Autumn has just started to show its colors on this mid-October afternoon. Sarah is leaning against a clothing rack, daydreaming about the summer. Tall and very thin, she’d be stunning in a potato sack, but she is always in high fashion, for her otherwise unremarkable job allows her discounted access to the latest designer styles and one-of-a-kind vintage pieces. Straight out of the pages of Steve Martin’s Shopgirl, she is the epitome of the attractive wallflower. In her days spent opening dressing room doors and suggesting accessories, she has grown accustomed to the advances of male customers, but most are too old or too forward, or, when one meets her fancy, she is too shy. Today is a slow day, though. Still lost in her own thoughts, she is suddenly jolted back into the moment with a high-pitched whisper in her ear. “There he is! That’s our friend Ian*! What do you think!?”

Not one to be set up, Sarah smiles in spite of herself. His messy long hair and handlebar mustache are paired with burgundy velvet trousers and what appears to be a woman’s paisley blouse. No, this is not the stylish, modern guy she lusts after. He is short and stocky, yet irresistibly charming. Before she can convince herself to say no, she has agreed to go on a double date the next evening.

In this moment, she can feel her mundane existence bursting at its designer seams. She is smitten and sure this is something different. It is October of 2007, she has just had her twentieth birthday, the world is her oyster, and she is sure Ian will change her life forever.

But forever comes sooner than expected. Only four months into their passionate, sometimes rocky relationship, she discovers a single small raised bump on her vulva while taking her morning wake-up shower.

Sarah recalls becoming panic-stricken, convulsing, eyes watering and mind darting. “No, no, no, no!” she repeats to herself, trying desperately to deny the growth’s existence. A wave of shame, angst and sorrow pours over her as the shower water runs off her skin and flows down the drain of the old-fashioned claw-foot bathtub. “Why me? Why is this happening to me?”

She has only had two sexual partners before Ian and has never had a sexually transmitted disease. She has never seen evidence of an outbreak on Ian or she would have insisted they be careful, get checked and get treated. Telling him about this, she thinks, would make matters worse. To confront him about it would make it seem like she didn’t trust him or that she was jumping to conclusions and accusing him of being unfaithful. But mostly, she thinks, “If he is sleeping around, I don’t want to know.”

It would be a long, anxious week before San Francisco State University's Student Health Center would open up for an appointment. Each day the tension builds with uncertainty and emotional turmoil as Sarah does her best to keep Ian and her closest friends from realizing anything is wrong. Until she knows exactly what it is, she vows she won’t tell anyone.

The verdict floats calmly from the lips of her soft-spoken doctor, but gained devastating momentum as the words hit Sarah’s ears and knocked the wind out her.

Genital warts. Yes, warts on her genitals, caused by a strand of the human papillomavirus (HPV). She, Sarah, has genital warts.

Her doctor then explains that HPV is a sexually transmitted infection. She tells Sarah that continued sex with her current partner is safe because they have both already been exposed to that particular strand of HPV, but that she should avoid sex with a new partner during an outbreak.

Not even the use of a condom will be enough to completely prevent spreading her strand or contracting another in the future, because HPV is spread by skin-to-skin contact, not through bodily fluids like many STDs. Within half an hour the doctor had diagnosed her, administered treatment to burn off the existing wart, and sent her out the door.

With her symptoms temporarily cleared up, Sarah was left with little information to clear up all of the confusion, and says she has been battling the physical, emotional and spiritual symptoms and speculations ever since.

Leaving the doctor’s office, Sarah chokes back the tears from this diagnosis, and again her mind begins to race as gravity pulls her thoughts lower and lower: “I’ll never have another boyfriend. I’ll just be single for the rest of my life… or if I do get to sleep with someone else ever again, I have to say I have warts. I have to tell them I will give them warts if they sleep with me, or I have to be completely immoral and not tell them and then they will spread it.”

Having HPV is “one more stress to add to an already stressful life,” she says.

However Sarah is far from alone in her experience, for more than half of sexually active women have HPV and experience a similarly infinite flow of emotions matched only by the number of possible symptoms, complications, and treatments.

According to the United States Food and Drug Administration (FDA), at least 50 percent of people who have had sex will get HPV at some time in their lives, despite the fact that many people don't know much about it. The FDA reports that there are at least one hundred different strands of HPV infecting people today, which range from low-risk types that can cause genital warts to high-risk types that can cause cervical cancer in women.

However, genital warts are not life-threatening, but they may cause pain, significant psychological problems and embarrassment, says Dr. Anne Katz, a sexuality counselor and author of Breaking the Silence on Cancer and Sexuality: A Handbook for Health Care Providers.

“[Warts] don’t look good and can be pretty scary and contagious for your partners,” says Katz. The HPV strands that can cause cervical cancer are life threatening, she says, but if diagnosed early can be managed.

Growing up in a small town in Kentucky, Allison Collins* visited the same gynecologist that her mother did. The doctor who examines her today is the same one who delivered her when she was born.

With no symptoms in sight, Allison was simply visiting her family doctor for a yearly check-up when her Pap smear results showed abnormal cell growth on her cervix.

“The phrase STD was never mentioned in Kentucky,” says Allison. “It was never made clear to me that this was an infection that I got from a particular partner through sex. I was just told that this is what happens when you sleep with multiple partners.”

Two years and two thousand miles later, when she ditched the Bluegrass State and settled in by the Golden Gate, she finally got some answers about her infection. At the Planned Parenthood office on Van Ness Avenue and Eddy Street in San Francisco, she learned that the ambiguous growths on her cervix were precancerous cells due to an existing HPV infection and were growing exponentially, exacerbated by a combination of diet, stress and her pack-a-day smoking habit.

Like Sarah, Allison says she was overwhelmed by a sense of moral guilt and shame that came with the stigma of a sexually transmitted disease. For Sarah, a vegetarian who grew up under her mother’s holistic care doing yoga and drinking wheat grass daily, and Allison, a fit gymnast, bicycle enthusiast and strict vegan, being sick doesn’t make sense. Although they are healthy and responsible, they, like approximately 5.5 million people every year, have contracted HPV.

Sarah is struck by the irony of a talk she had with her twenty-eight-year-old half-sister in the summer of 2006, just as the pharmaceutical company Merck introduced the HPV vaccine, Gardasil, to the market.

Over lunch at a casual Los Angeles café, her normally very shy, conservative sister admitted to Sarah that she had been diagnosed with a high-risk strand of HPV in her early twenties. And like Allison, Sarah’s sister showed early signs of cancer-causing cells, but she had to undergo painful procedures to clear them.

“You have to get the vaccine,” she told Sarah. “I wish I had Gardasil when I was your age.”

Although Sarah says she wanted to go through with the vaccination, the obstacles were stacked against her. At at least $300 for the three-shot sequence, the high price of the vaccine without the help of insurance was more than she could cover on her own, and with her mom’s opposition to modern medicine she had no help there either. By the time she started sleeping with Ian, says Sarah, the initial vaccine campaigns and HPV hype had died down, and her judgment was clouded by new love as she assumed an “it couldn’t happen to me” attitude of invincibility.

Today both Sarah and Allison go in for the recommended four Pap smears a year to check for further irregularities or complications as a result of their infections. And while Allison has shown clear results in her last two check-ups since quitting smoking and adding more folic acid to her diet, Sarah recently had a new outbreak more than six months after her initial treatment. For both girls, just the thought of the virus, or spotting a new wart, is a reminder that it's always there and that their sexual health is critical and vulnerable and has changed forever.

“It's constantly there," says Sarah. "I may always have this my whole life, and when I look at it like that, it's hard not to let it block my future happiness."