Last week I discussed the common STD HPV but wanted to further that forum. One of the interesting findings I came across when researching HPV was how the concept of sexual activity shaped provider’s and parent’s decisions on whether to vaccinate children against HPV. One of the parental concerns was that if children became vaccinated it would prematurely introduce them to engaging in sexual activity and children being labeled as “sexually active”. On the other hand, some providers have fear that pushing the HPV vaccine would harm their relationship with parents and even jeopardize their ability to subsequently effectively treat their patients. I was new to this notion that parents and providers were facing a social/stigmatizing dilemma that could pose a risk to patients’ health. In fact, HPV vaccination preference is often based of the combined efforts of the providers’ concerns and the parent’s confronting their fears of early sexual activity, and “the patient’s risk of imminent sex to decide whether the vaccine’s benefits to the patient are worth pushing vaccination and risking relational harm.” As a striving clinician, I would probably be biased towards pushing the potential benefits of treatment while being sensitive to parental concerns and social stigmas. However, I would probably feel so excited to be able to present this life-saving opportunity that I must admit that the conversation would be frustrating if emphasis was placed on potential fears in lieu of the impending threat/risk to the patient’s health and future well being. I think these type of issues demonstrate the need for clinician’s to be trained to be culturally sensitive so they can best serve the needs of their communities where viewpoints may differ or even opposing.
Another common STD, HSV-type 1 and 2, are two categories of the Herpes Simplex virus that result in a lifetime of being infectious. HSV-1 is highly contagious and commonly transmitted from oral contact and causes mouth sores via contact with the HSV-1 virus in sores, saliva, and surfaces in or around the mouth. The symptoms of oral herpes vary and can include painful blisters or open sores called ulcers in or around the mouth. The open sores are often found on the lips and are given the common term “cold sores.” When a person is infected they will often experience a tingling, or burning sensation around their mouth, which can sometimes become itchy. These events frequently occur before the appearance of the sores themselves and recur periodically after initial infection during latent infections. HSV-2 is usually sexually-transmitted through contact with genital surfaces, skin, sores or fluids of someone infected with the virus and leads to genital herpes. Symptoms of genital herpes are characterized by blisters or open sores occurring on the genitalia or anus of the infected person. Sometimes, these blisters are accompanied by a fever, body discomforts and aches and swollen lymph nodes, indicating an immune response. Since HSV infections are incurable, after the initial exposure with HSV-2, recurrent disease is likely, albeit less severe than the first outbreak, and reducing in frequency over time. In some cases infected persons may experience identifying symptoms such as sensations of mild tingling or shooting pain in the legs, hips, and buttocks before the occurrence of genital ulcers. Despite these varying symptoms, it is important to note that having oral-genital direct contact can lead to cross-infections, where oral HSV-I infection can result in genital herpes and vice-versa.
HSV are highly contagious, so it’s no wonder that it is estimated that approximately 2/3rd of the global population are infected with HSV-1 and around 400 million are infected globally with HSV-2. What people may not know is that HSV-1 and HSV-2 infections are often asymptomatic yet patients are still contagious and can infect others. Also, infections with HSV-2 increases the likelihood of becoming infected with HIV. With these elevated levels of exposure and associated risks it is reasonable that attempts are being made to develop a vaccine to prevent these diseases. When a vaccine is administered in an effective amount, they are a useful tool to inducing an antigen-specific immune response. One current protocol includes a RNA (e.g., mRNA) vaccine that may be used to induce a balanced immune response against herpes simplex virus (HSV). When injected it would comprise both cellular and humoral immunity, without risking the possibility of a common concern, insertional mutagenesis (mutations caused by addition of one or more base pairs). Conveniently, the RNA vaccines have many important features that allow them to be useful to treat and/or to prevent various genotypes and strains of HSV. Some of these features include having antigenic polypeptides that have at least 95-99% identity to several HSV (HSV-1 and HSV-2) glycoproteins, immunogenic fragments capable of inducing an immune response, or amino acids sequence coding for proteins involved in the fusion of viral and cellular membranes. Because of these features, they produce a superior immune response noticed in the much larger antibody titers observed. Finally, they are better than some commercially available anti-viral therapeutics in producing early responses to treatment thereby improving pharmaceutical efficacy.
I feel that with all the adverse effects associated with acquiring a STD it’s really a parents due diligence to ensure their children are prepared to face the dangers they will encounter as sexual activity is a more than likely eventuality. I would hope that parents wouldn’t use the fear of sexual exposure as a crutch to making healthy choices for their child, although I am aware of cultural differences in how such topics are presented. Therefore, since HPV and HSV are sexually transmitted diseases with lifetime consequences, it is only reasonable to have open discussions with the adolescents including the prevention AMC’s like abstinence, monogamy and use of condoms. Regardless of parental fears, I feel it is worth it to introduce alternative options to having sex, such as just not engaging in it – waiting until they are older or goodness forbid until they are in the confines of a marriage; realistically though, it’s fair to also discuss safer options if they do become sexually active such as having only one disease-free partner or using physical barriers like condoms. I think a clinician can be helpful along with a parent but I mostly believe this is a parental role. Additionally, I feel a valuable skill for clinicians, if they do become involved with this discussion, is being “culturally competent” where one makes decisions taking into account their ability to effectively communicate with people of different cultures and avoiding imposing one’s personal views. Gaining knowledge of other’s cultural practices encompasses developing a positive attitude towards different viewpoints and embracing world views that may differ from what one is used to.
Microbiology and You 