"Salud" is a Latin Post feature series that focuses on health and wellness topics and examines Latino health trends.

Unprotected sexual intercourse can produce outcomes far worse than unintended pregnancy, and those unfortunate consequences include the contraction and transmission of sexually transmitted infections (STIs). The DNA virus, Human papillomavirus (HPV) is the most common STI in the U.S. and it is one of the most infectious causes of cancer.

By age 50, at least 80 percent of sexually active women acquire HPV infection. For some of those infected with high-risk HPV, the infection will precede cervical cancer -- or anal cancer, vulvar cancer, vaginal cancer and/or penile cancer. According to the Centers for Disease Control and Prevention, black and Hispanic women have higher rates of HPV-associated cervical cancer than white women. Latinas have lower rates of cancer screening, contributing to cervical cancer-related health disparities in the Latino population. Also, Hispanic men have higher rates of HPV-associated penile cancer than non-Hispanic white men. 

Dr. Vincent Guilamo-Ramos, professor of social work and global public health at New York University and the co-director of the Center for Latino Adolescent and Family Health, shared insights about HPV with Latin Post. His role as a principal investigator on numerous research projects funded by the National Institutes of Health and the CDC had made him uniquely qualified to address adolescent health, STIs and unintended pregnancies among non-white youth.

According to Dr. Guilamo-Ramos, more than 30,000 people are diagnosed with HPV-related cancer each year in the U.S. In addition, virtually all cervical cancers are caused by HPV infections, with HPV-16 and 18 being responsible for about 70 percent of all cases.

"HPV is incredibly common. Most sexually active men and women will get at least one type of HPV at some point, but most people with HPV do not know they are infected. Vaccination is an effective way to avoid HPV and its associated health problems, i.e. cancers, genital warts," said Dr. Guilamo-Ramos, citing CDC statistics.

Knowledge, attitudes and cultural beliefs contribute to higher rates of HPV infection and subsequent decisions about diagnosis and treatment of cervical cancer. Former studies demonstrate that Hispanic women's knowledge of HPV and its relationship to cervical cancer is low, and misconceptions are prevalent.

Anal, penile, vaginal, vulvar and oral cancers, which are caused by HPV at varying degrees, are less discussed than cervical cancers. HPV causes 95 percent of anal cancers, and the number of new anal cancer cases increase each year. However, the social stigma associated with anal cancers, due to misconceptions, causes many to forgo screening. According to the University of California San Francisco Medical Center, intercourse is not a prerequisite for getting anal cancer; other forms of contact can be responsible for transmission of HPV to the anus.

Presently, there is no cure for HPV, but the virus can be undermined by preventative measures, i.e. the three approved vaccines available to prevent HPV types that cause most cervical and anal cancers, according to research provided by Guilamo-Ramos. All vaccinations are applied in a three-dose series. Gardasil covers four types of HPV; Cervarix covers two types; and Gardasil 9, approved December 2014, covers nine HPV types. Gardasil can be administered to females ages 9-26 years and for males 9-26 years. Cervarix can be given to females ages 9-25 years, but isn't approved for males. Also, Gardasil 9 can be given to females ages 9-26 years and for males 9-15 years.

The Advisory Committee on Immunization Practices (ACIP) recommended routine use of quadrivalent human papillomavirus (HPV) vaccine in boys aged 11 or 12 years. Additionally, vaccination is recommended for men age 22 through age 26 years who have sex with men or are immune-compromised as a result of infection (including HIV), disease or medication. However, HPV vaccine is recommended for females and males regardless of their sexual orientation.

"Vaccine uptake is low. We need parents and providers to encourage vaccination," said Dr. Guilamo-Ramos. HPV Vaccination coverage is low among female adolescents in the U.S. Just over one-third (37.6 percent) of adolescent girls aged 13-17 received all 3 doses of the vaccine in 2013. Nonetheless, interestingly, Latinos, Asians, and girls whose families live below the poverty line were more likely to receive three doses compared to whites.

The U.S. Department of Health and Human Services Healthy People 2020 has set the goal of 80 percent of 13 to 15-year-old girls becoming fully vaccinated, but barriers and misconceptions limits vaccine distribution. Language, cultural and geographic factors have been identified as lead barriers to reception of pap screening service.  

Additionally, some parents believe they can wait to vaccinate their children and others expressed concern about the vaccines themselves. Other parents have voiced concerns that HPV vaccine could encourage earlier sexual initiation or more risky sexual behaviors in their children, offered Dr. Guilamo-Ramos. However, there haven't been any published associations found between HPV vaccination and risky sexual behavior.

Cost can also be a huge barrier. While vaccination is covered by private insurance plans and the Vaccines for Children (VFC) program, as well as other programs (Immunization Grant Program, Medicaid and Children's Health Insurance Program (CHIP) that help to make the vaccine cost-free, uninsured, undocumented and uninformed families are left without access.

The CDC recommends highlighting the demonstrated efficacy of HPV vaccines and completing the full HPV vaccine series. Also, the CDC recommends women 21-65 get regular pap smears to detect precancerous cell changes. Regular screening is critical.