Analysis Sexual Health

Opening STD Awareness Month with a Success Story: HPV and Cervical Cancer

William Smith

I want to open this STD Awareness Blog series with a STD complication success story: fighting cervical cancer. Because here’s the thing: cervical cancer is almost completely preventable. This means that, given consistent and correct care, you will likely never been one of those 4,000 women who die of this preventable and treatable disease.

This article is published in partnership with the National Coalition of STD Directors (NCSD) as part of our joint series on STD Awareness

Each year, we recognize April as STD Awareness Month, and each year I am struck by the continued epidemics of sexually transmitted infections in this country. But this April there is an extra urgency among public health officials and practitioners to both prevent and reduce STDs. And throughout this month, NCSD is working with our friends at Rewire to feature articles addressing issues of greatest urgency.

Because let’s review the facts. In total, CDC estimates that there are approximately 19 million new STD infections each year, which cumulatively cost the U.S. health care system $16.4 billion annually and have huge personal costs for individuals. We also know that certain populations, such as men who have sex with men, youth, and communities of color bear a disproportionate burden of sexually transmitted infections (STIs) and related diseases. Each year, half of new STD cases occur in people ages 15 to 24.  And yet, throughout this ongoing public health crisis, STD programs across the country are facing more and more uncertain times with reductions in funding from state, local, and federal payers.

And while we have many, many challenges in fighting STDs and their complications (a set of issues we will cover throughout the month) I want to open this STD Awareness series with a success story: fighting cervical cancer. Because here’s the thing: cervical cancer is almost completely preventable. This means that, given consistent and correct care, you will likely never been one of those 4,000 U.S. women who die each year of this preventable and treatable disease.

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The reason that cervical cancer is almost completely preventable is because, unlike many cancers, which are caused by a number of physical, genetic, lifestyle and environmental factors, almost all cervical cancer is caused by a sexually transmitted virus, the human papillomavirus (HPV). HPV is very common in the United States— so common that at least 50 percent of sexually active men and women get it at some point in their lives, according to the Centers for Disease Control and Prevention. There is indication that this is a conservative estimate and that HPV is one of the most common STDs in the world and as common as the cold virus, with a prevalence of up to 90 percent. HPV is passed through skin-to-skin contact during sexual activity with another person, most often during vaginal and anal sex, as well as through oral sex. There are many different types of HPV and since it usually causes no symptoms (like many STIs), you can get HPV—and pass it on—without realizing it.

In 90 percent of cases, your own immune system clears HPV naturally within two years. But, sometimes (and for unknown reasons), HPV infections are not cleared and can cause cervical, anal, vulvar and vaginal cancers as well as genital warts. There are over 30 types of HPV, but two strains (16 and 18) cause 70 percent of all cervical cancers and are also responsible for most other reproductive cancers. In addition, two other strains (6 and 11) cause approximately 90 percent of all genital warts.

But here’s the good news about HPV: there are vaccines currently available that prevent against the types of HPV that can lead to cancer and genital warts. Let me say that again: there are now two vaccines that can prevent cancer. Currently on the market are two vaccines approved for women ages 11 to 26: Gardasil and Cervarix.

In addition, there is an HPV vaccine approved for use in men. That’s right– HPV vaccines are not just for girls anymore! Gardisal is now approved for males under 26. While they cannot get cervical cancer, HPV can cause genital warts in men, as well as cancer of the penis, anus, or oropharynx (back of the throat). Men who have sex with men, as is the case with many STIs, are at an increased risk of HPV-related disease.

Now many of us may get a little squeamish about the idea of preventing an STI in a pre-teen, even if it is one that is both prevalent and linked to cancer. But here’s the rub: a vaccine cannot prevent against something a patient already has. As a result, HPV vaccines offer the greatest health benefits to individuals who receive all three doses long before having any type of sexual activity. That’s why the HPV vaccination is recommended for preteen girls and boys at age 11 or 12 years.

Both vaccines are administrated in a three-shot series over a six-month time frame. It is vitally important that individuals complete the full three shot series. Only through the full three shots will women and men receive the full cancer protection of the vaccine. Research released in December 2010 found that only 14 percent of girls and women who start the series finish within the recommended time period. This research also found that women of color and those who do not have private insurance were less likely to receive all three shots compared to white women and women with private health coverage. These facts are disappointing and threaten to decrease the promise of a vaccine to cut cancer, particularly in reducing the existing health disparities that currently exist in cervical cancer.

While the vaccine is a huge step in fighting a preventable and treatable cancer, it is not the end-all be-all in cervical cancer care. There are over 30 types of HPV and the vaccines only protect against two or four strains, respectively. There are still other strains of HPV that cause cancer, and it is possible that a woman could already be infected by HPV when she was vaccinated. As a result, even with vaccination routine Pap tests or other cervical cancer screening tests are still necessary.

The National Coalition of STD Directors, and its member health departments across all 50 states, seven large cities and eight US territories, are key partners in the fight against cervical cancer as well as other reproductive cancers. State and local STD programs are a key location to receive the vaccine. I encourage you to visit our website (www.ncsddc.org) to find a site for STD testing and the HPV vaccine near you.

While we have come a long way, access to the vaccine continues to be a concern. There are programs such as the Vaccines for Children program to assist those in need, but a full series of the shot retails for approximately $390, according to the Centers for Disease Control and Prevention. Along with increasing the completion of all three shots, ensuring resources are available to those who find this cost out of reach is vital to ending cervical cancer as we know it in this country.

But this is the bottom line: cervical cancer is one fight we can win.

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.

Roundups Sexual Health

This Week in Sex: Women Want More Sex Than Men Think, and Who Needs a $15K Vibrator?

Martha Kempner

This week, there's not enough of an important syphilis drug to go around, a new study shows that men don't know how much sex their female partners want, a beer company unveils a new same-sex marriage ad, and a sex toy recommended by Gwyneth Paltrow's website is gold (literally).

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

Temporary Penicillin Shortage Could Be Dangerous for Pregnant Women with Syphilis

The development of antibiotics in the 1940s ushered in a new era in which bacterial infections—including syphilis, one of the oldest sexually transmitted infections (STIs)—could be treated or cured. With that came the ability to prevent congenital syphilis, which occurs when a pregnant woman passes the bacteria to her infant. Congenital syphilis can cause miscarriage, stillbirth, severe illness in the infant, and even early infant death. And, as Rewire recently reported, it is on the rise; between 2012 and 2014, there was a 38 percent increase in the rate of congenital syphilis.

The good news is that if a pregnant woman is treated with an antibiotic at least 30 days before giving birth, there is a 98 percent cure rate, meaning her infant would not be born infected. The bad news is that, until next month, there is a shortage of the one antibiotic approved for treating syphilis in pregnant women.

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Bicillin L-A, an injectable form of penicillin that is also used to treat other infections such as strep throat, is manufactured by Pfizer. The company said in April that it was experiencing “an unanticipated delay in manufacturing,” and that it would be shipping just 30 percent of the usual supply until July.

Typically, pregnant women are tested for syphilis during their first prenatal visit. If infected, they are treated with three injections of Bicillin L-A. In an attempt to keep these routine “test and treat” efforts going despite the shortage, the Centers for Disease Control and Prevention (CDC) has asked that health-care providers refrain from prescribing Bicillin L-A for any infection other than syphilis if other treatments are available.

Supply issues are unfortunately common in the pharmaceutical industry. NPR explains that generic, injectable drugs—like Bicillin L-A—are particularly susceptible to shortages because they are difficult to make but cheap to purchase, meaning few drug companies manufacture them. If those companies experience a difficulty in manufacturing that forces them to shut down temporarily, such as rust in the equipment or mold in the factory, there is no other supplier to pick up the slack.

Luckily, Pfizer expects to be back to full capacity on Bicillin L-A by July, which will help make sure there are no disruptions to efforts to prevent congenital syphilis. This is particularly important given the number of cases that have been seen in recent years and the seriousness of the outcomes. In 2014, there were 438 nationwide cases of congenital syphilis, which led to 25 stillbirths and eight deaths within 30 days of birth.

Women Want More Sex than Their Male Partners Think

There is an enduring myth that men always want sex and women, well, not so much. It turns out that women in long-term relationships with men want more sex than their partners realize. To determine if perception and reality differed, researchers conducted three studies with couples—44 couples in the first study, 84 in the second, and 101 in the third. All but ten were opposite-sex couples.

Though questions varied according to the study, each participant was asked to keep a diary that recorded some combination of the following factors: their own sexual desire; relationship satisfaction; commitment to their partner; and their perception of their partner’s sexual desire, relationship satisfaction, and commitment. Couples were also asked to keep a log of their sexual activity. Couples in the third study were asked to record how motivated they were to avoid sexual rejection on any given day.

While men in the study did report higher levels of sexual desire than their female partners, what was more striking was that across all three studies men consistently underestimated their partner’s desire. The researchers are not sure why men’s perceptions were so frequently off but they have at least two theories.

First, as Amy Muise, the lead author on the study, told Fusion via email it might be about avoiding complacency: “We don’t know exactly what men do when they underperceive, but it’s possible that this keeps them from becoming lazy about maintaining their partner’s interest.”

Alternatively, men may perceive less desire from their partners as a way to avoid sexual rejection. This is supported by the additional finding that men were particularly likely to underestimate their partner’s desire on days when they felt ill-equipped to handle rejection.

Of course, it could just be that men have been trained by every television show, movie, and magazine to believe that women just don’t want sex as much as they do.

No matter where the misperception comes from, the results of this study once again point out how important it is for couples to communicate openly and honestly about what they want and how often they want it.

Bud Light Ad Celebrates Same-Sex Marriage

While Budweiser ads of the past seem to have mostly celebrated bikini-clad women and Clydesdale horses, a new ad released in honor of LGBT Pride Month takes a big turn for the beer company. The ad depicts scenes of a wedding and features actor Seth Rogan and comedienne Amy Schumer leading a beer-bottle toast to the groom and the groom.

The company said in a press release: “June is the height of wedding season, and it is also LGBT Pride [M]onth in America. That’s why right now is the time to spark a national conversation by celebrating every kind of wedding—and everyone’s right to marry whoever they choose.”

The ad was released in partnership with Ellen DeGeneres and first appeared on her social media channels. The company will continue to air the ad on social media and plans a primetime television airing as well.

Gwyneth Paltrow’s Goop Suggests a Gold-Plated Vibrator

You may remember when Goop, the lifestyle site launched by Oscar-winning actress Gwyneth Paltrow, suggested steam-cleaning vaginas with the herb multwort, a practice that was roundly criticized by experts as unnecessary (the vagina cleans itself) and potentially dangerous (steam is hot). Goop made news again recently with a sexual-health suggestion that may be good for vaginas, but not so great for bank accounts.

Suggested on the website’s list of favorite sex toys was the LELO INEZ, a 24-karat gold vibrator that costs $15,000. Other pricey toys included a whip for $535 and a vibrating necklace for $395.

We here at This Week in Sex are all for sex toys. But we want to assure you that there a lot of good sex toys out there that won’t break the bank. You should be able to find some reliable toys for between $35 and $65 and even less, if you want to visit a local pharmacy and find vibrating rings (which, as an added bonus, are often packaged with a condom).