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Facts about HPV

What is HPV?
What does the distinction between low-risk and high-risk HPV mean?
How is HPV transmitted?
What are the signs and symptoms of HPV?
How can people protect themselves from HPV?
What are the short and long-term effects of HPV?
Is there a test?
Once I have HPV, do I have it forever?
If I already had HPV, can I get it again?
Is there a cure?
What are the latest medical advancements for HPV prevention?
Where can I find more information about HPV and safer sex?

What is HPV?

Human papillomavirus, or HPV, is a virus that infects the skin and genital area. More than 130 types of HPV have been identified. Some infect the skin and can produce warts, some infect the genital area and can produce genital warts, and some infect the genital area and can lead to cancer of the cervix, the opening of the uterus. They can also cause cancers of the vagina, vulva, penis, anus, mouth and throat.

What does the distinction between low-risk and high-risk HPV mean?

When the HPV virus is in contact with human cells, it may cause changes to the cell. These changes are called lesions. High-risk oncogenic HPV types are able to integrate into the DNA of the cell and modify its behaviour in a way that can result in cancer. High-risk HPV are the cause of nearly all cervical cancers. They can also cause cancers of the anus, penis, vagina and vulva. There is growing evidence that high-risk types may also be involved in some cancers of the mouth and throat. Conversely, low-risk HPV types do not cause cancer. Some low-risk HPV types can cause genital warts (these are called condyloma) and other low-risk types cause lesions that are of no medical consequence or cause no lesions at all. Although people might feel uncomfortable having warts in their genital region, these lesions are not life threatening and rarely present health complications. Condyloma can develop very quickly or very slowly, they may be undetectable to the eye and they may clear up without treatment.

How is HPV transmitted?

HPVs that infect the genital area are sexually transmitted.

HPV viruses are very common. So much so that more than 75% of women and men will have this type of infection at one point of their life or another, and between 10% and 70% of women and men have HPV at any one time. HPV is most common in young women and men who are in their late teens and early 20s.

HPV can be transmitted through skin-to-skin sexual contact, whether or not there is penetration. It can be transmitted through vaginal or anal intercourse, oral sex and mutual masturbation (genital touching). The vaginal and anal tracts are particularly susceptible to sexually-transmitted HPV and the risk of transmission is greatest during penetration without a condom. This being said, HPV is also found on parts of the body such as the vulva, scrotum and inner thighs which are not covered by a condom. It is thus possible to for partners to transmit HPV even when a condom is used.

HPV can be transmitted through vaginal sex, anal sex, oral sex, or skin-to-skin contact of the genitals.

Researchers of the HITCH Cohort Study found more than half (56 per cent) of young adults in a new sexual relationship were infected with human papillomavirus (HPV). Of those, nearly half (44 per cent) were infected with an HPV type that causes cancer. Results also indicated that there is a high probability of HPV transmission between partners. When one partner had HPV, the researchers observed that in 42 per cent of couples, the other partner also had the infection. Moreover, the researchers found that the presence of HPV in one partner was the strongest predictor of finding the same HPV type in the other partner. If one partner was infected with HPV, the other partner’s chance of also being infected with the same HPV type increased over 50 times.

What are the signs and symptoms of an HPV infection?

The types of HPV that cause genital warts do not cause cancer. Genital warts (also called Condylomata) may be flat or look like a small cauliflower. They can appear on the vulva, cervix, penis, scrotum, rectum, or thigh area.

The types of HPV that can cause cancer are often a “silent infection”. They have no obvious signs or symptoms, and most people will not even know they are infected. For women, the main concern is infection of the cells of the cervix. These infections can lead to changes in the cervical cells that can be observed under the microscope in a Pap test.

How can people protect themselves against infection with HPV?

Anyone who has engaged in sexual activity with a partner is at risk of getting HPV.

Practicing safer sex, including condom use, can lower your risk of sexually transmitted infections. However, more research, such as the HITCH Cohort Study, is needed to determine whether condoms do in fact reduce the risk of HPV.

Having multiple partners increases your risk of HPV infection.

What are some short and long-term effects of HPV?

In young women, most high-risk HPV infections actually present very low risk. Most will not lead to lesions and will clear within a few months. Even mild lesions usually regress within a short time frame without any treatment. That being said, some infections may progress to cancer and it is important that women be screened. Nearly all cervical cancers are caused by HPV. Cancer of the cervix was the most common cancer in Canadian women before Pap test screening, and is still one of the most common cancers among women in some other countries. Fortunately, over 99% of women who have HPV will never get cervical cancer. Most HPV infections go away by themselves and do not cause cancer. In a small number of women, HPV will cause changes in cervical cells that can eventually lead to cancer if the virus is not cleared. This process is believed to take 10 or more years.

In young men, the actual risk posed by infection with a high-risk type is very low. HPV-related cancers are rare among men. There are fewer than 1 cancers of the penis per 100,000 men in Quebec each year.

About 1 in 100,000 Canadians are diagnosed with anal cancer each year.

There are special cases where the risk posed by HPV may be higher. This occurs when a person’s immune system is compromised, for example by co-infection with human immunodeficiency virus (HIV). HPV-related cancers such as cervical and anal cancers are more common in HIV-positive men and women.

Is there a test for HPV?

A test for HPV is available for women, but usually it is not covered by provincial health care coverage. Women must pay out-of-pocket for this test. It is not generally recommended for women under the age of 30.

On the other hand, the Pap test is freely available and is covered by provincial health care coverage. The main purpose of the Pap test is to find abnormal cell changes caused by HPV that may arise from cervical cancer or before cancer develops. If you are a sexually active woman, talk to your health care provider about screening for cervical cancer and the Pap test. Precancerous cervical cells and lesions detected in a Pap test can be treated and cancer can be prevented.

Once I have HPV, do I have it forever?

Most HPV infections in young men and women are transient, lasting no more than one or two years. Usually, the body clears the infection on its own. It is estimated that the infection will persist in only about 1% of women. It is those infections that persist which may lead to cancer. There is some research that suggests that the virus can hide deep in the affected mucosa or skin for several years, below detectable levels. These are called “latent” infections. Having an HPV-positive test followed by an HPV-negative test might mean two different things: that the virus has been completely cleared by the body, or that the level of infection is so small that laboratory tests cannot detect it. Thus, HPV might “reappear” several years after an infection (whether or not it was treated) when the immune system weakens (because of aging, pregnancy, illness, etc.) and then cause lesions. It is unknown what proportion of HPV infections go latent, nor what proportions are truly cleared by the body.

If I already had HPV, can I get it again?

It is possible. There are several types of HPV. Infection with one type will not result in immunity to the other types. Moreover, research has yet to determine whether infection and clearance from one type of HPV provides immunity against subsequent infections from the same HPV type.

Is there a cure for HPV?

There is no cure for HPV infection itself, but there is treatment for the effects of HPV.

Genital warts can be removed by medicated gels or creams, or by surgical methods.

If minor abnormalities in cervical cells are found in a Pap test, women are usually asked to return to their health care provider in six months for repeat screening. If the abnormal cells are more severe, women go to a gynecology clinic where the cells of the cervix can be examined more closely (colposcopy). Lesions can be removed using surgical methods.

Treatment for men with HPV-related lesions other than genital warts varies according to the type and severity of the found lesion. If the lesion is mild, your doctor may choose to wait and see if it clears up on its own. If the lesion is moderate to severe, your doctor will likely refer you to have it surgically removed.

What are the latest medical advancements for HPV prevention?

In 2006, Health Canada approved a vaccine called Gardasil®, which has shown to be effective against infection with human papillomavirus types 6, 11, 16 and 18. HPV types 6 and 11 cause most genital warts, and types 16 and 18 cause most cervical cancers. Women between 9 and 45 years  and men between 9 and 26 years can receive Gardasil®. A second vaccine, called Cervarix®, has been approved for women aged 10-25 and offers protection against infection with HPV types 16 and 18. At this time Cervarix™ has not been approved for use in males in Canada. 

In 2008, Quebec introduced a voluntary vaccination with Gardasil® for girls in grade 4 and secondary 3, as part of the government-funded provincial vaccination program. Click here for more details. Girls and women may receive HPV vaccination for free until the age of 18. After this time, it is still accessible to women although it is not included in provincial health care coverage. More information on HPV vaccination is available via the National advisory Committee on Immunization: Clique here to learn more.

The McGill Division of Cancer Epidemiology has recently launched the TRAP-HPV study aiming to shed light on the effects of vaccinating both partners among young heterosexual couples on reducing the transmission of the virus. TRAP-HPV is currently looking for heterosexual couples in Montreal aged between 18 and 26 years to take part in this study. More information is available at TRAP-HPV or at 514-398-8191.

Since the vaccine does not prevent infections from all types of HPV, women who receive the vaccine would still need regular Pap tests.

There have also been technological developments that may improve cervical cancer screening, such as the ThinPrep Pap test and incorporating HPV testing with Pap testing. The use of such technologies to improve existing screening practices are currently being investigated.

Moreover, the McGill CATCH Study is evaluating the efficacy of a Carrageenan-based lubricant in preventing the transmission of HPV. Carrageenan may represent a very cost-effective prevention method against the transmission of the virus. The CATCH research team is seeking women aging from 18 to 29 years of age to participate  in this study. More information is available at CATCH or at 514-398-8191.

For more information about HPV, cervical cancer, and safer sex, check out the following websites:

The Society of Obstetricians and Gynaecologists of Canada
The Canadian Cancer Society
Sexuality and U
The Foundation for Women's Cancer
Canadian Foundation for Sexual Health
CDC HPV and Men Fact Sheet
Public Health Agency of Canada
National Cancer Institute
McGill Shag Shop STI information