Another Sexual Blight to Fight

By Denise Grady

"This virus is rampant," says Dr. Stephen Curry of the New England Medical Center in Boston. "If it weren't for AIDS, stories about it would be on the front page of every newspaper." The doctor is referring to a fast-spreading blight that afflicts millions of Americans, including more and more teenage girls. Caused by the human papillomavirus (HPV), it is sexually transmitted, sometimes painful and often incurable. Its chief symptom in both men and women is genital warts, which frequently occur after infection.

Conventional treatments cannot rid the body of HPV, which can remain latent for decades. Thus the warts often recur. Worst of all, some types of HPV have been linked to cervical and other cancers; carriers of the virus who do not have warts are often unaware of the risk to themselves or their sexual partners.

Private physicians reported to a national medical data bank a 46% increase between 1981 and 1986 in cases of genital warts. Although no official tally is kept, the federal Centers for Disease Control in Atlanta estimates that there are now between 500,000 and 1 million new cases each year. The hardest hit group seems to be young women in their teens and 20s.

Between 5% and 15% of those with persistent warts are expected to develop cancer, says Virologist Wayne Lancaster of Georgetown University. The most common by far is cancer of the cervix, but HPV has also been blamed for tumors of the vulva, vagina, anus and penis. The virus alone, however, probably does not cause cancer. Instead, say researchers, one or more of several co-factors seem to be required to trigger the disease. Among the suspected culprits: smoking, birth-control pills, and the presence of herpes and other venereal infections.

So far, the incidence of cervical cancer has not matched the rise in HPV cases. But that is little comfort: there may be a latent period of five to 40 years before virus-associated cancers appear. Clinics are already seeing an increase of young women with Pap tests that show HPV-linked cervical dysplasia. These tissue abnormalities sometimes mean the cells are becoming malignant. Some researchers think HPV is involved in as many as 90% to 95% of all cases of dysplasia and cancer of the cervix.

The cases in young girls are especially worrisome. Some researchers suspect that because a teenager's cervix has more developing cells than an adult's, it is more vulnerable to HPV. At Children's Hospital in Boston about six teenagers a year must undergo surgery for cervical cancer, which in the past was extremely rare in the young.

Since there are no symptoms until cervical cancer is advanced, Pap smears are the only way to detect the malignancy early. Some gynecologists recommend the test every six months for women with more than one sexual partner, and more frequently for those who have had warts. Even when the warts disappear spontaneously or are medically removed, the underlying viral infection -- and therefore the risk of cancer -- may persist. Hoping to reduce that risk, doctors are testing the antiviral substance interferon in adults with severe warts, and efforts to produce a vaccine are also under way. But no solution is close at hand. The prospect is for another sexually transmitted epidemic that will take many years to contain.

With reporting by Suzanne Wymelenberg/Boston