HERPES, syphilis, gonorrhea, genital warts - names that grab your attention? These are the names of the sexually transmitted diseases (STD) that are most commonly known. One STD that people may not have heard of is, HPV or human papillomavirus - a virus that should grab the attention of all women.

HPV has been around for some time and there are more than 100 different strains of the infection. While the majority of the strains are not serious, more than 40 HPV strains have been identified to infect the genital areas.

While the virus hasn't generated the notoriety that other STDs have acquired, it has become the focus of a public health frenzy in the last few years thanks to researchers identifying two HPV strains that cause 70 per cent of all cervical cancer cases and another two strains that were found to cause 90 per cent of all genital wart cases. This development certainly perked the ears of the medical world.

"When health authorities say that a virus causes a disease or condition, you know they mean business," explained Dr. J.J. Soares, general practitioner and director of the Hamilton Medical Centre located on Victoria Street in Hamilton. "Two strains of HPV are not just associated with cervical cancer, these strains are reported to cause a majority of cervical cancer cases."

According to the Centres for Disease Control in the United States, approximately 20 million Americans are currently infected with HPV, and another 6.2 million people in the U.S. become newly infected each year. It is estimated that at least 50 per cent of sexually active men and women acquire genital HPV infection at some point in their lives.

In Bermuda, there were 34 cases of HPV reported in 2007, 13 or 38 per cent of those cases reported as high risk for developing cervical cancer. So far this year, there have been 17 cases reported and 13 or 76 per cent of which were reported as high risk.

While compared to the U.S. Bermuda's numbers may seem low, Dr. Soares believes that there are more cases out there yet to be diagnosed because most people who become infected with HPV do not even know they have it.

"The infection is asymptomatic, you don't know you have it until a patient develops genital warts or is tested specifically for HPV. While many HPV infections occur without any symptoms and go away without any treatment, it's very important to ask your doctor to specifically check for HPV during your Pap test," said Dr. Soares.

At this point HPV is not routinely tested for during a woman's normal Pap test, although most abnormal Pap results are usually subsequently tested for it. Otherwise, the patient has to specifically ask her doctor. While Pap tests look for abnormal cells in the lining of the cervix before they have the chance to become cervical cancer, HPV can go unchecked, which can progress into problems down the road.

While half of all women diagnosed with cervical cancer are middle-aged (between 35 and 55 years old), many of these women were probably exposed to the two HPV types in their teens or 20s.

HPV is contracted by sexual contact with someone who has the infection. Both men and women can get HPV and according to Dr. Soares, practicing safe sexual contact is the best prevention.

"There is no substitute for safe sex, which in this case is a condom," he explained. "Like other STDs, the Pill will not protect you or your partner from HPV. And, people need to understand how to best use a condom - it needs to be put on before foreplay as HPV can be spread before sex. We've seen genital warts in areas that aren't necessarily in the immediate genital area."

The good news is, there is a vaccine for women. Gardasil, made by Merck and approved in the U.S. in June 2006, is the first vaccine developed to protect against the four types of HPV that cause the cervical cancer and genital warts.

Earlier this year it was announced that Bermuda was bringing the vaccine to Bermuda for physicians to administer. The vaccine is FDA approved to treat female patients from nine to 26 years of age, however, locally it is typically administered to girls aged 11 and older. While some may baulk at the very young age of nine or 11, times are changing says Dr. Soares.

"It's a modern world and children are experimenting with sexual contact earlier and earlier," he said.

Regular testing or a vaccine for men is not currently on the market, however, it could be on the horizon thanks to Bermudian Amne Foggo who conducted HPV testing on prisoners at Westgate for her Masters Degree thesis. Her work was selected out of more than 1,700 medical papers to be published by the World Cancer Congress in May of this year.

In 2007, the Governor of Texas made the vaccine mandatory for all girls entering sixth grade (11 years old) and to date, the Government of Bermuda is not considering such measures. The vaccine, is, however, available through doctors' offices on the island. Should your doctor not have the vaccine in stock, Dr. Soares' walk-in service does. People don't have to be patients of Dr. Soares - his Hamilton Medical Center offers walk-in/walk-out service where women who want the vaccination for themselves or their daughters can go without making an appointment.

"I recommend asking your personal physician first, and if they don't have it in stock, they can come to us," said Dr. Soares.

The vaccination includes three shots for the full course and some insurance providers may not provide full coverage yet. Even still, Dr. Soares says that the vaccination is too important to forgo.

"I would say that this vaccine is as important as getting your regular Pap test," he said.