Human papillomavirus (HPV)

Overview

Human papillomavirus commonly called HPV infection, is a viral sexually transmitted infection (STI) that causes mucous membranes or skin growths (warts). There are over 100 different kinds of human papillomavirus with the majority of them causing warts, while others cause different types of cancer.

The HPV virus is different from HIV and HSV (herpes). HPV affects mostly teenagers and young adults in their early 20s. It is transmitted through sexual contact with an infected partner, and several individuals are infected shortly after the onset of sexual activity. 

In most cases, the HPV infection does not cause cancer, but certain types of genital HPV can lead to a variety of cancers such as cancers of the penis, anus, vagina (cervical), and oropharyngeal.

Even though HPV can lead to the mentioned types of cancer, there are vaccines that can stop this from happening. It is important to treat it once the symptoms show up.

Facts and Figures  

Women are highly affected by HPV compared to men. There are over 100 types of HPV, and about 14 of them are cancer-causing (high-risk type). Cervical cancer is caused by sexually acquired infection, mostly through HPV types 16 and 18 that cause 70% of cervical cancers and cervical lesions.

According to the World Health Organization, cervical cancer is the second most common type of cancer affecting women in developing countries with approximately 570,000 new cases reported in 2018.

In the same year, about 311,000 women died from cervical cancer caused by HPV, with 85% of them reported in low-and-middle-income countries. Vaccines that protect against HPV 16 and 18 exist and are recommended by WHO to be used in the entire world. 

In Kenya, approximately 9.1% of women in the general population are estimated to harbor cervical HPV-16/18 infection at a given time. About 63.1% of invasive cervical cancers are linked to HPV 16 or 18.

Symptoms

Several people with strong immune systems manage to defeat the HPV infection before it creates warts. However, when warts appear, they differ in appearance depending on the kind of HPV involved:

Genital warts: they appear as flat lesions, tiny stem-like protrusions small cauliflower bumps. In women, they mostly appear on the vulva but can equally occur near the anus, in the vagina, or on the cervix.

Female genital warts

In men, they appear on the scrotum, the penis, or the anus.

Male genital warts

Genital warts rarely cause pain or discomfort, but they may feel tender or itch.

Common Warts: They appear as rough and raised bumps on the hands and fingers. Most of them are unsightly but can be painful or vulnerable to bleeding or injury.

Common warts

Plantar Warts:  They are grainy, hard growths that often appear on the heels or balls of the feet. These warts may cause slight pain and discomfort.

Plantar Warts

Flat Warts: They are flat-topped, slightly raised lesions. They may appear anywhere on your body, but children often get them on the face while men tend to get them in the beard area. Women mostly get them on the legs. 

Flat warts on the face

Causes

HPV infection takes place when the virus enters the body, normally through abrasion, a cut, or small tear in your skin. The virus transfers mostly by skin-to-skin contact.

Genital HPV infections are contracted through anal sex, sexual intercourse, and other skin-to-skin contacts in the genital area. Certain HPV infections that lead to upper respiratory lesions are contracted through oral sex.

Pregnant women with HPV infection and genital warts may possibly infect their babies during delivery. Rarely do infections on the babies cause growth in the voice box (larynx of the babies).

Warts may also spread when someone touches something that already touched a wart, which means that they are very contagious.

Risk Factors

  • Number of sexual partners: The more they are, the higher the risk
  • Weakened immune systems: Weak immune systems easily get HPV infections.
  • Age: Common warts mostly occur in children while genital warts mostly occur in adolescents and young adults in early 20s
  • Personal contact: Touching a person with warts or not wearing protection before contacting surfaces that have been exposed to HPV
  • Damaged Skin: Skin areas with punctured or openings are more prone to common warts.

Diagnosis

The HPV infection is mostly diagnosed through a visual inspection where the doctor can look at the area affected and determine whether warts or lesions are related to HPV or not. Nevertheless, additional tests may be required to confirm the presence of HPV or determine the specific HPV type.

These tests include a DNA test, Pap smear, and the use of acetic acid (vinegar). At times, a biopsy may be required to check abnormal areas.

Treatment

There is no cure for HPV infection, but there are several treatment options for the symptoms/warts as well as vaccines to prevent infection. The main vaccine used is the HPV vaccine.

As mentioned earlier, the majority of warts occurring because of HPV resolve without treatment if your immune system is strong.

Nevertheless, there are medications that can be applied to the skin to remove warts. They include over-the-counter salicylic acid for common warts. As of May 2019, DuoFilm Wart 15ml was worth Ksh. 1000.

Prescription medications to treat warts include:

  • Imiquimod (Aldara, Zyclara)
  • Podophyllin (Applied by a doctor)
  • Podofilox (Condylox)
  • Trichloroacetic acid (Applied by a doctor)

In some cases, surgical intervention may be required and include:

  • Electrocautery: Electro current that burns abnormal areas
  • Cryotherapy: This technique employs liquid nitrogen to freeze abnormal areas
  • Laser Therapy: A light beam used to remove unwanted tissue
  • Surgical removal
  • Interferon injection: This is rarely used because of the high risk of side effects and cost

Always speak to the doctor to determine the best treatment to use depending on the location of warts, severity, and HPV type.

Since there is no treatment of HPV infection, the virus is likely to remain in the body even after treating warts.

Prevention

  • Get HPV vaccination, especially if you are a teenager or young adult:  The most recent vaccine is Gardasil 9 (ages 9 to 45) that protects genital warts and cervical cancer. Recommended for teenagers aged 11 to 14.
  • Abstain from sex or use a latex condom when you engage in sexual activity
  • Avoid many sex partners – practice monogamy and go for STD test before engaging sexual contact
  • If you have a common wart, you can prevent spread and formation of new warts by not picking at a wart and avoid biting your nails
  • To avoid plantar warts, wear shoes or sandals in public locker rooms or pools

For more information on treatment, speak to a doctor, or get access to a hospital near you through the Uzima Health App.

Sources

https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer

https://www.medicalnewstoday.com/articles/246670.php

https://www.cdc.gov/std/hpv/stdfact-hpv.htm

https://www.mayoclinic.org/diseases-conditions/hpv-infection/symptoms-causes/syc-20351596