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Risky Business: Adolescent Sexual Behavior and HPV

Dr. Christine Sapienza of Jacksonville University and Dr. Bari Hoffman Ruddy of the University of Central Florida were recent community discussion leaders at TEDxJacksonville’s salon on community health. In this online article published originally by Metro Jacksonville, they discuss adolescent sexual behavior and the risk of Human papillomavirus (HPV).

Dr. Christine Sapienza, dean of the College of Health Sciences

Contrary to conventional wisdom, smoking and drinking are not the only causes of oral cancer. We are witnessing an alarming rate of oral and throat cancer caused by Human papillomavirus, or HPV. HPV is an extremely common sexually transmitted disease (STD) that is often passed during intimate contact. Roughly 20 million Americans are affected, with approximately 6 million new cases per year. But, to this day, we typically associate HPV with cervical, rather than oral, cancer.

Given the shifting landscape of risk factors, HPV requires serious public attention, and mechanisms need to be developed to create awareness and prevention practices. Those at particular risk are young men and women who are not vaccinated for HPV or who are already exposed to the virus. We need to better understand, as a community, the risk of infection and transmission among teenagers and we need to take steps to educate young adults and stymie the spread of HPV among this demographic.

Prof. Bari Ruddy UCF
Dr. Bari Hoffman Ruddy, associate professor in the UCF Department of Communication Sciences and Disorders

Even though FDA-approved vaccines can offer protection from cervical cancer (Gardasil for girls and boys and Cervarix for girls only), the vaccine must be fully administered prior to sexual contact in order to provide optimal protection. Compliance remains low.

Like any STD, having multiple partners increases the risk, yet not sleeping around is not a reasonable strict prevention rule. Primary prevention practices need to include education. Pamphlets alone will not work. Because nearly half of all teenagers are having intimate contact — some as early as age 14 — open communication must start early. While all parents worry about young pregnancy, and these apprehensions will continue, educating teenagers about the best practices for preventing the spread of STDs is critical.

Parents are the key communicators who will help protect their children’s sexual health. We know these conversations won’t be comfortable. STD transmission is a sensitive topic. But it’s important that teenagers and adults alike acknowledge that every sexual encounter results in potential exposure to an STD such as Human papillomavirus. We need to openly communicate the transmission path of HPV, publicize the risk of multiple sexual partners, reveal the risks to non-vaccinated persons, and share key details of HPV causes and types.

Above all, the information we present on HPV must be accurate. Included below are some key facts to get started:

What is HPV?
HPV stands for “Human papillomavirus.” There are more than 100 types of HPV. Sexually transmitted high-risk HPVs includes types 16 and 18.

Who needs to be informed?
Females and males of all ages, particularly those who are sexually active.

How is HPV transmitted?
Some types of HPV infection can develop without sexual relations, but often HPV is passed from one person to another during intimate contact, including open-mouth kissing, skin-to-skin contact, oral contact with genitalia, and vaginal and/or anal sex.

What is oral HPV?
The same types of HPV that infect the genital areas can infect the mouth and throat. Certain “high-risk” types of HPV (subtypes HPV16 and HPV18) are known to be associated with head and neck cancer.

What head and neck cancers can be caused by HPV?
HPV can cause cancers in the back of the throat, most commonly in the base of the tongue and tonsils, in an area known as the “oropharynx.” These cancers are called “oropharyngeal cancers.” Individuals who have cervical cancer have a risk of developing an HPV-positive oropharyngeal cancer as well as transmitting high-risk HPV to their partner resulting in oropharyngeal, bladder or penile cancer.

How does HPV cause cancer?
HPV can cause normal cells in infected skin to turn abnormal. These cell changes are rarely felt or seen. In most cases, the body fights off the HPV infection naturally and infected cells then go back to normal. In cases when the body does not fight off this virus, HPV can cause visible changes, and certain types of HPV can cause cancer. Cancer caused by HPV often takes years to develop after initially getting an HPV infection. HPV-positive cancers appear to be on the rise worldwide, including in younger adults with no history of tobacco smoking or alcohol consumption. Presently, it is unclear if additional factors have an impact on HPV to cause these cancers.

How common are cancers of the oropharynx?
Each year in the U.S., about 8,400 people are diagnosed with cancers of the oropharynx that may be caused by HPV. Cancers of the oropharynx are about three times more common in men than women.

How do people get oral HPV?
Only a few studies have looked at how people get oral HPV, and some of these studies show conflicting results. Oral HPV may be passed on during oral sex (from mouth-to-genital or mouth-to-anus contact) or open-mouthed (“French”) kissing. The likelihood of getting HPV from kissing or having oral sex with someone who has HPV is unknown. We do know that partners who have been together a long time tend to share genital HPV — meaning they both may have it. More research is needed to understand exactly how people get and give oral HPV infections.

How can I lower my risk of giving or getting oral HPV?
There are no studies that have explored how oral HPV can be prevented. However, it is likely that condoms and dental dams, when used consistently and correctly, will lower the chances of giving or getting oral HPV during oral sex, since they serve as barriers, and can stop the transmission of HPV from person to person. More research is needed to understand how oral HPV is passed, how it can be prevented, and the extent of health problems caused by an oral HPV infection.

Is there a test for me to find out if I have oral HPV?
There is no FDA-approved test to diagnose HPV in the mouth or throat. Medical and dental organizations do not recommend screening for oral HPV. Screening for oropharyngeal cancers may have health benefits.

Can HPV vaccines prevent oral HPV and oropharyngeal cancers?
HPV vaccines were developed to prevent cervical and other less common genital cancers. It is possible that HPV vaccines might also prevent oropharyngeal cancers, but studies have not yet been completed to determine if HPV vaccines will prevent oropharyngeal cancers.

Dr. Christine Sapienza is dean of the College of Health Sciences at Jacksonville University, a professor and program director for the Department of Communication Sciences and Disorders. She has authored more than 100 peer-reviewed publications, which can be found in the Journal of Speech Language and Hearing Research, The Journal of the Acoustical Society of America, Journal of Applied Physiology, Journal of Voice, AMJSLP and others. Dr. Sapienza authored the graduate textbook “Voice Disorders” (Plural Publishing) as well as the “Voice Disorders Workbook and DVD on Vocal Images” (Plural Publishing). Prior to JU, she was with the University of Florida and chaired the Communication Sciences and Disorders department for 8 years. Her work in respiratory strength training has been ongoing for more than 15 years, and she has been funded by NIH, The Michael J. Fox Foundation, and Veteran’s Affairs.

Dr. Bari Hoffman Ruddy is associate professor in the Department of Communication Sciences and Disorders at the University of Central Florida, and director of the Ear Nose Throat and Plastic Surgery Associates Voice Care Center. She also serves as the Director of the Voice Care Center at The Ear, Nose, Throat & Plastic Surgery Associates. Her current research interests include documenting treatment outcomes for disordered voice and aerodygestive disorders, implementing physiologic measures such as endoscopy, acoustics and aerodynamics. Her work is published in national and international journals, and she is co-author of the textbook “Voice Disorders, Second Edition.”