Table of Contents
What Is HPV? 1 2 3 4 5
Human papillomaviruses are double-stranded DNA viruses found in the squamous epithelial cells on the surface of the skin and also the mucous membranes of the body. There are more than 100 known types of human papilloma viruses (HPVs) and most are not harmful. In the majority of cases, the human immune system clears HPV infection without symptoms or complications.
More than 90 percent of those who become infected, naturally clear the infection from the body within two years. Antibodies to the HPV type causing the infection remain in the body to help prevent future infection with that same HPV type.
Low Risk HPV Types - About 75% of HPVs have been associated with non-cancerous warts (papillomas) on the hands, chest, arms and feet, such as low-risk (wart-causing) HPV types 6 and 11. Low-risk HPV types associated with genital warts are different from the high-risk HPV types associated with development of cancer after years of chronic infection.
High Risk HPV Types - About 40 HPV types have been found in the body’s mucosal membranes, such as the mucosal surfaces of the cervix, vagina, vulva, anus, penis, mouth and throat, including the most common high-risk (cancer-causing) HPV types 16 and 18. High-risk HPV types are associated with development of cancer of the cervix and five other genital and oral cancers affecting women and men if HPV infection does not clear and becomes chronic. High-risk HPV types currently include types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 69, 73, and 82.
The National Cancer Institute states that “Virtually all cervical cancers are caused by HPV infections, with just two HPV types, 16 and 18, responsible for about 70 percent of all cases. HPV also causes anal cancer, with about 85 percent of all cases caused by HPV-16. HPV types 16 and 18 have also been found to cause close to half of vaginal, vulvar, and penile cancers….In the United States, more than half of the cancers diagnosed in the oropharynx are linked to HPV-16.
Is HPV Communicable? 6
Yes but most HPV infections are asymptomatic and result in no clinical disease. The Centers for Disease Control (CDC) states that “HPV is transmitted by direct contact, usually sexual, with an infected person.”
The CDC also acknowledges that there are gaps in scientific knowledge about how, why and when HPVs are transmissible:
“HPV is presumably communicable during the acute infection and during persistent infection. This issue is difficult to study because of the inability to culture the virus. Communicability can presumed to be high because of the large number of new infections estimated to occur each year.”
History of HPV in America 7 8
HPVs are endemic in populations around the world and public health officials believe that HPV is the most common sexually transmitted infection in the United States with an estimated 6.2 million new HPV infections occurring annually. HPV is commonly found in adolescents and young adults and public health officials estimate that 80 percent or more of sexually active women in the U.S. have experienced HPV by age 50.
Prevalence in US Women -
In one HPV prevalence study published in 2007 in JAMA
HPVs were detected in 26.8% of US females aged 14 to 59 with the highest prevalence (44.8%) among 20 to 24 year old women. Low-risk HPV types 6 & 11 and high-risk HPV types 16 and 18 were detected in 3.4% of females evaluated in the study. Researchers concluded that:
- HPV is common among U.S. females but the prevalence of HPV vaccine types is relatively low;
- High-risk HPV types are detected in 99% of cervical cancers, and worldwide approximately 70% of cervical cancers are due to HPV types 16 and 18. Although HPV infection is common, studies suggest approximately 90% of infections clear within 2 years.
In the early 1960’s, after pap screening became a routine part of women’s health care in the U.S., cases of HPV associated cervical cancer dropped by more than 70 percent. By 2006, pap screening had driven the numbers of new cervical cancer cases to 9,700 annually with about 3,700 deaths in a U.S. population of more than 300 million people.10
Prevalence in US Men - In a 2006 published review evaluating 40 studies reporting HPV prevalence among U.S. men, researchers found a male HPV
prevalence rate ranging from 1.3% to 72.9%, depending upon the study.11
The researchers concluded that:
- Few studies are available that have determined the frequency of acquisition and the duration of infection in men. There is a wide range of HPV DNA prevalence among men and most studies in men found prevalences as high as those reported in studies in women.
- Screening for HPV infection is not recommended for men because infection is very common; no FDA-approved test is available, and finding HPV infection does not indicate an increased risk of disease or cancer in men or their sex partners.
Can HPV Cause Injury and Death?12 13
HPV infection usually causes no symptoms and most women and men clear the infection within one to two years. Antibodies to the HPV type causing the infection remain in the body to help prevent future infection with that same HPV type.
Most But Not All HPV Infections Resolve Spontaneously - However, sometimes HPV infection does not clear from the body and becomes chronic. After many years of undetected chronic HPV infection, cervical or other genital or oral cancers can develop and cause disability or death.The CDC states that “Although the incidence of [HPV] infection is high, most infections resolve spontaneously. A small proportion of infected persons become persistently infected; persistent infection is the most important risk factor for the development of cervical cancer precursor lesions.”
Persistent HPV infection associated with development of cervical cancer is clinically manifested in women by cervical intraepithelial neoplasia (CIN), which are also referred to as “pre-cancerous” lesions. Low-grade CIN (CIN 1) may spontaneously resolve when infection clears from the body or progress to CIN2 or CIN3, which may lead to cervical cancer if the pre-cancerous lesions are left undetected and untreated for years.
The American Cancer Society states “Cervical cancer tends to occur in midlife. Most cases are found in women younger than 50. It rarely develops in women younger than 20. Many older women do not realize that the risk of developing cervical cancer is still present as they age. More than 20% of cases of cervical cancer are found in women over 65.”
Women Need Pap Screening - Whether women have gotten HPV vaccinations or not,
routine pap screening is recommended for all womento detect high grade CINs and receive prompt treatment in order to prevent cervical cancer from developing.14 15
Six HPV-Related Cancers - In addition to cervical cancer, there are five other cancers also associated with chronic HPV infection: mouth and throat (oropharyngeal); vaginal, penile, anal and vulvar. The American Cancer Society estimates that in the U.S. in 2013:
- About 12,340 new cases of invasive cervical cancer will be diagnosed and about 4,030 women will die from cervical cancer.16
- About 36,000 people will get oral cavity or oropharyngeal cancer and an estimated 6,850 people will die of these cancers.17
- About 2,890 new cases of vaginal cancer will be diagnosed and about 840 women will die of this cancer.18
- About 1,570 new cases of penile cancer will be diagnosed and about 310 men will die of penile cancer.19
- About 7,060 new cases (4,430 in women and 2,630 in men) of anal cancer will be diagnosed with about 880 deaths (550 in women and 330 in men).20
- About 4,700 vulva cancers will be diagnosed and about 990 women will die of this cancer.21
The CDC states, “About 10% of women with high-risk HPV on their cervix will develop long-lasting HPV infections that put them at risk for cervical cancer. Similarly, when high-risk HPV lingers and infects the cells of the vulva, vagina, penis, anus, or the oropharynx (back of the throat, including the base of the tongue and tonsils), it can cause cell changes called precancers. These may eventually develop into cancer if they're not found and removed in time. These cancers are much less common than cervical cancer. Much less is known about how many people with HPV will develop cancer in these areas.”22
Low Number of HPV-Related Cancer Deaths - In the U.S. the estimated 14,000 annual deaths from the six cancers associated with HPV23 24 represent less than three percent of the more than 550,000 cancer deaths25 that occur every year.
Who is at Highest Risk for Getting HPV?26
HPVs are sexually transmitted viruses. It is estimated that more than half of sexually active people are infected with one or more HPV types at some point in their lives.
The CDC states that “risk factors for HPV infection are related to sexual behavior, including the number of sex partners, lifetime history of sex partners, and the partners’ sexual history. Most studies suggest that young age (less than 25 years) is a risk factor for infection.”
Who is at Highest Risk for Suffering Complications of HPV Infection?
Risk co-factors for developing cancer, including HPV-related cancers, differ depending upon the type of cancer and the health and choices (i.e., smoking, drinking, diet) of the person. Having one or more risk factors (or no risk factors) does not always determine whether or not cancer will develop.
Those at highest risk for suffering complications of HPV infection are the less than 10 percent of women and men, who do not naturally clear HPV infection caused by high risk HPV types, from the body and become chronically infected.
According to the National Cancer Institute, factors that can increase the risk of developing cancer following chronic infection with HPV types 11 and 16 or other high-risk HPV types, include: 27
- Having a weakened immune system
- Having many children (for increased risk of cervical cancer)
- Long-term oral contraceptive use (for increased risk of cervical cancer)
- Poor oral hygiene (for increased risk of oropharyngeal cancer)
- Chronic inflammation
The American Cancer Society 28
lists the following risk factors for developing cervical cancer after years of chronic HPV infection with high risk HPV types that is undiagnosed and untreated:
- Chlamydia Infection
- Poor Diet and Obesity
- Long term oral contraceptive use
- Multiple full term pregnancies (3 or more)
- Young age (under 17 years old) at the first full term pregnancy
- Poverty/lack of access to Pap tests
- Women whose mothers took the hormonal drug Diethystilbestrol (DES) during pregnancy (1940-1971)
- Family history of cervical cancer
Among risk factors for development of oral cavity and oropharyngeal cancers are:29
- Tobacco use
- Alcohol use
- Heavy drinking and smoking
- HPV infection
- Gender (men at greater risk)
- Age (over age 55)
- UV Light
- Poor nutrition
- Weakened immune system
- Genetic syndromes
Among risk factors for developing anal cancer are:30
- HPV infection
- Other cancers
- HIV infection
- Multiple sexual partners
- Lowered immunity
- Race and gender
Among risk factors for developing vaginal and vulvar cancers
- HPV infection
- Cervical precancer or cervical cancer
- Weakened immune system
- Chronic vulvar itching or burning
Among risk factors for penile cancer
- HPV infection
- Not being circumcised
- UV Light
- Age (over age 55)
HPV Prevention and Treatment Options
HPV infection prevention options focus on refraining from or limiting sexual activity in terms of numbers of partners, as well as consistent use of condoms. There are no recommended treatments for HPV infection, which usually clears naturally, but there are options for treatment of genital warts or pre-cancerous lesions that develop after chronic infection.
The CDC states “Treatment is directed to the macroscopic (i.e., genital warts) or pathologic (i.e, precancerous) lesions caused by infection. Subclinical genital HPV infection typically clears spontaneously, and therefore specific antiviral therapy is not recommended to eradicate HPV infection. In the absence of lesions, treatment is not recommended for subclinical genital HPV infection whether it is diagnosed by colposcopy, acetic acid application, or by laboratory tests for HPV DNA. Treatment also is not recommended for cervical intraepithelial neoplasia 1 (CIN1).”33
In addition to recommending HPV vaccination, the CDC states that:34
- “HPV transmission can be reduced but not eliminated with the use of physical barriers such as condoms. Recent studies demonstrated a significant reduction in HPV infection among young women after initiation of sexual activity when their partners used condoms consistently and correctly;
- “Abstaining from sexual activity (i.e., refraining from any genital contact with another individual) is the surest way to prevent genital HPV infection.
- For those who choose to be sexually active, a monogamous relationship with an uninfected partner is the strategy most likely to prevent future genital HPV infections.”
The National Cancer Institute lists the following HPV infection prevention options:35
Avoiding or Limiting Sexual Contact: “The most reliable way to prevent infection with either a high-risk or a low-risk HPV is to avoid any skin-to-skin oral, anal, or genital contact with another person. For those who are sexually active, a long-term, mutually monogamous relationship with an uninfected partner is the strategy most likely to prevent HPV infection. However, because of the lack of symptoms it is hard to know whether a partner who has been sexually active in the past is currently infected with HPV.”
Use of Condoms: “Research has shown that correct and consistent use of condoms can reduce the transmission of HPVs between sexual partners. Areas not covered by a condom can be infected with the virus, though, so condoms are unlikely to provide complete protection against virus spread.”
Stories & Photos of Gardasil Vaccine Reactions
“The Food and Drug Administration (FDA) has approved two HPV vaccines: Gardasil
® for the prevention of cervical, anal, vulvar, and vaginal cancer, as well as precancerous lesions in these tissues and genital warts caused by HPV infection; and Cervarix
® for the prevention of cervical cancer and precancerous cervical lesions caused by HPV infection.” (Gardasil vaccine is FDA approved for prevention of low-risk HPV types 6 and 11 and high risk HPV types 16 and 18; Cervarix vaccine is FDA approved for prevention of high risk HPV types 16 and 18. Gardasil and Cervarix have not been FDA approved for the prevention of oropharyngeal or penile cancers).
NVIC Press Releases, Statements, and Reports on Gardasil Vaccine
- Jan. 29, 2014. Gardasil Vaccine, Katie Couric & Cyber-Lynching. BL Fisher, NVIC Newsletter
- Aug. 24, 2009: Gardasil & Swine Flu Vaccine: Inconvenient Truths. BL Fisher, NVIC Newsletter
- July 14, 2009: Preventing Gardasil Injuries & Deaths. BL Fisher, NVIC Newsletter
- Feb. 9, 2009: Gardasil Death & Brain Damage: A National Tragedy. BL Fisher, NVIC Newsletter
- Aug. 15, 2007: NVIC Report/Analysis of Gardasil Vaccine Adverse Events Part III (Debold V, Downey C, Fisher B)
- Aug. 15, 2007: Gardasil Vaccine Risks Increase With Other Vaccines — NVIC press release with live links to references
- Aug. 14, 2007: Letter to Advisory Committee on Immunization Practices (ACIP) of Centers for Disease Control.
- Mar. 8, 2007: “Gardasil and HPV Infection” – Statement by Barbara Loe Fisher at Rally held by Parents 7 Citizens Committee to Stop Medical Experimentation in D.C.
- Feb. 21, 2007: NVIC Report/Analysis of Gardasil Vaccine Adverse Events Part II (Debold V, Fisher B) (2007)
- Feb. 21, 2007: Vaccine Safety Group Releases GARDASIL Reaction Report — NVIC press release with live links to references
- Feb. 1, 2007: NVIC Report/Analysis of Gardasil Vaccine Adverse Events (Debold V, Fisher B)
- Feb. 1, 2007: Survey of GARDASIL Costs in Private Pediatricians Offices (January 2007)
- Feb. 1, 2007: HPV Vaccine Mandates Risky and Expensive NVIC press release with live links to references — NVIC press release with live links to references
- June 27, 2006: Merck's GARDASIL Not Proven Safe for Little Girls NVIC — NVIC Press Release on GARDASIL aluminum c ontent and clinical trials with live links to references
Select Broadcast Media Reports on Gardasil Vaccine
- Dec. 9, 2013. CBS-TV - The Doctors. HPV Vaccine Controversy.
- Aug. 19, 2009. “Gardasil Researcher Speaks Out,” a report by Sharyl Attkisson, CBS-TV.
- Feb. 6, 2009. Gardasil Vaccine Draws Concerns, a report by Sharyl Attkisson, CBS Evening News.
- Nov. 11, 2008. “One Mother’s Story & Bigger Questions About the U.S. Vaccine Safety System,” an investigate report by Jane Miller, WBAL-TV 11 (Baltimore).
- July 7, 2008. “Gardasil Concerns,” a report by Nancy Yamada, WUSA-TV (Washington, DC).
- February 13, 2007. “Should HPV Vaccine Be Mandatory?” Meredith Viera moderated debate with Nancy Snyderman, MD; Barbara Loe Fisher, NVIC President; Jessica Farrar, TX legislator. “Today Show,” NBC-TV.
Selected Print Media Reports
- Dec. 28, 2013. Dennis B. Washington Post. Five pressing health priorities in 2014.
- Nov. 24, 2013. Reuters. Sanofi sued in France over Gardasil vaccine.
- Nov. 4, 2013. Merck Press Release - Business Wire. Merck’s Investigational 9-Valent HPV Vaccine, V503, Prevented 97 Percent of Cervical, Vaginal and Vulvar Pre-cancers Caused by Five Additional HPV types, in Phase III Study.
- Oct. 16, 2013. Baklinski T. Japan Withdraws Support of Controversial HPV Vaccine Over Safety Concerns. Lifesite News
- Jan. 31, 2012. Gonthier V. Family Sues After Teen Dies Following HPV Vaccination. Toronto Sun
- May 14, 2010. Green G. Gardasil: Krystal’s Story. Women Hurt by Medicine
- Jun. 8, 2010. Xinhuanet. HPV vaccine comes under spotlight in Korea. Xinhuanet
- Jun. 14, 2010. New Report Explores Gardasil Deaths.
- July 4, 2009. Medical News Today. Cost-Effectiveness of HPV Vaccination in The Netherlands.
- Feb. 28, 2009. Scoop Independent News (NZ). Vaccine Roll-Out Is Wrong Without Honest Advice.
- Jan. 16, 2009: Seattle Post Intelligencer — “Gardasil Vaccine for boys?” by Betsy Hart
- Jan. 9, 2009: Wall Street Journal — “FDA Again Says No to Expanded Gardasil Use”
- Oct. 24, 2008: NY Daily News — “New Gardasil cervical cancer vaccination requirements for immigrants stirs controversy”
- Oct.17, 2008: Bloomberg News — “Merck Aims Gardasil to Women Least Likely to Benefit”
- Aug. 21, 2008: Wall Street Journal — “Study Questions Cost Effectiveness of Gardasil Cervical Cancer Vaccine”
- Aug. 19, 2008: New York Times — “Drug Makers Push Leads to Cancer Vaccine’s Rise
- Jul. 6, 2008. Edelman S. Fed’s Warning Shot. New York Post
- July 20, 2008: New York Post — “My Girl Died as ‘Guinea Pig’ for Gardasil”
- July 6, 2008: New York Post — “Fed’s Warning Shot – Gardasil Cancer Vaccine Probed for Links to 18 Deaths”
- July 2, 2008: US News & World Report — “Is HPV Vaccine To Blame for Teen’s Paralysis?”
- June 30, 2008: Judicial Watch — “Judicial Watch Uncovers New FDA Records Detailing Ten New Deaths & 140 “Serious” Adverse Events Related to Gardasil.”
- June 19, 2008: Time Magazine — “Anti-Vaccine Activists vs. Gardasil”
- December 6, 2007: Fox News — “28 Women Miscarry After Receiving HPV Vaccine Gardasil: FDA Says No Reason to Re-examine Approval.”
- December 4, 2007: MSNBC — “Merck Reaffirms 2007 Profit Outlook”
- November 2, 2007: TheStreet.com — “Vaccines Give Merck Booster Shot.”
- September 21, 2007: Bloomberg News — “Merck Vaccine Should Be Required, Global, Experts Say”
- September 7, 2007: AlterNet.org — “HPV Vaccine Flags Need for More Pap Tests.”
- August 27, 2007: Bloomberg News —“Oral-Sex Cancer Link Suggests Boys Need Merck Vaccine”
- May 23, 2007: The Record-Courier — Family Awaits News on Daughter’s Illness
- May 11, 2007: Sacramento Bee — Dan Walters Column
- May 10, 2007: San Francisco Chronicle — UCSF Doctors Warn on Wide Use of Cervical Cancer Vaccine
- April 19, 2007: Market Watch — “Merck posts 12% profit rise, affirms 2007 forecast”
- March 3, 2007: Boston Globe — “VA set to Mandate Gardasil”
- February 20, 2007: Bloomberg News — Merck Stops Campaign to Mandate Gardasil Vaccine Use
- February 11, 2007: Washington Post — Drugmaker Assists In Pushing for Mandate For HPV
- February 2, 2007: Bloomberg News — Merck Gets First U.S. Cancer-Shot Mandate, From Texas
- February 1, 2007: Washington Post— Letter to the Editor from Barbara Loe FIsher, “Risk, Racism and the HPV Vaccine”
- January 24, 2007: Washington Post — “Force Is Not the Only Way to administer a Vaccine” by Courtland Milloy
- January 10, 2007: Washington Post — D.C. Bill Would Mandate Vaccine
- July 18, 2006: New York Times — “A New Vaccine for Girls, But Should It Be Compulsory?” by Roni Rabin.