We dance around in a ring and suppo. But the cret sits in the middle and knows.—Robert Frost M y interest in human papillomavirus start-ed with a patient––a nun with cervical can-cer. You do feel funny telling someone who swears that they never had x that they have a xually transmitted dia. On the other hand, we know that HPV infection is common in girls before initiation of xual activity1and that as many as 14.8% of women with HPV have not had xual intercour.2
There is no clarity when it comes to HPV and its activation and transformation into a cancer-causing virus.3The argument that HPV can be transmitted with a single xual contact,4or that outercour5is
another mode of transmission, does not
detract from the need to prevent or treat
the problem. In addition, it makes discus-
sions with patients unc omfortable and
makes our lack of understanding about the
cancer-causing virus apparent.
Another patient of mine was as mad as
can be that a man had given her this dis-
ea, that we were not going to treat him
and that we didn’t need to e him. Adding平静的拼音
to her frustration was the fact that after she
was treated, she could go back to normal
xual relations with the untreated person
如何做奶油who suppodly infected her.
So what about men and HPV? Should
we treat an asymptomatic male patient to
protect his theoretical x partners? Is it
truly a benign virus in men? And are sub-
Editor in chief
证券公司是做什么的Gilbert E. D’Alonzo Jr, DO
Supplement editor
Tyler C. Cymet, DO
Assistant director of
special publications
附件区囊肿Walter Wachel
Creative director
Leslie M. Huzyk
Art director
Kiersten J. Linde
President
Carlo J. DiMarco, DO
President-elect
Larry A. Wickless, DO
Executive director
John B. Crosby, JD
Director of publications
枉费心机
and publisher
Michael Fitzgerald
Director for advertising
and production and
associate publisher
Richard D. Sullivan
Circulation manager
Debbie Blissmer
Advertising sales
Randall Roash
National sales manager
124 Prescott St
Strathmere, NJ 08248
(609) 263-9500
Fax: (609) 263-6522
AOA’s Women and Wellness is a publication of
the American Osteopathic Association, 142 E.
Ontario St., Chicago, IL 60611-2864. Telephone:
(312) 202-8178, Fax: (312) 202-8378.
Copyright 2009 by the American Osteopathic
Association. No part of AOA’s Women and
Wellness may be reprinted or reproduced
without permission from the director of
publications.
AOA’s Women and Wellness
is supported by an independent
educational grant from Merck & Co, Inc.
To view this and other
publications on-line, go to
www.do-online
(e publications)
NEW TERRITORIES The cret sits
ts of men at much greater risk for the virus to transform into a cancer-causing agent? How should we counl men who have x with men regarding the risk of anal, esophageal or penile cancer and the role of the HPV virus?
Why is it that we warn women that x with an uncircumcid male may make them more likely to contract a cancer-caus-ing virus?6Is the risk of HPV significant enough that we should enc ourage all newborn males to be circumcid for the well being of themlves and their future partners?
屈颈试验
Condoms may not prevent the spread of HPV,7but does infection with a non-c anc er-c ausing HPV prevent infec tion with the cancer-causing type? We don’t test for HPV type, but some types of HPV may be protec tive against developing more virulent c anc er-c ausing types of HPV.8
When what we tell patients doesn’t make n, that doesn’t mean that it isn’t true. It just means that we don’t have the whole story or a full understanding of the issues. More than a few physicians have expresd frustration with conditions asso-ciated with HPV.9,10We are not even sure if we should test for the virus before or after treatment, but we are sure of the natural history of certain types of HPV, and that cancer is a potential outcome.8
The answers may be found by looking at HPV where we don’t expect it—in men. It is still a cancer-c
ausing virus in men, al-though with a much lower frequency. And the cancers are different, mainly penile, rec-tal and esophageal. The warts and skin changes that we e from HPV are nowhere near as lethal but are en often by physi-cians in practice.
This issue of AOA’s Women and Wellness looks at the less-discusd issue surround-ing HPV—at men who are mostly en as carriers and infectors but who can also develop cancers, warts or asymptomatic colonization. In addition, we include a look at the basic biology of HPV so that you can think about the issue and come to your own decisions on how HPV is trans-mitted and get a better understanding about the role of screening, vaccination,treatment and other interventions regard-
ing this condition.
There are now two vaccines approved
四季平安对联
for the prevention of HPV, and some
groups are pushing to vaccinate tho at
low risk for developing rious illness from
HPV. In working to convince people to
purcha the vaccine for “peace of mind”
or protection of their partners, we need to
be able to look at the issue from our pro-
fessional position and advi our patients
to the best of our ability.11
This isn’t the first time that osteopathic
physicians are being pushed to make deci-
sions without posssing all of the informa-
tion we feel is necessary to make the right
decisions. The goal is to feel comfortable
that what we do is logical and in the best
interest of the individual we are treating, as
well as being responsible to society as a
whole. HPV is an issue that we cannot ig-
nore as physicians. The vaccine manufac-
turers are out there lling their products,
and our patients need accurate information
and guidance.
Certainly, the questions I have noted
make our jobs c hallenging. And, even
though the science is lagging behind the
practice, life needs to be lived in the pres-
ent. That means making decisions with the
information we have available, not with the
information we wish we had.
I hope you find this issue of AOA’s
Women and Wellness informative. Hopeful-
ly it rais questions in our minds and helps
stimulate the arch for answers that will
ultimately be found in our patients.
—Tyler C. Cymet DO
References
1. Doerfler D, Bernhaus A, Kottmel A, et al.
Human papillomavirus infection prior to coitarche.
Am J Obstet Gynecol. 2009;200:487.e1-487.e5.
2. Pao CC, Tsai PL, Chang YL, Hsieh TT, Jin JY.
Possible non-xual transmission of genital human
papillomavirus infections in young women. Eur J Clin
Microbiol Infect Dis.1993;12:221-222.
3. Cymet TC. Sexually activated or transmitted? Ques-
tions about HPV. J Am Osteopath Assoc. 2006;106:423.
4. Manhart LE, Holmes KK, Koutsky LA, et al. Human
papillomavirus infection among xually active young
women in the United States: implications for develop-
ing a vaccination strategy. Sex Transm Dis.
2006;33:502-508.
5. Krueger P. Respon: xually activated or transmit-
ted. J Am Osteopath Assoc2006;106:423.
6. Tobian AA, Serwadda D, Quinn, TC, et al. Male
circumcision for the prevention of HSV-2 and HPV
infections and syphilis. N Engl J Med. 2009;360:
1298-1309.
7. Weaver BA. Epidemiology and natural history of
genital human papillomavirus Infection. J Am
Osteopath Assoc. 2006;106:S2-S8.
8. Jastreboff AM, Cymet TC. Role of the human papil-
loma virus in the development of cervical intraepithe-
lial neoplasia and malignancy. Postgraduate Medical
Journal. 2002;78:225-228.
9. Krueger P. Infections with human papillomavirus:
hope for prevention and guidance for diagnosis and
management. J Am Osteopath Assoc. 2006;106:0-1.
10. Cymet TC. HPV prevalence and transmission.
JAMA. 2007;298:38.
11. Bailey J, Cymet TC. Planning for the HPV vaccine
春节休假and its impact on cervical cancer prevention. Compr
Ther. 2006:32:102-105.
T yer C. Cymet, DO, is the associate vice president
for medical education at the American Association
of Colleges of Osteopathic Medicine. He is the pres-
ident of the Maryland Association of Osteopathic
Physicians and is on the Board of Trustees for
DOCARE International. He can be reached at
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