In this new age of globalization, young girls and women now face greater challenges to their health. Old diseases are changing and becoming increasingly difficult to treat and relatively new and supposedly harmless infections are affecting a greater population with unfavourable outcomes. It therefore becomes imperative for both the young and old to become extremely vigilant about health matters concerning themselves and those of their loved ones.
Human papillomavirus (HPV) is a group of viruses that are extremely common worldwide. It is the most common viral infection of the reproductive tract. There are more than 100 types of HPV, of which at least 13 are cancer-causing (also known as high risk type). It is not a new virus, but more is being learnt about it. HPV is mainly transmitted through sexual contact and most people are infected with HPV shortly after the onset of sexual activity and some may be repeatedly infected.
Although HPV can be spread during sex – including vaginal, anal, and oral sex – sex isn’t the only way for the infection to spread. All that’s needed is skin-to-skin contact with an area of the body infected with HPV.
Sexually transmitted HPVs fall into two categories:
• Low-risk HPVs, which do not cause cancer but can cause skin warts (technically known as condylomata acuminata) on or around the genitals or anus. For example, HPV types 6 and 11 cause 90 percent of all genital warts.
• High-risk or oncogenic HPVs, which can cause cancer. Two of these, HPV types 16 and 18, are responsible for the majority of HPV-caused cancers.
Infection with HPV is very common. In most people, the body is able to fight and clear the infection on its own without intervention within a few months after acquisition, and about 90% clear within 2 years. But sometimes, a re- infection occurs. Chronic, or long-lasting infection, especially when it’s caused by certain high-risk HPV types, can cause cancer over time.
Cancer types linked with HPV
In Africa, especially the sub-Saharan African region faces a number of important public health issues, including HIV/ AIDS, infectious diseases and cancer. It is noted that due to the overwhelming burden of communicable diseases in Africa, there has been a paucity of focus in cancer in the continent.
Cervical cancer is the second most common cancer in women living in less developed regions with an estimated 445 000 new cases in 2012 (84% of the new cases worldwide). In 2012, approximately 270 000 women died from cervical cancer; more than 85% of these deaths occurring in low- and middle-income countries. It is by far the most common HPV-related disease with nearly all cases of cervical cancer being attributable to HPV infection. Two HPV types (16 and 18) cause 70% of cervical cancers and precancerous cervical lesions. There is also evidence linking HPV with cancers of the anus, vulva, vagina, penis, mouth, throat and oropharynx.
Presently, it is estimated that over 200 million females older than 15 years are in sexual relationships, and are therefore at risk of cervical cancer in sub-Saharan Africa. it is however difficult to estimate the true burden of cervical cancer in the region due to the failure of women to report cervical cancer in hospital settings and the limited number of cancer registries in sub-Saharan Africa.
Signs and symptoms
The majority of HPV infections do not cause symptoms or disease and resolve spontaneously. However, persistent infection may lead to precancerous lesions. If untreated, these lesions may progress to cervical cancer. It takes 15 to 20 years for cervical cancer to develop in women with normal immune systems and 5 to 10 years in women with weakened immune systems, such as those with untreated HIV infection.
Symptoms of cervical cancer tend to appear only after the cancer has reached an advanced stage and may include:
• Irregular, inter-menstrual (between periods) bleeding
• Abnormal vaginal bleeding after sexual intercourse;
• Back, leg or pelvic pain
• Fatigue, weight loss, loss of appetite;
• Vaginal discomfort or odourous discharge
• A single swollen leg.
More severe symptoms may arise at advanced stages
Risk factors for HPV infection and Cervical Cancer
• Having sex at an early age
• Having multiple sexual partners
• Having a partner who has had multiple sexual partners
• Having sex with uncircumcised males
• Weakened immune system
• Sexually transmitted infections
• Having many children ( >5: increased risk of cervical cancer)
• Long term use of oral contraceptives ( increased risk of cervical cancer)
Can HPV infection and Cervical Cancer be prevented?
There is no one way to prevent all the different types of HPV but there are lifestyle choices that can decrease the chances of being infected.
• Abstinence before marriage
• Use of latex Condoms during every sexual contact. (does not completely prevent infection)
• Get vaccinated against HPV
There are two vaccines currently available for prevention of HPV in girls and boys, and both are available in Nigeria (Cervarix manufactured by GSK Biologicals and Gardasil by Merck & Co). They are prepared from virus like particles, best used prior to sexual and HPV exposure and not used to treat existing infection. They are both taken as 3 doses over a 6 month period. WHO has approved the vaccines for administration from the age of 9 -13 years, which is the period in which optimal efficacy of the vaccine is achieved. However, the two dose strategy has recently approved in place of three doses for the same age group.
Get screened for HPV and Cervical Cancer
Cervical cancer screening is testing for pre-cancer and cancer among women who have no symptoms and may feel perfectly healthy. When screening detects pre-cancerous lesions, these can easily be treated and cancer avoided. Screening can also detect cancer at an early stage and treatment has a high potential for cure.
3 different types of screening tests are currently available:
* Conventional (Pap) test and liquid-based cytology (LBC)
* Visual inspection with Acetic Acid (VIA)
* HPV testing for high-risk HPV types.
Women who are sexually active should be screened for abnormal cervical cells and pre-cancerous lesions, starting from 30 years of age. It should be done every three (3) years after two (2) consecutive negative test results done 1 year apart.
Treatment options for HPV and Cervical Cancer
There is currently no medical treatment for HPV infections. However, the genital warts and precancerous lesions resulting from HPV infections can be treated.
Methods commonly used to treat precancerous cervical lesions include cryosurgery (freezing that destroys tissue), LEEP (loop electrosurgical excision procedure, or the removal of cervical tissue using a hot wire loop), surgical conization (surgery with a scalpel, a laser, or both to remove a cone-shaped piece of tissue from the cervix and cervical canal), and laser vaporization conization (use of a laser to destroy cervical tissue).
If signs of cervical cancer are present, treatment options for invasive cancer include surgery, radiotherapy and chemotherapy.
• Almost all women who have had sex will have HPV infection at some time
• Most HPV infections go away without causing cervix cell changes. HPV causes no symptoms and cannot be treated but the changes it can cause in the cervix can be treated.
• HPV that does not go away over many years can cause cervical cancer
• Most Cervical cancer can be prevented by vaccinating both girl and boys, regular screening and early treatment of precancerous lesion
• See your doctor or nurse for more information on vaccination, screening tests and support on HPV and Cervical Cancer