Roundups Sexual Health

Sexual Health Roundup: Promising Advances in HIV Prevention and Treatment; New Evidence on HPV, Cancer, and Vaccines

Martha Kempner

In this week's sexual health roundup: scientists use engineered stem-cells to attack HIV; California tests a new pill that prevents HIV infection when taken daily but some question how expensive it is; the CDC releases alarming data on cancers caused by HPV in women; and South Carolina lawmakers take steps to increase HPV vaccination among middle school students.

Scientists Engineer Stem Cells to Target HIV

A new study published in the journal PLoS Pathogens finds that engineered stem cells can effectively target and suppress HIV in living tissue. Scientists from the University of California, Los Angeles engineered human blood stem cells and implanted them in  “humanized mice.” HIV infection in these mice closely resembles the disease in humans so this gave them a good platform to study the effects on a living being.

The scientists then tested the mice’s blood, plasma, and tissue two weeks and six weeks after implantation of the cells. They found “that the number of CD4 ‘helper’ T cells—which become depleted as a result of HIV infection—increased, while levels of HIV in the blood decreased. CD4 cells are white blood cells that are an important component of the immune system, helping to fight off infections.” Based on these results, they concluded that engineered cell can develop and migrate to organs and fight infection there.

As one of the researchers explained: “We believe that this study lays the groundwork for the potential use of this type of an approach in combating HIV infection in infected individuals, in hopes of eradicating the virus from the body.”

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The researchers cautioned, however, that some differences between the immune system of the mice and those of humans might mean different results in people.

A Pill That Can Prevent HIV Gets Tested in California, But is it Worth the Money?

Truvada is a combination of two drugs used to treat HIV (tenofovir-emtricatabine) that has been shown in a clinical trial to reduce an individual’s risk of HIV infection by an average of 44 percent (up to 73 percent in some) if taken daily. The pill is very expensive, however, at $26 per pill or $10,000 a year per person.

In a new study, researchers at Stanford University used an economic model to analyze the cost effectiveness of this new prevention method.  They focused on men who have sex with men (MSM) because according to the CDC 56,000 new HIV infections occur in this group each year. They concluded that giving the pill to all MSM would cost $495 billion dollars over 20 years and that if 20 percent of all MSM took the pill daily there would 63,000 fewer infections over those 20 years. Giving the pill just to those MSM considered high-risk (those who have five or more partners in a year) would cost only $85 billion dollars over 20 years and if 20 percent of this group took the pill daily it would result in 41,000 fewer infections over those 20 years.

They concluded, therefore, that it was more cost effective to target just those MSM who are at highest risks for becoming infected with HIV.

California may be the first state to test this theory. The state announced last week that it will conduct a trial of the HIV-prevention pill with 700 high-risk HIV-negative gay and bisexual men and transgender women in Los Angeles, San Diego, and Long Beach.

The trial is part of an $11.8 million state program that is also working to get 3,000 HIV-infected people in Southern California into treatment. The grants have been awarded to different campuses of the University of California as well as local governments and AIDS organizations.

Some experts are optimistic about this new prevention method but others are skeptical that individuals will take their pills daily. Moreover, some fear that the pill will be viewed as another reason not to use condoms and as such may increase HIV infection and the spread of other STDs.

Given the limited resources available to HIV/AIDS- prevention and treatment efforts, it also seems fair to question providing such an expensive intervention that requires daily action by individuals when behavior changes such as having fewer partners and using a condom every time can prevent HIV for significantly less money.

New HPV-Cancer Numbers Underscore the Need to Vaccinate Boys Too

The CDC released new data showing that HPV causes 18,000 cancers in women and 8,000 in men each year. Researchers analyzed data in two large cancer registries collected between 2004 and 2008. Though by now most people know that HPV is the cause of almost all cervical cancer, they may not know that it causes many other cancers as well.  HPV is responsible for one third of all penile cancers, two thirds of all mouth and throat cancers, and 93 percent of anal cancers.

Among women, cancers caused by HPV are more common than ovarian cancer and nearly as common as melanoma skin cancers. In men, cancers caused by HPV are as common as invasive brain cancer.

And yet, somehow we are still fighting an ideological battle over the available HPV vaccines, Gardasil and Cervarix. Though these vaccines have for years been recommended by the CDC for girls, in 2010 less than a third of all girls had received all three doses necessary for the vaccines to be effective. The vaccines were not recommended for boys until last year and there are not yet numbers available on how many young men have been vaccinated.

I’ve said it before and I’ll say it again now—we have a vaccine against cancer. It prevents cancer! Parents need to stop listening to the voices that say it causes promiscuity and run (not walk) to their pediatrician’s office as soon as their kids are old enough.  I know I will.

South Carolina Takes Steps to Encourage HPV Vaccinations

It’s clear that we need to take steps to expand HPV vaccinations for young people but given how politicalized the issue has become, widespread state efforts are likely to be controversial. We all remember the political heat Texas Governor Rick Perry took for his decision to mandate HPV vaccines for school girls in his state. Still, a House panel in South Carolina has a plan to encourage parents to get their middle school children vaccinated.

Last week, the House’s Medical, Military, and Municipal Affairs Committee approved a bill requiring the state’s Department of Health and Environmental Control (DHEC) to provide educational brochures about HPV to parents of all students entering the seventh grade. The brochures will encourage parents to get the vaccine but will not require it.

The bill, which is set to go to the full House, faces some obstacles. While it is estimated that it will cost DHEC nearly $312,000 to produce the brochures and provide additional vaccines to those who come to public health clinics, the department is only required to do this if lawmakers approve the bill and provide the money.

Though no group has vocally opposed the idea yet, a 2007 bill on this topic became very controversial. That bill, which required middle school girls to be vaccinated, was opposed by the South Carolina Baptist Association as well other groups and was defeated unanimously.

Still, the sponsor of the current bill is optimistic about its chances because it recommends the vaccine but does not mandate it.  

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: News From the HIV Epidemic

Martha Kempner

This week in sex: Scientists report the first case of HIV transmission to a patient adhering to PrEP protocols, two studies show a new vaginal ring can help women prevent HIV, and young people still aren't getting tested for the virus.

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

With the death of Nancy Reagan, the 1980s AIDS crisis is back in the national spotlight. But, of course, HIV and AIDS are still ongoing problems that affect millions of people. This week in sex, we review scientists reporting the first case of HIV transmission to a patient adhering to PrEP protocols, two studies showing a new vaginal ring can help women prevent HIV, and evidence that young people still aren’t getting tested for the virus.

First Case of HIV Transmission While on Truvada

Last week, Canadian scientists reported on what they believe to be the first HIV infection in a patient who was following a PreP (Pre-Exposure Prophylaxis) regimen.

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PrEP is a method of HIV prevention. By taking a daily pill that contains two HIV medicines, sold under the name Truvada, individuals who are HIV-negative but considered to be at high risk of contracting the virus can prevent infection. Studies have found that PrEP is very effective—the Centers for Disease Control and Prevention estimates that people who take the medication every day can reduce their risk of infection by more than 90 percent from sex and by more than 70 percent from injection drug use. One study of men taking PrEP found no infections over a two-and-a-half-year period.

PrEP is less effective when not taken regularly, but the new case of reported PrEP failure involves a 43-year-old man who said that he took his medication daily. His pharmacy records back up that assertion. The man’s partner has HIV, but is on a drug regimen and has an undetectable viral load. The man did report other sexual encounters without condoms with casual partners in the weeks leading up to his diagnosis.

Dr. David Knox, the lead author of this case study, notes that it is difficult to know if a patient really did adhere to the drug regimen, but the evidence in this case suggests that he did. He concluded, “Failure of PrEP in this case was likely due to the transmission of a PrEP-resistant, multi-class resistant strain of HIV 1.”

Experts say, however, that they never expected PrEP to be infallible. As Richard Harrigan of the British Columbia Center for Excellence in HIV/AIDS told Pink News, “I certainly don’t think that this is a situation which calls for panic …. It is an example that demonstrates that PrEP can sometimes be ineffective in the face of drug resistant virus, in the same way that treatment itself can sometimes be ineffective in the face of drug resistant virus.”

Still, some fear that the new study will add to the ongoing debate and apathy that seem to surround PrEP. While some experts see it as a must-have prevention tool, others worry that it will encourage men who have sex with men to forgo using condoms and perhaps increase their risk for other sexually transmitted infections. Still, only 30,000 people in the United States are taking the drug—an estimated one-twentieth of those who could benefit from it.

A New Vaginal Ring Could Help Women Prevent HIV Infection

Researchers have announced promising results from two studies looking at new technology that could help women prevent HIV. The dapivirine ring, named after the drug it contains, was developed by the International Partnership for Microbicides. It looks like the contraceptive ring, Nuvaring, and is similarly inserted high up into the vagina for a month at a time. Instead of releasing hormones to prevent ovulation, however, this ring releases an antiretroviral drug to prevent HIV from reproducing in healthy cells. (A ring that could prevent both pregnancy and HIV is being developed.)

The two studies of the ring are being conducted in Africa. One study recruited about 2,600 women in Malawi, South Africa, Uganda, and Zimbabwe. It found that the ring reduced HIV infection by 27 percent overall and 61 percent for women over age 25. The other study, which is still underway, involves just under 2,000 women in seven sites in South Africa and Uganda. Early results suggest that the ring reduced infection by 31 percent overall when compared to the placebo.

Both studies found that the ring provided little protection to women ages 18-to-21. Researchers are now working to determine how adherence and other biological factors may have impacted such an outcome.

Young People Not Getting Tested for HIV

A study in the February issue of Pediatrics found that HIV testing rates among young people have not increased in the last decade. The researchers looked at data from the Youth Risk Behavior Survey (YRBS), which asks current high school students about sexual behaviors in addition to questions about drugs and alcohol, violence, nutrition, and personal safety (such as using bike helmets and seat belts). Specifically, the YRBS asks students if they’ve ever been tested for HIV.

Using YRBS data collected between 2005 and 2013, the researchers estimated that 22 percent of teens who had ever had sex had been tested for HIV. The percent who had received HIV tests was higher (34 percent) among those who reported four or more lifetime partners. Overall, male teens (17 percent) were less likely than their female peers (27 percent) to have been tested.

Researchers also looked at data from the Behavioral Risk Factor Surveillance System, which asks similar questions to young adults ages 18 to 24. Among people in this age group, between the years of 2011 to 2013, an average of 33 percent had ever been tested. This review of data also found that the percentage of young women who get tested for HIV has been decreasing in recent years—from 42.4 percent in 2011 to 39.5 percent in 2013.

The authors simply conclude, “HIV testing programs do not appear to be successfully reaching high school students and young adults.” They go on to suggest, “Multipronged testing strategies, including provider education, system-level interventions in clinical settings, adolescent-friendly testing services, and sexual health education will likely be needed to increase testing and reduce the percentage of adolescents and young adults living with HIV infection.”