March 4th is Human Papillomavirus (HPV) International Awareness Day– by Joanna Palmieri, M.D.

 It’s unbelievable that since 2018 a mere virus has been given its very own day of awareness. There are quite a few reasons why and here some very important HPV facts to mention:

• Absolutely every single human being is at risk of becoming infected with HPV.

• The prospect of a high-risk HPV infection progressing to cancer is about 10%, even though about half of HPV infections are from high-risk strains.

• There are approximately 13 million Americans infected with HPV annually.

• The human papillomavirus is indeed a sexually transmitted infection (STI).

• HPV is spread by close skin to skin contact or touching during vaginal, anal and oral sex.

• A person can get HPV when their vulva, vagina, cervix, penis or anus is touching another person’s genitals, mouth or throat.

• The virus is spread by the skin to skin contact itself, which means that the sharing of bodily fluids is not necessary for transmission.

• This virus can also be spread when an infected person has no known or visible signs or symptoms of active HPV.

Studies show that 85% of people will get an HPV infection in their lifetime.  According to the World Health Organization (WHO) about 5% of all cancers worldwide are caused by HPV. It is estimated that 625,600 women and 69,400 men get HPV related cancers annually. Cervical cancer is the most common HPV associated cancer in women and oropharyngeal cancers are the most common in men.  Knowing that HPV has the potential to result in cancer at all seems like a great reason to get vaccinated.

The HPV vaccine is indeed associated with a clinically significant decreased risk of invasive cervical cancer, and that risk is decreased even more when vaccination occurs before age 17.  Studies have shown that there is an 88% reduction of risk for invasive cervical cancer development in young women that are vaccinated prior to age 17, and a 53% reduction in women vaccinated between the ages 17 and 30 compared to unvaccinated women.

The natural progression of HPV is important to help understand it better and to be able to openly discuss it with preteens, teens and young adults.  It is a lot to digest and while awareness is paramount, the vaccine holds the key to prevention.  Let’s get our kids vaccinated and prevent HPV related cancers!

Some more important HPV points are:

• It is impossible to track the exact time of exposure to HPV, especially because a person can be infected with more than one strain at a time. 

• Most people will clear a strain of HPV in about 2 years. 

• It is not known how long a person can pass a strain on to others within that 2-year time frame.

• A person develops natural immunity to a strain once exposed and usually will not get the same strain again

• There many different strains of HPV and they are classified into low risk and high risk subtypes.  

• Low risk HPV strains, most commonly HPV 6 and 11, do not progress to precancerous or cancerous lesions.  They are the most common culprits causing external genital warts (EGW). The high risk strains are the ones that have the risk of progressing to cancer.

HPV has no gender biases. It’s sort of like a “come one come all, no exceptions” type of virus. The gender differences that appear in statistical analyses only exist because there are currently no screening tests for males.

Guidelines have changed over the years regarding pap smear screening (a test that collects cells of the cervix)*. Current recommendations are to begin obtaining a pap smear at age 21 even though people are likely exposed to HPV at a much younger age. Mostly, our bodies clear these infections and they do not proceed to cancer.

It is still important to see a healthcare professional, at any time, to discuss questions or concerns about your own body or anything that is present on the genitals.  External genital warts (EGW) can feel like raised bumps, can be clustered or separate, usually flesh colored, may look cauliflower-like in appearance and can be anywhere on the genitals of anyone.  These warts can be treated by the healthcare professional but it is important to note that this is not a cure for the virus itself.  The most common causing strains of EGW are included in the HPV vaccine series.

There are many misconceptions, concerns and questions that keep people from getting the vaccine, so I will do my best to dispel those here:

• “Getting our children vaccinated is equal to giving them a license to engage in sexual activity.” 

• Answer: To date, there is no known increase of birth control visits, counseling, pregnancies or STI’s in vaccinated individuals. This suggests that there is no correlation between the HPV vaccine and increased sexual activity in youth populations.

• “I had my child vaccinated, how can they still get HPV?” 

• Answer: The HPV vaccine only protects against certain HPV strains, which include two of the more common low risk types (which cause 90% of genital warts), and seven of the high-risk strains.

• “Why give it so early when my kid is not yet sexually active at all?”      

•  Answer: vaccines are most effective when administered prior to exposure of the virus, therefore, vaccinating at the recommended time will provide the recipient with the highest amount of protection.  

• “My child has already had HPV, so why get vaccinated?” 

• Answer: anyone can still get other strains of HPV that they have not yet been exposed to. In addition, the vaccine builds on the natural immunity that develops after exposure to the virus. Also note, it is not harmful to be vaccinated if you have already been exposed.

The vaccine is approved for ages 9-26, but older individuals may receive the vaccine and should discuss it with their health care provider. The vaccine schedule is not complicated, and your physician’s office will have the most up to date recommendations and guidelines available.

• Currently, the Center for Disease Control (CDC) recommends two doses of the HPV vaccine for all 11- or 12-year-old youth. The second dose should be given 6-12 months after the first. It is also important to understand that the vaccine only protects individuals from future HPV infections and does not treat pre-existing HPV or ongoing infections.

There are no taboo subjects in my line of work, and they are only ever taboo if we shy away from them. Let’s be aware on HPV awareness day, and get our kids vaccinated!

*Not every pelvic exam includes a pap smear, so those terms are not synonymous.