Roundups Sexual Health

This Week in Sex: ‘Virgin’ Boys May Have HPV Anyway, Even Without Having Intercourse

Martha Kempner

Sexual contact, outside of penetrative sex, can spread HPV too. Young women are missing opportunities, even in OB-GYN clinics, to be vaccinated against contracting HPV. And are seven words really banned from the CDC?

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

Boys Who Have Never Had Sex May Have HPV Anyhow

Opponents of the HPV vaccine sometimes argue that it’s not necessary to immunize teenagers from a sexually transmitted infection because the teenagers could just instead not have sex, but new research suggests this strategy isn’t foolproof: Researchers from the University of Texas Health Science Center found some self-identified male “virgins” had HPV anyhow.

The researchers looked at data from a previous study that followed more than 4,000 men ages 18 to 70 in Brazil, Mexico, and the United States from 2005 to 2009. During that time, the men had check-ups every six months. The goal of that study was to track how HPV spread in men.

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The current study looked specifically at the health records of 87 men who identified themselves as virginsmeaning they had not engaged in penetrative sex (penile-vaginal or penile-anal)—at the start of the study and found that many of them actually had HPV. And, among the virgins who did not have HPV, many of those who began having penetrative sex during the study contracted it quickly.  About one quarter (28.7 percent) of men who started the study as virgins but went on to have penetrative sex during the study period contracted HPV within the first year, and 45 percent contracted the virus within two years.

Alan Nyitray, one of the study’s authors, said in a statement: “Previous studies have found HPV among female virgins, but this is the first to find it among male virgins. Finding HPV in this population was not entirely surprising, but it reinforces the point that HPV vaccination should not be thought of only in the context of sexual behavior.”

In fairness to the abstinence-alone-is-enough crew, the men likely contracted the STI through nonpenetrative sexual behavior like hand-to-genital or even genital-to-genital contact that didn’t involve penetration. Still, this finding underscores the importance of getting young people vaccinated before they become sexually active—and that doesn’t just mean before they lose their “virginity.” The CDC now recommends that both boys and girls get the HPV vaccine at age 11 or 12, but the vaccine remains controversial and vaccination rates still lag those of other routine immunizations (see the next story for more on this).

Doctors Missing Opportunities to Provide HPV Vaccine

Another new study, this one from Yale University, found that two-thirds of young women had at least one “missed opportunity” in which they were seen at an obstetrics and gynecology clinic, were eligible to get the HPV vaccine, but were not given the shot.

Researchers analyzed medical records of more than 1,200 women ages 18 to 26 who were treated at an urban, hospital-based obstetrics and gynecology clinic between February 2013 and January 2014. The women were unvaccinated or under-vaccinated, meaning they hadn’t received all three shots in the HPV series. The women went to the clinic for various reasons including STI screenings, visits to get contraceptive, and postpartum checkups. These visits were considered “missed opportunities” because the women, many of whom were there to get another injection, such as for birth control or another vaccine, were still not given the HPV vaccine shot.

During the year of the study, 833 women, 67 percent of those studied, had at least one such missed opportunity—33 percent of these were during contraceptive visits, 21 percent during STI screenings, and 17 percent were during postpartum check-ups. The researchers noted that many of these visits were scheduled with nurses and that the patient did not see a physician, who may have been more empowered to suggest the HPV vaccine.

Sangini Sheth, one of the researchers on the study, suggested that a change in the way the role of nurses is viewed could help: “If we can create a clinical culture where nurses are empowered to discuss, recommend, and administer the HPV vaccine, we could potentially affect the rates of immunization for a population like the one we studied. Nurses are always allies and partners in care, especially in [preventive] and primary care medicine.”

As mentioned earlier in this update, HPV vaccination rates lag behind other routine vaccinations despite the fact that it prevents cancer. Some of the shortfall in vaccination rates may be the result of parents worried that vaccinating a school-aged child against an STI could lead to increased sexual activity (a fear that has been routinely disproved by research). Other research suggests that physicians may also be undermining the vaccine—a 2012 study found that only 71 percent of physicians said they strongly recommended the HPV vaccine to girls 11–12 years old and only 57 percent strongly recommended it to boys the same age.

Are Seven Words Really Banned From the CDC?

Late Friday afternoon, as public health experts at the Centers for Disease Control and Prevention were packing up their charts and graphs, a story broke that they would no longer be able to say seven words that by all accounts are key to their work.

The Washington Post first reported that some CDC employees, during a meeting about the agency’s budget with senior agency officials Thursday, were given a list of words and phrases they should stop using. The forbidden words: vulnerable, entitlement, diversity, transgender, fetus, evidence-based, and science-based. The CDC is part of the U.S. Department of Health and Human Services (HHS), and the original article said that another HHS department had been given similar instructions to avoid using words including entitlement, diversity, and vulnerable.

The story gained a great deal of attention on social media this weekend as commentators and Twitter users alike tried to comprehend just how much of the CDC’s work would be impacted by these seven words. After all, as the nation’s top public health agency, everything is supposed to be evidence- or science-based. The agency has a number of projects geared toward improving the health of transgender individuals, and others are designed to protect other vulnerable populations. It also spearheads work on preventing fetal alcohol syndrome and other health complications that occur during fetal development such as the impact of the Zika virus.

The reaction captured by the Twitter hashtag #CDC7words included outrage, heartbreak, and humor: The March for Science tweeted about the right of scientists to openly discuss their research. One woman tweeted pictures of a transgender child saying that erasing the words are an attempt to erase her. Many noted that the CDC cannot do its job without being based on science, and others pointed out similarities to other restrictive regimes both real and fictional. Our favorite tweet was from a musical theater writer who promised to write a play entitled, “The Science-Based Vulnerable Entitlement of the Transgender Fetus for Evidence-Based Diversity.”

By Sunday, however, the head of the CDC—Dr. Brenda Fitzgerald—had walked back the concept of banned words. She tweeted: “CDC has a long-standing history of making public health and budget decisions that are based on the best available science and data and for the benefit of all people—and we will continue to do so.”

Later, an HHS spokesperson said that calling this a ban on words was inaccurate. Matt Lloyd said in an email: “The assertion that HHS has ‘banned words’ is a complete mischaracterization of discussions regarding the budget formulation process. HHS will continue to use the best scientific evidence available to improve the health of all Americans. HHS also strongly encourages the use of outcome and evidence data in program evaluations and budget decisions.” And, the New York Times reported that several CDC officials described the move not as a ban but as a suggestion to help advance Republican objectives during the budget process.

Of course, if this story teaches us anything, it’s that words matter. Not being able to say the word fetus is clearly designed to force the use of the term baby or unborn baby, which in turn is designed to advance an anti-abortion agenda. And, whether we call it a ban or a strategy, the list of words-that-shall-not-be-spoken tells us a lot about the direction the Trump administration would like to take our public health infrastructure—away from relying on science and evidence that protects diverse, vulnerable populations like transgender individuals and fetuses.

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