Human Papillomavirus (HPV) is a sexually transmitted infection that produces epithelial tumors of the skin and mucous membranes in the vagina areas, anus, mouth and throat. There are over 100 types of HPV strains, and the genomes of more than 80 have been completely sequenced. The current classification system is based on similarities in genomic sequences, which approximate 3 clinical categories of HPV. They are:

  • Mucosal
  • Nongenital cutaneous
  • Epidermodysplasia verruciformis (EV)

The staggering increase in prevalence of HPV infections, particularly among adolescents, is a major public health concern due to the risk of developing HPV derived cancers. Recent data revealed that 40 percent of sexually active adolescents have at least one sexually transmitted infection, of which HPV is at the top of the list. Moreover, the increasing incidence of oral HPV and associated increases in cancer of the mouth and throat is attributable to increased percent of adolescents whom engage in oral sex. Interestingly, a small percentage of adolescents, when surveyed, will endorse having engaged in oral sex, but deny that they are sexually active. The role of intoxication in the transmission of HPV and other STDs among teens is significant, yet this fact has not garnered nearly the attention it should. Specifically, the sexual debut for most females occurs while they are intoxicated, and therefore more likely to be unprotected from both the physical and emotional consequences of early sexual debut.

HPV and Cancer: Increasing Prevalence

The National Health and Nutrition Examination Survey (NHANES) 2011-2014 and NHANES 2013-2014 provides excellent data, but does not include those in higher risk demographics, such as persons who are institutionalized, incarcerated, in long-term care health facilities, IV drug users or the homeless. Therefore, this data provides conservative estimates of HPV among US adults.

The NHANES survey screened for 37 HPV types, 14 of which are associated with more serious infections, cancer and mortality. The results showed that HPV is now the most common sexually transmitted infection in the United States. The other key findings include:

Oral HPV

  • The prevalence of any oral human papillomavirus (HPV) for adults aged 18–69 was 7.3%. High-risk HPV prevalence was 4.0%.
  • The prevalence of any and high-risk oral HPV was lowest among non-Hispanic Asian adults, and highest among non-Hispanic black adults.
  • Prevalence of any and high-risk oral HPV was higher in men than women.

Genital

  • The prevalence for men with any and high-risk genital HPV between ages 18–59 was 45.2% and 25.1% respectively. For same age women, it was 39.9% and 20.4% in respectively.
  • Prevalence of any and high-risk genital HPV was lowest among non-Hispanic Asians and highest among non-Hispanic blacks.
  • Rates of all STDs including HIV, as well as viral hepatitis and TB are substantially higher among drug abusers compared to persons who do not use drugs.

Overall: (CDC Data)

  • Currently, there are about 79 million Americans infected with HPV.
  • Each year, 14 million new infections occur in the United States and about half of the newly infected people are 15 to 24 years old.

HPV and Cancer

  • HPV infection causes virtually all cases of cervical cancer (Parkin & Bray F, 2006) In cervical neoplasias, the HPV genome can be detected in more than 95% of tumors.
  • There are more than 40 types of HPV that infect the genital area. Of these, nine (types 6, 11, 16, 18, 31, 33, 45, 52, and 58) are known to cause the majority of HPV-related cancer.
  • About 11,600 US women are diagnosed with cancer of the cervix caused by HPV every year.
  • Approximately 15,000 people with oral-HPV infection develop an oropharyngeal cancer each year.
  • An increase in the incidence of oropharyngeal cancer has paralleled the increased prevalence of tonsillar HPV infection, which is the primary cause oropharyngeal cancer.
  • An increase in oral sex is suspected to be the cause of the increased prevalence of tonsillar HPV infection.

The good and bad news

The dramatic increase of HPV is largely the result from modifiable behavioral, social and cultural changes. Specific behavioral risk factors include increased sexual activity and per capita sexual partners (oral, vaginal and anal). Alcohol intoxication, particularly among adolescents, often precedes unsafe and unprotected sexual behaviors.

The only surefire way to prevent HPV and most STD’s it is to abstain from sex, or through mutually monogamous sex with an uninfected partner. Although vaccines have been developed that reduce the risk of infection with certain subtypes of HPV, their effect in preventing oropharyngeal cancers linked to high risk strains of HPV is unclear.

Changing behaviors, especially those that engage and reward our hedonic survival drives (food, drugs and alcohol and sex) are extremely difficult. It will take more than a new pill to reverse this disturbing trend. Joint efforts between, medical professionals, educators and parents will be necessary.