What you need to know about HPV

Informative

Cervical cancer (caused by HPV 80% of the time) is the second most common cancer in South African women despite being largely preventable. Here's the info you need about HPV and the vaccine that could prevent the cancers it can cause.

What is HPV:

Human papillomavirus, or HPV, is a group of over 200 related virus strains that can infect the skin and mucous membranes of both women and men. About 40 of these HPV strains may affect the genital area and are spread through sexual intercourse (including vaginal, oral and anal sex), as well as genital skin-to-skin contact (meaning condoms are not proven to be an effective method of prevention). HPV is the most common sexually transmitted disease (STD), and it’s estimated that approximately 90% and 80%, respectively, of sexually active men and women, will contract HPV at some point in their lives.

While most HPV infections don’t result in any symptoms and are cleared by the immune system, some forms of the virus can cause warts and certain cancers. The most common HPV-related cancers are throat cancer in men and cervical cancer in women – the World Health Organisation estimates that 80% of cervical cancers and pre-cancerous cervical lesions are caused by HPV. HPV can also lead to cancer of the vulva, vagina, penis, or anus. Please note that not everyone who is infected with a cancer-causing strain of HPV will necessarily develop cancer. Most importantly, most HPV infections that lead to cancer can be prevented with the HPV vaccine that can be administered to both boys and girls (and men and women).

HPV cervical cancer facts

Symptoms:

Most HPV infections show no symptoms, so people are usually unaware that they have the virus. When it comes to sexually-transmitted HPV, you can develop symptoms years after you have sex with someone who is infected, making it hard to determine when exactly you first became infected.

Where HPV symptoms are present, (depending on the strains) they can be any of the following:

  • Abnormal cells: These develop on the cervix and are detected through Pap smears (a test that determines whether precancerous or cancerous cells are present on the cervix, the opening of the uterus).
  • Genital warts: These are either small bumps resembling cauliflower, flat lesions, or stem-like protrusions. In women, genital warts appear on the vulva, around the anus, in the vagina or on the cervix, and in men, they can be found around the anus, and on the penis and scrotum.
  • Common warts: Common warts are rough, elevated bumps, usually affecting the hands, fingers and elbows.
  • Flat warts: Flat warts are raised lesions that are often darker than the rest of the skin. Women tend to get these on their legs, while men get them in the beard area and children on the face.
  • Plantar warts: Appearing on the heels or balls of the feet, plantar warts are small, hard growths.

Warts may appear anywhere from several weeks to several months after exposure to HPV, and in some cases, they don’t appear at all.

The HPV strains that cause warts (genital or otherwise) differ from those that cause cancer. It can take years, even decades, for cancer to develop following HPV infection. By the time symptoms caused by these strains are evident, the cancer has typically progressed to a stage that requires radical treatment (a hysterectomy, chemo or radiotherapy). For this reason, it is crucial that ALL sexually active women have regular Pap smears (and an HPV test if they have not been vaccinated, followed by a vaccination).

Diagnosis/Testing:

For women potentially carrying HPV strains that can cause cancer, the first step towards an HPV diagnosis is a Pap smear. Sexually-active women should have a Pap smear annually before turning 30, after which the test should be done every three years at least. The Pap smear helps identify abnormal cell changes in the cervix, and if any are found, your doctor can then perform DNA analysis to confirm whether or not the changes are the result of an HPV infection.

An HPV PCR Test is also available to test for the specific strains of the virus that could cause cancer in women (specifically strains 16 and 18). This is useful if you think you may already have been exposed and/or if you are already sexually active and still want to get vaccinated. Results from your HPV test will come back as either positive or negative. A positive test result means that you have a type of high-risk HPV that’s linked to cervical cancer (again, strains 16 and 18). It doesn’t mean that you have cervical cancer now, but it’s a warning sign that cervical cancer could develop in the future. The presence of these HPV types in a woman can lead to cell changes that may need to be treated so that cervical cancer does not occur.

The HPV test can be done at the same time as the regular Pap smear at your regular gynaecological appointment, or as a separate test on its own, as the procedure is the same. A sample is taken by using a small soft brush to collect cervical cells which are then sent to the laboratory (the HPV testing sample may be taken directly from the existing Pap sample). The procedure is painless (albeit slightly uncomfortable) and takes less than a minute to complete.

The HPV test (strains 16 and 18) can be done at PathCare (among others), although they do require a recommendation from your healthcare provider. The cost for the test is R1249.10 when paying cash, or R1469.50 when paying as a private patient (your medical aid may cover part, or all, of this amount out of a medical savings account, depending on your plan).

Prevention:

There are two HPV vaccines currently available in South Africa, namely Gardasil and Cervarix. They protect against strains that are most likely to cause cancer. It’s recommended to have the HPV vaccine before first becoming sexually active (girls, and boys, can be vaccinated as early as age 9) but those who have passed this stage can still benefit if they haven’t yet been exposed to the specific strains targeted by the vaccines (this can be confirmed by the aforementioned HPV tests). For either vaccine to be effective, it needs to be administered before an individual has been exposed to strains 16 or 18 of the virus.

Sticking to one sexual partner also greatly reduces your risk of contracting HPV.

The vaccine, Gardasil, immunises against HPV strains 16 and 18, the cancer-forming strains, and strains 6 and 11, which cause genital warts. This vaccine is available to both women/girls AND men/boys. Cervarix immunises against HPV 16 and 18 with some cross-protection of other high-risk HP viruses that can cause cancer; this specific vaccine is only available to women.

Why should boys/men get vaccinated:

When it comes to HPV, the virus can cause rare cancers in men too, such as those of the anus and rectum, mouth/throat and penis. There are unfortunately no screening tests for these cancers, so they are often only caught at a later stage. Vaccinating boys could potentially save their lives.

An added benefit of vaccinating boys against HPV is that once vaccinated, they won’t be carriers of the virus, thus reducing the risk for any future partners too.

Costs:

Vaccines are available, without a prescription (as it’s classified as a schedule 2 medication), at most pharmacies with clinic facilities; call your nearest pharmacy to confirm availability and the exact costs involved. (Shop around to find the best price!)

Stelkor Pharmacy (Stellenbosch): Gardasil R1077 x 3;  Cervarix R1099 x 3 *
Boord Pharmacy (Stellenbosch): Gardasil R940 x 3 *
Clicks Pharmacies: Gardasil R820 x 3; Cervarix R 835 x 3 *

*Costs may vary depending on if the administration of shots is included. Depending on your medical aid provider and plan, they may cover all, or part, of the costs out of a medical savings accounts or similar.

The vaccine schedule calls for two or three shots, (depending on your age) spread over six or more months, to help maximise immunity. Currently, it appears that the vaccines protect against HPV for at least six years. Additional studies need to be done to see how long vaccinated people remain immune and whether booster shots are needed, or how often. Be sure to discuss all options and schedules with your healthcare provider.

(While an HPV vaccine can greatly reduce a woman’s risk of developing cervical cancer, it doesn’t negate it entirely. Remember, there are 13 strains of HPV that can potentially cause cervical cancer, so regular Pap smears are still ESSENTIAL. The vaccine is by no means a substitute for a Pap smear.)

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