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All My Children takes on the world of STDs with a storyline about HPV that is, unfortunately, more dramatic than it is accurate. 

Written by Martha Kempner for RHRealityCheck.org. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

About a week ago, driving my husband to a doctor’s appointment, I began dreading my time in the waiting room. This doctor often keeps us waiting and the last time we were there, Fox TV was blaring right-wing propaganda from the flat-screen in the corner.  It was during the Gulf oil spill and the talking heads were somehow managing to twist events to blame those who wanted new more efficient energy sources. When they turned to Michael Brown, the former head of FEMA who botched the Katrina recovery so badly, for his expert opinion, I found myself screaming at the TV.  So, I was relieved when this time the receptionists had chosen to force us to watch All My Children instead.  I haven’t watched a real soap opera in over a decade, but I grew up on General Hospital and As the World Turns and would take their silly melodrama over Fox’s asinine analysis any day.  And yet, 20 minutes later, I found myself yelling at that same flat-screen in the corner.


The storyline I watched unfold in a series of two-minutes scenes seemed to go like this: The girl in the pink shirt had had a one night stand with the smarmy guy with the slicked back hair (who I assumed was named Storm, Chase, or Brick).  A pregnancy scare had turned out to be a false alarm but now she was anxiously awaiting results of STD tests. She confided this to a ridiculously blond friend who reminded her it could just be a simple infection and she shouldn’t do anything until she hears from the doctor. Instead of heeding blond friend’s advice, she confronts smarmy guy and they each accuse the other of being the source of the not-yet-confirmed infection. Then, standing with a young doctor in what appears to be a hospital corridor (good for privacy and confidentiality), pink shirt girl is informed in classic soap opera overacting mode “You have [pause for dramatic effect] human papillomavirus!!”


That’s when I started screaming at the TV for its inaccuracies and overreaction. It’s also when it was our turn to see the doctor so I didn’t get to find out what happened next or whether the writers redeemed themselves in anyway.  Here is how ABC.com explains this ongoing storyline:


In another part of the hospital Amanda tries to process the news that she has HPV. She could have gotten it recently or a long time ago; often the symptoms stay dormant. Cara is gentle but matter of fact as she informs Amanda is at high risk for cervical cancer. Amanda freaks out, but Cara urges her to keep calm until the next test results return. Amanda heads to the Chandler mansion where she confirms to JR that she has HPV. She urges JR to get tested and tell Marissa, but all JR can do is complain that he might lose Marissa. Furious Amanda calls JR  “selfish;” he could at least show some compassion. She could have cancer! JR thinks that Amanda got HPV from a long time ago since he tested clean after Annie left, which means no one has to know about his one-night with Amanda. Frustrated Amanda reminds JR that he has an obligation to tell Marissa and leaves.



Ah the exclamation points.  While they got a few things right, AMC’s coverage of HPV leaves a lot to be desired.  Here are some things I wished they’d explained better:


HPV doesn’t usually present with symptoms.


As I understood the back story (admittedly not having seen it transpire), Amanda sought STD testing because she had symptoms—she felt something was wrong—and was told that maybe she just had a simple  infection.  Given that set up, I expected her to be diagnosed with Chlamydia or Gonorrhea both of which can cause itching, burning, and discharge in women, though they often have no symptoms. Human papillomavirus (HPV), on the other hand, can cause genital warts or changes to the cells on a woman’s cervix neither of which are things that a woman is likely to actually feel and neither of which would be confused with a simple infection.


It seems like the writers aimed at accuracy with the comment “She could have gotten it recently or a long time ago; often the symptoms stay dormant.” It’s true that HPV can be in the body undetected for a long time. Again, however, “symptoms” is a bit of a misleading concept here as the virus rarely causes anything that individuals can feel.


Testing for HPV is different than for other STDs.


It is unlikely that a woman like Amanda who goes to her health care provider with symptoms would be tested for HPV right away—again, Chlamydia and Gonorrhea are more likely suspects.  Moreover, as the CDC explains, “there is no general test for men or women to check one’s overall ‘HPV status,’ nor is there an HPV test to find HPV on the genitals or in the mouth or throat.”  There are tests that can check for HPV but they are primarily used to help screen women for cervical cancer. It is suggested that women over 30 undergo these tests in conjunction with their Pap tests, a routine gynecological test that can detect cervical cancer and/or precancerous changes to the cells on a woman’s cervix.  For women under 30, it is only recommended that they have HPV tests if their Pap test comes back abnormal or inconclusive.  In general, women learn that they have HPV as part of the results of their Pap tests rather than as part of set of STD tests.


The reality of HPV testing also means that JR's insistence that it wasn’t him because “he tested clean after Annie left,” is misleading as well.  While he may have been tested for other STDs, there currently is no FDA-approved HPV test for men.  Some men are diagnosed with HPV when their health care provider notices genital warts on their penis or around their anus but there is no other test, and most men never know whether they do or don’t have this virus.


In the United States, cervical cancer is relatively rare.


I didn’t see the scene where Amanda accuses JR of being insensitive because he’s just worried that their one night stand may be revealed while she now has to worry that she may have cancer, but the recap of it contained exclamation points so I am sure that it was very dramatic.  And as such, it was probably pretty misleading.


It is true that several specific strains of HPV are responsible for virtually all cases of cervical cancer, but it is also important to understand that cervical cancer is a rare and preventable outcome of HPV infection. Moreover, where it does occur, HPV infection does not lead to detectable cervical cancer overnight; it takes time to develop and become detectable.  Approximately 6 million people in the United States get HPV each year and only 12,000 women get cervical cancer.  In fact, most HPV infections clear up on their own and cause no long-term health problems. 


Any doctor who lets a patient newly diagnosed with HPV walk out of his/her office in fear of cancer has not done a very good job of explaining the facts.  Instead, health care providers should explain that further tests can determine whether the patient has those strains of HPV that are linked to cervical cancer (to give credit, the writers did point to further testing). And, he/she should emphasize the importance of routine Pap tests as these can detect precancerous changes and allow for treatment before cervical cancer develops.


HPV infections are widespread.


Obviously, we need to take all STDs seriously, they are an epidemic in this country.  But there is a difference between seriousness and melodrama.


I’m sure real women who, like Amanda, are told that they have HPV need time to “process it” but I hope that while they’re doing that, they are reminded that over 20 million Americans are living with HPV, that it is estimated that between 50 and 80 percent of all sexually active individuals will get HPV at some point in their lives, and that most cases of HPV are cleared by the body with no treatment and no lasting impact. 


Amanda should take STDs seriously, she should think about using condoms the next time she has a one night stand, and she should continue to be screened for cervical cancer but she should know she’s not alone in this and should not feel embarrassed or ashamed (she might feel a little bad for cheating on her husband but that’s another article).


Blame is Not Helpful.  


Soap operas have never provided a model of good communication—doing so would reduce the tension, cut the number of scenes the writers could get out of one conversation at least in half, end the possibility of a whole storyline based on a misunderstanding, and ruin any chance of a good Friday afternoon cliffhanger. So it is not surprising that the two scenes in which JR and Amanda discuss her STD provide an example of bad communication between sexual partners. There are a lot of accusations and much finger-pointing. To be fair, these characters have a lot of other things to deal with—they’re both married to other people, his wife is having an affair though it’s unclear if he knows it, and her husband seems to be part of an evil plot to take over the hospital (or maybe that’s someone else).  Still, it would be nice to see them show a little more understanding and civility (if not empathy).


Prevention is Most Important.


Obviously, staying monogamous is one way to prevent the spread of HPV but monogamy is unlikely in Pine Valley, Port Charles, or other soap opera towns because it makes for boring TV.  So, I would hope that Dr. Cara used this opportunity to remind Amanda and JR (and viewers) of the importance of using condoms to prevent STDs.  Condoms have been given a bad rap against HPV because the virus is transmitted from infected skin to non-infected skin and infected skin can include the scrotum or other areas that are not covered by the condoms. While they can’t provide complete protection against HPV, the CDC still recognizes condoms as important in the fight against HPV and cervical cancer.  Recent research suggests that most HPV infections in men are, in fact, located on portions of the penis covered by a condom. Moreover, research has shown that using condoms has been associated with a reduction in HPV-related health outcomes such as cervical cancer and genital warts in women.


HPV is also unique because there are now two FDA-approved vaccines that can prevent it (Hepatitis-B is the only other STD for which there is a vaccine). Both vaccines (Cervarix and Gardasil) have been shown to protect females against the types of HPV that cause most cervical cancers. Gardasil also protects against most genital warts. The CDC now recommends HPV vaccines as a routine part of health care for adolescent girls.  Of course since the vaccines only recently became available most women today did not receive it at that stage, therefore, the CDC recommends that all women ages 13 to 26 be vaccinated.  Gardasil is also available for boys and men ages 9 through 26.


I know that in television accuracy is often sacrificed for drama and I can forgive a lot for the sake of the art form. Hell, I totally believed that Robert Scorpio was part of an international spy agency and that his arch enemy was able to control the weather in Port Charles (General Hospital circa 1984). Still, as with anyone in the media, I think AMC writers have a unique opportunity to reach an audience (at least until the show goes off the air in September) and should use that opportunity to spread as much accurate information as possible even if they do it with audible sighs and pauses for dramatic impact.


 


Unless otherwise cited, all information about HPV comes from CDC's Genital HPV Infaction - Fact Sheet

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Comment Preferences

  •  HPV vaccine (0+ / 0-)

    In 30 years, the HPV vaccines will be heralded as one of the most effective public health initiatives in the last 50 years...that is if kids get it.  The number of girls and boys getting it in the US is too low...needs to be higher to really help.  Cervical cancer is a much, much bigger problem in the developing world, so the vaccines can have a huge impact.

    To Hell isn't where this country is headed, that is where it is coming from.

    by Mote Dai on Tue Jul 19, 2011 at 10:52:56 AM PDT

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