• 8/1/2007
  • Seattle, WA
  • Tom Paulson
  • Seattlepi.com

Virus found under men’s fingernails, pointing to more ways of it spreading.

Controversy continues to plague efforts to protect young women against cervical cancer by vaccinating them against HPV, the human papillomavirus, but one leading scientist’s discovery could throw a monkey wrench into the debate.

“We found HPV under the fingernails of young men,” said Dr. Laura Koutsky, a University of Washington epidemiologist.

Koutsky led some of the pioneering research and clinical trials that resulted in an HPV vaccine, Merck’s Gardasil, recently approved for use in girls and young women. The reason her fingernail finding is a potential bombshell has to do with why the vaccine is controversial.

HPV, which is the leading cause of most cervical cancers, is primarily a sexually transmitted disease. Opponents of HPV vaccines believe that immunizing girls against this virus sends the message that engaging in sex at a young age is acceptable behavior.

The presence of HPV under fingernails, she said, at the very least suggests another possible route of transmission. It’s an additional route of infection, she said, that could explain some previous apparent anomalies such as HPV infection in infants and young girls who had not yet engaged in sexual activity.

Koutsky’s not quite sure what to make of the finding, which has yet to be reported in a journal, but she said it is certainly “a surprise.”

“In spite of (the debate), a considerable amount of the vaccine has been distributed already,” said Dr. Lauri Markowitz, an expert on HPV with the U.S. Centers for Disease Control and Prevention who spoke this week at a Seattle meeting of the International Society for Sexually Transmitted Diseases Research.

More than 40 states have enacted some kind of legislation to encourage wider use of the HPV vaccine, Markowitz said, including a few states, such as Washington, that have avoided the mandated vaccine debate by simply offering the immunizations free.

The CDC, which recommends routine use of the HPV vaccine in females between the ages of 9 and 26, estimates that 25 percent of all women in the U.S. are already infected with the virus.

Not all HPV strains are equally likely to result in cancer, however. The vaccine protects against four strains that are thought to be more likely to cause cervical cancer. There are hundreds of types of HPV, and most people have been infected by one or another. Most infections have no symptoms and go unrecognized.

More severe forms of HPV can cause genital warts and penile and anal cancers. Non-genital strains can cause head and neck cancers. But the greatest cancer risk from HPV is to women. Cervical cancer, if detected early by Pap smear, is treatable but still kills more than 4,000 women a year in the U.S. In the developing world, cervical cancer is massive — the leading cause of cancer deaths of women, killing nearly 300,000 annually.

The cultural and moral concerns of other countries are sometimes an even bigger barrier to introducing new vaccines or health measures, said Dr. Jacqueline Sherris, vice president at Seattle-based PATH, an organization that specializes in the health needs of the developing world. Widespread acceptance of a vaccine in the industrial world, she added, can often be a necessary precursor to expanding its lifesaving use in poor countries.

But opponents of making HPV immunization widespread argue that if a young woman simply abstains until marriage, no vaccine is needed. Koutsky’s finding may give pause to those arguing from this moral perspective. If HPV can be found under fingernails, will these daughters of chastity need to also abstain from a handshake?

There’s no evidence to support that kind of transmission, Koutsky noted, but the finding of severe forms of HPV under the fingernails of young men should serve as a reminder of how much we yet have to learn about the behavior and transmission of the human papillomavirus.

“Basically, it’s not just about sex,” Koutsky said. “You have to know how people get it in order to prevent it.”

At some point, she predicted, it will become clear that boys and young men should also be vaccinated against the virus. It would be nice if just living a good, moral lifestyle could protect against microbial invasion, Koutsky said. But right at your fingertips, she said, might be a hint that this is just wishful thinking.