Epidemic of sexual diseases; media strangely silent
By Yvette C. Cantu and Heather E. Farish
January 5--The United States has the highest rate of sexual disease in the developed world, and a higher rate than some developing countries.
Human papillomavirus is the most common incurable sexual disease in the United States, with as many as 24 million Americans currently infected. Known as HPV, the virus has been linked to over 90 percent of all invasive cervical cancers, and it is the number two cause of cancer deaths among women, after breast cancer. Approximately 16,000 new cases of cervical cancer are diagnosed each year, and 5,000 women die annually from this disease.
Even if condoms are used consistently and properly (which occurs only between 5 and 40% of the time), they still are ineffective barriers against disease. Condoms, whether used correctly and consistently or not, do not prevent the spread of HPV.
However, federally-funded, sexual health organizations and the Centers for Disease Control continue to promote condoms as effective disease barriers. They briefly mention sexual abstinence as a tool for disease prevention, before campaigning for the "consistent and correct" use of condoms as sufficient disease deterrents. Those concerned with public health should strongly encourage the only guaranteed method of conquering this public health epidemic – sexual abstinence until entering into a lifelong, monogamous marriage with an uninfected partner.
In 1960, there were only two significant sexually transmitted diseases, syphilis and gonorrhea. Both are easily curable bacterial infections. Today, after the sexual revolution and the significant cultural decay in which it played a part, there are at least 25 such diseases. According to the Kaiser Family Foundation, "Since 1980, eight new sexually transmitted pathogens have been recognized in the United States alone. …" The Institute of Medicine reports, "Approximately 12 million new [cases of sexually transmitted diseases], 3 million of them among teenagers, occur annually."
In addition to curable bacterial diseases, there are several viral infections that cannot be cured. An estimated 56 million Americans have an incurable viral disease other than HIV, such as genital herpes or human papillomavirus. That is more than one in five Americans. "Sexual diseases represent a growing threat to the nation’s health and national action is urgently needed," wrote Institute of Medicine Doctors Thomas Eng and William Butler. "Women and infants bear a disproportionate burden of complications associated with sexually transmitted diseases."
The Medical Institute of Sexual Health estimates that 33 percent of all women are infected with HPV. The people most at risk for this disease are college and high school students. The University of California at Berkeley found that almost half of its female students were infected with HPV. In some studies, "up to 15% of sexually active teenage women have been found to be infected with HPV, many with the strain of this virus that is linked to cervical cancer." Penny Hitchcock, D.V.M., chief of the sexually transmitted diseases branch of the National Institute of Allergy and Infectious Diseases, said, "The incidence of HPV infection in sexually active young college women is alarming. Furthermore, we currently have no effective way to prevent infection."
In a 1988 Time magazine article, Dr. Stephen Curry, of the New England Medical Center in Boston, commented on HPV, "This virus is rampant. If it were not for AIDS, stories about it would be on the front page of every newspaper." Thanks in part to this underreporting by the media, most Americans have never even heard of this disease. In a recent Kaiser Family Foundation survey, only 11 percent of teens aged 15-17 and adults aged 18-44 could name HPV as a disease, and only 30 percent of them were aware that HPV is incurable.
In an article about identifying the risk of cervical cancer, the Washington Post reported, "[W]ithout HPV infection, the disease [cervical cancer] virtually never develops. … Researchers calculated that by itself, the HPV test was somewhat better than a repeat
Pap smear for identifying women with cancer or precancerous changes in the cervix."
What Is HPV?
Human papillomaviruses are a collection of more than 70 types of viruses that tend to cause warts, or papillomas, on various parts of the body. More than 20 types of HPV are incurable diseases that can infect the genital tracts of both men and women. They can cause genital warts, which are the most obvious manifestation of HPV and indicate a clinical infection. Only 1 in 100 people infected with HPV experience genital warts, however. Most of the time, HPV infections are subclinical or asymptomatic.
Subclinical HPV infection is detected by abnormal Pap smears or microscopic lesions. Asymptomatic HPV infection, the most common, is the presence of the virus in apparently normal tissue. Most people infected with HPV do not know it. The virus can lie dormant on the cervix for as long as 20 years before cervical dysplasia (precancerous cells) is detected. Some strains of HPV are considered low-risk (HPV-6 and HPV-11) and some high-risk (HPV-16 and HPV-18), but both can cause cervical dysplasia. To further exacerbate the problem, there are no practical screening tests available for subclinical and asymptomatic HPV infection, so it can be difficult, and with some strains impossible, to diagnose.
Even when HPV is detected, current medical tests are unable to discover the type, or types, of human papillomavirus a woman has or the probability of her developing cancer. Doctors, at this point, do not know which HPV-infected women will end up with pre-cancerous or cancerous cells. It is certain, however, that one out of every 50 American women will be diagnosed with cervical cancer. It is also certain, as mentioned above, that almost all cervical cancer in the United States is caused by HPV. While it is impossible to estimate how contagious high-risk HPV is compared with low-risk HPV, 2.5 million women are infected each year with at least one strain of the virus. Scientists estimate that between 30 and 75 percent of all sexually active adults are already infected with HPV.
Why Don’t Condoms Stop HPV?
Human papillomavirus differs from other sexual disease in its method of transmission; it is not spread from one person to another through the exchange of bodily fluids. Rather, it spreads through skin-to-skin contact. Since HPV is a regional, multicentric disease, it infects the entire genital area: the penis, scrotum, vulva and surrounding areas. Condoms do not cover the scrotum, nor most of the other areas that can be infected with the virus. There also tends to be contact between the anogenital skin of the partners before a condom can be correctly placed on the penis. "No known effective barrier exists that will protect the vulva or prevent vulvar transfer of the virus," according to Barbara S. Apgar, M.D., M.S., clinical associate professor of family practice, University of Michigan Medical School.
Adds Mary E. Verdon, M.D., of the American Academy of Family Physicians, "In the 1970s, it was demonstrated that a single sexual contact with a person infected with external genital warts carries about a 60 percent chance of transmission." However, there are several different strains of HPV that do not cause genital warts; therefore, transmission can occur without the presence of any visible symptoms. These strains are more likely to be cancerous.
What Do Medical Doctors Say?
Doctors know that condoms are useless against HPV.
• "Condoms appear to provide little, if any, protection against HPV, one of the most common sexual diseases in America today and one that causes cervical cancer." Medical Institute for Sexual Health.
• "Condoms can prevent the spread of many diseases, but not HPV. HPV is found on all the genital tissues, and a condom on the penis usually will not prevent transmission of HPV." Louisiana State University Medical Center.
• "Human Papillomavirus, thought of as the ‘seed’ of cervical cancer, is a regional rather than localized disease, and its infectivity is not contained by condoms." John V. Dervin, M.D., associate specialist in radiology and assistant clinical professor, University of California, San Francisco.
• "[S]everal studies have shown that condoms do not protect against this virus (HPV)."
Kenneth L. Noller, M.D., professor and chairman, department of obstetrics/gynecology, University of Massachusetts School of Medicine; past chairman of the American College of Obstetricians and Gynecologists Committee on Gynecologic Practice; and past president of the American Society for Colposcopy and Cervical Pathology.
• "Condom use is of little or no value in protecting patients from papilloma infection." Thomas V. Sedlacek, M.D., chairman, department of gynecology, Graduate Hospital, Philadelphia.
• "Condoms are useless in preventing HPV transmission, because the virus is spread by cells that are shed onto the scrotum, which then comes into contact with vulvar skin." Michael Campion, M.D., director of gynecologic endoscopy at Graduate Hospital, Philadelphia.
Federally Funded Sex Education
Despite this evidence, people and organizations supposedly dedicated to public health are pushing condom use as an effective deterrent to the spread of disease, including HPV. They fail to adequately communicate that condoms do not work against HPV; nor do they promote abstinence until marriage as the only way to stop this potentially deadly disease. Keep in mind that 74 percent of teenagers agree with the statement, "If Americans had higher moral standards … sexual diseases would not be the problem they are today."
Sharon Stone, film actress and research campaign chairwoman of the American Foundation for AIDS Research, at a United Nations panel discussion on youth and AIDS on December 1, 1998, said, "I believe that if you truly, truly love your children, you need to supply condoms in a place in your home, at a quantity that makes it a nonjudgmental situation for them to have them. I mean, put 200 condoms in a box in some place in the house where everybody isn’t all the time so that your kids can take them."
Other such statements include the following:
American Social Health Association
• "Studies have shown condom use can lower the risk of acquiring HPV infection. … For these reasons, condoms should play an important part in any new or non-monogamous sexual relationship."
• "Can condoms protect me from HPV? Condoms do not give complete protection against HPV because they do not cover all genital skin. But with a new partner, condoms are useful to protect both of you from most other disease. Many people are shocked or upset when they find out they have HPV. But HPV does not have to mean a big change in your life. The most important step is to get help by talking with your health care provider, getting a yearly Pap test [sic], and taking care of yourself."
SIECUS – Sexuality Information and Education Council of the United States
• "Condoms are … up to 99.9 percent effective in reducing the risk of disease transmission when combined with spermicide."
Planned Parenthood of Western Washington
"Because the virus that causes the genital warts is contagious, abstinence or the use of condoms during intercourse is recommended." [emphasis added]
"How can you avoid spreading Genital Warts? To decrease the spread of Genital Warts: Seek medical advice and evaluation if symptoms are present. Share information, both printed and verbal, with your partner(s). Partners with obvious warts may also choose to seek treatment. Always use a latex condom."
Teenwire, Planned Parenthood Federation of America ("Sexuality and relationship info you can trust from Planned Parenthood Federation of America")
"Condoms Work – If you’re lucky enough not to have a genital HPV infection now, make sure you stay that way. Genital HPV infections can spread even when the infected person hasn’t shown any symptoms. Your partner could seem perfectly fine and still infect you. Remember that genital HPV is usually spread by vaginal and anal intercourse – abstinence is your key to remaining totally safe, but using a condom can help cut down on the chances for transmission."
"You can have a fulfilling sex life no matter what infection you may have – if you act responsibly and use protection every time."
Centers for Disease Control
The Centers for Disease Control and Prevention is a government organization responsible for tracking the spread of communicable diseases and developing strategies for containment. However, even though an estimated 24 million Americans are already infected with HPV, it does not report the number of HPV infections, nor does it offer specific means for prevention. Other than the disease associated with AIDS, HIV, it is required to report only syphilis, gonorrhea and chlamydia rates. All three are curable, bacterial infections.
When discussing the dangers of diseases and their prevention, it groups all sexual diseases together, including HPV. It recognizes that abstinence until marriage to an uninfected partner is the only guaranteed way to prevent the spread of all diseases, yet it still suggests "consistent and correct" use of condoms as a viable method of prevention:
• "Refraining from having sexual intercourse with an infected partner is the best way to prevent transmission of HIV and other diseases. But for those who have sexual intercourse, latex condoms are highly effective when used consistently and correctly."
• "Even when used correctly, condoms aren’t perfect," CDC acknowledges, comparing them to other important safety enhancing behaviors like wearing seatbelts and bicycle helmets. "Imperfect as they are, condoms can significantly reduce the rates of unintended pregnancies and sexually transmitted diseases."
• "When used consistently and correctly, latex condoms are very effective in preventing a variety of diseases, including HIV infection. Multiple studies have demonstrated a strong protective effect of condom use. …"
• "A primary strategy for decreasing the spread of human immunodeficiency virus and other sexually transmitted diseases is to increase the rate of condom use among at-risk persons. …"
• "Recommended Prevention Strategies. … Abstaining from sexual intercourse is the most effective HIV prevention strategy. For individuals who are sexually active, the following are highly effective: Engaging in sexual activities that do not involve vaginal, anal, or oral intercourse. Having intercourse only with one uninfected partner. Using latex condoms correctly from start to finish with each act of intercourse."
• "Prevention through avoiding exposure is the best strategy for controlling the spread of sexually transmitted disease. Behavior that eliminates or reduces the risk of one disease will likely reduce the risk of all diseases. … Abstinence and sexual intercourse with one mutually faithful uninfected partner are the only totally effective prevention strategies. Proper use of condoms with each act of sexual intercourse can reduce, but not eliminate, risk of STD. … Condoms are not always effective in preventing STD. Failure of condoms to protect against STD is probably explained by user failure more often than by product failure."
In March 1999, the House Commerce Subcommittee held a hearing on cervical cancer at which the Centers for Disease Control and the National Cancer Institute were present. Dr. Ronald Valdiserri of the National Center for HIV, STD, and TB Prevention at the Centers said that "the causal association between persistent genital HPV infection and cervical cancer is similar to that between cigarette smoking and lung cancer." In response, subcommittee chair Rep. Tom Coburn (R-Okla.), who is also an M.D., pointed out, "The CDC says, ‘don’t smoke,’ but does nothing to promote sexual abstinence."
In an interview with the Kaiser Family Foundation’s Daily Report, Coburn said that although "there is no study that shows that HPV is helped by condoms," the CDC still tells people condoms provide protection against the disease. He said, "There is no safe sex when it comes to HPV. … We’re in an epidemic of [HPV]. … The CDC knows about this epidemic. They should have studies on it, but they don’t. They’re behind the curve and they know they’re behind."
HPV Policy Proposals
We can no longer ignore the HPV epidemic. With knowledge of the prevalence of HPV, its link to cervical cancer and condoms’ inability to protect against the transmission of this disease, the following proposals should be implemented:
1. Congress should require the Centers for Disease Control to conduct studies on the nature and effects of HPV. It should also be required, as it is with other diseases, to report on HPV transmission rates.
2. Condom manufacturers should be required to include a warning on their packages that alert people to condoms’ ineffectiveness in shielding against HPV transmission.
3. A public health campaign, organized by the Centers, should be launched to heighten public awareness of HPV and to shatter the myth that condoms provide protection against the disease.
As public health organizations promote condoms, HPV infections increase, and the cost for treatment of all sexual diseases mounts. Ten billion dollars per year is spent treating selected major sexual diseases, other than Human Immunodeficiency Virus (HIV). Including HIV, the cost for treating sexual disease rises to $17 billion a year. All Americans share this expense through higher health care costs and taxes. Considering the physical and financial toll that these diseases, such as cancer-causing HPV, are taking on society, we must ask why abstinence until marriage is not being taught as the only foolproof method to stop this epidemic – and why condoms are being sold as "safe sex" to unsuspecting youngsters.
Yvette Cantu is a policy analyst in the cultural studies department and Heather Farish is communications coordinator at Family Research Council.
This article together with 44 citations appears
on the web site of the Family Research Council which can be found online.