STI Files: H.P.V.

why are cells n stuff so pretty? are these cells? microbes? Img Source dr_microbes/istock/sciencealert.com

I have a vivid memory of sitting on the toilet at Strathpine Shopping Center, legs dangling, staring at a silver framed advertisement hanging on the back of the door. Pap smears, not quite sure what that is, but women over the age of 18 should get them every two years, hmf, I’ll put it on my adult to-do list. Fast forward to high school, the teachers said something about needles for cervical cancer, forms were signed and some unknown amount of time later the library was turned into a makeshift hospital. We lined up, got our needles and a lollipop and went back to class. Well… I actually went home because I react poorly to injections and/or some say a hypochondriac. But that’s not the point. Fast forward again and we meet here at The H.P.V. Diaries.

Pap smears, HPV, immunisations, STIs, cancer, flashbacks to childhood and school, mish mashes of information, if this all seems confusing, it kinda is. I promise I will try to break it down comprehensively, explain how they are all intertwined and why they are so important to be informed about. This is the STI Files.

THE HUMAN PAPILLOMAVIRUS

HPV has over 100 strains (different kinds), can be transmitted through skin to skin contact (yes, even hand stuff, no, condoms can’t guarantee protection) and can be asymptomatic (no symptoms). For these reasons, HPV has claimed the title of “Most Common STI”. In fact, 90% of Australians will contract HPV at some point in their lives. The symptoms (if any) and effects of HPV depend on which strain you are infected by. Strains are categorized as low risk and high risk, low risk can cause warts, high risk can, although rare, lead to cancer. Low or high, most strains are asymptomatic, so those infected may never develop a wart but simply have the virus present within their skin cells. Though this also means the virus can be passed around with the host never knowing they had it in the first place. Again, why it takes place holder of most common STI.

The facts and figures of HPV are quite alarming but keep in mind these stats have been taken from tracing symptoms to the cause of HPV, not from the origin point of HPV to see if they get symptoms… Does that make sense? I did prevocational mathematics at school, now watch me flex. It is estimated that 79 million Americans currently have HPV, with a fresh 14 million infected each year BUT only one in 100 have genital warts. Insto-facto, 1% chance of warts. Don’t get me wrong, I’m not trying to downplay it, but I also don’t want you to have a panic attack reading the following. Now let’s talk about warts!

LOW RISK

95% of Genital warts are caused by strains of low risk HPV, some strains are also responsible for the common warts found on hands and feet. They can appear as raised or flat lesions, single or multiple and often have a cauliflower like appearance. That’s how they are described in my medical textbook and let me tell you, I truly, truly hate when food is used for medical descriptors.

For the vast majority of people who are infected with HPV, their own immune system will kick in and clear the virus within 1-2 years. However, for a small proportion, the virus doesn’t clear and becomes incorporated into the cells, causing cellular changes, usually when the infection is with high risk types. This is called persistent HPV.

HIGH RISK

“ Persistent HPV infection can cause abnormal cells to develop on the cervix which may develop into cervical cancer if left untreated. Cervical cancer is the most common type of cancer caused by HPV, persistent infection also causes less common cancers affecting men and women, including anal, vulvar, vaginal, mouth/throat and penile cancers. “  - cancer.org.au

Again, flipping the stats around, while HPV is present in 99.7% of cervical cancer cases, more than 95% of people who have HPV will clear it themselves without ever knowing they had it. We also have proven methods of detection and prevention.

PAPAROONIES & C.S.T.’s

The pap test (Papanicolaou test) is a method of cervical screening used to detect changes in the cervix or colon caused by HPV. This test, with normal results, was recommended every two years for women aged 18-69. In 2017, it was replaced with the Cervical Screening Test which, with normal results, is only needed every 5 years for women aged 25-74. What’s the difference? The process of collecting the cells (legs bent, relax your knees, there she blows) is the same, it’s the way they are tested after that, that has changed. I am going to directly quote from cancer.org.au because they put it so simply it’s just beautiful.

“ In the Pap smear test, scientists use a microscope to look for precancerous changes to the cells. This is why the Pap smear test needs to be done every two years. Instead of looking for changes to the cells of the cervix, the new HPV Cervical Screening Test allows scientists to look for the virus that causes the cell changes in the first place. HPV testing looks for the virus inside the cervical cells, which means doctors can find women who could be at risk of developing cervical cancer in the future. “

Just to let you know how important cervical screenings are, since the introduction of the National Cervical Screening Program in 1991, a program that offers free pap tests, our fatality rate dropped, and we now have one of the world’s lowest rates of cervical cancer mortality. With the new CST, our cervical cancer incidence and mortality rate is expected to reduce by up to another 20%. With that in mind, 80% of Australian women with cervical cancer have never been screened or have not had regular screening tests.

IMMUNISATION

In 2007 the National HPV Vaccination Program was rolled out across Australia. An initiative to provide HPV vaccines for free to eligible children. That’s when I had my injections. Girls in school from 2007 (and boys from 2013)  https://www.cancer.org.au/news/news-articles/boys-join-national-hpv-vaccination-program.html

should have had 3 shots of Gardasil. Gardasil protects against HPV strains 6 and 11 – they are non-cancerous but cause 90% of genital warts and strains 16 and 18 – the two strains that cause the majority of HPV related cancers. In 2018 Gardasil was replaced with Gardasil9, as well as strains 6, 11, 16 & 18, it covers the next 5 most common HPV types associated with cancer, types 31, 33, 45, 52 & 58.

~ Side note, I want to point out the words “protection against” are important, you’re provided with protection against HPV strains 6, 11, 16, 18 (& 31, 33, 45, 52, 58 if you were in school from 2018). This doesn’t mean you’re immune to HPV or HPV related cancers. In saying this, this injection is, in my opinion, so fucking important. ~

The best time to be immunised is before you become sexually active because If you have had sexual contact, you may have already been infected with a strain of HPV. If you have been infected any type of strain included in the vaccine, the vaccine will not protect you against HPV related cancers and diseases caused by that HPV type. For example, say if I had already been infected with type 18 and then had my shot of Gardasil, I would only be protected against 6, 11 and 16.

If you’re under 20 and didn’t get your shots at school, you can get two doses of the HPV vaccine for free under the National Immunisation Program. If you’re over 20, never had the shots and you want them, go and talk to your GP. I spoke with my doctor and gynaecologist and they said I shouldn’t bother getting the Gardasil 9 over the top of my Gardasil because the chances are so high that I have already been exposed to those strains and sorted it out myself.

In summation, 4 out of 5 people will get HPV at some point, condoms don’t fully protect you but they sure as shit help. If you get HPV you will more than likely not know and your body will clear it up on its own but the only way to be certain is to keep on top of your cervical screenings.

PREVENTION & DETECTION

Now, this is my favourite bit. In the early 80’s Dr Zur Hausen and his team cracked the fucking code and discovered the link between cervical cancer and HPV. In 1984 they cloned HPV strains 16 & 18 from patients with cervical cancer and even though his peers had earlier dismissed his theories, once Dr Hausen had the clones, he made them freely available to the scientific community. His research eventually led to development of a vaccine against HPV 16 & 18.

For the list of resources I used and some links for more info click here.