This article is the fourth in a five-part series looking at sex on campus. The articles will be based in large part on anecdotal evidence, asking the question "How do we behave sexually at Tufts, and how aware are we of the risks?"<$>
In the past year, Health Services has administered 109 tests for syphilis, 720 for chlamydia, 674 for gonorrhea, and 223 for HIV. Margaret Higham, the Medical Director of Health Services, notes that every single day Health Services treats at least one person for a sexually transmitted infection - and that these statistics represent only the individuals who are symptomatic and interested in treatment.
One of the most common STIs for people of college age is human papillomavirus (HPV), which can lead to genital warts. Seeing as condoms do not eliminate the risk of transmission - as condoms do not cover all areas affected by the infection - and transmission is possible without the presence of symptoms, HPV is easily spread without the knowledge of either participants. (An STI is something that is possibly asymptomatic, while an STD has to show itself.)
"Condoms help, but do not completely eliminate the risk," Higham said. "This is true for herpes as well, because the virus is found on the skin, so any direct skin-to-skin contact, particularly with friction, can spread the disease from one to another."
One Tufts senior was shocked this August when her OB-GYN called her to say that her routine pap smear had been irregular. She had been dating her boyfriend in a monogamous relationship for six months and they had been using the pill as their form of birth control.
"He did not realize he carried HPV; thus it was an unpleasant surprise for the both of us," she said. "He was only the third person I had ever had sex with, so I felt relatively cheated by the system of life."
The student's initial sadness quickly turned to anger. "As I read more, I became really angry simply because I had broken up with the boy from whom I contracted it, but was still involved in the emotional aftermath of the relationship," the student said. "I felt hugely betrayed and taken advantage of."
Though this student has not yet had new partners to inform, she still had to call her ex-boyfriend to explain that she had HPV and that it was from him. She saw him as a "legitimate partner" and therefore felt "knowing my own sexual habits I thought for sure there would never be a chance I could contract an STD." She knew of the risks but, like many of her peers, used to think she was "immune" from STIs.
Other students stayed with their significant others even after contracting the disease from this person. One senior at Tulane University got three STIs from her current boyfriend. "We used condoms at first - I had been tested recently and he believed that we had no reason to worry," she said.
It was not until she had gone to get a routine gynecological exam that she learned she had gonorrhea and chlamydia, just a few days before she left for a semester abroad in Europe.
"I felt very stressed and frustrated," she said. "My boyfriend felt guilty and disturbed because his ex had cheated on him and he imagined that the diseases had come from those encounters. I felt stupid for just not having him get tested before we had sex without condoms. I've been on birth control for years and we honestly just got lazy."
When this Tulane student returned from her semester abroad, her mother told her information that she had been sitting on since the beginning of the semester: her pap smear had shown abnormal cells that turned out to be high risk HPV, which can lead to cervical cancer if untreated.
"I was so outraged," she said. "My boyfriend was riddled with guilt."
Higham supported what the student's doctor told her. "There is currently no real test to look for HPV in men or women carrying the virus without any signs or symptoms," Higham said. "The vast majority of people don't know they have it because they can't see or feel anything. Unless the pap smear is abnormal, there is no way of testing."
Higham went on to estimate that as many as fifty percent of people between the ages of 18-24 have HPV in the genital area, whether or not they are cognizant.
This student had to have surgery (a procedure called LEEP) in which doctors scrape the dangerous cells off of the cervix with an electrified wire. Patients bleed for about ten days after surgery, with general discomfort.
Due to the fact that even casual contact can lead to an infection now, it is very difficult for this student to prevent a reoccurrence, particularly in light of the fact that she remains with her boyfriend. In the meantime, she continues to get pap smears every few months to monitor the containment.
The Tufts student's treatment has multiple stages and is plagued with uncertainty. "If my body has rid itself of the cells, then I will feel extremely fortunate and just be extremely cautious in the future," she said.
However, there is a likelihood that the condition will persist, and even worsen. In this case, she will undergo cryotherapy, in which the cells are frozen and removed. If this fails, she might have to consider the removal of part or all of her cervix to prevent the spread of cancer, a "debilitating" procedure that would keep her from having children in "any normal way."
Though the student will undergo more intensive testing over Thanksgiving break to search for pre-cancerous cells, she finds solace in the fact that "the benefit about being a young woman with HPV is that if you are under the age of 30 and not bearing a child your body can typically rid itself of the malicious cells, pending sexual contact with that particular partner is terminated."
The Tufts senior has since had one partner, under the influence of alcohol, and they used a condom. She did not inform him of her HPV. Though this knowledge has changed her outlook on the future, she is not letting it change her present.
"As of yet I know I am more cautious and aware of my sexual behavior, but I haven't let myself behave all together that differently when it comes to passion, or the heat of the moment," she said. "I know that I should always include a condom, regardless of my birth control status, but until I find out about the progression of my particular case of HPV, I refuse to stop living as the typical college student."
"Don't let laziness jeopardize your health," the Tulane student said. "When I look back on all I went through and how willing my boyfriend would have been to get tested had I only required it before we had sex, it is the most absurd thing in the world to me that I didn't just have him do it."<$>
