As a leading cause of cervical cancer, it’s no wonder everyone is talking about the HPV virus and whether or not to vaccinate against it.
HPV (human papillomavirus) is a common virus with more than 130 different subtypes1, 40 of which affect the genital area2.
While most people clear the virus naturally1, others are not able to and it can lead to genital warts, and cancers of the cervix, vulva, vagina, anus, penis, and throat.3
It can be undetected for years
“HPV is a common virus. It can cause infections which can lead to cancer in both men and women,” says Dr Trudy Smith, a Johannesburg-based gynaecologist and obstetrician. “There are often no symptoms of HPV infection and it can lie undetected for years. In that time, the infected person can pass it unknowingly onto others.”
The virus is predominantly spread through genital and intimate skin-to-skin contact.4 The main concern is that certain strains of HPV can ultimately turn cancerous.
There is little awareness that boys and men can also be infected with and transmit HPV. Genital warts are the best-known HPV-related disease in boys and men, however, HPV has also been linked to anal, penile and head and neck cancers in men.5
Pap smears detect certain strains of HPV
“Although screening programmes for HPV in boys and men are lacking, pap smears may detect certain cancer-causing strains of HPV in women,” says Professor Hennie Botha, head of Gynaecological Oncology at the University of Stellenbosch.
HPV is a common cause of cervical cancer
In women, HPV causes most cases of cervical cancer – the number one ranked cancer in women aged 15 to 44 in South Africa,6 and one of the leading causes of female cancer-related deaths in South Africa.6
Professor Botha says HPV can be a silent killer because those with the infection often only seek help when a resultant cancer is at an advanced stage.
“Many women are diagnosed with cervical cancer in their mid- to late thirties,” he adds. “It is most likely that these women were exposed to cervical cancer-causing HPV subtypes during their teens and twenties.”
Do HPV vaccines work?
HPV vaccines are designed to help the body’s immune system learn how to protect itself against HPV infection.
HPV vaccines first became available in South Africa’s private pharmacies in 2009 and since 2014 as part of a national, school-based programme run by the National Department of Health. The government school programme is free of charge.
“The vaccines have had a significant impact on HPV-related diseases in Australia and the United Kingdom,” says Dr Smith. “Studies conducted so far demonstrate that the vaccines are very effective. There is significant proof that the vaccines have reduced precancerous lesions, and the incidence of abnormal pap smears in areas that have a high uptake of the vaccine – as a result, we will see a decline in cervical cancer. Remember that vaccination is not a treatment for an existing disease, such as cancer or genital warts, but can help prevent these conditions.”
There is currently no single HPV vaccine that protects against all the subtypes. Of the two HPV vaccines on the market, one prevents HPV 16 and 18 infections, protecting against cervical cancer and related lesions. The second vaccine covers four HPV subtypes (HPV 6, 11, 16 and 18), offering protection against both cervical cancer and related lesions, as well as genital warts in both males and females. HPV subtypes 16 and 18 cause 70% of cervical cancers worldwide, and HPV subtypes 6 and 11 cause 90% of genital warts.7, 1
Dr Smith stresses that like all clinical compounds, the vaccines have been extensively tested for years, and are constantly monitored for potential adverse effects. By all measures, they have been found to be safe and are often an effective intervention, in the treatment of a virus that has long haunted humankind.
When is the best time to vaccinate?
Research shows that individuals aged 15 to 24 years are at highest risk for genital HPV infection.2 Some studies have shown that young women who have not had contact with HPV16 or HPV 18 have a lower occurrence of acquiring HPV-16 or HPV 18 high-grade lesions.7
“The best time to vaccinate both boys and girls is between the ages of nine and 12 years, because the younger the child, the better their body’s ability to mount an immune response against HPV,” explains Professor Botha. “There has been wide acceptance of the vaccine in public schools, but there are still many children, boys and young people who remain unprotected. Girls in grade four and their parents are generally well aware of the benefits of protecting against cancer.
Related: HPV vaccination: is it necessary?
Should boys be vaccinated too?
“Boys may also develop serious diseases and cancer due to HPV infections, and they too are protected by the vaccine,” he stresses.
“Men get HPV-related diseases less frequently and, for that reason, in places where funding is limited, the first aim is to ensure girls are protected. However, we encourage universal vaccination. By vaccinating boys as well as girls we increase the likelihood of ‘herd protection’ – when a large percentage of a population has become immune to an infection, it provides a measure of protection for individuals who are not immunised.”
Professor Botha hopes that if enough people in the population are vaccinated against the most dangerous strains of HPV, these may eventually be eradicated altogether. “If enough boys and girls are vaccinated, we could fight back against the worst cancer-causing HPV viruses in future,” says Professor Botha.
For more information on HPV-related diseases, please visit www.cdc.gov/hpv or //ipvsoc.org/news/4th-march-international-hpv-awareness-day/
Your healthcare professional will be able to discuss the optimum vaccination schedule with you in more detail.
- Hathaway JK. HPV: Diagnosis, prevention and treatment. Clinical Obstetrics and Gynaecology. 2012; 55(3):671-680.
- Weaver BA. Epidemiology and natural history of genital human papillomavirus infection. JAOA. 2006; 6(3):S1-S8.
- Jin XW, Lipold L, Sikon A, Rome E. Human papillomavirus vaccine: safe, effective, underused. Cleveland Clin J Med 2013; 80(1):49-60.
- Winer RL, Lee S-K, Hughes JP, et al. Genital human papillomavirus infection: Incidence and risk factors in a cohort of female university students. Am J Epidemiol 2003; 157: 218–226.
- ICO information centre on HPV and cancer. South Africa human papillomavirus and related cancers, fact sheet 2013 (January 31, 2014). Accessed on: 30thof June 2014. Available on //www.hpvcentre.net/statistics/reports/ZAF_FS.pdf
- Arima Y, Winer RL, Feng Q, et al. Development of genital warts after incident detection of human papillomavirus infection in young men. The Journal of Infectious Diseases 2010; 202(8):1181–1184.
- Cervarix approved package insert. MIMS Desk Reference. 2013. Volume 48. Pg. 471- 479.
- Gardasil approved package insert. 10 April 2014. MSD South Africa.
- The FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. New England Journal of Medicine 2007; 356(19): 1915-1927.
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