by a guy you might know*

After being together for six months, our nightly fooling-around was becoming fairly routine: undress each other, a bit of fondling, some oral sex, then I’d strap on the condom and play submarine. The night in question was particularly special, because she had just come back to town after visiting her parents for two days. We were just arriving at the oral sex portion of the evening when things went sour. “What’s this?” she asked.

“Oh, haven’t you been introduced? Mr. Winkle, this is Sarah. Sarah, Mr. Winkle.”
“No, I mean this lump here.”

Ah, the lump. About a week ago, the end of my foreskin seemed to grow a little bit. An innocuous nub of skin right at the tip that I tried to ignore at first, the rationalization being that it was growing because it was being put to so much use lately. Now that my girlfriend was inspecting it, though, I realized it was time to confront the problem honestly.

“Um, I dunno. I didn’t notice it before,” I lied.
“Maybe you should have a doctor look at it.”

Later, standing nervously in the examination room, my pants around my ankles, face flushed with embarrassment, I explained to the doctor what had just cropped up. I was worried that Mr. Winkle would interpret the situation differently, since he’d been trained to be very receptive to being touched. Fortunately, the doctor handled my penis like he was inspecting my ear or armpit, and Winkle recognized the difference.

Of course, the doctor knew what it was immediately: Human Papilloma Virus (HPV), or genital warts. The most common sexually transmitted infection (STI), genital HPV, is a “silent epidemic,” according to every medical professional I’ve talked to about it. About 75% of men and women of reproductive age have it, according to one study. The Centers for Disease Control and Prevention and American Social Health Association web sites say that among 15-24-year-olds, 9.2 million have been infected, although, because of the difficulty in detection, such studies may be inaccurate. The fact is that HPV is hugely widespread.

The virus is transmitted through contact with infected skin (a wart). When the virus gets onto new skin, it tries to infect it. If the recipient is in good health, the immune system will usually do what it does and terminate the virus. But if the recipient’s immune system is “compromised”— due to poor diet, stress, bad health, smoking or lack of sleep; read, college students—the virus penetrates to the basal layer and takes root. It can lie dormant for months or years, or it can generate warts. If the immune system is severely compromised by a condition like diabetes or HIV, the virus can manifest as lesions.

Very few people are aware of genital HPV, a fact that contributes to its status as the number one most common STI. In women, the warts tend to be internal and unnoticed, in men they can be noticed and ignored, as in my case, since the warts themselves usually have a lifespan. They appear on the skin for a short time, and most are self-terminating. Transmission occurs only when warts are present on the surface of the skin, but some warts can be too small to see without a microscope. Condoms can greatly reduce the chance of transmission of HPV, but only if the condom covers the infected area.

I was terrified. The reality is that tons of people have HPV without knowing it. It’s all over the place, so it would be best to acquaint myself with the problem.
Besides the wart on my foreskin, the doctor found another wart lower down the shaft. He decided to have them removed. He got the second one by touching it with liquid nitrogen, an experience I found rather painful, at least until the second one was removed—with laser surgery. The surgeons also found a third wart inside my urethra, which they also cut out with a laser. It hurt to pee for over a week. I mean seriously hurt. My girlfriend Sarah (not her real name, incidentally) had a few more warts than I did: patches of them, in fact. She had hers removed using an acidic, chemical ointment, which I understand tingled a bit.

Once you are infected with HPV, you probably have it for life. Medical opinion on the subject changes every year or so. Currently, it seems that some infections last indefinitely, but in many cases, the infection clears up entirely within two years. Since there is no test available for men, I have to assume it’s still in me. The infection waits around just beneath the surface layer of skin, waiting for your immune system to weaken again so it can resurface, grow warts and spread to others. I’ve been fortunate, my three lumpy little friends have not come back (visibly, at least) since that awful month when poor Mr. Winkle was subject to such constant inspection.

HPV causes all sorts of warts, not just on the genitals. There are over 100 different strains of HPV, and most of them are benign, resulting in bumps, flat patches or cauliflower-like growths. Out of the 100+ strains, about one third cause genital warts, and less than one third of those can cause cellular changes to the cervix. One reason that women who are sexually active are advised to have regular Pap tests is to detect early appearance of warts on the cervix, because if left untreated, HPV can cause cervical cancer.

A vaccine is being developed that may provide protection from two of the more common genital HPV strains linked with cervical cancer. The vaccine would be most effective if included with other mandatory inoculations given to prepubescent girls. Some social conservative groups are already preparing to fight it, saying that such a vaccine would encourage young people to have sex.
Everyone agrees on one thing: the only way to completely avoid the risk of contracting genital HPV is by avoiding genital contact with others. If that is simply not an option, condom use will reduce the risk of contracting genital HPV (not to mention loads of other STIs), and regular Pap tests for women will help to identify potential cervical growths before they become a cancer risk.

Finally, to keep your immune system in good condition, stay healthy: don’t smoke, get some sleep, don’t stress out, don’t get sick, and wear your mittens.
I am tainted. Damaged goods. When I meet a girl with whom I might like to get naked, I have this hanging over my head (or lurking in my skin, to be accurate). Sooner or later, I have to tell her about the exciting story of Mr. Winkle and his little bumpy friends, and that they might still be with me, so she can weigh the consequences of knowing me (in the biblical sense). I’m deathly shy around girls anyway, and with this relationship hurdle lurking in the back of my mind from the moment I say “hello,” my chances of getting a girlfriend ever again are fairly miniscule. Oh well, at least I can spread the word about HPV, if not the HPV itself.

Thanks to SAIC’s Director of Health Services Linda Pas and Planned Parenthood Chicago’s Michele Megregian for providing direction, information and sources used in developing this article. Statistics mentioned are based largely on a study by Willard Cates, Jr. and ASHA entitled “Estimates of the incidence and prevalence of sexually transmitted diseases in the United States,” 1999.

For more information on HPV and other sexual issues, please see these websites:
www.ashastd.org
www.cdc.gov
www.plannedparenthood.org
www.cancer.gov/cancertopics/factsheet/Risk/HPV

Illustration by Russell Gottwaldt

FEBRUARY 2006