As hard as she tried not to, her eyes kept darting back to the clock. Her appointment with the campus doctor was scheduled for 3pm. Now it was 3:05. It felt as if she’d been in the waiting room all afternoon. Angela tried to focus on the daytime television that was blaring in the corner, but the echo of the clock’s second hand overpowered it.
She’d noticed two bumps near her vagina. It was easy for her to think about, but she couldn’t imagine saying it out loud. Feminine health issues made Angela feel awkward. She had only gotten her first pap-test one month before and since then she had been back with minor issues. But this was major and she knew it. She’d been lounging in her boyfriend Chris’s dorm room before coming here. As far as he knew, this was just another doctor’s appointment.
An olive glow courtesy of a tanning bed and dramatic facial features helped her look older than her 18 years. She radiated a natural beauty from almost black saucer- shaped eyes, which seemed to be smiling constantly.
She wasn’t smiling now, nervously twisting the knees of her gray jogging pants with her hands. What am I gonna do. What am I gonna do? She heard a door creak open.
“Angela?” a friendly voice chimed.
In just three months, Angela had grown to trust this doctor. She was a short woman with well-groomed dark hair and kind eyes that beamed through a pair of glasses. Her face was free of makeup, projecting a natural and honest feeling.
Angela explained what she had found.
“I know I’m probably just overreacting but....”
“Well, I’ll have to have a look,” the doctor replied, calm as ever.
Angela stripped off her pants, lay down on her back in the dreaded position of vulnerability and stared at the ceiling. Taking deep, long breaths she put her energy into making sure she didn’t cry. It’s going to be OK, she tried to convince herself. The paper sheet crinkled beneath her. It didn’t take long for the doctor to give her the diagnosis.
“You have HPV, the Human Papilloma Virus.”
As the doctor began to explain the virus to her, Angela’s mind went blank. She appeared to be taking in the facts and figures, nodding stone-faced, but she didn’t hear a word. Before leaving the office Angela was given her first treatment of Podophyllin, an acidic liquid, to cure her warts.
The deep burning of the acid may have been what awakened her from a zombie-like state. She was approaching her first final exams in her first year of university and she had a sexually transmitted infection. Back in her room, through a rush of tears, Angela managed to see the keypad of her telephone long enough to dial seven digits.
“Hello,” muttered Chris.
The floodgates opened.
Though at this moment she could barely speak, Chris managed to make out three words before he hung up the phone and bolted for the door.
HPV is the most common sexually transmitted infection in the world. The virus is passed through skin-to-skin contact. You don’t have to engage in intercourse to contract it, and if you do have sex, a condom can’t protect you. HPV is broken up into many different strains---some cause genital warts, some show no symptoms and some lead to cervical cancer. Nova Scotia has some of the highest cervical cancer rates in Canada.
Recently the virus made its way into the medical spotlight, engendering much public health debate in Canada. Shortly after Angela was diagnosed, the HPV vaccine Gardasil was highly publicized. The vaccine consists of three needles given over six months and costs about $400, and has proved effective against four strains of HPV. Gardasil is marketed for women aged nine to 26. The idea of administering the vaccine to school-aged girls is what stirred up the controversy nationwide. Many parents and health professionals saw the mass inoculation as premature, given that the vaccine was so new and there are differing forms of the virus it may not treat. While questions about long-term effects and the necessity of the shots have been raised, the inoculation was administered to junior high girls this past fall in provinces across the country, including Nova Scotia.
Trying to ignore the knot in her stomach, Sara listened closely to the explanation of what was about to happen. Her gynecologist was going to apply a chemical similar to liquid nitrogen, but not as harsh, directly onto her warts. This wouldn’t be the same as burning a wart off your foot--- it would be more sensitive and careful. The doctor told her the treatment wouldn’t work right away; she’d have to come back every two weeks until the warts were gone. After a lengthy conversation, the doctor left Sara to undress.
Sara was tough. She had a no-fuss personality---she was the kind of person you didn’t want to mess with. She was older and more mature than most of her friends. Tight, dark ringlets framed her flawless, porcelain-doll face.
She had found a growth, which she thought was a mole, near her vagina. When it spread within a week, she thought she had a skin irritation or razor burn. When that didn’t clear up, she found herself at the campus doctor. It was three weeks into school when Sara first heard the letters “H-P-V.”
When the doctor called Sara into her office the tension began to ease. She sat Sara down and demystified HPV. The diagnosis by the campus doctor had left Sara constantly mulling over questions in her head, questions that her gynecologist was now trying to answer. The doctor went on, telling stories of past patients who had been in the same position---some even worse. She told the story of one woman who had a breakout so bad that the doctor had planned to completely skip the treatment and go straight to surgical removal. By the time the surgery date came around, the woman’s warts had cleared; her body had fought them off. The doctor’s storytelling helped to put Sara at ease as she realized how many other women were going through the same thing.
Sara lay on the bed as the gynecologist examined her breakout. Her gynecologist held a little brown bottle in one hand and a long swab in the other. At first the burning wasn’t too bad, but when she repeatedly swabbed the same section, Sara’s stomach turned. It wasn’t a sharp pain, but more like an annoying burning and she wanted it to stop.
“Are you OK? Do you want to take a break?” the doctor asked thoughtfully. She knew how uncomfortable Sara was.
“No, no, that’s OK,” Sara answered, closing her eyes and taking a deep breath.
It’s been over two years since Angela and Sara were diagnosed with HPV. While they are both clear of genital warts now, their experiences are still fresh. Though Angela and Sara didn’t know anything about HPV, today it would be nearly impossible for a university-age woman not to have heard of it. “I would probably have at least one or two abnormal paps come back to the office every week...genital warts; I probably diagnose a case every week or two,” says Dr. Kim Plaxton, director of Dalhousie’s Health Services---and that’s with her patients alone. Plaxton says she’s seen heavy amounts of HPV for years now, but it was the introduction of the vaccine that got people talking about it so publicly. The year following Angela and Sara’s diagnoses brought with it commercials, awareness and the vaccination. Now, Health Canada statistics say 75 percent of sexually active Canadians will contract some form of the virus during their lives.
One afternoon Chris was putting off schoolwork when Sara, a friend of his and Angela’s, dropped by. He noticed her mood was low. There was something she wasn’t letting him in on and he pressed her to talk. She explained she had been going to see her doctor for the past couple months. She had found something at the beginning of the school year, something abnormal...genital warts. She had HPV.
HPV? Chris had no idea what she was talking about. She explained the sexually transmitted infection to him as best she could. She thought she had gotten it from her ex-boyfriend, but couldn’t know for sure.
Once during their year-long friendship, Sara and Chris had had sex. It was a one-time deal they barely spoke about and since then they had become very close friends. This had happened before Sara got together with the boyfriend who she assumed had passed her the virus, and before Chris and Angela started dating. Chris believed what she said and thought nothing of it. He told her he was there for her. The conversation was over.
Later that day when Chris and Angela were hanging out, gossiping about nonsense as they usually did, Angela noticed Chris was quieter than usual. When Angela called him on it he said, “OK, you can’t tell anyone this but…” and spilled Sara’s story. At that point, Angela had never heard of HPV before. The two turned to the internet, as Chris didn’t understand the virus well enough to explain. They sat, terrified, staring at the Sex With Sue website, trying to make sense of the details---warts, scars and cervical cancer.
From what they read, it seemed HPV was barely preventable. Apparently, this was the most common sexually transmitted infection and most women would contract some form of it during their lifetime. But if this was true, why hadn’t they ever heard of it before? Pictures of barely recognizable genitals left Angela and Chris without words---only a desperate hope that they wouldn’t have to deal with what Sara was going through.
The information they found together left a lot of room for wondering and worrying. Angela reacted differently than Chris had. She freaked out, which rubbed off on him. Sara had told him he’d know it if he had it. It wasn’t the type of thing he wouldn’t notice. But he got Angela to check him anyway. There was nothing. Angela begged him to go to the doctor, but he wasn’t worried.
When Chris got the desperate phone call from Angela days later, any suspicions he had pushed to the back of his mind came true. He didn’t even give her a response over the phone. He just ran. Her face was swollen and her eyes were slits. When she told him what the doctor had found, he was floored. A sexually transmitted infection? He hadn’t thought it was possible. Angela was crying, but she was mad. Chris was defensive as she sobbed, “You gave this to me!” How did she know for sure he had given it to her? There was no proof. This was nobody’s fault. How was he supposed to know? Angela told him the doctor said that men are usually carriers of the virus and that you can have it but never show signs of it.
Chris was sick with guilt. How could I do this to my girlfriend? She’s only 18! Sure, he didn’t show physical signs like Sara and Angela, but he was going to have to watch them suffer through treatments. Shame and remorse were the only symptoms he’d have. He and Angela lay in bed trying to figure things out. None of it made sense.
The best two ways to prevent catching HPV---given how contagious it is---are abstinence and the vaccine. Getting regular pap tests and checking yourself for visible abnormalities are ways to detect any sign of the virus, but it can sometimes stay dormant for lengthy periods of time. An infection of genital warts, for example, can reveal itself just weeks after the sexual encounter, while sometimes, it takes months. This is what makes it difficult to track the source of the disease if you’ve had more than one partner. Dr. Plaxton says, “If your partner has HPV, you have a 50 percent chance of getting it, even if you just have sex with them once”.
One thing Angela stresses when she reflects on the multiple doctors she’s seen is the urge to explain herself to them. She says she always wanted to tell the doctors that she’d only had one serious boyfriend and dreaded what they thought about her. She believes that most of the struggle with HPV is mental. Dr. Plaxton agrees, saying that genital warts can be psychologically harmful. Both Sara and Angela admit that during the time of their breakouts they couldn’t look at their own bodies---they felt ugly and dirty. It was hard not to buy into the stigma of having a sexually transmitted infection.
Angela kicked her black- heeled sandals off onto the bathroom floor and curled her toes. They were nearly numb from the bitter February air. She sat on the side of the bathtub, the porcelain cold on her bare legs, and put her head in her hands. Her mascara ran down her cheeks as she wiped away tears. The dress that she had borrowed was pulled up around her waist and she didn’t care. A few drinks of vodka had made her honest and brave. This is it. I’m gonna tell her.
She had spent the night at a winter dance. She curbed her insecurities with a little black dress and a flower pinned in her hair. The night hadn’t gone well. When she wasn’t enjoying herself, Angela ducked out early. Sara found her outside in the cold, crying. Angela chalked her sadness up to an argument with Chris.
Now they sat in the bathroom of Chris’s residence apartment and Sara was comforting her. Angela held a ball of toilet paper in her hand; it was soaked from tears and blackened from makeup.
Angela stood. “I have HPV,” she blurted.
Sara stared, mute.
“And I know you do, too...” Angela had wanted to say this for months. She knew no one could begin to understand her problems as well as Sara could.
She stared back at Sara, holding her breath, waiting for a response.
“Isn’t it painful?” Sara asked.
As the two hugged, they didn’t have to say anything. Knowing someone else understood was enough. That night they didn’t sit around and speculate or swap treatment details. They just knew things would be different.
Sara had a fairly quick recovery. After six months of treatments, the only remaining sign of HPV was a slight discolouration on her skin. However, Angela experienced a slower, more drawn-out process. By the end of the school year, her condition had worsened to a point where she couldn’t count how many warts she had. It wasn’t until after a year and a half of painful treatments that Angela was finally clear, but her last treatment involved surgery. She underwent a procedure that involved getting dozens of needles in her vagina. Both she and Sara haven’t had a breakout since finishing treatment. Angela has had the Gardasil shots in an effort to protect herself from other strains of cervical-cancer-causing HPV.
Though they originally met through Chris, Angela and Sara have since formed their own friendship. The trust they have built through sharing this experience serves as the foundation for their connection. They’ve had enough time to grow comfortable with what they’ve been through. Now the two can joke about the stresses of coming clean about their sexual past to new partners.
Chris and Angela split up this year for unrelated reasons; HPV didn’t end their relationship. After her initial anger passed, the virus was something she never blamed him for. There were too many unanswerables to point fingers. For all they know, the virus could have rooted with Sara and a past lover, or Sara and Chris could have contracted it from two separate people.
Angela and Sara have realized there are lots of whys and what-ifs that came along with being infected with HPV. They both have their own theories about what happened, but they know there are lots of things they’ll never know for sure. Angela and Sara have accepted the uncertainties. Their biggest challenge was getting over the shame of having the virus. Being hard on themselves was something they couldn’t control. They’d been branded with the scarlet letters “STI,” and even though no one knew, they felt filthy and judged. “I think we were lucky that we had each other eventually to talk about it. Until you actually go through the process of coming to terms with your body changing uncontrollably, no one gets it,” says Angela. Although the virus is something they’ll carry with them forever, they don’t have to carry the shame anymore.