Help for Genital Warts

Controversy continues to plague efforts to protect young women
against cervical cancer by vaccinating them against HPV, the human
papillomavirus, but one leading scientist’s discovery could throw a
monkey wrench into the debate.

“We found HPV under the fingernails of young men,” said Dr. Laura
Koutsky, a University of Washington epidemiologist.

Koutsky led some of the pioneering research and clinical trials that
resulted in an HPV vaccine, Merck’s Gardasil, recently approved for
use in girls and young women. The reason her fingernail finding is a
potential bombshell has to do with why the vaccine is controversial.

HPV, which is the leading cause of most cervical cancers, is
primarily a sexually transmitted disease. Opponents of HPV vaccines
believe that immunizing girls against this virus sends the message
that engaging in sex at a young age is acceptable behavior.

The presence of HPV under fingernails, she said, at the very least
suggests another possible route of transmission. It’s an additional
route of infection, she said, that could explain some previous
apparent anomalies such as HPV infection in infants and young girls
who had not yet engaged in sexual activity.
Koutsky’s not quite sure what to make of the finding, which has yet
to be reported in a journal, but she said it is certainly “a
surprise.”

“In spite of (the debate), a considerable amount of the vaccine has
been distributed already,” said Dr. Lauri Markowitz, an expert on HPV
with the U.S. Centers for Disease Control and Prevention who spoke
this week at a Seattle meeting of the International Society for
Sexually Transmitted Diseases Research.

More than 40 states have enacted some kind of legislation to
encourage wider use of the HPV vaccine, Markowitz said, including a
few states, such as Washington, that have avoided the mandated
vaccine debate by simply offering the immunizations free.

The CDC, which recommends routine use of the HPV vaccine in females
between the ages of 9 and 26, estimates that 25 percent of all women
in the U.S. are already infected with the virus.

Not all HPV strains are equally likely to result in cancer, however.
The vaccine protects against four strains that are thought to be more
likely to cause cervical cancer. There are hundreds of types of HPV,
and most people have been infected by one or another. Most infections
have no symptoms and go unrecognized.

More severe forms of HPV can cause genital warts and penile and anal
cancers. Non-genital strains can cause head and neck cancers. But the
greatest cancer risk from HPV is to women. Cervical cancer, if
detected early by Pap smear, is treatable but still kills more than
4,000 women a year in the U.S. In the developing world, cervical
cancer is massive — the leading cause of cancer deaths of women,
killing nearly 300,000 annually.

The cultural and moral concerns of other countries are sometimes an
even bigger barrier to introducing new vaccines or health measures,
said Dr. Jacqueline Sherris, vice president at Seattle-based PATH, an
organization that specializes in the health needs of the developing
world. Widespread acceptance of a vaccine in the industrial world,
she added, can often be a necessary precursor to expanding its
lifesaving use in poor countries.
But opponents of making HPV immunization widespread argue that if a
young woman simply abstains until marriage, no vaccine is needed.
Koutsky’s finding may give pause to those arguing from this moral
perspective. If HPV can be found under fingernails, will these
daughters of chastity need to also abstain from a handshake?

There’s no evidence to support that kind of transmission, Koutsky
noted, but the finding of severe forms of HPV under the fingernails
of young men should serve as a reminder of how much we yet have to
learn about the behavior and transmission of the human
papillomavirus.

“Basically, it’s not just about sex,” Koutsky said. “You have to know
how people get it in order to prevent it.”

At some point, she predicted, it will become clear that boys and
young men should also be vaccinated against the virus. It would be
nice if just living a good, moral lifestyle could protect against
microbial invasion, Koutsky said. But right at your fingertips, she
said, might be a hint that this is just wishful thinking