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HPV Infections in Newborns Short-lived

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Babies who acquire HPV from their mothers at birth typically clear the virus in a short time, according to a study published in Virology Journal.

Researchers in Korea enrolled 300 pregnant women in a study to examine HPV prevalence in expectant mothers and look at the rate of “vertical transmission” (when HPV is passed from a mother to the baby), along with factors that may be linked with mother-to-infant transmission. 291 women gave birth during the study, 55 of whom (18.9%) had cervical HPV detected. Swabs of the buccal mucosa (the lining of the cheeks) were taken from newborns and tested for HPV.

Of the babies born to women with HPV, HPV was found in 10 (18.2%). None of the babies delivered by women without HPV were found to have the virus. Factors associated with transmission were vaginal delivery (each of the 10 infants with HPV detected were delivered vaginally) and the mother having multiple HPV infections. Length of labor and premature rupture of membranes were not associated with neonatal transmission.

The HPV didn’t last long, however: Each infant who had HPV detected at birth cleared the virus within six months, however, leading the investigators to conclude these may not have been “true” infections.

Reference:
Park H, Lee SW, Lee IH, et al. Rate of vertical transmission of human papillomavirus from mothers to infants: Relationship between infection rate and mode of delivery. Virology Journal, 2012. 9(80).

 

HPV Takes Longer to Clear in African-American Women

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A study finds young African-American women take longer to clear high-risk HPV infections than white women of similar age.

Cervical cancer rates and mortality are higher among African-American women than in society at large. Compared to whites, for example, African-American women are more than twice as likely to die from the disease. The disparity has largely been attributed to factors such as poverty and lack of access to health care (African-American women tend to be diagnosed with cervical cancer in later stages, when the prognosis isn’t as good).

The Carolina Women’s Care Study began in 2004 and followed 467 women (including 111 African-American and 326 white or European-American women) at the University of South Carolina throughout their time in college. Researchers gave the subjects Pap and HPV tests every six months to examine both HPV infections and their duration. African-American and white participants were similar with regard to number of sexual partners, age at which they first had sex, and the number of new HPV infections found throughout the study. HPV-16, the type found with about half of all cervical cancers, was the most common high-risk type detected.

A finding the investigators referred to as “striking” was the difference in viral clearance: 56% of African-American women with high-risk HPV still had the infection 24 months after it was first detected, compared to only 24% of white women. African-American women were also 1.7 times more likely to have an abnormal Pap test result than their white counterparts.

HPV infections tend to clear naturally (90% resolve within 6-24 months) due to the immune response. HPV infections that don’t clear (referred to as persistent infections) are the key factor in the development of cervical cancer, though. The researchers say it isn’t clear why African-American women in this study took longer to clear HPV infections, but say their findings suggest a possible “biological basis” to consider when examining disparities in cervical cancer incidence and mortality.

Reference
Messersmith A, Banister C, Spiryda L, et al. (April 2012). Increased risk of persistent human papillomavirus infection and abnormal Pap tests in African American compared to European American women in a college-age cohort. Paper presented at the Annual Meeting of the American Association for Cancer Research, Chicago, IL.

 

Study: Most HPV Infections Resolve Quickly in Young Women

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A study by researchers at the University of Washington finds most HPV infections in young women resolve naturally within 24 months.

Between 2000 and 2007, Rachel Winer, PhD, and colleagues followed female college students between ages 18-22 years. Subjects were given HPV and Pap tests three times a year so the investigators could examine and chart HPV infections over the course of the study. The authors say understanding short-term, incident HPV infection in young woman might give insight into transmission of the virus.

It was common for subjects in this study to have more than one type of HPV detected, as over 300 different HPV infections were found in 85 women. Also, 60% of cervical lesions found among study participants contained more than one type of HPV.

90% of the infections were undetectable on HPV DNA tests in two years or less (median time to clearance was about 9 months). Approximately 1 in 5 infections were detected again within 12 months, however. Incident HPV infections of the cervix were more likely to have short-term duration compared to infection of the vulva and vagina (either alone or with cervical infection).

Reference:
Rachel L. Winer, James P. Hughes, Qinghua Feng, Long Fu Xi,Stephen Cherne, Sandra O'Reilly, Nancy B. Kiviat, and Laura A. Koutsky. Early Natural History of Incident, Type-Specific Human Papillomavirus Infections in Newly Sexually Active Young Women. Cancer Epidemiology, Biomarkers, and Prevention, 2011. 20(4):699-707.

 

ASHA Report: States Spend Billions to Treat STDs

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States spend nearly 15 billion dollars each year to treat new cases of sexually transmitted diseases (STD), and a new study by ASHA finds much more can be done to stem the epidemic.

An estimated 19 million new STD infections occur each year in the U.S. – HPV alone accounts for approximately 6 million cases – yet states have slashed spending on STD prevention programs. While the average per capita spending for all public health was $40.25 across the U.S., in FY 2009, states reported only spending an average of $0.16 per capita of that on STD prevention, a reduction from $0.23 in FY 2007.

With STDs continuing to be a major public health challenge (rates of chlamydia and syphilis are climbing, for example), states are increasingly looking to Washington for help. In FY 2009, states reported funding about one tenth of their total STD prevention effort. Since ASHA’s last report (FY 2007), the federal government is funding an increasing share of STD prevention budgets, from 75% of the total in FY 2007, to 90% of the total in FY 2009. Much of the increased federal funding was tied to stimulus spending and is unlikely to be maintained, however.

Budgets are under pressure everywhere, and the desire to restrain pending is understandable. However, principal investigator of the study and ASHA Vice President of Research and Health Communications, Lisa K. Gilbert, PhD, says diverting funds from prevention programs may be short-sighted: “STD prevention is much less expensive than treatment, especially when you count the health consequences that often result. Fully funding prevention efforts is an effective means of avoiding more costly interventions and serious health outcomes. These programs remain a cornerstone of good public health policy.”

Thirty states reported funding decreases leading to reductions in staff, training, capacity building, and services (both clinic and laboratory) as well as increases in furloughs. The range for state’s public health funding in general, and STD prevention funding specifically, was enormous. For example, per capita public health funding in Nevada compared with Hawaii was $3.55 and $169.92, respectively. STD prevention funding also ranged wildly from $0 per capita in three states (Colorado, Indiana, and South Carolina) to $1.57 in Louisiana. ASHA President and CEO Lynn Barclay says “Literally, your health could depend on where you live. Such discrepancies are heart-breaking and unfair. Robust prevention programs save dollars and protect our health. It only makes sense to fund them at adequate levels.”

Medical care related to STDs and reproductive health is tricky even beyond matters of funding and program support. Dr. Gilbert says barriers include time, transportation, and child care. Embarrassment and shame also keep many from accessing vital prevention and screening services, as does fear around testing/vaccines (such as with getting “shots”) and even anxiety over what the test results might reveal.

Visit ASHA for the full report and an interactive, searchable website that details state-by-state investment in STD prevention. This study was funded by the Centers for Disease Control and Prevention (CDC).

 

HPV May Increase HIV Risk

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A study in Kenya finds men with HPV are at increased risk of acquiring HIV.

Reams of data indicate that a number of sexually transmitted infections – including genital herpes and chlamydia -increase the risk of contracting HIV. The link primarily involves an immune response to an infection that increases specific cells that HIV targets. The risk with herpes is also thought to be increased due to sores caused by the virus allowing HIV easier access to the bloodstream. Little attention, however, has been paid to HPV in the context of HIV risk.

To assess if a similar link exists with HPV, Jennifer Smith, PhD, and colleagues collected swabs for penile cell samples from HIV-negative men ages 18-24, and tested them for HPV DNA. The men were part of a study in Kenya that examined the impact of circumcision on HIV acquisition.

Of 2,168 subjects in this arm of the study, half were positive for current HPV infection. Over 42 months of follow-up, 5.8% of HPV-positive men contracted HIV, compared to 3.6% of those were tested negative for HPV at baseline. After controlling for variables such as circumcision, HSV-2 status, and sexual and social risk factors, the researchers found the probability of developing HIV in a study subject with HPV infection anywhere on his penis is 38%, a significantly higher risk than with HPV-negative men.

While it isn’t clear exactly why HPV may increase the risk of HIV acquisition, the authors point out that HPV-related lesions in males can result in skin trauma that may increase susceptibility by creating “portals of HIV entry.” They also conclude that in the absence of an effective HIV vaccine, being immunized against HPV may have a role in HIV control programs.

Reference:
Jennifer S. Smith, Stephen Moses, Michael G. Hudgens, Corette B. Parker, Kawango Agot, Ian Maclean, Jeckoniah O. Ndinya-Achola, Peter J. F. Snijders, Chris J. L. M. Meijer, and Robert C. Bailey. Increased Risk of HIV Acquisition among Kenyan Men with Human Papillomavirus Infection. Journal of Infectious Diseases, 2010. 201(11):1677–1685.

 
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