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HPV and you


Dr Shirley Jhagroo

HPV and you

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Genital warts is the most common sexually transmitted disease, with an incidence of six million new cases per year, the highest prevalence in ages 14 to 24 years.
It is caused by the human papillomavirus (HPV) which is described as an oncogenic virus. An oncogenic virus can change normal cells into cancer cells, and there are more than 100 strains of this virus, but about 30 types put you at risk for cancer.
HPV is responsible for 99 per cent of the cervical cancers in women, cervical cancer being the second cause of mortality by cancer in women.
In Barbados the mortality is about 19 to 20 women per year. These should be considered preventable deaths.
Other sites of infection include respiratory tract (oropharyngeal), anus, and genital areas. Methods of transmission can be sexual and non-sexual. Sexual transmissions include oral HPV, anal, vagina and uterine cervix.
Non-sexual infections occur through the birth canal of the infected mother. In virgins, genital warts can be contracted by partner contact by fingers or penis and not necessarily by intercourse.
HPV can also be found in the fingernail beds of 38 per cent of females and 65 per cent of males. Also, statistics have shown that oral transmission is three times more common in males than in females.
About 70 to 80 per cent of sexually active women will contract an infection by one or more strains of HPV in their lifetime. Most are transitory, but some are persistent and carry the risk of causing precancerous lesions and cancer.
Most oncogenic HPV infections resolve themselves spontaneously. For the persistent lesions these need to be treated according to the type of lesion, grade of lesion, and extent of lesion.
The best method of treatment for HPV is prevention, but there are ways that people can protect themselves.
1. Use of condoms. Condom use decreases the transmission but does not completely prevent it, as skin to skin contact can play an important part.
2. It’s important to have pap smears regularly to detect early precancer changes on the uterine cervix, which can be treated. A pap smear is still the gold standard for screening and can be a diagnostic tool, as it can tell who has the disease at the time.
3. Vaccination prior to sexual exposure has shown higher efficacy in preventing the disease. HPV molecular testing can also be used as a screening test and gives a forecast of who is at a greater risk, but is not diagnostic.
Strains of the HPV commonly associated with cancer are six, 11, 16 and 18. Strains 16 and 18 are considered high risk, but others are still potentially dangerous. Strains six and 11 are responsible for 90 per cent of genital warts. Strains 16 and 18 are responsible for 70 per cent of cancer of the uterine cervix.
Women with high risk HPV are advised to be followed up with regular pap smears and colposcopy.
HPV vaccines are now routinely given to girls to help protect them from cancers caused by the human papillomavirus. The vaccine which is prepared from highly purified virus like particles contains no viral DNA, so it cannot cause disease or infect cells.
The vaccine does not give protection against all strains of the virus only those included in the vaccine for example: six, 11,16,18.
Results from HPV vaccination in the prevention of high grade cervical intraepithelial neoplasia lesions (precancer changes) on the uterine cervix, in young girls and women prior to sexual exposure, has been good.
This has been tried in Australia, the United States, and Britain. In vaccinated females, the immune response is dominated and sustained by a rapid elevation in serum antibody; this high serum level correlates with high levels of antibody at the uterine cervix.
As it does not give protection against all strains of the virus, pap smear screening should be continued.
Three doses of the HPV injection should be given, the second after a month and third at six months, in the muscle of the arm.
In females who have been sexually active, or who have had contact with the virus, some elevation of the serum antibodies which correlates with the antibodies in the mucus of the uterine cervix has been found.

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