Everything you need to know about HPV

Although there are a number of sexually transmitted diseases, the human papillomavirus (HPV) is one of the least talked about although it is the commonest. It is spread through skin-to-skin contact and almost everyone who is sexually active will have at least one type of HPV at one time or another. Although it is usually harmless and goes away by itself, some types can lead to cancer or genital warts.

More than 200 types of human papillomavirus (HPV) exist and several of them affect the genital area including the vulva, vagina, cervix, rectum, anus, penis, scrotum as well as the mouth and throat. These kinds of HPV are spread during sexual contact. Other types of HPV cause hand warts and plantar warts on the feet but are not sexually transmitted. Two types of HPV (types 6 and 11) cause most cases of genital warts; while types 16 and 18 lead to cancer.

Infections

Genital HPV infections are more common. In fact, most people who are sexually active suffer from HPV at some point in their lives. Most people with HPV may have no symptoms and feel totally fine, so they usually do not even know they are infected.

A pap smear test is usually done to test the presence of HPV among women. Unfortunately, there is no HPV test for men. Therefore, if a woman is diagnosed with HPV, then their sexual partner must also seek treatment.

While abstinence can prevent HPV, condoms can only reduce the risk of spreading it but not prevent it. HPV vaccination is believed to protect young girls who are not yet sexually active from becoming infected with HPV later in life.

Cancers

Several cancers such as cervical vulva, vagina, penis, anus, mouth, and throat cancers are all linked to HPV. According to the World Health Organisation (WHO), worldwide, cervical cancer is the fourth most frequent cancer in women. In Uganda, it is the second commonest cancer among women, after breast cancer. It affects the lower part of the uterus that connects to the vagina.

Dr Noleb Mugisha, an oncologist at the Uganda Cancer Institute (UCI), says it takes 15 to 20 years for cervical cancer to develop in women with normal immune systems. However, it can take only five to 10 years in women with a weak immune system, such as those with untreated HIV infection.

“It is recommended that all girls between the ages of nine and 13 years get vaccinated against HPV to reduce their risk of getting cervical cancer. The vaccine, given in the form of an injection on the upper arm, is given in two doses, six months apart,” Dr Mugisha says, adding that the vaccine works best when girls are vaccinated before they are exposed to HPV (before they start having sex).

Screening for cervical cancer should start from 30 years of age, with regular screening and a validated HPV test every five to 10 years; and from 25 years of age for women living with HIV. Women living with HIV need frequent screening, (every three years). It is also important to note that the HPV vaccination does not work in place of cervical cancer screening.

Warts

Warts develop when the virus enters a cut or break in the skin, causing an infection. They are caused by type six and 11 of the HPV. This skin infection causes rough coloured bumps to form anywhere on the skin such as the hands, feet, face and the genitals.

Warts are highly contagious and one can get them from touching someone who has them. According to Dr Edward Ogwang, a dermatologist, everyone can get warts. He adds that people with a weakened immune system are also susceptible to the virus that causes warts.

The types of warts depend on the part of the body they affect. Flat warts affect the face and forehead, with the commonest being those found on the hands. Plantar warts appear on the soles of the feet and they look like calluses with tiny black dots in the centre. They are often painful and form in clusters. The periungual and subungual warts form under or around one’s fingernails and toenails respectively.

“Warts that form on the penis, vagina or rectum are called genital warts and are sexually transmitted. They appear as flat lesions or small cauliflower-like bumps,” he says.

In women, genital warts appear mostly on the vulva but can also occur near the anus, on the cervix or in the vagina. Genital warts in men appear on the penis and scrotum or around the anus. Genital warts rarely cause discomfort or pain, although they may itch or feel tender.

Dr Ogwang says HPV can spread from person to person or from different parts of the body through sexual intercourse, direct contact with a wart, shaving, touching something contaminated with the virus, such as towels, doorknobs and shower floors, nail biting and cuticle picking.

Warts vary in appearance and may be dome-shaped, flat, rough, grey, and brown or the same as your skin colour. Sometimes, warts can go away on their own when the immune system fights off the virus. If they are persistent, then one must visit a doctor for an examination.

Treatment

To treat warts, Dr Ogwang says, it is important to see a doctor who will recommend treatment. Depending on the intensity of the warts, a dermatologist may recommend over-the-counter (OTC) wart removal medications, which dissolve warts one layer at a time.

Cryotherapy, immunotherapy, laser treatment in combination with topical medicine can be used to treat persistent warts.

There is no way to prevent warts, but one can lower their risk of getting the virus through:

● Getting the HPV vaccine before you become sexually active and using condoms to prevent genital warts.

● Keeping your feet dry to prevent the spread of plantar warts.

● Wearing shoes when using a public pool area or showers.

● Do not touch another person’s wart.

● Do not share towels, washcloths, clothing, nail clippers, razors or other personal items.

● Avoid shaving over a wart. Try not to scratch, cut or pick at a wart.

● Break the habit of biting your nails or picking at cuticles.

Takeaway

The Centre for Disease Control (CDC) recommends that all 11 and 12-year-olds receive two doses of HPV vaccine at least six months apart. Younger adolescents aged nine and 10 and teens aged 13 and 14 can also receive vaccination on the updated two-dose schedule. According to research, the two-dose schedule is effective in preventing cervical cancer among children, especially those that are under 15 years of age and are not yet sexually active.

Once someone is already infected with HPV, the vaccine might not be as effective or might not work at all.

There is no cure for HPV but one can reduce their risk of developing genital warts and other HPV-related genital lesions by being in a condom.

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