Human papilloma virus (HPV) was back in the news on both sides of the Atlantic early this year. The UK press was euphoric about a new vaccine against HPV which would be available 'within the next five years'. [1] This is indeed good news but predictions of women no longer needing cervical smears seemed a little premature, given that the vaccines have not yet completed clinical trials.

The two vaccines currently being developed are Gardasil, made by Merck, and Cervarix, from GlaxoSmithKline (GSK). Both protect against the HPV-16 and HPV-18 strains, which cause over 70% of cervical cancer cases. Gardasil also protects against some other HPV strains that cause genital warts. [1] The hope is that this will improve take up rates of the vaccine in men. Dr Anne Szarewski, of Cancer Research UK considers both men and women will need to be vaccinated in order to maximise the potential reduction in cervical cancer. [1]

If the vaccine proves to confer long-lasting protection, the developers quite rightly identify the main problem regarding its use will be the ethical dilemma of vaccinating, say twelve year-old girls, against what is essentially a sexually transmitted disease. Prevention is clearly better than cure, but could prevention of this STI induce complacency in sexual behaviour that may cause a rise in the spread of others? Certainly the complacency associated with the increasing availability of ART for AIDS patients [2] does not look encouraging for preventative measures depending on an HPV vaccine alone. HPV is causing other ethical dilemmas in the USA where a controversial study funded by the National Institutes of Health is proposing to research how HPV is passed from men to their female sexual partners. According to lead researcher, Dr Anna Giuliano of the Moffitt Cancer Center, the aim is to learn whether men should be vaccinated against HPV along with women.[3] Clearly she needs to talk with Dr Szarewski who already seems sure that they should be.

Another issue for Dr Giuliano is that the men in the study, mostly recruited from Mexico and Brazil, won't be told whether they are infected or not. 'There is no treatment for HPV, so we are not doing any harm by not disclosing infections,' Giuliano said. 'There also is no strategy for prevention of transmission to partners,' she said, 'because condoms aren't protective against HPV.' We should perhaps hear more about that in the UK whilst we await the vaccine, as most condom users are blissfully unaware of this. One further twist in the tale is that Americans were officially unaware that HPV caused cervical cancer until this year. The National Institute of Environmental Health Sciences and the National Toxicology Program, which maintain the official list of carcinogens and update it every two years, only just added HPV, along with Hep B and C, to the list in January 2005. [4]

So now it's official. HPV is a sexually transmitted disease against which the condom offers no protection; it has carcinogenic strains against which there will be no vaccine for at least five years. This surely has implications for sexual health promotion to which the Department of Health continues to turn its back leaving every sexually active man to 'do what seems right in his own eyes'. [5] The outcome now is likely to be no better than it was then.