I love you, warts and all… and I urge you to have a pap smear
An overview of the human papillomavirus and how to prevent it
Human Papilloma virus (HPV) is the most common infection in the reproductive system of both males and females. It comes from a family with more than a 100 types, fourteen (14) of which have been identified as high risk or cancer-causing types.
Eighty percent of the sexually active population will at some point get the infection but individuals with healthy immune systems will be able to clear it. Penetrative intercourse (vaginal, oral and anal) is not necessary to get infected with the virus, because even just rubbing against a person who has it will lead to its transmission. Even worse is that most people who are infected with it do not show signs and symptoms of the infection. Aside from sexual intercourse, using personal items of people with HPV infection can also transmit the disease. Since it is a virus it can easily be transmissible through inanimate objects. Persistence of the infection will unfortunately lead to warts, and worse — cancer of the cervix, vulva, vagina, throat (oropharyngeal area) and the penis.
It does not only affect the reproductive system. It could infect different parts of the body — most commonly the fingers, the face, the neck and the chest. Patients with warts in these areas usually opt to have them cauterised. Unfortunately, recurrence rates are high. Inspite of antiviral medications, it is ultimately the body’s immune system that fights off the virus. People with lowered immune systems are more prone to infection.
In 2006, two companies released vaccines that would protect against HPV infection. One of them released the bivalent vaccine which protected people against HPV types 16 and 18 — both of which have been isolated and identified as high risk types causing cervical cancer. The other company released a quadrivalent vaccine against HPV types 6, 11, 16 and 18 — protecting individuals against both warts and cervical cancer. The ideal time to have the vaccination was during childhood at 9 to 14 years of age, and it required only 2 doses at 0 and 6 months (now, then six months after the first dose). For those aged 15 to 26 years of age, three (3) shots were advised at 0, 2, and 6 months (now, two months after the first dose, then 4 months after the 2nd dose). The rationale behind this was kids of this age have very active immune systems that respond very well to the vaccine and are (hopefully) not sexually active yet and exposed to HPV yet. Both boys and girls are advised to undergo vaccination because it does not only protect against cervical cancer but against oropharyngeal and penile cancers as well.
Patients beyond 26 years old were also advised to undergo vaccination because it still managed to confer 70% protection against cancer even if they’d already had sexual intercourse and a previous history of HPV infection.
In 2014, a nanovalent vaccine was released. It protected individuals against nine (9) HPV virus types 6, 11, 16, 18, 31, 33, 45, 52 and 58. It is indicated for both boys and girls, men and women aged 9 to 45 years of age for the prevention of HPV related infections and pre-cancerous lesions.
Common side effects when undergoing vaccination are mild and resolve within a few days or hours. They are usually pain, redness and swelling at the injection site, nausea and dizziness immediately after the vaccine has been administered, mild fever and malaise.
Studies have not shown a relationship between vaccination with HPV and promiscuity among younger women.
Studies have also failed to demonstrate that having the vaccine leads to infertility. Pregnant women are advised to delay completing their vaccination shots until they have delivered their baby.
Vaccination has become the cornerstone in preventing the spread and occurrence of HPV infection. It is most effective when given pre-exposure, and it should be noted that it is not a cure once a patient is infected. Giving the vaccine post exposure helps the body’s immune system fight off succeeding infections making them less frequent and less severe.
Having had a vaccination does not negate the need for screening.
In addition to vaccination, screening tools have been recommended to help prevent the progression of an HPV infection to a full blown cancer. Women are encouraged to have Papanicolau smears annually starting at 21 years of age, and decrease it to every 3 years if she has had 3 consecutive normal results. Contrary to what most women think, pap smears do not “clean” the inside of their vagina. It involves the Gynecologist inserting a speculum into the vaginal canal so the cervix may be visualised. A cotton swab or a cervical brush is then inserted to gather sample cells from both the cervical surface and the cervical canal. These cells are transferred to a glass slide which is then sent to the laboratory for examination. The best time to have a pap smear done is 2 weeks after your last menstrual period. Sexual intercourse prior to the procedure is not advised as seminal fluid and sperm may interfere with the results.
In areas where laboratories are difficult to access, Visual Inspection by Acetic acid is recommended. The health care worker inserts a speculum to visualise the cervix then applies cotton balls soaked in acetic acid to the cervix. After a few minutes, the cotton is removed and the cervix is inspected for the presence of whitish areas of discoloration. The presence of these aceto-white areas may indicate the presence of an HPV infection and requires referral to a center equipped to deal with the infection. Most of the time, these patients undergo colposcopy where their cervix is visualised under a colposcope which magnifies it 8–25x. Different lesions show different patterns. If an infection is suspection, the infected area is sampled and sent to the laboratory for a biopsy to confirm the diagnosis.
HPV caused infections are preventable. There is totally no reason why we shouldn’t take advantage of these monumental and revolutionary advancements in Medicine. With each other’s help, we might be the generation that ended the reign of HPV-related cancers.
