- The Washington Times - Tuesday, November 7, 2000

An incurable sexually transmitted virus is quietly spreading through the U.S. population, but government officials disagree as to the danger it poses and how it should be handled.

On one side is Rep. Tom Coburn, Oklahoma Republican and an obstetrician, who speaks bluntly about the human papilloma virus (HPV), calling it "a very insidious disease."

He has been fighting for more than a year to make HPV a reportable disease like AIDS is now and to put warnings on condom packages saying that they offer little or no protection against HPV.

On the other side is the American College of Obstetricians and Gynecologists (ACOG), Planned Parenthood Federation of America and the Society of Gynecologic Oncologists, whose combined protests succeeded in stripping Dr. Coburn's proposed legislation from one bill.

Dr. Coburn's new version no longer calls for mandatory HPV reporting. But it does call for "medically accurate" condom labels and more public education on the disease. These requests have been added to another bill to be taken up by Congress.

HPV is arguably the most common sexually transmitted disease in the United States, with an estimated 24 million active cases and 5.5 million new cases each year.

Most people contract a strain of HPV that is suppressed by the immune system with no medical intervention.

Other HPV strains cause troublesome genital warts. An even smaller number of HPV strains lead to cervical cancer, which kills around 4,800 women a year more than the number of women who die of AIDS.

Public ignorance about HPV is high. Internet sites buzz with questions about "those bumps," and doctors say most women are stunned to learn that their abnormal Pap smears are caused by a sexually transmitted virus.

"Yes, yes they don't know what it is," said Dr. Alan Ross, who often diagnoses HPV in the college students he sees at the Women's Health Care Center in Bethesda.

In February, the Kaiser Family Foundation asked 1,006 people to name all the sexually transmitted diseases they knew. Eighty-five percent listed AIDS, but only 11 percent listed "genital warts" and 2 percent said "HPV."

Dr. Coburn sees HPV as another AIDS crisis an emerging epidemic caused by an incurable virus that is easily spread, linked to a deadly cancer and largely impervious to condoms the biggest weapon in the nation's sexually transmitted disease-fighting arsenal.

"The scientific facts are irrefutable. Condoms don't protect you against HPV or they offer such limited protection that you will most probably get it anyway," said Dr. Coburn.

If women could read on a condom label, "This does not protect you from the leading cause of cervical cancer in this country," they might "rethink their thoughts about sexual intercourse," he said.

Dr. Coburn has support from doctors like Dr. Curtis C. Stine of the Medical Institute in Austin, Texas, and Dr. Hal Wallis, a obstetrician from Red Oak, Texas.

Both doctors urge their patients to use condoms as general protection against some sexually transmitted diseases, but warn that condoms don't protect well against HPV and other diseases that are spread by skin-to-skin contact.

"The only completely safe way [to avoid HPV] is sexual abstinence until marriage, marry an uninfected partner and sexual fidelity within marriage. That's the bottom line," said Dr. Stine.

To make his points on HPV in public talks, Dr. Wallis uses a slide show with a scene from the movie "The Naked Gun" in which the detective and his girlfriend wear head-to-toe condoms.

"When the kids ask me, 'What do I need to protect myself against HPV?' that's the slide that comes up," Dr. Wallis said.

Others have seen Dr. Coburn's tactics as counterproductive.

In a letter to Congress this year, the ACOG opposed telling people that condoms don't work against HPV because such warnings were "not medically appropriate" and "would discourage condom use."

Making HPV a reportable disease is wrong because it would involve "every woman who gets an abnormal Pap smear," said Dr. Penelope Hitchcock, chief of the sexually transmitted diseases branch of the National Institute of Allergy and Infectious Diseases in Maryland.

This, in turn, might discourage women from getting Pap smears, which would put them at even greater risk for cancer, she said.

The priority is for women to get regular Pap smears, so the relatively few HPV infections that may become cancerous can be caught, said Dr. Hitchcock.

"The first goal is for no one to die of cervical cancer," she added.

With research lagging, questions on HPV are likely to continue.

HPV is "kind of like an iceberg," summed up Deborah Patterson, associate medical director of Planned Parenthood of Maryland.

Some HPV infections are obvious, like the top of the iceberg, she said. "But think about the bottom of the iceberg we don't even know what size it is yet."

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