Can you catch HPV (and cervical cancer) without going near a penis?

Cervical cancer is caused by Human Papilloma Virus, HPV is caught through sexual intercourse. So if you haven’t had sex you’re unlikely to get cervical cancer. But does the sex need to be with a man? A recent article in the BMJ revealed that it didn’t, and that you could catch HPV through sex between women.

This was actually a report of a systematic review of the literature performed by Julie Fish. The report itself was prepared for the NHS cervical cancer screening service, and wasn’t published. But there’s a link to the PDF.

Now most of this document is about the barriers found by lesbians who wish to have a cervical smear, and how embarrassing it is to be assumed to be heterosexual. The other barrier that is mentioned in the report is the fact that women are unsure if they need to have screening and GPs and Nurses aren’t that helpful.

There’s a little about why women who have sex with women need cervical screening – 4 out of 5 of them will (statistically) have sex with a man at some stage. So that’s a risk for carrying HPV. And it seems that you can catch HPV from lesbian sex. One study found that 19% of women who had never had sex with a man had HPV. They must have caught it from somewhere.

Lets have a look at this study in more detail – here’s a link . This was a survey of 149 American women who self referred to have a smear taken. They were recruited through the lesbian community, 21 had never had sex with a man. Of these 21, 4 had HPV DNA detected. This appears to be all the evidence we’ve got that women who have never had sex with men need cervical smears. Based on 21 American Women. Who for all we know may have filled in the survey with their partners standing over them when they filled in the questionnaire.

I find the idea of having a smear test totally revolting, but I am equally revolted by the idea of cervical cancer. I decided to solve this problem by having a hysterectomy. I basically had a hysterectomy based findings in 4 American women, and 1 case report of Ovarian Cancer. Oh and because it seemed like a good idea at the time.

Now there’s a great deal written about problems  lesbians have in accessing cervical screening, and the rest of the report is dedicated to quotes about the attitude of health care professionals to lesbians. This is an important topic of course. But I do wish some of that energy could be dedicated to investigating whether you can actually catch HPV through lesbian sex.

But until then I’d recommend all lesbians to have smear tests just like the rest of women. Sorry girls.

Oh and guys – if you have a cervix have it taken out, or have smear tests. End of.

In this week’s BMJ – is depression overdiagnosed? – And Acupuncture doesn’t work for OA of knees.

I’ve decided to write a blog entry every week on my thoughts on the week’s medical journals – partly to try and keep myself up to date. As the New England Journal Of Medicine hasn’t yet got my change of address request this week it’s the BMJ.

Depression

There are two opinion pieces: one that depression is over diagnosed and we are medicating sadness, and one that treatment for depression is lifesaving. I’ve got no strong feelings on this – partly because I don’t personally treat depression. I do treat the consequences of depression – as in patients who overdose, and I have worked in psychiatry in the past. I can do a psychiatric assessment on someone who has self harmed if I have to.

Here’s a link (by the way you can only see the first 150 words).

When I was an F1 in Psychiatry I saw people with depression in outpatients clinics, I treated them with anti-depressants – they wanted talking therapy or a sick note. I didn’t have time to do psychoanalysis or CBT, I hadn’t been trained to do CBT but if I had done then I didn’t have the time, I did give them sick notes, though sometimes I wondered if being unemployed was really what was getting them down. Then I saw them again in three months time, some of them had recovered, some of them hadn’t. Sometimes I tried other sorts of drugs. The whole thing was unbelievably depressing.

A lot of people who are treated for depression are basically sad because their life is rubbish, but as a Doctor you want to help, so you prescribe anti-depressants. A few times I told people that they were sad because their life was rubbish – but it was probably easier to get their life better than to treat depression.

Interestingly when Imipramine, the first antidepressant, was first developed Geigy were wondering if there were enough people with depression to warrant marketing it. Now it seems the world and his wife have depression.

A few months later a friend lost her natural bounce and I persuaded her to take an SSRI.  She got her bounce back, it wasn’t quite back to normal, it was definitely a sightly artificial bounce, but it was a bounce all the same.

I don’t think she’d have bothered going to her GP to tell him that she felt a bit miserable if she hadn’t known that there were treatments available. She did benefit though.

So yes, maybe we are treating more sad people with tablets when previously we’d have just thought that they were a bit run down. But they are feeling better as a result. Well some of them are.

Thank god I’m not working in Psychiatry any more. The patients didn’t get much better but by the end of your average outpatient clinic I wanted to slit my wrist.

OA and Acupuncture. Here’s a link

Sometimes I wonder if there’s any point doing trials of alternative medicine, because it seems that most people have made up their mind before reading the trial. Either you think that alternative medicine works and if the trial shows that it doesn’t it was badly conducted, or you believe that acupuncture is balls and the trial was badly conducted if it showed that it worked.

Anyway, whatever the outcome of this trial you have to give them credit for developing a placebo acupuncture needle – that makes you feel that the skin is penetrated even though it isn’t. Now that’s cool.

I personally had thought that sticking a needle in a spasmed muscle did probably relief the spasm, and had some belief that Western Style Acupuncture worked. This was a trial of traditional Chinese Acupuncture, which is different it was rather large and didn’t seem to have any effect on subjective pain though.

Will it change my practice?

No, because most of my contact with arthritis is clearing up the renal failure, and GI bleeds caused by Non-Steroidal Anti-inflammatory. I usually change their analgesia to Co-Codamol, which has one of 3 effects

1. None at all, and they want their NSAID back

2. Constipation – and they want their NSAID back

3. Confusion – and they want to kill the small goblin under the hospital bed.

I’d quite like to be able to advise them to try acupuncture. It wouldn’t cause them to have stomach ulcers or renal failure, so would be A Good Thing. Unfortunately it doesn’t work, this trial was convincing enough that I would probably not recommend acupuncture now. Not that I ever did before – because they all wanted their NSAIDs back, not acupuncture.

Proof that we must have evolved.

I was reading the Oxford Textbook of Medicine today when I realised that certain things in the human body are convining arguments for evolution.

 Lets assume you are a divine being and have decided you want to have a system where increased blood glucose leads to Insulin release: if you were designing the biochemistry you’d probably think of a fairly simple system.

 Instead here’s what happens:

1. Glucose goes into the cell: so the concentration is the same as the concentration in the blood.  
2. Glucose is turned into Glucose 6 phosphate by glucokinase
3. Glucose 6 phosphate is broken down by a long complex series of reactions and turned into ATP: this is the way glucose is normally turned into energy.
4. ATP opens channels in the cell membrane that lets potassium out of the cell
5. As potassium is positively charged this means the charge inside the cell is increased so voltage gated ion channels let calcium ions into the cell
6. The influx of Calcium ions stimulates the release of the Insulin.

Now I’m sure that if I was an omnipotent being I could design a system with less than six steps to do one thing, actually it’s about 26 steps if you include all the steps that turn glucose into ATP.