Sex: Warts and All

Life has its warts, just ask Letterman…

What is all this news about warts? Although incurable, genital warts (condyloma acuminata for the Greek among us) are the most common sexually-transmitted disease caused by a virus. The human papillomavirus (HPV) to be exact. Not to be confused with HSV that causes genital herpes. Less than 5% of those who have an HPV infection will actually develop visible warts, but either way, they may be infectious. The viral particles penetrate the skin through small abrasions in the genital area that may occur during sexual activity. When visible in men, warts are treated with chemicals such as podophyllin, interferon and trichloroacetic acid when small, and by liquid nitrogen or surgical excision when larger. Since they cannot be cured, the goal of treatment is to remove all visible lesions and theoretically to reduce the chances of transmission.

So that’s the scary part. But what’s new? What’s relatively new is that it has become clear than certain subtypes of HPV cause only benign warts (types 6 and 11) while other subtypes can cause cervical cancer (types 16,18). Of course, any association with cancer thankfully leads to more research and the outcome of research thus far is the development of an HPV “vaccine”. Like many vaccines, this one does not cure HPV but simply prevents it. And, it must be given before exposure to the virus to be effective, ideally before sexual activity begins. To date, the vaccine (Gardasil, Merck & Co) is widely approved for use by young women in many countries including the U.S. and is being widely used to prevent HPV and hopefully cervical cancer.

But what about boys and men with HPV? Similar to women, it would not be expected that an HPV vaccine would have any effect once a man has HPV or warts. But what about vaccinating boys before they begin sexual activity, similar to girls?  Our FDA is considering precisely this question and now has some real information on which to base a decision.The data comes from Britain, where the vaccine has been already been approved for boys.

A very recent study now suggests that although it might be cost-effective to vaccinate girls in Britain, it appears not to be the case for vaccinating boys. This is based on the assumption that all girls would already be vaccinated. So, a “coed” vaccination campaign would double the cost of treatment but is likely not to double the results. Basically, the vaccine can prevent the infection quite well thank you, but it may not be worth the public health investment to offer it to boys. However, if the coverage of girls is low, then it may be worth vaccinating boys.

And so it goes. A story similar to that of contraception: If one partner is well protected, then the other may not need to be protected. So there you have it concerning HPV, warts and all.

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