Even ‘virgins’ can have HPV

MANILA, Philippines - One problem with health awareness campaigns is that these sometimes become victims of their own success. With so many stories about a health topic of concern, there is a tendency for the target audience to steer clear of the subject. “It’s that topic again,” they disparagingly say as they pass up on the chance for more information. And thus, the chance to educate, update, and protect themselves and their families is lost.

Perhaps, this is true in the case of the Human Papillomavirus (HPV) and its correlation to cervical cancer. About 70 percent of cervical cancer is caused by the HPV types 16 and 18, but with numerous features on the subject matter often saying the same things, one cannot fault the target audience if there is a tendency to pay less heed.  However, repetition is necessary as the problem persists. “Around 288,000 deaths due to cervical cancer are reported each year, with over 80% of cases occurring in developing countries such as the Philippines,” says Dr. Benjamin Cuenca, member of the board of trustees of the Philippines Obstetrics and Gynecological Society (POGS). “In the Philippines, 12 women die of cervical cancer every day.” Thus, obstetricians and gynecologists were again urged to push for cervical cancer awareness during the POGS convention in Subic, Zambales.

“We have to cover 75% of the target population in order to make a dent and lower cervical cancer incidence,” notes Dr. Genara Limson, a respected pioneer in cervical cancer prevention. “Two thirds of cervical cancer cases in our country are diagnosed when these are in the advanced stages.” The challenge of mass screening, she says, is partly due to the lack of government cytopathologists. “They are overworked and overburdened.” The difficulty is further compounded by the reality that trained cytopathologists are lured by better work opportunities abroad, and the fact that the budget for a more organized mass screening program is sorely lacking. “Sadly, there are added priorities that local governments deem as more pressing.” Moreover, says Dr. Limson, there is a need to convince more women to undergo screening since “we cover the same people year after year.” She reminds the group, “It is the obligation of every obstetrician and gynecologist to tell her patient about the HPV vaccine.”

But Professor Sun Kuie Tay, a respected gynecologist at the Singapore General Hospital, takes it a step further. “We need to get all doctors — not just obstetrician-gynecologists — to join us in the advocacy against cervical cancer,” he points out. “There is a continuous need for public education and women should be reminded to take responsibility for their health.”

He adds, “Patients’ willingness to be educated and seek treatment is important. Women need to be told:  Vaccinate and protect your daughters.”

Physicians should be able to reassure their patients that the vaccine has been available for several years now and that it has been found to have no major adverse side effects. Vaccination of girls as young as nine years old is recommended because the immune response works best at an early age.

The following are more pertinent facts about HPV:

• Non-sexual transmission of the virus is possible. “An infected mother can pass the HPV virus to her baby during delivery,” explains Dr. Tay. “The virus can remain dormant on her skin for years, but may be introduced to the cervix via sexual intercourse in later years.”   

• Safe sex is important.  The incidence of HPV infection is lowered by limiting the number of sex partners, so a faithful relationship with one partner is a good idea. Condom use can lower the incidence of infection, but female condoms offer better protection because they are more effective in preventing skin-to-skin contact.

• HPV infection is common. Almost every sexually active person will get HPV during his/her lifetime. Most people do not realize that they are infected and are infecting their partners.

• “Virgins” can have HPV. Non-penetrative sexual contact can be a mode of infection. A person can still have HPV even if years have passed since her last sexual contact.

The virus cannot be transmitted through towels or toilet seats.

• Smoking, excessive alcohol intake, and stress put a person at higher risk: Unhealthy habits and diseases (like HIV or herpes) that lower immunity put people at higher risk for HPV infection.

• Oral HPV infection is possible. Recurrent respiratory papillomatoses (RRP) a condition where warts grow in the throat, can occur in the children of women with genital warts. Oral HPV infection through oral sex can cause oropharyngeal cancers.

Routine screening of women 21-65 years and appropriate treatment markedly lower mortality rate from cervical cancer.

Cervical cancer is preventable through regular screening and vaccination.