College campuses are host to a variety of easily spread illnesses, among them the common cold and influenza. While these short-lived illnesses come and go in a given population over time, the human papillomavirus, commonly known as HPV, is consistently widespread.
According to Tufts Medical Director Margaret Higham, it is possible that the entire sexually active population of a college campus is infected. "Studies say that 50 to 80 percent of the sexually active students on a given college campus have [human papillomavirus]," she said, "with some experts saying that closer to 100 percent of the sexually active student body is infected."
But while this statistic once caused great concern, recent findings have concluded that the matter may not be as worrisome as previously thought for young women. Accordingly, health care guidelines for women under 21 are changing.
There are dozens of different strands of HPV, and while the most serious can cause cervical cancers, not all of them lead to problems, Higham explained.
Two studies, the "SEER Cancer Statistics Review," published by the National Institutes of Health in 2006, and a 2004 Am J Obstet Gynecol study on diagnoses and outcomes in cervical cancer screening, both found that women under 21 have a higher rate of HPV infections, as well as more minor-grade cytological irregularities, but a much smaller chance of having invasive cervical cancer than women 21 and over.
In light of this fact, the American Society for Colposcopy and Cervical Pathology (ASCCP) recently revisited and revised its guidelines for the care of women under 21.
Because all gynecologists follow the ASCCP's regulations, the change in guidelines will result in widespread procedural changes in cancer screening tests also known as a cytology or Pap test.
Previously, if a Pap test revealed any abnormal cells, the patient would be sent to a gynecologist for a colposcopy, Higham explained. In this stage, the cervix is magnified and observed, and bits of tissue may be extracted for further examination in a biopsy to determine if invasive surgery or another treatment is necessary.
Higham explained that the new guidelines mandate that only the most serious type of abnormality, High-Grade Squamous Intraepithelial Lesions (HG-SIL), requires subsequent examination through a colposcopy. Higham emphasized that the milder cases of cell abnormality are now believed to often go away on their own, allowing the patient to avoid an unfamiliar and sometimes painful colposcopy.
"We don't need to get as bent out of shape about abnormal Pap smears as we used to," Higham said. "This is good news for young women."
But not everyone agrees with the updated guidelines. A September 2004 American College of Obstetricians and Gynecologists news release expressed concern that if patients do not come in for their first Pap screening until as late as age 21, they may not visit an ob-gyn for preventive care and testing for other sexually transmitted diseases until that age as well. They recommend that these visits begin in girls' early teen years to guide them towards healthy choices.
Interim Director of the Tufts University Women's Center Susan Gilbert said the new guidelines seemed "less proactive." However, she pointed out that if the new guidelines take effect, the Women's Center will make information available and would look into having a brown-bag lunch event with Higham to talk about them.
Gilbert emphasized the emotional consequences that could result from these tests and stressed that, should a student be distraught over the results of an abnormal Pap test or other STD tests, the Women's Center can provide support and connect the student to other resources such as health services or counseling if necessary.
Gilbert insisted students be responsible with their sexual health. "It is important to be proactive if you detect something wrong," she said. "Take care of yourself and go to the doctor."
In general, Higham said she believes students at Tufts are responsible for their health and their sexual health, with one exception: HPV.
"I don't think there is enough information about HPV and enough care about using a barrier with a partner until you have found a life partner," Higham said.
She emphasized that even if a partner shows no symptoms, it is still possible to spread the virus, and that many people who have HPV have no symptoms. In these cases, while the disease can still be spread, there is no test that will detect that the person has it.
Tufts Voices for Choice (VOX) Treasurer Nikki Bruce said the group worked last year to spread awareness of HPV through an informational poster campaign. They also alerted students that Gardasil, which vaccinates against HPV, is available at Health Services.
Like Higham, Bruce said Tufts students aren't aware of how widespread HPV is. "I think a lot of people just kind of lump [sexually transmitted infections] in the category of things to avoid, but I'm not sure people fully grasp how prevalent it is," she said.
As for Gardisil, which is relatively new, Higham is careful to do away with the misconception that the vaccine protects from the HPV virus. She said the vaccine really only protects against four strands of HPV while dozens exist.
