In August 2005, Melissa Keenan requested an STD test when she went in for her yearly doctor’s appointment. She was surprised to find out she’d tested positive for HPV, which causes genital warts and, in some cases, cervical cancer.

After finding out she had HPV, Keenan, an alumna of Youngstown State University, says she spent some time researching the virus and learned that it is the most common sexually transmitted disease.

“It was something I didn’t know I could get that easily,” the 22-year-old says.

Her situation isn’t unusual. According to the Centers for Disease Control and Prevention, at least 50 percent of sexually active men and women acquire genital HPV at some point in their lives.

A closer look

There are more than 100 types of HPV, and about 40 of these affect the genital area. The 40 strains of genital HPV are divided into high-risk and low-risk categories.

What distinguishes high-risk from low-risk HPV is that low-risk types are benign — they cause a skin reaction but don’t become integrated and change the cell DNA, says Wendy Clinger, obstetrician and gynecologist at PrimeHealth Women’s Health Specialists. High-risk types can lead to changes in cells lining the cervix and, in cases such as Keenan’s, may develop into cancer.

Tests, tests, tests

Keenan says she saw her doctor every two months for Pap tests, and they all came back abnormal. Pap tests that are abnormal don’t necessarily mean a patient has HPV — a local irritation or infection unrelated to HPV or a lab error could result in an abnormal Pap. Multiple Pap tests and an HPV DNA test, which can detect the 13 types of HPV most commonly found in cervical cancer, can also be administered, according to the CDC.

The severity of the abnormality determines the treatment. In most cases, the person’s immune system fights off the infections, but Keenan’s infection wasn’t going away. Keenan’s doctor took biopsies of her cervix during a colposcopy, which allowed her to examine Keenan’s cervix more closely.

Keenan says the first biopsy was done to determine how many cell layers deep the abnormal cells permeated and whether they were precancerous or cancerous. In all cases, moderate to severe abnormal cervical cells need to be removed.

“Once you cross over that threshold, you need to get those cells out,” Clinger says. “They can turn into something bad.”

Like the Pap tests, Keenan’s biopsies kept coming back irregular. After five colposcopies in a year, Keenan says the doctor decided to do a large surface biopsy. The result: Stage 1 cervical cancer.

“It was probably caught the earliest you could,” Keenan says.

After being diagnosed, Keenan had surgery to remove the cancerous tissue. She says the doctor removed most of her cervix, cutting out about an inch and a half.

“I had to look at it after,” Keenan says. “I just had to. It’s so graphically unappealing.”

The doctor left just enough for the cells to regenerate so her cervix could grow back.

An early defense

Keenan jokingly laments that Gardasil, the first vaccine to prevent cervical cancer caused by HPV types 16 and 18, came out two years too late for her. The Food and Drug Administration approved the vaccine in June 2006.

Dr. Ray Leone, chief university physician at DeWeese Health Center, says 30 women have received the vaccination on campus.

According to the CDC, if a woman has already been exposed to a strain of HPV, Gardasil won’t protect her from that particular strain. Because women can be infected with more than one type of HPV, Gardasil will protect her from the types she doesn’t have.

Because HPV has no symptoms, the infected person can pass it on without knowing, Clinger says. HPV is found on the skin around the genital areas and can be transferred by touch, so people don’t need to have sex to spread the virus, but a study by the American College of Obstetricians and Gynecologists found consistent condom use decreased the spreading of HPV by 70 percent.

That’s enough of a decrease that it’s worth it to use a condom, Clinger says.

A positive attitude

According to the CDC, about 50 percent of women diagnosed with cervical cancer are between 35 and 55 years old. These women were probably exposed to high-risk types of HPV while in their 20s, and because it went untreated, the cells became cancerous.

Keenan’s situation was a little different. She discovered she had cervical cancer a year after finding out she had tested positive for HPV.

“That freaks you out,” Keenan says of how she felt after learning she had cervical cancer.

But through it all, she remained positive.
“If you could pick a good cancer, that’s probably the best you could have,” Keenan says. “You have to look on the bright side — glass half full. There are so many worse things that could happen to a person.”

It was that positive attitude that helped Keenan finish her last year of school. She missed a lot of classes, but says she was honest with her professors and informed them of the situation. In May 2006, she graduated with degrees in chemistry and biology.

Jennifer Mussig is a senior magazine journalism major.
This is her first story for The Burr.
Contact her at jemussig@kent.edu.

STORY Jennifer Mussig
PHOTO Heidi Weber

ABOVE The Food and Drug Administration has approved Gardasil, a vaccine which prevents two types of HPV. Although the vaccine is still expensive, the state is fighting to make it mandatory for 7th graders.

 

GARDASIL:
The Controversy

In January, the Centers for Disease Control and Prevention issued an immunization recommendation that by the age of 18, girls should receive the human papillomavirus (HPV) vaccine, Gardasil.

Sarah Adams, pediatrician and section chairman of pediatrics at Robinson Memorial Hospital in Ravenna, says although the vaccine is recommended for women between the ages of 9 and 26, in practice, the target age is 11 to 12 years old.

The CDC’s recommendation has left lawmakers in a dilemma: Require the vaccine to prevent the spread of sexually transmitted diseases and future cancer cases or leave the decision up to the discretion of parents?

“There’s controversy because some people view it as a permission slip to become sexually active,” Adams says.
Cost is another factor prohibiting widespread approval of the vaccine.

Although many insurance companies are recognizing the vaccine, Adams says without help from insurance, the three-shot series during a six-month period costs $120 to $130 per shot.

To help make the vaccine available for low-income and uninsured families, Kristopher Weiss, a spokesman for the Ohio Department of Health, says the department has distributed more than 24,000 doses of the vaccine through the federal Vaccines for Children program.

Because of its recent release, Adams says the long-term effectiveness of the vaccine is still unclear, but so far, no booster shots have been recommended.

— Jackie Valley