HPV: Another silent, highly contagious virus to worry about

Linked With Cancers In Men, Women

About 80 per cent of every sexually active man or woman, will likely contract at least one strain of Human Papillomavirus (HPV)- the most common sexually transmitted virus, at some point during their life time, according to world health bodies.The virus is known to be the root cause of many cases of cancers in both men and women, including all cervical cancers, which kill one woman every hour in the country, according to experts.Globally, about 630 million people are estimated to be infected with HPV, compared to the 40million infected with HIV.

This virus, which presently has no cure, is not spread via bodily fluid alone, hence cannot be prevented completely using condom.The World Health Organisation (WHO), and other bodies reveal that HPV is spread through skin-to-skin contact, and can infect anyone (many times) who is, or has ever been sexually active.Known to be highly contagious, experts say HPV infection can affect the skin, cervix, anus, mouth and throat, of both men and women.

According to a cancer expert from Committee Encouraging Corporate Philanthropy (CECP- Nigeria) Dr. Abia Nzelu, HPV can cause cancers in both men and women.
“Nearly all cervical cancers are caused by HPV. Eight out of 10 cases of cancer of the anus are linked to HPV; half of vulval cancers (the outer private part of women) are related to HPV; seven out of 10 vaginal cancers are HPV-related; one out of three cancer of the penis are linked to HPV. Other places that can be affected are the mouth, throat, scrotum, conjunctiva (covering of eye), skin, nose, nail beds and tonsils”, she said.Nzelu said most of the time, HPV usually has no signs or symptoms, goes away by itself within years, and does not cause health problems.

This is because the immune system fights it off naturally. “It is only when HPV remains in the cells for many years that it can cause cancer. It can be transmitted from a mother to child during childbirth and can lead to Recurrent Respiratory Papillomatosis (RRP) (asthma-like condition), which can cause the death of the innocent child,” she said.

Although there are over 150 types of HPV, Nzelu said the four that cause most of the diseases are Types 6, 11, 16 and 18.Experts say it is also the most common sexually transmitted infection (STI) in the world, with the highest prevalence in sub-Saharan Africa.

For those who assume they’re free from the virus because they are not promiscuous, Nzelu, said skin-to-skin contact is all that is needed to contract the virus.“Although HPV can be spread during sex − including vaginal intercourse, anal intercourse, and oral sex, sex doesn’t have to occur for the infection to spread. All that is needed to pass HPV from one person to another is skin-to-skin contact with an area of the body infected with HPV. Therefore, even never having sex doesn’t guarantee that one cannot get infected.  

“Recently, a woman presented at the National Cancer Prevention Programme (NCPP) with complaint of post-coital bleeding (bleeding after sexual intercourse). She was investigated and confirmed to have cervical cancer. The news was received by her with utter disbelief, because she has had only one sexual partner –her husband. This story buttresses the point that having only one partner does not preclude one from being infected with HPV. However, it is important to note that women who get sexually exposed at an early age, and those with multiple sexual partners have a higher risk of developing the disease,” she said.

Other risk factors according to her are smoking, suppressed immune system and poor genital hygiene, adding that women in developing countries like Nigeria are regarded as high risk since sub-Saharan Africa has the highest prevalence of HPV, while 26 per cent of women in Nigeria are positive for the virus.

Because of this, Nzelu, advocates yearly cervical cancer screening, which she said would facilitate early detection. “In Nigeria, therefore, a woman’s first cervical screening should be done when she turns 18 or three years after she begins having sex, whichever comes first. This is because we have seen teenagers with cervical cancer in the country. Cervical cancer gives no symptom at the early stage,” she explained.

However, the good news is that there are now vaccines that can help prevent certain types of HPV and some of the cancers linked to those types. These vaccines are also available for both male and females.

“There are three types of HPV vaccines – a bivalent vaccine (Cervarix), a quadrivalent vaccine (Gardasil) and a 9-valent vaccine (Gardasil 9).  The bivalent vaccine protects against only two types of HPV (16 and 18) and is recommended for females alone for prevention of cervical cancer. The quadrivalent vaccine protects against four types of HPV (6, 11, 16 and 18). Gardasil 9 protects against four types of HPV as the quadrivalent vaccine, plus five other high-risk types: 31, 33, 45, 52 and 58. The Gardasils thus prevent most cases of cervical cancer, and other cancers caused by HPV infection, including a proportion of genital, anal, oral and throat cancers.

The Gardasils also prevent genital warts and Recurrent Respiratory Papillomatosis (RRP). The Gardasils are approved for both males and females. Vaccinating boys against HPV might also help protect girls from the virus by decreasing transmission. The vaccines are usually given in three doses over six months. The US Centre for Disease Control (CDC) recommends that people should get the same vaccine brand for all three doses i.e. Cervarix and Gardasil should not be used interchangeably”, she said.

To be effective, she said the vaccine should be given before a person becomes exposed to HPV – usually through sexual activity, and is recommended for widespread use by girls between ages nine to 26 years old.The quadrivalent vaccine, according to her, is also licensed for males between ages nine through 26 years, and are given as shots in a series of three doses within six months.

A Consultant Clinical and Radiation Oncologist at the Lagos University Teaching Hospital (LUTH), Dr Omolola Salako, said getting screened and getting a vaccination is the cheapest and easiest way to avoid cervical cancer in women.

“It takes only N7, 000 to get a pap smear test once in five years and N21, 000 to get vaccinated for life. But when the infection has been allowed to grow into full blown cancer, one is not even sure of curing it with N500, 000,” she advised.

Shedding more light on HPV, a gynecologist at the University of Calabar Teaching Hospital, Dr. Nelson Egwu, said the strains of HPV, which cause a person to develop warts, is not in the same group of HPV strains that cause cancer.“The strains of HPV known to cause genital warts are low-risk HPV 6 and 11, while the strains of HPV associated with cancer include high-risk HPV 16, 18, 31, 33, 45, 52 and 58.

HPV can infect anyone who is, or has ever been sexually active, and sometimes the most infected individuals are asymptomatic, meaning they display no symptoms of the virus, at times they can remain dormant and later infect a new or existing sexual partner.

When genital warts become present, they may appear as small bumps, cluster of bumps or stem-like protrusions. They can range in size and appearance and be large, small, flat or cauliflower shaped and may be white or flesh toned.

The most common area affected in women includes the vulva. However, they can also be present near the anus, on the cervix or within the vagina. Warts in men may appear on the penis, scrotum or around the anus. In both men and women, the groin may also be another area where genital warts are found.”
Some wrong perception about HPV:

ONLY recently, some false reports were circulated about HPV on the social media. The reports described the virus as a “strange and new ailment,” which has killed about 13 people in LUTH.Chief Medical Director of the hospital, Chris Bode, Lagos, while debunking the rumour, explained that HPV does not cause sudden mass deaths in humans.

“Medical literature informs us that the human papillomavirus causes a number of diseases in man, and the ordinary wart is the commonest of these. Although warts have been documented since the time of ancient Greece, its viral nature was described over a 100 years ago,” he said.