The case against generous definitions of STDs
Consider: Cervical cancer is evidently caused by Human Papilloma Virus (HPV) which is sometimes also known as genital warts. Cervical cancer is detectable with pap smears and cervical exams. If you turn out to have it, and if your cancer has been diagnosed early, your chances of survival are very high.
Consider: Roughly 1,500 women in the U.S. still die of it each year. In populations around the world with less access to regular medical care many, many more women die of it each year.
Consider: There's a vaccine for HPV but FDA approval is being held up for political considerations. It turns out that while HPV can show up all over the body, there's very strong evidence that it makes its way to the cervix mainly through sexual contact. (The first hint: epidemiologists noticed that cervical cancer is virtually unknown among cloistered nuns and quite rare among exclusive lesbians.) For political reasons, FDA appointees feel, certain medical treatment should be denied to people who have sex.
Consider, then, that HPV is an STD and therefore cervical cancer is an STD. Sexual transmission implies sex and therefore approving a vaccine for HPV is sanctioning sex.
[Aside: if an HPV vaccine is immoral why aren't pap smears? Why one and not the other? For instance does the same political faction in the FDA believe pap smears should be withheld from unmarried older women? I want to think about that more some other time but I believe it's worth examining. --fl]
Now for a digression with a point.
I appear to be suffering from a mild case of Fifth Disease. Fifth Disease is a very common childhood ailment. I had it as a child. But it's making the rounds at my children's school and my daughter got it. She brought it home and since I have a highly vigilant immune system it's decided to take no chances, so I'm down too -- a little woozie, a little feverish, a little achy, pretty low energy.
Question #2: This whole "evidence of sex" disease thing is kind of tricky. I think HPV is just the tip of the iceberg and the FDA needs to do a little cracking down. For instance, if I hadn't had sex I wouldn't have had children. If other people hadn't had sex they wouldn't have children either. If I didn't have children my children wouldn't have gone to school with other children. And if my partner and I, and all these other parents from around our neighborhood hadn't had sex I wouldn't be sick right now.
Now, chances are very, very low that anyone will bother to develop a vaccine for fifth disease. It's highly contagious so mild in childhood they don't even bother to take you out of class. So mild the kids rarely notice they have it, though grown-ups quickly notice the pink, lacy rash on the face, hands, and torso that gives it its common name "slap-face fever."
But! If children are a product of sex, and fifth disease (not to mention the rest of the old-fashioned childhood rashes of which fifth disease is, well, the fifth) is a product of children, then fifth disease is also a sexually transmitted disease.
Well. At least by the same reasoning that lets people imagine that cervical cancer is a sexually transmitted disease.
And here's the thing! Now that I realize that I don't just have a virus I picked up while picking up my children from school I'm suddenly ashamed. I'm a decent, law-abiding member of my community. I can't just let anyone know I've got fifth disease -- it's an STD!
In fact now I'm ashamed to go to the corner store for Tylenol!
What would I say if a neighbor asked "how're you doing?" I'd have to lie and say I'm feeling fine!
And, my goodness, I could wind up shaking someone's hand, someone who in turn might have children, who in turn might help their children brush their teeth or get into their car seat. Then the child might get it and take it to school where the whole vicious cycle could begin anew!
Now if I hadn't made that *sexual* connection to the disease I might have been able to go to the doctor, go buy some Tylenol, warn my neighbors that I might be contagious so they could avoid giving it to their children and thus perpetuating the disease through the population. But no, now that I realize that I'm polluted with the wages of sin there's nothing I can do but watch in horror.
---
Hyperbole? Duh! So why would I go on at such length? Well, how about because that's the sort of thing that happens when you tie an illness to sex.
Contrary to those who put their political agenda over science by tying it closely to sex, HPV can and often is transmitted nonsexually. HPV, like fifth disease, is very contagious. For instance it can be passed from individual to individual, from hand to hand, in a corner store and then passed by the individual, from hand to genitals, in the bathroom. In other words while it *CAN* be transmitted sexually, it's by no means transmitted *EXCLUSIVELY* through sexual contact.
So what message, exactly, are radicals in and out of the FDA communicating with their censorious attitudes towards an HPV vaccine? I can think of one: if you wind up with HPV you are unclean. And if you're an upstanding member of your community there are consequences if word gets out that you're unclean.
If we take those guys at their word, and allow HPV to become an STD then how likely is it people willingly seek early diagnosis? How likely we'll seek early treatment? And more to the point how likely is it we'll risk transmitting the disease rather than seek treatment?
It's not a trivial question.
[Second aside: In comments, Learn of Learn as you go notes that if both nuns and homosexual women are spared this illness then conventional arguments about morality are off the mark. --fl]
I loved this Figleaf, thanks for writing it. It's something that really bothers me too.
If they kept at it, we could almost be convinced the devout and sexually 'moral' are exclusively protected from ever catching any disease or getting any cancer. (Or being killed in a flood for that matter.) The evidence seems to be to the contrary, in both directions.
If God is smoting or rewarding us in this life by some kind of rule-book, I don't get the rules yet.
The first hint: epidemeologists noticed that cervical cancer is virtually unknown among cloistered nuns and quite rare among exclusive lesbians.
My favorite line. Lesbians and nuns, both the Beloved. Enough said.
Maybe you're right,they need their Scarlet Letters, and a completely preventative vaccine doesn't let them fish it out at all, whereas a diagnostic pap smear lets them chastise still a little bit, just a mere slap on the hand. You'll have caught the evil virus, you'll be scared, but maybe after that they'll let it be treated early. (As generous as they are.)
If you ask me, that's evil. But what do I know?
Sorry for reiterating pretty much all you said. I just felt like yes, yes and yes.
Thank you again for bringing this up,
[Please don't apologize, Learn. Imitation isn't the most sincere form of flattery, summarization is. Thank you! (Also, I've promoted your 'lesbians and nuns' point. Thanks for that too.) --fl]
Forgive me for being a little sleep-deprived and therefore slow, but by your reasoning, aren't CHILDREN also an STD?
:D
[Children get off on a technicality. The Left-Handed Dictionary defines children as "innocent byproducts." :-) Thanks, AAG. --fl]
I've noticed the commercials all over the TV this week. What's up with that?
[TV Commercials? I'm not much of an old-media guy so I've missed these. Details? Thanks, MW. --fl]
Of course they're going to hold it up. Drugs for women are notorious for not receiving approval. It would be interesting to check the figures on how long or short a time it took Viagra to pass through the rank and file without qualm.
[Funny you should mention that, DN. I'm working on a post about a CDC recommendation for the period between when you get pregnant and you discover you're pregnant. Since a lot of medications can adversely affect very-early fetal development without terminating the pregnancy it's not completely stupid that they're more cautious... but a) Plan B is meant to be used just *prior* to pregnancy and b) I believe Plan B-like medication has been studied where there's an established pregnancy so the hold up here isn't about science anyway. Thanks! --fl]
heh, Figleaf (and AAG): I want this on a t-shirt:
"Life is a Sexually Transmitted Disease. Use Protection."
[Works for me! Thanks, TYH. --fl]
I can't believe that there is remedy to this situation and the gov't sits on their thumbs. I contracted HPV a couple of years ago when my ex fooled around. That was one of the products of my law and moral abiding union. In my mind, life is over. Anyone that I am interested would need to know before we decide to sin (and no I'm not getting married again anytime soon, so I guess it would be a sin). Yet telling him means almost certain death of the relationship. Even though according to statistics , he more than likely already has it.
The other nice little tidbit, condoms only protect the penis and vagina, not the out lying areas where the warts actually reveal themselves. In essence, there is no protection except abstinence.
Thanks for this post Fig. Timely and insightful, as always.
[Hi, Price. Boy is *that* a perfect illustration of the principle! When your choices are a) never have another relationship, in your community anyway, or b) fail to disclose a common illness you can guess which way most people are going to go. It's exactly why HIV is an epidemic instead of a minor curiosity -- it had time to establish critical mass because virtually everyone was thrown into deep denial of one form or another. Thank you, Price. --fl]
Don't be so sure. I felt the same type of fear when I found out I had HPV; even though I knew statitiscally my partner probably had it too, and based on evidence it seemed most likely that I got it from him - I was still nervous about his reaction. But it didn't faze him. His main concern was that it could lead to cancer for me, but once he learned that the strains that cause warts don't lead to cancer, he dropped that concern. Sometimes I still get self-conscious about it even though I know I shouldn't; but his response was, "If I had a wart on my thumb, would you stop holding my hand?" It's important to see HPV for what it is: a virus that the majority of people have! And if you have warts, it's important not to view them as some horrible disease that marks you as a terrible person that must be cut off from all interpersonal relationships; basically, it's just a skin condition.
To sum up... yes, there are people out there who would break off a relationship if they found out their partner has HPV. But there are a lot of jerks out there who would break off relationships for plenty of stupid reasons! Do you really want to be with someone who would be that petty? I hope you will be as pleasantly surprised as I was in people's reactions - that is, that it's not a big deal. It's a way bigger deal to you than it is to anyone else.
[I still think it's a good illustration of the point: if something is *perceived* to be an STD people are far more cautious about disclosing it, or seeking treatment. And incidentally the vaccine in question would provide protection against cancers the virus can cause in other, "non-sexual" parts of the body. But if it's seen as an STD... Thanks, Amber. --fl]
I am not supporting any attempt to ban approval of the vaccine for religious or moral reasons. However, the conservative factions are basing their stance on the following findings regarding cervical cancer:
1. HPV is the cause of approximately 90% of cervical cancers.
2. While there are over 80 types of HPV, 30 of these types can be transmitted sexually, including those that cause genital warts.
3. About one-half of the sexually transmitted HPV's are associated with cervical cancer.
4. Gardasil, the vaccine developed by Merck, protects against the two types of HPV which scientists believe cause 70% of cervical cancer, and two other viruses that cause 90% of genital warts. According to The New York Times, All four viruses are sexually transmitted.
(Information in items 1 through 3 are from Wikipedia)
Therefore, to be fair in presenting the facts, fl, the vaccine does target those viruses that are sexually transmitted.
However, conservative opponents of the vaccine have made the following error in their logic: they assume that HPV's are primarily transmitted in promiscuous relationships. While multiple sex partners can increase the probability of contracting HPV, it is a logical fallacy to assume that women who contract cervical cancer were infected due to premarital or extramarital sexual relations. Thus, withholding approval of the vaccine on "moral" grounds would indeed be punishing the innocent.
As for making the vaccine mandatory as are vaccines for other contagious diseases, I do support the right of individual parents to choose whether their daughters will receive the vaccine. Why? The debate as to whether there are irreversible side effects caused by any program of required immunization is still ongoing. Even thought the FDA ruled that the thermisol content of vaccines did not contribute to what is seen as an epidemic of autism, there is concern that a child's immature immune system may be overtaxed by the vaccination process. Since (a)the vaccine could be administered when a girl reaches the age of majority and still be effective in preventing cancer, and (b) non-vaccination does not directly threaten the health of her fellow students, in the interests of letting consumers make their own informed healthcare choices, I believe this decision should be left to the parents or adult woman.
Thank you for an excellent post and comments, fl and readers.
[Thanks for the sources, Kochanie. The presumably-neutral Planned Parenthood site confirms that the forms of HPV in question are most commonly transmitted sexually, however other researchers leave the door open. For instance according to a fairly recent article in the Journal of Microbiology suggests that "Several studies have confirmed the detection of human papillomavirus (HPV) in children, but the transmission modes are still partly unknown. Sexual abuse has been claimed to be the source of genital infections in some cases, but nonsexual modes of HPV transmission also have to be considered. These include vertical transmission from parents to infants, horizontal transmission from other family members and those in close contact with the child, autoinoculation from one site to another, and possibly indirect transmission via fomites." The point being that an *over-emphasis* on sexual transmission puts an unproductive stigma on things, as Pay As You Go mentioned. As for requiring vaccination, I'm fine with leaving it optional *AS LONG AS* it's possible to choose that option without stigma. Thanks, Kochanie. --fl]
I agree w/ you, figleaf - that's basically what I was saying, that we need to remove the stigma. I wrote a post about this on my own blog, as well.
[Thanks, Amber. My point isn't about the vaccine (which was just approved on Friday, by the way!) It's about the consequences of sexualizing issues involving personal or public health. --fl]
Like AAG, I'm also sleep deprived so forgive me for shunning the scientific and political aspects to embrace the personal.
In my early 20's, following a routine pap smear, I was diagnosed as being CIN 2, which is 'moderate' dyskaryosis (cell abnormalities) yet closer to invasive cancer than normal cells on the chart. I only know this because I sat down on the stairs after the examination and read all my notes. I copied key parts and did the research otherwise I'd have been in the dark.
I was petrified. I was with my second ever sexual partner, so the promiscuity arguement held no ground.
I received excellent treatment and made a full recovery. But since that time, I have been exceptionally proactive in my own healthcare, primarily the gynaecological.
I'm actually glad I'm too tired to involve myself in the political arguements because I think I'd rage. I'm best leaving such matters to Kochanie, whose words and dedication I can only admire and say 'amen' to.
[Thanks, Lena. I'm glad everything turned out well! --fl]
Just a couple of clarifications. To paying the price: there is actually no clear medical understanding of whether HPV is a one-time, treatable condition or a virus that stays in your system and reappears eventually. This is because so many people have HPV with no visible signs, that it may actually not be that your warts or HPV symptoms are coming *back,* but that you have caught them from a new person.
Since there is no real factual evidence either way, you'd have to decide which side you want to err on, but you don't *have* to believe that you are infected for life if you choose not to, and if your symptoms and/or warts are gone.
If you had the kind of HPV that showed visible warts and you have had the warts treated and removed, you should not have to feel your life is over. In fact, unless visible warts come back, you should be able to feel you are perfectly fine to be sexually active.
It is equally as likely you will never transmit the disease to someone else as that you will--no one knows. And while you may decide you want to treat it as if you may *possibly* have a latent virus, and therefore tell your partner, it doesn't mean he'll be infected by you. AND he may already be infected already, anyway, even if you are or aren't. Over 3/4 of Americans are, for instance. You really wouldn't be able to tell in most cases.
Also, it has been my experience that, right or wrong, most males don't care at all if you've had HPV at any time, once they hear that if they get HPV it doesn't really mean much for them, the way it does for women. Unless they get warts (and if you have no visible warts, that's unlikely), if they did contract it, they can carry it with no discomfort and very little chance of consequence to their physical health. In fact, they probably will never know if they're carrying it. I'm not gonna comment on my attitude about the myriad of issues surrounding *that* here, but I will say that this is generally the reality: "It won't do anything to me? Who cares! Let's have sex!"
Re:
...then how likely is it people willingly seek early diagnosis? How likely we'll seek early treatment?
Though I appreciate your sense of unity on this issue, fl :), I have to emphasize that "people" and "we" aren't really appropriate in the majority of the above. It's women. Men can't get an early diagnosis, as there *is* no test for men (other than if the warts are already there--and that is not early). Men also can not receive early treatment--or ANY treatment, actually (unless the warts are there).
And in fact, there is no real test for truly early diagnosis of HPV for either gender. A diagnosis of HPV comes as a result of cervical cell changes that have already happened in women (or, to a far, far lesser extent, in cancerous cells in the anus or in very rare cases on the penis in men). The HPV itself, on the other hand, may have been dormant in the woman's body for years. There is no test administered for that, and no way to treat it unless cell changes or warts show up. In fact, sometimes the body heals it itself and the virus goes away on it's own, so preventative measures may not be necessary.
In any case, women can catch the cell changes in the pre-cancerous stages, and can confirm these changes are probably HPV related. But they can not detect or deter HPV until that point. I don't really consider that early diagnosis. More "middle-stage diagnosis."
And finally, my understanding is not so much that the religious right doesn't want this vaccine produced because HPV is an STD. They don't want the vaccine produced because HPV is their ace in the hole to continue to preach abstinence. All other STDs can be prevented relatively effectively by condom use. As a result, AIDS is not the scare tactic it once was. HPV is the only STD that can not be fully prevented by condom use and safe sex practices, because, as someone commented, one can still transmit HPV via parts of the genetalia that are not covered by a condom.
As such, religious organizations have been using HPV as a convienient scare tactic to negate the "safe sex is good enough" argument and prove that abstinence is the only way to prevent death by sex.
So to allow HPV to be cured or prevented in any way would be a serious blow to their cause. They'd no longer have any strong arguments to back up their stance other than moral ones, which, as history shows, have never really been all that good at convincing people.
It's a sad time when health is put on the back burner to such agendas.
[Hi Syl. All good points but I would like to generalize beyond any one illness or any one gender. (It's one of tne of the reasons I chose the almost trivial fifth disease in my original post.) Yes, I totally agree the main argument for blocking the HPV vaccine was to try to terrorize women about sex -- with the marked indifference of (and indetectibility in) men a bonus source of terror. But it's no less improbable that a sexually transmittable virus could cause, say, prostate cancer (or perhaps the source of the rumors that uncircumcized men might be more prone to penis cancer.) If that became the case then I suspect the same process would then play out. And it's the "then play out" part of these controversies that I'm concerned with. Thanks! --fl]
Magdelena:
Thank you for your story and support. I hope that more women will be sparred that moment of terror. And I bow my head in thanks to your fellow countrymen at the Lancet who urged acting FDA commissioner Andrew von Eschenbach to rule favorably on the Plan B morning after pill to demonstrate that he is capable of acting independently, without giving in to political or religious pressures. Click here for the full article.
I hate to ask this, but considering the attitudes of some U.S. conservatives towards women, abortion, and healthcare, could you ask a few MP's whether the UK would consider taking back a few of the colonies? Not all, just a few.
[Heh! So it's all a plot by those Burkean/Churchhillian conservatives to reunite us with the Mother Country? :-) By the way, they're absolutely right about Plan B -- it is a matter of independence and I appreciate that our cousins across the water have asked Eschenbach to remember that. Thanks, Kochanie. --fl]
Heh! So it's all a plot by those Burkean/Churchhillian conservatives to reunite us with the Mother Country? :-)
Actually, fl, I am trying to find a place where I can enjoy my golden years in wanton abandon and have access to reliable healthcare. Right now, Merry Old England is at the top of my list. If my suspicions are correct, based on sexblog hits, there are enough like-minded libidinous middle-age Americans to fill up a couple of states and secede from the Union ;-). Or, we could all move up to the Pacific Northwest and join the Dominion of Canada...This requires more deep thought, which is really a ruse for a mid-morning nap. (Move over, Ginger Tabby, Mama is reclaiming the bed.)
P.S. Hope you're feeling better. Since my household is not equipped with the walking Petri dishes known as children, I was not aware of the existence of the Fifth Disease. Thank you for the info and the link.
[Thanks, Kochanie. I am feeling a little better though. As for talk of succession I have a feeling we're in an "it's always darkest before the dawn" period. The next couple of election cycles will tell, but I have a feeling things will turn out all right. --fl]
It's just those dirty female sluts you have to watch out for.
[I think that might have been true as recently as the 1970s, and it's possible someone would try it, but I have a hard time believing they'd succeed. So I'm going to provisionally, but not completely, accept your point. Thanks, Amber. --fl]
So who would ever have dreamed that the "private" warts I got back in college, presumably from some GD asshole summer boy "friend" --not dumped nearly soon enough-- could come back and haunt me 25 years later in the form of abnormal cervical cells. Which then needed to be removed. Not a pleasant undertaking.
And yet, I'm HPV negative according to several tests I've had over the last two years.
Thank god for small favors I guess.
At some point, the vaccine will be processed and be sold. If they think they can make money on it....
[Yikes, KJ. I'm glad you appear to be clear now and I hope you stay that way. Thanks. --fl]
My point isn't about the vaccine (which was just approved on Friday, by the way!) It's about the consequences of sexualizing issues involving personal or public health. --fl
FL -- Last week Gardasil was approved by the panel of U.S. health experts that advises the FDA. The FDA has not approved Gardasil for distribution. I am bringing this to your attention because I hope you will post on this subject again while the FDA is reviewing Gardasil. Because of the number of readers who visit your site each day, I believe you can, very effectively, let people know what are the consequences of not approving this vaccine. The article from Reuters linked here will provide an update on this issue. Thank you.
[Yeah, after seeing the intitial reports I noticed it was only an advisory board recommendation and not full FDA approval. Sigh. I still think this one will go through. Thanks, Kochanie. --fl]
Merck has been running an ad, at least on the east coast, to make HPV as amoral as the flu. I was not even aware that HPV was considered a STD until I read this post, then followed up and found an article that spoke of the controversy. I had seen Merck's ad quite a few times. From the information in the article the vaccine is only for preventing the disease, not curing it. I wonder if any anti-viral drugs are use to treat it. Why would any Christian want to prevent a drug or vaccine from coming to market. If no one would ever sin, there would be no need to be born again. Who would they have to save? I'm sorry I didn't mean to stray from the topic.
I have lived most of my life getting the yearly PAP smear. If I had had cervical cancer years ago, there would have been nothing to blame. The scientists were beginning to suspect that some cancers may be caused by viruses or genes. I was genuinely hoping that the scientist would find a link to something so they would figure out how to cure it. If I found I had HPV now it would not excite me, I would be in the same position as many years ago. I still would not know who to blame. I might have to get more test.
When I was a teen, most women I remember having cancer, had cervical cancer. None of these women would ever been considered sluts. I would think if even those who oppose the vaccine, look at women in their own families, they may find some who had cervical cancer. May be there own mothers. I think some may know how terrible it is to die from cancer. Would they tell their mother and their daughters to stop getting a PAP smear? Are those same women that preach abstinence, going to stop?
[First of all I'm glad to hear Merck is doing the right thing with their ad campaign. I mean, yeah, they may be the ones selling the vaccine but any port in a storm when it comes to countering the 'winger's STD push. As for why, I think it's because they're just wiggy about sex. And possibly with good (local-to-them) reasons -- as a class they're *tremendously* immoral people with way higher than average tendencies towards infidelity, rape and "date rape," drunkenness, drug abuse, incest, divorce, STDs, teen pregnancy, you name it -- that make no sense to Blue staters only because for all our occasional excursions into birth control, polyamory, and maybe BDSM we're a startlingly intentional, comparatively moral bunch. I don't *think* they'd really prefer that women die unnecessarily, they're just grasping at straws, desperate to control their own personal tendencies so they're just not thinking things through. Important: an explanation for their behavior should not be construed as an excuse; compassion for their motivations should not be mistaken for condoning them. Thanks, 5o9. --fl]