comment “She could have gotten it recently or a long time ago; often the symptoms stay dormant.” It’s true that HPV can be in the body undetected for a long time. Again, however, “symptoms” is a bit of a misleading concept here as the virus rarely causes anything that individuals can feel.

Testing for HPV is different than for other STDs.

It is unlikely that a woman like Amanda who goes to her health care provider with symptoms would be tested for HPV right away—again, Chlamydia and Gonorrhea are more likely suspects.  Moreover, as the CDC explains, “there is no general test for men or women to check one’s overall ‘HPV status,’ nor is there an HPV test to find HPV on the genitals or in the mouth or throat.”  There are tests that can check for HPV but they are primarily used to help screen women for cervical cancer. It is suggested that women over 30 undergo these tests in conjunction with their Pap tests, a routine gynecological test that can detect cervical cancer and/or precancerous changes to the cells on a woman’s cervix.  For women under 30, it is only recommended that they have HPV tests if their Pap test comes back abnormal or inconclusive.  In general, women learn that they have HPV as part of the results of their Pap tests rather than as part of set of STD tests.

The reality of HPV testing also means that JR’s insistence that it wasn’t him because “he tested clean after Annie left,” is misleading as well.  While he may have been tested for other STDs, there currently is no FDA-approved HPV test for men.  Some men are diagnosed with HPV when their health care provider notices genital warts on their penis or around their anus but there is no other test, and most men never know whether they do or don’t have this virus.

In the United States, cervical cancer is relatively rare.

I didn’t see the scene where Amanda accuses JR of being insensitive because he’s just worried that their one night stand may be revealed while she now has to worry that she may have cancer, but the recap of it contained exclamation points so I am sure that it was very dramatic.  And as such, it was probably pretty misleading.

It is true that several specific strains of HPV are responsible for virtually all cases of cervical cancer, but it is also important to understand that cervical cancer is a rare and preventable outcome of HPV infection. Moreover, where it does occur, HPV infection does not lead to detectable cervical cancer overnight; it takes time to develop and become detectable.  Approximately 6 million people in the United States get HPV each year and only 12,000 women get cervical cancer.  In fact, most HPV infections clear up on their own and cause no long-term health problems. 

Any doctor who lets a patient newly diagnosed with HPV walk out of his/her office in fear of cancer has not done a very good job of explaining the facts.  Instead, health care providers should explain that further tests can determine whether the patient has those strains of HPV that are linked to cervical cancer (to give credit, the writers did point to further testing). And, he/she should emphasize the importance of routine Pap tests as these can detect precancerous changes and allow for treatment before cervical cancer develops.

HPV infections are widespread.

Obviously, we need to take all STDs seriously, they are an epidemic in this country.  But there is a difference between seriousness and melodrama.

I’m sure real women who, like Amanda, are told that they have HPV need time to “process it” but I hope that while they’re doing that, they are reminded that over 20 million Americans are living with HPV, that it is estimated that between 50 and 80 percent of all sexually active individuals will get HPV at some point in their lives, and that most cases of HPV are cleared by the body with no treatment and no lasting impact. 

Amanda should take STDs seriously, she should think about using condoms the next time she has a one night stand, and she should continue to be screened for cervical cancer but she should know she’s not alone in this and should not feel embarrassed or ashamed (she might feel a little bad for cheating on her husband but that’s another article).

Blame is Not Helpful.  

Soap operas have never provided a model of good communication—doing so would reduce the tension, cut the number of scenes the writers could get out of one conversation at least in half, end the possibility of a whole storyline based on a misunderstanding, and ruin any chance of a good Friday afternoon cliffhanger. So it is not surprising that the two scenes in which JR and Amanda discuss her STD provide an example of bad communication between sexual partners. There are a lot of accusations and much finger-pointing. To be fair, these characters have a lot of other things to deal with—they’re both married to other people, his wife is having an affair though it’s unclear if he knows it, and her husband seems to be part of an evil plot to take over the hospital (or maybe that’s someone else).  Still, it would be nice to see them show a little more understanding and civility (if not empathy).

Prevention is Most Important.

Obviously, staying monogamous is one way to prevent the spread of HPV but monogamy is unlikely in Pine Valley, Port Charles, or other soap opera towns because it makes for boring TV.  So, I would hope that Dr. Cara used this opportunity to remind Amanda and JR (and viewers) of the importance of using condoms to prevent STDs.  Condoms have been given a bad rap against HPV because the virus is transmitted from infected skin to non-infected skin and infected skin can include the scrotum or other areas that are not covered by the condoms. While they can’t provide complete protection against HPV, the CDC still recognizes condoms as important in the fight against HPV and cervical cancer.  Recent research suggests that most HPV infections in men are, in fact, located on portions of the penis covered by a condom. Moreover, research has shown that using condoms has been associated with a reduction in HPV-related health outcomes such as cervical cancer and genital warts in women.

HPV is also unique because there are now two FDA-approved vaccines that can prevent it (Hepatitis-B is the only other STD for which there is a vaccine). Both vaccines (Cervarix and Gardasil) have been shown to protect females against the types of HPV that cause most cervical cancers. Gardasil also protects against most genital warts. The CDC now recommends HPV vaccines as a routine part of health care for adolescent girls.  Of course since the vaccines only recently became available most women today did not receive it at that stage, therefore, the CDC recommends that all women ages 13 to 26 be vaccinated.  Gardasil is also available for boys and men ages 9 through 26.

I know that in television accuracy is often sacrificed for drama and I can forgive a lot for the sake of the art form. Hell, I totally believed that Robert Scorpio was part of an international spy agency and that his arch enemy was able to control the weather in Port Charles (General Hospital circa 1984). Still, as with anyone in the media, I think AMC writers have a unique opportunity to reach an audience (at least until the show goes off the air in September) and should use that opportunity to spread as much accurate information as possible even if they do it with audible sighs and pauses for dramatic impact.

Unless otherwise cited, all information about HPV comes from CDC’s Genital HPV Infaction – Fact Sheet

News Health Systems

Texas Anti-Choice Group Gets $1.6 Million Windfall From State

Teddy Wilson

“Healthy Texas Women funding should be going directly to medical providers who have experience providing family planning and preventive care services, not anti-abortion organizations that have never provided those services," Heather Busby, executive director of NARAL Pro-Choice Texas, said in a statement.

A Texas anti-choice organization will receive more than $1.6 million in state funds from a reproductive health-care program designed by legislators to exclude Planned Parenthood

The Heidi Group was awarded the second largest grant ever provided for services through the Healthy Texas Women program, according to the Associated Press.

Carol Everett, the founder and CEO of the group and a prominent anti-choice activist and speaker, told the AP her organization’s contract with the state “is about filling gaps, not about ideology.”

“I did not see quality health care offered to women in rural areas,” Everett said.

Heather Busby, executive director of NARAL Pro-Choice Texas, said in a statement that it was “inappropriate” for the state to award a contract to an organization for services that it has never performed.

“The Heidi Group is an anti-abortion organization, it is not a healthcare provider,” Busby said.

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State lawmakers in 2011 sought to exclude Planned Parenthood from the Texas Women’s Health Program, which was jointly funded through federal and state dollars. Texas launched a state-funded version in 2013, and this year lawmakers announced the Healthy Texas Women program.

Healthy Texas Women is designed help women between the ages of 18 and 44 with a household income at or below 200 percent of the federal poverty level, and includes $285 million in funding and 5,000 providers across the state.

Bubsy said the contract to the Heidi Group was “especially troubling” in light of claims made by Everett in response to a recent policy requiring abortion providers to cremate or bury fetal remains. Everett has argued that methods of disposal of fetal remains could contaminate the water supply.

“There’s several health concerns. What if the woman had HIV? What if she had a sexually transmitted disease? What if those germs went through and got into our water supply,” Everett told an Austin Fox News affiliate.

The transmission of HIV or other sexually transmitted infections through water systems or similar means is not supported by scientific evidence.

“The state has no business contracting with an entity, or an individual, that perpetuates such absurd, inaccurate claims,” Busby said. “Healthy Texas Women funding should be going directly to medical providers who have experience providing family planning and preventive care services, not anti-abortion organizations that have never provided those services.”

According to a previous iteration of the Heidi Group’s website, the organization worked to help “girls and women in unplanned pregnancies make positive, life-affirming choices.”

Texas Health and Human Services Commission spokesperson Bryan Black told the Texas Tribune that the Heidi Group had “changed its focus.”

The Heidi Group “will now be providing women’s health and family planning services required by Healthy Texas Women, including birth control, STI screening and treatment, plus cancer screenings to women across Texas,” Black said in an email to the Tribune.

Its current site reads: “The Heidi Group exists to ensure that all Texas women have access to quality health care by coordinating services in a statewide network of full-service medical providers.”

Everett told the American-Statesman the organization will distribute the state funds to 25 clinics and physicians across the state, but she has yet to disclose which clinics or physicians will receive the funds or what its selection process will entail.

She also disputed the criticism that her opposition to abortion would affect how her organization would distribute the state funds.

“As a woman, I am never going to tell another woman what to tell to do,” Everett said. “Our goal is to find out what she wants to do. We want her to have fully informed decision on what she wants to do.”

“I want to find health care for that woman who can’t afford it. She is the one in my thoughts,” she continued.

The address listed on the Heidi Group’s award is the same as an anti-choice clinic, commonly referred to as a crisis pregnancy center, in San Antonio, the Texas Observer reported.

Life Choices Medical Clinic offers services including pregnancy testing, ultrasounds, and well-woman exams. However, the clinic does not provide abortion referrals or any contraception, birth control, or family planning services.

The organization’s mission is to “save the lives of unborn children, minister to women and men facing decisions involving pregnancy and sexual health, and touch each life with the love of Christ.”

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.


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