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HPV

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HPV

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

Human papillomavirus (HPV) is the most common sexually transmitted infection in the world. Almost all sexually active people will be infected at some point in their lives, usually without symptoms. HPV usually goes away on its own without treatment.  HPV can affect the skin, genital area and throat. Some HPV infections cause genital warts whilst others can cause abnormal cells to develop, which go on to become cancer. Cervical cancer is the most common type of cancer caused by HPV. Other less common cancers affecting both men and women include anal, vulva, vaginal, mouth/throat and penile cancers. Cancers from HPV can be prevented with vaccines.

HPV IN SOUTH AFRICA

Cervical cancer is the second most common cancer among women in South Africa after breast cancer, but the cancer most women die of.  Close to 80% of cervical cancers are caused by HPV.

The Department of Health provides free HPV vaccination for girls aged 9 – 14 at government schools as part of its Expanded Programme on Immunisation. Children at private schools can be vaccinated by private health professionals or clinics. The HPV Vaccine is available from Bonitas as a preventative care benefit across all plans: you can find more information here.

Boys younger than 15 can also receive the vaccination privately. This is important as HPV can also affect them, causing anal and penile cancers, and cancers of the mouth and throat.

The HPV vaccine used in South Africa is very safe and effective in preventing the HPV-16 and HPV-18 strains of the virus. HPV Types 16 and 18 cause about 70% of cervical cancer cases.

RISK FACTORS FOR HPV

HPV is spread through skin-to-skin or skin-to-mucosa contact. While mostly transmitted sexually, it can also be spread through fingers, mouth, and skin contact (other than sexual).

Your risk for HPV infection is increased if you:

  • have multiple sexual partners

  • have sex with someone who has had multiple sexual partners

  • have sex without using barrier protection, such as a condom or dental dam (it is important to note that even if you do use condoms, they help prevent HPV but do not protect you completely, as they do not cover all the genital skin).

  • have areas of broken or damaged skin

  • have contact with warts or surfaces where HPV exposure has occurred

  • have not been vaccinated against HPV

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SYMPTOMS OF HPV INFECTION

Most people will not have any symptoms from an HPV infection. In 90% of cases, the immune system clears HPV from the body within a year or two with no lasting effects. However, because the virus is still in a person’s body during this time, that person may unknowingly transmit HPV.

HPV infection that does not go away on its own can cause changes to cervical cells, which lead to precancers that may become cervical cancer if left untreated. It usually takes 15–20 years for cervical cancer to develop after HPV infection.

The early changes in cervical cells and precancers mostly do not cause symptoms. Symptoms of cervical cancer may include bleeding between periods or after sexual intercourse or a foul-smelling vaginal discharge. If you have these symptoms, it is important that you speak to your healthcare provider.

Because HIV weakens the immune system, people living with HIV are more likely than HIV negative people to have an HPV infection that continues (persistent infection). One study found HPV in more than three out of four women living with HIV. Women living with HIV who have HPV are also more likely to have:

  • Difficulty clearing the infection naturally

  • HPV infections that were once under control and come back again

  • HPV that responds poorly to standard treatment; multiple therapies using different methods may be needed

  • Several types or strains of HPV at once

  • Infection with the “high-risk” HPV types that can cause cancer

  • Greater vulnerability to developing cervical and anal cancer when living with the “high-risk” types

If you have sex, it is important to be checked regularly by your healthcare provider for signs of HPV such as genital warts, cervical cancer, and anal cancer.

HPV AND PREGNANCY

Contracting HPV doesn’t decrease your chances of becoming pregnant. If you’re pregnant and have HPV, you may wish to delay treatment until after delivery. However, in some cases, HPV infection can cause complications.

Hormonal changes that occur during pregnancy may cause genital warts to grow and in some cases, these warts may bleed. If genital warts are widespread, they may make a vaginal delivery difficult. When genital warts block the birth canal, a C-section may be required.

In rare cases, a woman with HPV can pass it on to her baby. When this happens, a rare but serious condition called recurrent respiratory papillomatosis may occur. In this condition, children develop HPV-related growths in their airways.

Cervical changes can still occur during pregnancy, so you should plan to continue routine screening for cervical cancer and HPV while you’re pregnant up to 20 weeks. Pregnant women with abnormal screening results should therefore go for re- screening six to 12 weeks after delivery.

HOW DO I PROTECT MYSELF AGAINST HPV INFECTION?

Being vaccinated is the best way to prevent HPV infection, cervical cancer and other HPV-related cancers.

  • HPV vaccines should be given to all girls and boys aged 9–14 years, before they become sexually active.
  • The vaccine may be given as 1 or 2 doses. People with reduced immune systems should receive 2 or 3 doses.
  • Adults ages 26 and younger should receive the vaccine. This recommendation applies whether you’ve never received a vaccine or started the series earlier and never finished it.
  • Adults up to age 45 should receive the vaccine in certain circumstances. Research shows it can prevent HPV infections in this age group, too.

Using condoms during sex is an important way to prevent HPV infection. Voluntary male circumcision also reduces the risk of infection. Being a non-smoker or stopping smoking reduces the chances of developing persistent HPV infection.

It is important to note that the HPV vaccine isn’t intended to replace pap smears. Routine screening for cervical cancer through regular pelvic exams and pap smears remains an essential part of a woman’s preventive healthcare. Screening can detect cervical precancers that can be treated before they develop into cervical cancer.

The South African HPV Advisory Board recommends that a woman begins having pap smears when she becomes sexually active or turns 21 each year until the age of 30 and then every 3 years after the age of 30.

HOW IS HPV TREATED?

There is currently no treatment for HPV infection. Treatments exist for genital warts, cervical precancers and cervical cancer.

Non-cancerous genital warts and precancerous lesions in the cervix, vagina, vulva, anus or penis can be removed or treated by freezing or heating, or with surgery.

Treatments for cancers caused by HPV (including cervical cancer) are more effective if diagnosed early. Regular pelvic exams and pap smears can save your life.

FURTHER READING