HPV and You

Welcome to, In Case You Missed It, with Christina Williams, the podcast that's your go-to source for women's hoops. From buzzer beaters to breaking news, I bring you the highlights, analysis, and expert insights you need to stay ahead of the game.

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Hey, and welcome to the podcast. I'm Josh, and there's Chuck, and Jerry's here too. And this is Stuff You Should Know. And I've got an intro for this, Chuck. You ready?

Yeah, let's hear it.

Dearly beloved, we are gathered here today to talk about this thing called human papillomavirus.

That's good. I hear the beat starting in the background.

Such a good album.

Sure. Well, we're talking about HPV, like you've mentioned, and we should say right out of the gate, HPV is a very, very, very, very common sexually transmitted infection. If you have HPV or have had it, you may have not even known about it, perhaps, because your body just took care of it. But if you have it and you know about it, or have had it and knew you had it, it's no big deal. for the most part.

It is. The problem is this, like that would be the end of the episode if, if HPV wasn't a virus, actually the first virus found to cause cancer. That is rare in and of itself, compared to all of the HPV infections that are running around the world at any given time. There's a lot. And there's a lot of different types of HPV.

That's right. And if people get this vaccine, they are potentially looking at eradicating, at least HPV caused cervical cancer.

Yeah, just getting rid of it. So long, goodbye, cervical cancer. You were a thing of the past. And because we brought up the vaccine so early, I believe I heard the sound of 100,000 people skipping to the next episode, or maybe finding a new podcast altogether.

Come on. So the other thing that you might think about when you hear of HPV, besides cervical cancer, is genital warts. Maybe the last few people have tuned out now. But we're gonna dig into this, because those including talk of genital warts and cervical cancer. But HPV itself, we should say, is a larger name, an umbrella term, basically, for many, many different viruses.

Yeah, and one of the stars, the villain, I guess, is HPV 16.

You know what you gotta do before you try and give your dog HPV though?

What?

You gotta make him sit.

I don't get it.

What?

You gotta make your dog sit before you give it HPV.

All right, I'm just gonna scoot right on past that one.

Okay.

So we're talking a little bit of history. We'll see, we'll do a poll of people who get that joke, and don't. I wanna hear from you.

Is it?

No, I get chastised for explaining jokes, so I'm not even gonna do that this time. We'll let the people speak.

Wait, why don't you do it next time? I really wanna know this one.

I'll tell you after.

Okay.

So, looking at our history of human beings, people have long suspected that warts that you see, like you got a wart on your nose or a wart on your elbow, that there was an infection that was responsible for that happening. Finally, we proved that in the middle of the 19th century or so, when there were scientists that were intentionally trying to give themselves warts. Yeah. And it worked by infecting their skin. So, like, all right, we figured that out.

With wart extracts.

Yeah, gross.

It's trying to point that out.

So it took a little while for that to go downstairs and apply to genital warts, because people thought for a very long time, hey, if you have genital warts, that's just a symptom of like syphilis or something. Right. And we eventually learned that that's not the case at all.

Yeah, there was a 1917 German paper that purposefully infected a virgin girl to prove that genital warts exist outside of STIs, that it's its own thing. And they did, they proved it. So there's another thread going on at the same time, back in the 19th century. They figured out that cervical cancer was a strange conundrum, scientifically speaking, because if you took a group of nuns and you took a group of married women and put them together, the incidence of breast cancer would probably be about the same. The incidence of lung cancer, probably about the same.

I wonder if one person knew it and they were sharing with other scientists and they were like, I don't know. And they're like, what do nuns not do that other married ladies might do? Drink wine. No, no, what's something I might do in the bedroom, maybe?

Watch TV. I don't know, just tell me.

Oh, there's a good sketch in there somewhere, I think.

Sure. So they figured all this out, they put it all together, and they finally realized, thanks to a German virologist, another one, named Harald Zurhausen, great name. In 1983, he found that if you took a specimen of cervical cancer, a biopsy, and studied it closely, you would actually find a papillomavirus inside. And specifically, it turned out to be what we now know as HPV-16.. The chances are there's going to be some form of HPV-16 found in that biopsy, in that cancerous cell, taken from a cervical cancer patient.

That's right, and, like you said, that was in 1983, flash forward to 2008,, when Harald Zurhausen gets a Nobel Prize in physiology or medicine for his continued work developing that HPV vaccine that we mentioned.

Right.

It's a nice work, Zurhausen.

Yeah, way to go. I think he deserved it. Because he found this is the first virus that we've ever shown to cause cancer. It's like this whole field of medicine that's starting to kind of wrap its head around the role that viruses play in all sorts of diseases. I know there's a hypothesis that schizophrenia might actually be triggered by a dormant virus that comes to life later on, around your teenage years.

Yeah, so we mentioned that it's a lot of viruses, over 200, if you wanna get a little more exact. And they generally divide these into a couple of different groups, the cutaneous and the mucosal types. Cutaneous HPVs are, this is where you think of the warts. They infect the skin. If you have, like plantar, warts on your feet or you have warts on your hands or something like that, it's because of the cutaneous type of HPV.

Yeah, and because all of those, or a lot of those, are sexy parts, the inside of your eyelid notwithstanding, it goes to show that HPV infection can be transmitted sexually. It's not all the time. Like the other kind, the cutaneous type, that causes plantar warts, you can get that from walking around a pool deck where there's HPV hanging out. But it's a different kind of HPV. HPV-16, that can cause cancer, that is a sexually transmitted HPV.

Yeah, that's right. If you think, hey, can I use a condom to get around this? That helps. But HPV, the mucosal type at least, doesn't require bodily fluids for transmission. So if you are sexually active as a person and you have been so for a few years, then chances are you probably had HPV and maybe not even known it.

Yeah, and that's a really big point that you don't have to exchange body fluids. And also, similarly, Chuck, I wanna make sure it's totally clear, genital warts doesn't cause cancer. It's a different type of HPV. So you actually can give somebody genital warts from sexual contact, but that's almost certainly not going to lead to any kind of cancer. They're just different types, even though they can be passed along similarly through skin-to-skin contact.

That's right.

So yeah, I think you said, just from being sexually active, you're probably going to pick up some form of HPV or another. About 14 million Americans, yeah, just Americans alone, get a new infection every year. There's at least 80 million Americans running around with an HPV infection right now. And if you do the math, here in America, we have a pretty close replacement rate where we have just a few more 100,000 births than deaths every year, right? So let's just say that's a wash.

Hmm. Should we just put a pin in that? Sure. Okay. We'll reveal what that might mean later on.

Miss the latest in women's basketball? Don't sweat it. I've got you covered. Welcome to, In Case You Missed It, with Christina Williams, the podcast that's your go-to source for women's hoops. From buzzer beaters to breaking news, I bring you the highlights, analysis, and expert insights you need to stay ahead of the game.

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All right, so we're back. We promised more talk, that is, of genital warts. I believe you mentioned the low-risk, mucosal type, usually 6 and 11, HPV, the ones that cause these warts. or other, you know, moist membranes, mucous membranes. They don't generally cause a lot of health problems, or any really.

No, you don't say, like, just disregard my genital warts.

Yeah, I mean, well, I'm sure plenty of people have said that, but who knows.

It doesn't always work.

Who knows whether it works. But it's nothing to be ashamed of. It is quite common, and they can be removed. Sometimes medication can do it. Sometimes they'll do the old freeze with liquid nitrogen routine.

I used to get that. I got warts on my elbows, and I used to get it burned off with liquid nitrogen pretty regularly. I think I remember that.

Yeah, I feel like I've had that done with – I think I had plantar warts that they did that to when I was in college.

Yeah, I mean, you can get rid of warts that way.

Yeah. There's also lasers these days that can handle that.

Yes. So there are some types of HPV infections that lead to warts, mucosal warts, that can be a problem. There's one in particular. Respiratory papillomatosis is a condition that's caused by warts in the airways. And it typically happens in kids, and it's treatable, but it can narrow the airway, and that in and of itself is problematic.

Yeah, for sure. But that is only in young children. Usually you see it between the ages of two and six. It can occur in adults, but I think it's even more rare. But, again, you can remove these surgically, so you can get that taken care of as well.

Yeah, plus, you get to go back to school in the fall and be like, yeah, they shot lasers down my throat. What did you do this summer?

That's right. To get rid of my warts.

Yeah.

There's also infections with the high-risk kinds of APV that don't clear up on their own, and these are the ones that could eventually lead to cancer.

Yeah, so this is a very, very long process. But essentially, this HPV infection that is akin to causing warts just hijacks the cell, just like any other virus. It causes it to multiply and multiply and multiply. And then, as these cells rupture, they release more viruses into the extracellular membrane, and they get into more cells, and it just gets worse and worse. The difference between an HPV infection and other types of infections from viruses is that they're not systemic.

Yeah, but it isn't just cervical cancer, though, that we should point out. I believe there are six kinds of cancer. I think the data that we got—was this Livia? Did she help us with this?

Yeah, hats off.

I could tell, in a good way. I was like, oh, jeez, I could tell.

All the dirty jokes that we can't say.

2021 is when we got the latest CDC data, with more than 37,000 cases of cancer associated per year that are associated with HPV, 22,000 in women, 16,000 in men. And the six kinds of cancer, or I guess the five besides cervical, are, anal cancer, penile cancer, vaginal cancer, vulvar cancer—man, that's hard to say. It is. That's a good pre-stage warm-up.

Okay.

If you hear me backstage saying that.

Good Lord.

And then finally, oropharyngeal cancer, which is the base of the tongue, the back of the throat, tonsils. You can also get that through tobacco use, not surprisingly. So. you should also not be surprised to learn that as tobacco use has gone down, so have incidences of non-HPV oropharyngeal cancer.

But incidence of oropharyngeal cancer overall has increased because there's been a rise in HPV infections. Right. And I think I made it pretty clear. HPV-16 is one of the big baddies of this episode. So is HPV-18..

Yeah, and I think 18 causes 20% of cervical cancer. So between those two, you're looking at 70%.

So let's talk cervical cancer, shall we? Because it's really important. It's become, I guess, how do you put it? It's really emerged as a condition. that's gotten a lot of attention, because there's so much potential for getting rid of it altogether.

Yeah, and it's a situation where here in the United States, due to early detection and treatment, it is really, really lowered. I think it's gone down by more than 50% from the mid-70s to the mid-2000s. And only, of course, 4,000 people. It's a lot of people, but when you're talking about what the rates could and would have been in the past, 4,000 Americans dying of cervical cancer each year is a lot of progress has been made.

Yeah, and overall, I think there's 350,000 deaths from cervical cancer worldwide every year. Yeah. And, I mean, Americans make up a decent portion of the world population, but not a good portion of the cervical cancer death population. The reason why is because America has a really robust screening process that is easily accessed by American women to search for cervical cancer and catch it early on. And it's not nearly as robust in some other developing parts of the world.

Yeah, because in America, once you turn 21,, if you're a woman, generally from about 21 to 65, you're going to be getting a pap test about every three years, or at least you're supposed to. And the U.S. Preventative Services Task Force, the USPSTF, says, if you're under 30, they don't recommend that you get tested for HPV unless you have some pretty obvious risk factors. Why? Well, because generally, by then, you have probably gotten it, and it has probably cleared up on its own.

Yes. So they say don't bother with the HPV test, but definitely do get your pap test. Pap, by the way, isn't short for papioma. It's short for the guy who came up with the test, Georgios Papadnikolaou. Pap, I guess, to his friends and family.

That's right. If, during your screening, you happen to see what's a precancer or a dysplasia, then what they're probably going to do next is to examine the cervix. It's not a pleasant process. It's done using an instrument called a colposcope. You may get a biopsy performed, but a lot of times it's a minor thing that's going to go away on its own.

Hey, welcome to your year of anxiety until your next test. It sucks.

Yeah, but the odds are with you.

Yeah, for sure. Because we've got this early screening, because they have like a lot of telltale signatures,

That's right. That's the great news with cervical cancer. Unfortunately, the other kinds of cancers, the other five that we mentioned caused by HPV, there isn't a routine screening for those or preventative treatments for those. And that is one of the reasons why you mentioned oropharyngeal cancer is growing, even though tobacco use and tobacco-caused oropharyngeal cancer is falling.

Yeah, because people stopped using tobacco as much, but they replaced tobacco use with oral sex, which is one of the, it's actually the biggest risk factor now for developing oropharyngeal cancer. And the more oral sex partners you've had, the greater your risk of developing oropharyngeal cancer a few decades later is, as a matter of fact. So that's what I was saying earlier, when I was saying that there's been a change in sexual mores and behavior. Oral sex has become much more prevalent since the 60s and 70s than before. And a lot of those men in particular are starting to age into that point in their life where that HPV infection is developing into a cancer and is developing into oropharyngeal cancer.

Right. And we're talking specifically about oral sex performed on women. So I guess the idea is that you can get that HPV, and many, many years later, when you're, like you said, in your 50s or 60s, that's when it might rear its ugly head.

Yeah. Do you remember when Michael Douglas said that he had oral cancer, throat cancer, I think? And he's like, it's from oral sex.

Yeah. And everyone laughs.

Yeah, that's exactly what he was talking about. And he's right in that age group of boomers that were like, you know, let me try this. Right. Back in the day. So we don't have a good handle on really anything besides cervical cancer.

That's right. Good time for a second break.

I think so.

All right. Great. We're going to take a break. And, you know, we talked about the vaccine a couple of times. We're going to come back and put all our cards, all our vaccine cards, on the table right after this.

Miss the latest in women's basketball. Don't sweat it. I've got you covered. Welcome to, In Case You Missed It, with Christina Williams, the podcast that's your go to source for women's hoops. From buzzer beaters to breaking news, I bring you the highlights, analysis and expert insights you need to stay ahead of the game.

Well, Dawn, the Olympics are underway. It's useless to talk about it as a thing. that's happening in the future, when it's happening in the present. It's happening now. And what's happening now is our podcast, Two Guys, Five Rings, is a phenomenon.

Chuck, before we move on to the vaccines, which I agree we should do post haste, we do want to mention that the other kinds of high risk HPV mucosal cancers include, I think, like you said, anal cancer, vulvar cancer, penile cancer and vaginal cancer. And they start to get much, much more rare, starting with anal cancer down to vaginal cancer, as far as cancer cases go caused by HPV. Hopefully, we'll be able to figure this out and there won't be any of those cases. But that's another reason why cervical cancer got so much attention, because it was much more prevalent, in addition to much more treatable.

That's right. I'm glad you said that stuff.

So now we can talk about the vaccine, OK?

Yeah, let's do it.

There were two guys, Jean Zhou and Ian Frazier. They both worked at the University of Queensland. I believe Ian Frazier ran the lab and Jean Zhou and his partner worked for Ian Frazier. And together, they started studying HPV, specifically HPV-16.. And they figured out that you could take HPV-16 and isolate proteins from it.

That's right. It's meant for girls and women between 9 and 26 years old. There's a group called the ACIP, the Advisory Committee on Immunization and Practices, that said, you know, this stuff's good to go. Let's get it out there. And it protected against HPV.

Yeah. And after this thing was released, they started launching studies on the like, real world studies on people who've gotten, and they found like this is actually pretty good at protecting people against those four HPV strains. And in fact, they also figured out that it could protect men against genital warts and anal cancer. Because anal cancer, or HPV that causes anal cancer, I think 16, or probably 18 as well, can be transmitted from anal intercourse. I can't remember.

That's right. So that was in 2009 when the FDA licensed it for for boys and men from 9 to 26.. And again, a couple of years after, that is when the ACIP said, yep, we should get it, get it going in that population. Yeah.

So at the same time, GlaxoSmithKline said, us, too. We want to make some money off of this, too. And they released Cervarix, which I guess just never really picked up steam against Gardasil, because in 2014,, Merck released Gardasil 9.. And that is essentially the de facto HPV vaccine in most of the developed world. Yeah.

Yeah. And that's why they went from nine down to nine years old. It's two shots, six months to a year apart.

And they were like, sucks for you.

Yeah. Well, you know, you're not going to get the full benefit necessarily from that vaccination. But they said it still may be worth getting if you weren't vaccinated as a kid.

Especially if you had fewer sexual partners. So less sex, the older you are, the likelier the vaccine is to protect you against it later in life.

Right. And if you were a 40 year old virgin, then they made a movie about you. Pretty good movie, too. Yeah, I like that one.

So, like I said, this thing was released in the midst of the vaccine. Vaccines cause autism, firestorm. And so it was controversial right out of the gate. But Rick Perry, who is governor of Texas at the time, did not help things at all. He did something that seems extraordinarily bizarre today.

No, a lot of parents were either just, you know, sort of like stuff you hear about today. Like, you know, parents rights groups saying that we want to make those decisions. Some of them were part of the anti-vaccine movement. And some of them also and just people in general, I think, were like, well, wait a minute, Perry. You've got you're cozied up to these lobbyists for Merck.

Yeah. And Rick Perry had big time ties to Merck. That was the only HPV vaccine on the market at the time. So it's not like he could choose from a different type. But it just those ties made the whole thing smell fishy.

Yeah. And I bet one reason is because parents probably didn't say, all right, you're going to the doctor and you're getting this vaccine. And you know what that means. So the other one of the other things that popped up was the idea that, whether or not you need to vaccinate boys, in 2011, there was a story in The New York Times that that basically kind of suggested that the biggest benefit for male vaccination was either protecting female partners because, well, it was protecting female partners, because the only way to if you're going to get it as a man or a boy is to have, like you said, have that receptive anal sex. And so we've learned since then that straight men are also at risk, especially for that oropharyngeal cancer.

Yeah, because I mean, HPV-16 causes 70% of oral cancers, right? So if you give a boy the vaccine against HPV-16, you're going to take a big bite out of that possibility of them developing oropharyngeal cancer later in life. It just makes sense. So it does make sense for boys and girls to both get the vaccine. And yet there's, thanks to the anti-vax movement, thanks to Rick Perry and his Merck ties, thanks to that study that linked autism with vaccines, there's still today just a lot of hesitancy in mandating HPV as part of a required vaccine schedule among boys and girls in America.

Yeah, I mean, that's. the one takeaway is that this is a vaccine that really seems to work. There was a study in 2021 that found that among women who had been vaccinated between 12 and 13,, there were 87% fewer cases of cervical cancer.

Yeah, that's nuts. And Johns Hopkins came up with a model that said that because of vaccination rates among men, there should be 1,000 fewer cases of oropharyngeal cancer by 2045.. You might be like, that's it? That doesn't seem like that much. The reason why is because only 20 to 30% of boys aged 13 to 17 are getting that vaccine.

That's right. How many people are getting this vaccine? More and more. In 2022, 57% of kids between the ages of 15 and 17 had gotten at least one dose. If you are from a family that has parents that are college educated and maybe a little more money, you're more likely to be vaccinated against it.

Yeah. So I guess that's it, Chuck.

HPV.

Yeah. If you want to know more about HPV, there's a lot to go. read out there and educate yourself on. Same with the HPV vaccines that are available. You should probably read up on anything like that first.

This is good because it ties into an episode on whistling and something we both love, which is whistling the scorpions.

Oh, yeah, I love this one.

Hey, guys, listening to the show about whistling and and got to the part of the episode about popular songs. And, as I hoped, you guys did mention the classic Wind of Change by Scorpions. Side note, he says it's just scorpions, not the.

Oh, sorry.

Didn't know that. Kind of like eagles and indigo girls.

And Edie Brickell and New Bohemians.

Yeah, and Edie Brickell and New Bohemians. Yeah, that's right.

Yeah.

Know what you said?

Yeah.

Yeah. Brand new Bohemians.

And brand new heavies.

That's right. Oh, God. I used to love that band.

And new pornographers.

Well, you know, I still love them.

Who else? Jethro Tull.

I love Jethro Tull, too. He whistled through his flute. However, guys, I was half expecting one of you to mention this crazy fact, and you passed over it. To state it briefly, there exists a conspiracy theory that the song Wind of Change was written or partially written by the CIA as a mode of propaganda to help bring an end to the Cold War. I had never heard this.

No, but it really rang true, because I remember when the song came out and what the sentiments were like.

Oh, sure. Down to Gorky Park.

Yeah.

The song was written and released just months before the Berlin Wall was brought down and became hugely popular throughout the Soviet Union. At the time, a political-leaning song was very out of character for scorpions. I just can't say it.

Yeah.

I just picture a bunch of scorpions.

Yeah. It doesn't quite sit right. It's not like Jethro Tull.

No. Very out of character for the scorpions. Yeah. The band claims that the song was written by lead singer Klaus Meine, who typically never wrote music for the group. I didn't know that either.

Yeah. They were a political hairband.

Yeah, that's right. I hope this email finds you guys. well. I've been a huge fan for years. Glad I could share this with you.

Charon, like the river sticks boat keeper?

Yeah, Charon. Sails of Charon. C-H-A-R-O-N. Yeah. If you only know the scorpions from the early 80s, then check out this gem from 1978, because it's awesome.

All right. Well, we've got a couple minutes left before we hit 45, so I am going to tell you about a movie that I watched last night from 1979, called Tourist Trap. Have you ever seen it?

I don't think so.

It is the definition of camp without intentionally being camp, without being annoying camp. It's one of the best schlocky late 70s horror movies I've ever seen in my life. It is really good.

All right. What year? 1970??

You can stream it online somewhere.

I'm looking it up right now.

You don't even have to pay for it. Please watch it. It's a really good one. It's like a highly watchable, enjoyable movie. And there's some surprising little directorial bits in there that you're like, wow, that seems sophisticated for this movie.

Tonya Roberts and Chuck Connors, aren't it? That's enough for me.

That's all you need right there, yeah.

90 minutes. Also perfect.

Yeah. So go forth. Look up Sales of Charon. video by Scorpions.

Yeah. You need to watch that one. You're going to love it.

I still need to watch your whistling video that you sent me.

You haven't watched that?

I know. I feel like a jerk. I'm sorry.

All right. You got work to do.

I do. Well, while I do that, you guys go out and send us a listener mail. You can send it off to stuffpodcasts at iheartradio.com.

Stuff You Should Know is a production of iHeart Radio. For more podcasts from iHeart Radio, visit the iHeart Radio app, Apple Podcasts, or wherever you listen to your favorite shows.

Welcome to, In Case You Missed It, with Christina Williams, the podcast that's your go-to source for women's hoops. From buzzer beaters to breaking news, I bring you the highlights, analysis, and expert insights you need to stay ahead of the game.

Well, Bowen, the Olympics are underway. It's useless to talk about it as a thing. that's happening in the future, when it's happening in the present. And what's happening now is our podcast, Two Guys, Five Rings, is a phenomenon. Two Guys, Five Rings.