In Reply.—The purpose of our comments about de-emphasizing human papillomavirus (HPV) as a sexually transmitted disease was to facilitate widespread use of this sensitive testing modality without stigmatizing patients who have undergone HPV testing.1 We did not intend that this statement be read as encouraging irresponsible sexual behavior.
Anogenital human papillomavirus infections represent the most common sexually transmitted infections.2 A sizable percentage of the people in this country will be exposed to HPV at some point in their lifetime, and many are never aware because the infection clears quickly. We do not completely understand all issues of viral transmission and latency.2 Women may be infected years before there is an apparent problem like an abnormal cytology specimen. Immunosuppression may cause reemergence of a previously undetectable HPV infection years later. While sexual transmission is the most common route, there may be rare instances of nonsexual transmission also. Thus, a couple may share a monogamous relationship for years before an HPV infection becomes apparent. Since HPV is a pan-genital infection, barrier protection such as condoms may reduce infections, but do not completely prevent exposure.2 In short, while monogamy and barrier protection may minimize HPV exposure, they cannot prevent it. Lifetime abstinence is the most protective action; however, that is not a realistic solution for most people.
For all of these reasons, detailed discussions of sexual history are not likely to be helpful in women who have undergone HPV testing and might easily discourage women from future screening and necessary follow-up measures. Instead, the focus should be on giving women the necessary information and tools to deal with their current HPV status.
In closing, we fully agree that women should be provided accurate information about the role of HPV in carcinogenesis. We also agree that families and health care providers should encourage responsible sexual behavior, as this may help decrease (but not completely eliminate) exposure to HPV. However, the primary purpose of HPV testing is to aid with early cancer and precancer detection, treatment, and follow-up. If women and their families are stigmatized by news of a positive HPV test, health care providers may be hampered in taking advantage of this highly sensitive cancer screening test.