About HPV

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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.

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 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?

Currently, in Canada there is an HPV DNA test approved for women but not for men. However, it is possible to detect anogenital warts, which are the most common consequence of an HPV infection in men. Anogenital warts are diagnosed by a visual inspection during a physical exam by a health care professional. It is important to remember that just because you cannot see warts, does not mean that you do not have any. They may be small, or in a place where you cannot see them, such as inside the rectum. It is important to have regular check-ups by a health care professional.

There are currently no general screening recommendations in place for penile or anal cancer. The Pap (Papanicolaou) test can be used to screen for cell changes in the anus (precancerous and cancerous changes) in the same way it is used to detect cell changes in the cervix of woman. Researchers are still working to see if this is both an adequate and cost-effective way to screen for anal cancer. In the absence of screening recommendations or effective screening tests, it is very important to have regular check-ups and to tell your health care professional about any signs or symptoms you are having.

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: Click here to learn more.

In 2015 Health Canada approved Gardasil 9®, a second-generation HPV vaccine. Gardasil 9® is designed to prevent cervical, vulvar, vaginal and anal cancers caused by nine HPV strains, five more than the original Gardasil® vaccine. Gardasil-9® covers types 6, 11, 16, 18, 31, 33, 45, 52, and 58.

Effective as of September 1, 2016, the vaccine will also be offered to all boys in Grade 4 in order to provide all young people with fair and direct protection.

Under the Québec Immunisation Program, the following people can also be vaccinated free of charge:

• Girls between 9 and 17 years old

• People aged 26 or under who:

  • Have a weakened immune system
  • Are infected with HIV

• Since January 1, 2016, men aged 26 or under who have or plan to have sex with men.

Where can I find more information about HPV and safer sex?

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

The Canadian Cancer Society
Sexuality and U
Canadian Federation for Sexual Health
CDC HPV and Men Fact Sheet
Public Health Agency of Canada
National Cancer Institute
Getting involved with HPV research

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