Tuesday, September 6, 2011

Why There is No HPV Test for Men

There has long been a frustration, upsetment and for some a feeling of discrimination because there is currently no available HPV test for boys and men.

We are the ones burdened with the diagnoses, having to inform partners, shouldering feelings of shame and guilt and ultimately if persistent and progressive having to deal with all the physical and emotional ramifications of treatment.

The medical community has not been falling over itself in a race to make available a test for men and so the predominant question becomes - why not?

To begin with the current HC2 technology used in testing for HPV does not discriminate. It knows not whether the specimen is from a male or a female. PCR, or polymerase chain reaction, is a test which has been used long before the digene HPV test and most currently used was approved by the FDA. This is also true of the tests available through Hologic and Roche's new cobas test.

It is often heard that there is no consistently reliable test for men, yet PCR is typically used in the majority of research studies, including those on men. If it were so unreliable, then the research study results should also be in question but they're not. These same results are used to develop policies and guidelines relative to things like screening, so obviously it isn't because the test is unreliable.

According to Joel Palefsky, MD, of the University of California San Francisco, who deals with infectious disease and HPV related anal cancers, the unfortunate fact is, that it doesn't serve a purpose. Unless a man has some type of lesions which can be further tested simply knowing that he has HPV is not going to change anything. He states that most individuals are not tested in advance of sexual involvement with a partner but typically are dragged in by a partner who has been diagnosed with HPV. By that time, it is too late to undue transmission for any strain of virus which may have been acquired.

I know many are now adamantly disagreeing with this. It's unfair that women cannot have their partners tested in advance, it is unfair to put the burden on women and essentially result in women taking the blame for HPV transmission and a host of other reasons women typically consider.

Many may be surprised to know that the current test is only approved by the FDA for use with cervical specimens despite the fact that HPV can also be found in vaginal, vulvar and anogenital tissue. Once again, the test cannot distinguish from where the sample originates and would work just fine on any of these other areas.

Many of you may have heard of the anal pap. This is usually performed more on men than on women so of course one would wonder how this would work. Simple really, the origin of the specimen would simply be changed prior to submission to the lab for analysis. While this can be highly dangerous if it were done with a biopsy, for the HPV test which is simply looking to detect HPV DNA the sample area isn't significant. Either the DNA is present or it's not.

So why is it considered of no use in men? Well because while a urethral swab could be taken and perhaps a penile swab there is nothing that can be done for the patient if it were to reveal him to be HPV positive. Just as with women there would have to be some type of lesion which could be biopsied to check for dysplasia and/or cancer and penile cancer is very rare and there are rarely if ever visible penile lesions (unless of course they are genital warts which are the low risk type of HPV and not what we're talking about here). You don't need a test to tell you that genital warts are present, they're pretty obvious. It's the high risk oncogenic strains we're talking about here.

Tests are not typically performed by a physician unless there is the ability to then DO something based upon those results. There isn't anything that can be done for a man who is diagnosed as HPV positive other than to provide the standard precautions regarding the spread of the virus and using condoms and this information can be given even without an HPV result.

Even with condoms, HPV is so contagious and often exists in the tissue around the penis, testicles and perianal area that transmission is highly likely even with condoms and the only thing that will really make a difference would be if the man were to become a cloistered monk.

So its not that there isn't a test able to detect HPV in men, it's just viewed as pointless in testing for it. When it comes to the blame and shame which falls almost exclusively on women, what will make a difference is the FDA changing their current position regarding male vaccination against HPV. Right now vaccination is only recommended for women. It is approved for boys and men but not recommended. That recommendation carries all the difference, it says that protecting against HPV is just as important for men as women and levels the field when it comes to people's perception that women are to blame. Having the FDA make it a recommendation says that men are equally involved and accountable when it comes to the transmission of the virus and helps to lift the burden currently placed solely on women.

So in summary, it isn't that a test doesn't exist because it does. It is just not embraced for use by the medical community because knowing if they are positive is not going to really change anything and if their HPV is dormant at the time resulting in a negative test it would only be misleading. anyway.

The reason other vaccines have such a high compliance rate compared to HPV is because they are mandatory, typically required if a child is going to be allowed into school. Being "recommended" as HPV currently is certainly doesn't prompt compliance and since most doctors do not discuss HPV with patients they typically only learn about it as part of their positive diagnosis.

Since there are so many other means of transmission now being discovered and even kissing being suggested by those at Johns Hopkins doing research on HPV oral cancers then what is to prevent a child from transmitting it to another child by sharing a drink in the cafeteria. This is how Hepatitis B is transmitted very often and that results in cancer as well. Those against mandatory vaccination say that since it is an STI and younger children are not engaging in sex it isn't necessary, but if indeed it is as simple as sharing a drink or kissing (HPV has been identified in saliva) then it can easily be transmitted even without the sexual component in that age group.

Given the fact that male oral cancers from HPV have doubled from 1973 to 2004 is all the more reason for the FDA to make vaccination recommended in boys and men. Perhaps then this will lessen the stigma so often placed upon women and educate others to the fact that men are just as responsible for HPV transmission as women.
HPV Oral Cancers on Rise as Oral Sex Becomes More Popular, May Spread Human Papilloma Virus - ABC News." ABCNews.com: Daily News, Breaking News and Video Broadcasts - ABC News. N.p., n.d. Web. 5 Sept. 2011. http://abcnews.go.com/Health/ReproductiveHealth/hpv-oral-cancers-rise-oral-sex-popular-spread/story?id=11916068&page=2

Joel M. Palefsky, MD - UCSF Helen Diller Family Comprehensive Cancer Center." UCSF Helen Diller Family Comprehensive Cancer Center. N.p., n.d. Web. 5 Sept. 2011.

HPV and Anal PAP Testing, Health Facts For You, UW Health, University of Wisconsin Hospital, Madison ." UW Health, University of Wisconsin Hospital, Madison . N.p., n.d. Web. 5 Sept. 2011. http://www.uwhealth.org/healthfacts/B_EXTRANET_HEALTH_INFORMATION-FlexMember-Show_Public_HFFY_1126667028463.html