hpv head pic

HPV (Human Papilloma Virus)

If you left school, like me, sometime between 2007-2010 you may be a little behind when it comes to knowing the details on HPV. Since September 2008, the NHS has had a national programme to vaccinate all year 8 girls against the human papilloma virus (HPV) and instituted a catch up programme for those who were under 18 without the vaccination. As such the younger generation is a little more savvy about HPV.

For us older ones in the crowd lets cover a few general facts. You may be surprised to learn HPV is the most common STD and 50% of sexually active men and women will contract a genital form of HPV at some point in their life although many never show any symptoms or even know that they have it. The more high risk types of HPV are responsible for 99% of cervical cancers (the second most common cancer in women under 35) and other types of HPV are the culprits when it comes to genital warts (remember those gross photos they show you at school in attempts to scare you into never having sex). So let's agree it's good to understand what it is, how you can catch it and ways to prevent it.

+   What is it?

  • There are around 100 types of HPV all of which are infections of the skin or mucous membranes
    • Along with the types of HPV that cause genital conditions, other types are responsible for verrucas and standard warts
  • The HPV virus causes normal cells on the infected skin to turn into abnormal cells (often not noticeable to the sight or touch)
  • HPV effects both males and females but possible long term effects tend to be more serious in women
  • Most cases (90% in fact) of HPV are easily fought off by your body’s immune system within two years and 70% are gone within a year. The abnormal cells go back to normal and there are no long term health problems
  • Unfortunately there are a couple of really bad types of HPV and some less good types
    • The less good guys go by the names of HPV type 6 and HPV type 11 and they are the main culprits when it comes to genital warts (cue nasty picture from school) as well as potentially warts in the throat
    • The really bad guys go by HPV type 16 and HPV type 18 and they are the types of HPV that can cause cervical cancer
  • In the cases where the body doesn’t successfully fight off HPV more skin cells and mucous membranes turn from normal to abnormal often causing visible changes such as genital warts

+   How do you get HPV?

  • Like any other STD the most common way to contract HPV is through “genital contact”. This slightly odd term is meant to cover all the down and dirtiness you and your experimentally-inclined other half may be considering
    • Vaginal sex
    • Oral sex
    • Anal sex
    • Or just Genital to genital contact (which often happens before condoms enter the picture)
  • Even if your partner shows no sign of symptoms you may still contract HPV and you could show no symptoms yourself for weeks or months after the sexual encounter
  • Condoms are not 100% effective at preventing you from contracting HPV, as they don’t cover all the areas that can be infected by HPV. In fact they are only successful in preventing transmission of HPV in 50% of cases
  • Infected individuals can pass on HPV to partners up to two years after they were infected
  • Finally it is possible to have more than one type of HPV at a time

+   Symptoms and Complications

  • Most people never show any signs or symptoms of HPV and recover from the virus naturally without any adverse health effects
  • Genital warts occur in some cases of HPV, if you don’t remember the photos (that seem to have scared me) here are some signs and need to knows of genital warts:
    • Small bumps or groups of bumps in the genital area (penis or vagina)
    • They may be small or large, raised or flat or maybe even shaped like a cauliflower
    • They may appear weeks or months after sexual contact with an infected partner
    • Genital warts will not turn into cancer
    • They may however, increase in size or number
    • Or they may go away on their own
    • There are around 100 000 new cases a year and the highest rates are in women aged 16-19 and men aged 20-24
    • Treating genital warts is thought to cost the NHS £17 million a year
  • RRP (recurrent respiratory papillomiatosis) and layryngeal papillomas are where you get warts due to HPV on the back of your throat or on your larynx
    • They may block you airway
    • Give you trouble breathing
    • You may develop a hoarse throat
  • Cervical Cancer affects 5 – 10% of women infected with high risk types of HPV and where  infection persists they can develop precancerous lesions
    • Cervical cancer usually shows very few symptoms until it is quite advanced and it usually takes years to develop from abnormal cell growth caused by HPV
    •   The best defense against cervical cancer therefore is regular screening
    • Regular screening can catch cancerous cells early or even before they become cancerous
    • HPV vaccine has been proven as a very effective prevention of cervical cancer especially if administered before first sexual activity – hence the Year 8 inoculation programme
  • Other HPV related cancers – these cancers like cervical cancer have very few symptoms until they are quite advanced and are fairly hard to treat. The good news is that they are extremely rare
    • Cancer of the vulva
    • Cancer of the vagina
    • Cancer of the penis
    • Cancer of the anus
    • Cancer of the oropharynx (back of your throat near to and including your tonsils)

+   Prevention and Treatment

Condoms

  • Condoms can lower the risk of contracting HPV and therefore HPV related diseases if used for every sex act (i.e. oral sex, vaginal sex, anal sex) from beginning to end (in practice from as soon as the genitals get involved, to the bit in movies where they cut to the couple discussing how good it was in bed after)
  • As condoms do not cover all areas of the boy that can be infected by HPV they do not offer full protection from the virus (in fact they only seem to help in 50% of cases)

Screening

  • If you are female and ever “engage in sexual relations” (or as normal people would say  “have sex”) you should have regular screenings, to search for tell-tale cell abnormalities. These come in the form of a PAP test
  • PAP tests examine the cervix for abnormal cells by taking a swab of the area
  • If abnormal (often referred to as pre-cancerous) cells are found they can be easily treated at this early stage. These days this is most regularly done by freezing the cells

Vaccines

  • The main form of vaccine offered in the UK is Guardasil
  • Gardasil offers effective treatment for the HPV types responsible for 70% of cervical cancers and the HPV types responsible for 90% of genital warts
  • It consists of 3 doses of the vaccines (usually administered via injection to the upper arm or thigh)
    • The second dose needs to be given at least one month after the first
    • The third dose needs to be given at least 3 months after the second
    • All three doses need to be given within a 12 month period
  • Currently the vaccine is provided to girls ages 12-13 on a national scheme via schools
    • It is estimated that this vaccination program will help to save 400 lives a year
    • Girls under 18 who have not been vaccinated are eligible for the catch-up vaccination programme and should talk to their GP (you do not need a parent’s consent over the age of 16)
    • There is currently no NHS option for being vaccinated over the age of 18. Though research shows the vaccine is still effective up to the age of 26. The reason that the NHS does not offer vaccination over the age of 18 is because the vaccine is more effective if you receive it before you engage in sexual activity of any sort and therefore are extremely unlikely to have contracted genital HPV in any form.
    • Private vaccination options are available but are reasonably expensive
    • Vaccination is not yet available for men. The hope is that vaccinating women will help bring down overall infection rate
    • Gardasil has gone through a number of safety test and regulations and provided no statistically unusual effects but it does have a couple of temporary side effects such as
      • Nausea
      • Pain and swelling at the site of injection
      • Dizziness
      • Fatigue

Medication and removal

  • Genital warts can be removed via medication or by a freezing procedure
  • Genital warts may clear up on their own however

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