World Aids Day commemorated each year on 1 December has arguably become a success story thanks to years of awareness and life-preserving medical advances helping those who suffer from it lead relatively normal lives. This year, however, People’s Post also explores its lesser-known cousin – the human papillomavirus (HPV).
Professor of virology at the University of Cape Town (UCT) Anna-Lise Williamson elaborates on the virus, thanks to her area of expertise in human papillomavirus, also known on an international level for her work in developing vaccines for HIV, according to Wikipedia.
Recognising her extensive experience in HPV research, Williamson was director of the World Health Organisation (WHO) HPV reference laboratory for the Africa region (established at UCT in 2006). “I have spent over fifteen years researching novel HPV vaccines, as well as over twenty years on the immune response to HPV . . . to inform local HPV vaccine introduction.
“As HIV and HPV are both the cause of major public health problems in South Africa,” she says, “we have a specific interest in the impact of HIV infection on HPV and have established our lab as an important world centre of expertise in the area.”
What is HPV?
HPV is a common sexually transmitted infection, according to the WHO. Almost all sexually active people will be infected at some point in their lives, usually without symptoms.
According to the Centres for Disease Control and Prevention (CDC), the disease usually goes away on its own without treatment. Some HPV infections, however, cause genital warts. Others can cause abnormal cells to develop, which go on to become cancer. WebMD says the term “papilloma” refers to a kind of wart that results from some HPV types. HPV lives in thin, flat cells called epithelial cells. These are found on the skin’s surface as well as on the surface of the vagina, anus, vulva, cervix and head of the penis. They’re also found inside the mouth and throat.
HPV Spread & Symptoms
HPV is spread through intimate genital skin-to-skin contact, Williamson explains. “Transmission of genital HPV largely occurs via direct sexual contact with an infected individual, resulting in estimated lifelong HPV acquisition rates as high as 60–80%. Therefore, the highest rates of newly acquired HPV infections are observed in young women, peaking at an age soon after the onset of sexual activity, with estimates of up to 75% of HPV infections occurring in 15–24-year-old females.”
WHO’s site went further by providing a shocking statistic according to a new study published in The Lancet Global Health “showing that almost one in three men over the age of 15 are infected with at least one genital HPV type, and one in five are infected with one or more of what are known as high risk, or oncogenic, HPV types.”
If a person is sexually active, they can get HPV, even if the person has had sex with only one person, says the CDC. Here, Williamson points out that sex with increased numbers of sexual partners “increases the risk, whilst circumcision has a protective effect”.
WHO’s website goes on to say that “condoms help prevent HPV but do not offer total protection because they do not cover all the genital skin.”
Some HPV strains cause cancer
HPV infection that does not go away on its own can cause changes to cervical cells in women, which lead to pre-cancers that may become cervical cancer if left untreated, the WHO continues. “It usually takes 15–20 years for cervical cancer to develop after HPV infection,” it says.
Williamson says there are many different types of HPV. “Other types of HPV cause warts on the hands and feet, while specific HPV types cause genital warts and cancers.” Most of these cancers comprise of the cervix and anal canal; and a substantial proportion of other anogenital sites (like the vulva, vagina, penis) and oropharyngeal cancers (in the middle section of your throat). “HIV co-infection (living with two or more viruses at the same time) increases both the incidence of HPV and the persistence of HPV, resulting in a higher incidence of HPV-associated cancers,” Williamson continues.
The early changes in cervical cells and pre-cancers mostly do not cause symptoms, says the WHO. “Symptoms of cervical cancer may include bleeding between periods or after sexual intercourse or a foul-smelling vaginal discharge.”
These symptoms may be due to other diseases and people with these symptoms should speak to their healthcare provider.
HPV Treatment and Vaccines
Speaking about stigmas surrounding HPV, Williamson says “emphasis should be removed on HPV being a sexually transmitted disease but rather a virus that can cause cancer”. She adds that early cancer detection is possible with treatment and women must be encouraged to participate in screening programmes to detect early treatable cancers rather than waiting for symptoms and advanced cancers which are more complicated to treat.
“Vaccination could prevent most HPV-associated diseases and must happen for both girls and boys.”
She goes on to cite WHO’s Strategic Advisory Group of Experts on Immunisation (SAGE) concluded that evidence supported that a single-dose HPV vaccine protects against HPV at a level comparable to two-dose schedules.
WHO now recommends:
- A one or two-dose schedule for girls aged 9-14 years.
- A one or two-dose schedule for girls and women aged 15-20 years.
- Two doses with a six-month interval for women older than 21 years.
- People living with HIV and those who are immunocompromised should receive three doses. If this is not possible, then at least two doses, as there are knowledge gaps in this community on reduced vaccine doses.
Get tested
To conclude, testing for HPV is seen as somewhat tricky. Williams says while women can get screened in the private sector as part of their cervical screening programme, there are no standard tests for men to determine their HPV status and men are managed on the presence of defined lesions associated with the virus. “This is why it is important for boys to get vaccinated as well as girls.”
For women, HPV testing has started to replace pap smears (cytology) in the private sector. This detects HPV on the cervix but not in sites where one could develop an HPV-associated cancer.”
