Guidelines: FAQ's HPV, Cervix Cancer & HPV Vaccines
What is Human Papilloma Virus?
Human Papilloma Virus (HPV) is a highly contagious viral infection that spreads through skin-to-skin contact. It may affect all areas of the skin but certain types infect both male and female genital areas, including the lining of the vagina and the cervix. It belongs to a family of over 100 types of viruses. Some types of HPV are sexually transmitted and can cause either genital warts or cancer of the cervix, anus or penis. The types of HPV that infect the anogenital region are not the same as the HPV that cause warts in other areas such as the hands, feet and face. These types do not usually cause cancer.
What is cervix (cervical) cancer?
Cervix cancer starts at the mouth of the womb. It causes a malignant growth that can involve nearby organs such as the bladder and the bowel. It may also spread in the blood and lymph nodes to the rest of the body. Cervix cancer is the most common form of cancer in women in South Africa . It is estimated that one in 26 South African women will develop cervix cancer during their lifetime. More than 6 500 new cases of cervix cancer are diagnosed each year and more than 3 000 deaths a year are due to cervix cancer.
How is HPV implicated in cervical cancer?
If the HPV infection persists in a female, the high risk type of HPV becomes integrated in the cervix cells. Certain cofactors such as smoking, diet, drugs, immune-suppression and sexual behaviour also play a role. Cervical HPV infection is, however, the single most important risk factor for the development of cervix cancer.
Do all types of HPV cause cancer of the cervix?
The various types of HPV are classified as low or high risk according to their association with cancer. These low risk types are rarely associated with cancer. The high risk types, on the other hand, are more inclined to lead to cancer.
Why is HPV important in 2008?
Cancer of the cervix is the most common of all reported cancers in women in South Africa which has one of the highest incidences in the world. Preventative measures and active screening to reduce the suffering and death of women beset by this disease must be instituted.
Is HPV infection common?
HPV infection is the most common sexually transmitted infection in the world. About half to three-quarters of sexually active people will have HPV at some stage of their lives.
How is HPV implicated in genital and other skin warts?
Warts caused by certain HPV types are transmitted by direct contact with infected tissue or indirectly by contact with objects containing viral particles.
How is HPV transmitted?
HPV can spread through sexual contact, and barrier contraceptives such as condoms may not be totally protective. Skin-to-skin contact with an infected person may cause transmission of the virus. In rare cases, HPV may be passed from a mother to her newborn baby and warts may develop in the mouth, throat or voice box of a baby.
How can one protect oneself from getting HPV?
Of course, abstinence is the best form of protection. Another obvious method to reduce the risk of acquiring an HPV infection is to practise safe sex and to always use a condom during sex. While condoms do not eliminate the risk of infection, the proper and consistent use of them will decrease the risk of passing on HPV to one's partner. Delaying the onset of sexual debut as well as limiting one's sexual partners also decreases the risk of acquiring HPV infections. In addition to the above, vaccination is a preventative, but even if the vaccine is given, barrier methods are still recommend to prevent other infections not covered by the vaccine, among other HIV.
What are the symptoms of HPV?
Genital HPV usually has no symptoms unless it is a type that causes genital warts. These genital warts may occur within weeks or even months after exposure. Sometimes they can even occur years later. Most people will never know they have HPV as the virus causes cell changes in the cervix that over many years may lead to cancer. On the other hand, an HPV infection can be diagnosed with a Papanicolaou smear (commonly known as a Pap or cervical cytology smear). These tests are designed to pick up abnormal cells caused by HPV infection before it turns into cancer. Other tests can be done to identify the specific HPV types.
What is the role of the newly available HPV vaccines?
Two HPV vaccines are now licensed and available in South Africa .
* Gardasil ® will protect against infection with high risk types HPV 16 and 18 (which cause cervical cancer) as well as against HPV 6 and 11(which cause anogenital warts).
* Cervarix TM will protect against infection with high
risk types HPV 16 and 18 (which cause cervical cancer).
How does the HPV vaccine work?
The vaccine contains virus proteins that were identified from the most serious types of HPV. It is combined with an inactive substance that stimulates the body to cause a strong immune response. It does not contain any antibiotics or live viruses.
Who should receive the HPV vaccines?
In order to be most effective, the HPV vaccine should be given before a female becomes sexually active. The vaccine should be administered to girls aged 11-12 and as early as age 9. Young women aged 13-18 who have not yet started the vaccine series or who have started but not yet completed the course should be vaccinated.
Why does the vaccine have to be given at such a young age?
The vaccine will only prevent HPV infection if it is given before a girl has been exposed to the virus (i.e. sexually active).
Should young boys be vaccinated?
Studies are currently being done to determine whether the vaccine will prevent HPV infection and genital warts in boys. At this stage the vaccines are not registered for use in males. Furthermore, at present it is not cost effective to vaccinate young boys.
How many doses of HPV vaccine should be given?
A series of three doses of HPV vaccine within a period of six months should suffice.
How effective are the HPV vaccines?
The Gardasil ® HPV vaccine has demonstrated a high success rate in preventing cervical cancer precursors (70%) and genital warts (90%). The Cervarix TM HPV vaccine also claims excellent results in preventing cervical cancer precursors.
For how long will HPV vaccination last? Is a booster necessary?
We must bear in mind that the vaccine is new, but recent studies have indicated good protection against HPV for five years (which was the duration of the studies). Studies are ongoing to determine if further immunization or a booster dose is necessary.
Does the vaccine protect against all HPV types and other sexually transmitted diseases (STDs)?
The vaccine only protects against the types of HPV mentioned earlier.
Is the vaccine safe?
The vaccines have been tested extensively and all indications are that they are safe.
Does the vaccine have any side effects?
There have been a few side effects reported, the most common being a brief discomfort at the site of the injection.
Will females who have been previously vaccinated still need to be screened for cervical cancer?
As mentioned, the HPV vaccines do not protect against all types of HPV. Even when someone is vaccinated, it is still possible to become infected with one of the less common types of HPV that the vaccine does not claim to protect against. Therefore, it is important that vaccinated females continue to have regular screening tests such as Pap smears and/or HPV molecular testing.
Document compiled by the South African HPV Advisory Board
An expert panel on human papilloma virus infection and its clinical implications June 2008
