Hiyala Magazine

HPV and Cervical Cancer

Dr Raya Ibrahim Rasheed

What is HPV?

HPV (Human Papilloma Virus) is a group closely related viruses out of which more than 40 types can infect the genital areas, anus, mouth and throat. It is the most common sexually transmitted infection and more common among young men and women. Nearly 80% of sexually active people will have HPV at some point of their lives. However, most of the time the body’s immune system can eradicate infections before any symptoms develop and without people knowing that they have been infected. 10-20% of the time, the infection can persist and some strains can cause serious implications to health over time.

HPV can be transmitted from sexual intercourse as well as from skin to skin contact of genitals.

Does HPV cause cancer?

Sexually transmitted HPV infections can be either low risk or high risk. Low risk infections include strains of HPV 6 and HPV 11. These cause warts around genital area and anus which are infectious but no not cause any long-term damage to your health. The warts can be treated with topical applications.

High risk strains of HPV can cause cervical, anal, vaginal, vulval, penile and oropharyngeal cancers which can include base of the tongue and parts of the throat. These strains that can cause gene mutations causing cells to divide faster than normal leading to risk of development of cancerous growths. These include HPV 16 and 18 which are responsible for 80.3% of invasive cervical cancer cancers. Cervical cancer is currently the 4th most common type of cancer which affects women and persistent HPV infection with these strains may cause cervical dysplasia (changes to the cells lining the cervix) which can over time, progress into cervical cancer. It can take a long time after you are infected to develop symptoms of cancer – some symptoms may develop even after 20 years.

It has been estimated that about 41 new cervical cancer cases are diagnosed annually in Maldives and 21 die from this disease. In South Asia, about 4.4% of women in the general population are estimated to be infected with cervical HPV-16 , 18 infection at a given time.

Can HPV be prevented?

Two vaccines are currently available for HPV – Gardasil and Cervarix both of which aim to protect against cervical cancer. Gardasil can protect against 4 strains – HPV 6 and 11 which causes genital warts as well as HPV 16 and 18 which can cause cancer. Cervarix protects against the high-risk strains 16 and 18.

Evidence suggests that vaccination of both men and women can reduce the incidence of cervical cancer worldwide by almost 90% in the future.

How effective are these vaccines?

Most trials show a 100% effectiveness in preventing the two strains which cause cervical cancer. However, it does not protect against the 30% of cervical cancer which is not caused by the virus.

Early data from USA and Australia shows reduction in the signs of early cancer, reduction in genital warts and reduction in invasive procedures used to treat and assess cervical cancers such as colposcopies and biopsies. It has also shown that taking the vaccine reduced further HPV infections in women who have already been tested positive for HPV.

Who should get vaccinated for HPV and when should they be vaccinated?

The best time to receive this vaccine is before a person becomes sexually active – to prevent HPV infection before exposure. Hence, it is recommended for all boys and girls at ages 11-12. Usually, you need two doses. The second dose is given 6-12 months after the first dose. Children who are vaccinated after the 15th birthday may need 3 doses over 6 months.

If you did not get vaccinated when you were younger, it is recommended through the age of 26 for women and 21 for men. The peak risk for developing HPV is within the first 5 – 10 years of being sexually active so the window for receiving vaccines is open even after a person is sexually effective.

Males are a major source of infection for women and vice versa. Vaccinating men does not only protect them from HPV but also protects women from getting exposed to HPV from men.

Vaccination should be avoided in pregnant women and in people who are suffering from a moderate to severe acute illness until the condition improves.

Should you and your loved ones get vaccinated for HPV?

On one hand, getting the vaccine reduces the chance of getting a debilitating and life-threating disease such as cervical cancer by reducing infections with high-risk strains of HPV. It can also prevent non-cancerous genital warts which can cause significant distress even if it is not cancerous. On the other hand, there is a shot which hurts a little bit and may cause some redness which is usually just for a few days. The very real risk of getting cervical cancer without the vaccination far outweighs any risk of possible side effects.

Since HPV vaccination programs for young girls held in countries have led to a dramatic reduction in the number of HPV infections, the government of Maldives with the support of WHO launched the HPV vaccination campaign for young girls in March 2019. A 2-month campaign was successfully conducted and HPV vaccine was included in the national vaccine schedule. This is an important step in vaccinating all girls before they are exposed to HPV in order to eradicate cervical cancer in the Maldives in the future.