Human papillomavirus (HPV), the virus that causes genital warts, is the most common of all sexually transmitted diseases (STDs) in the United States with about 20 million Americans infected. In fact, it is estimated that 80 percent of sexually active people will contract HPV during their lifetime. While most HPV infections resolve spontaneously on their own without medical intervention, a very small percentage of women with HPV are at risk for developing cervical cancer. There are 100 strains of HPV, 30 of which are sexually transmitted. Some strains are called "high risk" because they are most likely to be associated with cervical cancer.
The correlation between these strains of HPV and cervical cancer has been politicized as part of the debate over whether young people should receive abstinence-only-until-marriage or comprehensive sexuality education that includes information about both abstinence and contraception.
Under a law signed in 2000, the federal Centers for Disease Control and Prevention (CDC) was required to issue a report to Congress on strategies for prevention of HPV. This same law also required the Food and Drug Administration (FDA) to ensure that condom labels are "medically accurate." The delay of these agencies' reports by one month-it was due to Congress in December 2003-caused Rep. Mark Souder (R-IN), a conservative lawmaker who is outspoken in his support for abstinence-only-until-marriage programs, to take the agencies to task by scheduling time before his subcommittee for the heads of those agencies to testify. This hearing has been postponed.
The CDC report on HPV, released in January 2004, recognized that "Cervical cancer is an uncommon consequence of HPV infection in women, especially if they are screened for cancer regularly with Pap tests and have appropriate follow-up of abnormalities."
The report identifies abstaining from sexual activity or, for those who choose to be sexually active, maintaining a monogamous relationship with an uninfected partner as primary prevention strategies. Reducing the number of sexual partners and "choosing a partner less likely to be infected" are also listed as prevention strategies.
After recognizing that further research must be done to help determine the efficacy of condoms in preventing HPV and that "available scientific evidence is not sufficient to recommend condoms as a primary prevention strategy," the report states that "There is evidence that indicates that the use of condoms may reduce the risk of cervical cancer." Later in the report slightly stronger language is used: "Available studies suggest that condoms reduce the risk of the clinically important outcomes of genital warts and cervical cancer."
"Regular cervical cancer screening for all sexually active women and treatment of precancerous lesions remains the key strategy to prevent cervical cancer," the report says.
"The take-home message here is that we need to ensure that women are being properly screened for abnormal cervical cell changes and using condoms if they are sexually active. If we want to talk about decreasing cervical cancer rates, we should be teaching young people the truth about condoms and we should be talking about increasing Title X funds which provide medical services like Pap tests rather than about increasing funding for unproven abstinence-only-until-marriage programs," said Tamara Kreinin, President and CEO of SIECUS.
Some have accused the CDC and other federal agencies of folding under political pressure to subvert science for ideology. At the request of Rep. Henry Waxman (D-CA), the Democratic staff of the House Government Reform Committee prepared a report titled "Politics and Science in the Bush Administration." The report found many instances in which the Administration had distorted or suppressed scientific findings or processes, the result often benefiting social conservatives or powerful industry groups. One such instance identified by the report was the Administration's changing of the measures used to determine the effectiveness of abstinence-only-until-marriage programs in order to claim that such programs are more effective than they actually are.
"This is a highly charged, partisan debate based on misinformation which is influencing policy. We are talking about a public health issue here yet we see ideologues trying to shape the debate. Especially when we are talking about public health strategies that affect adolescents, we need to be absolutely certain that we are using the best possible information and giving the necessary tools to our young people," said Bill Smith, director of Public Policy at SIECUS.
"We should be using what we know works: comprehensive sexuality education to give young people all the tools and information they need combined with regular screening and treatment for abnormal cervical cell changes," Smith said.