HPV has been called " the least talked about sexually transmitted disease." In 1998, the American Social Health Association (ASHA) urged people to "break the silence", as part of National STD Awareness Month about the human papillomavirus (HPV).

Moreover, many populations are neglected in the efforts to prevent the spread of HPV. Women who have sex with women are represented disproportionately in this demographic. In a recent article, "Lesbians need Pap tests too" the importance of getting regular pap smears for early detection of cervical cancer is emphasized.

 Because HPV, one known risk factor of cervical cancer, can be transmitted by female to female sexual contact, many health care practitioners recommend regular pap smears for lesbians. Age, smoking and any kind of sexual activity will also increase any woman's risk of cervical cancer.

 One of the reasons the human papillomavirus poses so many problems for health care providers is that so little is known about the way the disease manifests itself. It is not known whether it can ever be truly eliminated from the body, if condoms can protect future sex partners, or if it causes cervical cancer.

Most HPV is diagnosed before it becomes cancerous, usually due to genital warts or abnormal Pap smears. Since the link to cervical cancer is so strong, doctors who find HPV routinely take a closer look at the vagina and cervix. If a biopsy shows the abnormal cells are likely to become cancerous, women are often advised to have the lining of their cervix removed, usually done with lasers or by freezing. The procedure carries a risk of infertility through damage to the cervix.

The government has approved a few new tests, but doctors have not been utilizing them, and rely heavily on Pap smears for detection. Although the pap smears have been estimated to misdiagnose about 20 percent of cases and doctors are aware of the test's shortcomings, it is fully covered by many health plans.

The effects of ignorance about HPV's virulence and prevalence have been far-reaching. At the University of Washington, researchers tracked 600 young women through their college years, starting in 1991, and found that 20 percent contracted HPV after their first sexual encounter. More than 90 percent of those infected women picked up another HPV strain within two years.

In developing countries, the high incidence of STDs (detailed information about prevalence of HPV in the developing world has not been collected) has been attributed to:

• rapid urbanization,
• unemployment and poverty,
• breakdown of traditions which limited sexual activity,
• large numbers of people in the sexually active age group.

The psychosocial impact of HPV has also been studied. Feelings of depression, anger, and shame often accompany the pathological manifestations of the disease. These findings suggest the need for various types of support systems within health care settings.

Michelle Boorstein, Associated Press. "Human Papilloma Virus—30-75% Sexually Active Infected Poses Multi-Billion Dollar Public Health Dilemma", from Robert Boudreau.

 Sexually transmitted diseases and reproductive health. Anonymous. Progress in human reproduction research 1992 21:6-7

 International Journal of STD and AIDS. The psychosocial impact of human papillomavirus infection: implications for health providers. 1996 may-jun, vol 7(3):197-200.

 *SHOP Talk (School Health Opportunities and Progress) Bulletin

March 20, 1998 Volume 3, Number 1