Written by Dr. Nancy Durand, a gynaecologist at Sunnybrook, with a clinical and research interest in minimally invasive surgery, HPV and colposcopy.
"You have an abnormal Pap test." Anxiety-producing words many of my female patients have heard. If you're sexually active in Canada, chances are you may hear them at some point, too.
Abnormal Pap tests are caused by strains of the Human Papilloma Virus, or HPV. HPV is the most common sexually transmitted infection in the world. Estimates show about 75 per cent of sexually active men and women will have at least one HPV infection in their lifetime. Prevention for women includes regular Pap tests, which take a sample from the cervix or vagina to look for cell changes that show cancer, or conditions that may develop into cancer.
An abnormal Pap test doesn't mean you have cervical cancer. Most HPV infections will actually go away within 24 months. About 20 per cent of infections will not clear and may go on to cause disease.
Unfortunately, men don't have the safety net of a Pap test for detection.
Here's the low-down on HPV
There are over 100 types of HPV. About 40 infect the anus and genitals, or anogenital tract.
Infection with low-risk HPV can cause genital warts. This type of HPV can cause mild precancerous changes, but there's no increased risk of cancer.
In both women and men, infection with high-risk HPV may cause cancer. For men, there is a risk of cancer in the anus and penis. In women, there is a risk of abnormal cervical cell changes, as well as anal cancer. There has also been a rise of cancer in the back of the throat, including the tonsils, base of the tongue and soft palate (called oropharyngeal cancer) in both men and women -- these cancers have also been associated with the same HPV types.
How to protect yourself
Patients often ask me about relationship and lifestyle changes. The reality is that most people have no symptoms and so they aren't aware that they have the virus. Using condoms is good, but it doesn't offer complete protection against HPV. Even if you've only been with one partner, the virus is so common that you may get the infection from that one partner. And there's generally no way of determining from whom, or when, you contracted HPV.
The good news? As Canadians, we have access to safe, effective vaccines to protect against HPV infection. If you're vaccinated it will help prevent future infections and will decrease recurrences if you've already had HPV. The really good news? All provinces and territories have publicly funded school-based HPV vaccination programs for girls 9 to 13 years of age (grades 4 to 7). And now many vaccination programs also include boys.
I recommend receiving Gardasil 9, which protects against two types of low-risk HPV that cause 90 per cent of genital warts, and seven types of high-risk HPV that cause 90 per cent of HPV-related cancers. Receiving the vaccine during the school-age years is best, but I also recommend it to older patients (both male and female) who are sexually active.
HPV and HPV-related cancers are preventable. Whether you're male or female, it's never too late to receive the vaccine. If you're sexually active at any age, please talk to your doctor or health care professional.
Learn more about sexual health from Sunnybrook experts at health.sunnybrook.ca
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The vaccine Gardisil, which protects against four strains of HPV that account for most HPV-associated cancer and genital warts, is available to and recommended for boys. The American Academy of Pediatrics released a statement early last year in favor of the vaccine for boys before the start of sexual activity: The vaccine is most effective if administered before the onset of sexual activity, and antibody responses to the vaccine are highest at ages 9 through 15 years. Immunization of children against HPV infection will help prevent cancers and genital warts caused by HPV.
Gay and bisexual men are 17 times more likely to develop HPV-associated anal cancer than men who have sex with women, according to the CDC.
Most HPV screening happens during women's Pap smears in which the doctor scrapes some cells from the cervix to test for abnormalities. There is no clinically-available blood test for the virus and so the majority of carriers -- of both genders -- are unaware that they have the virus.
One multi-country study found that 50 percent of men over age 15 have been infected with HPV. What's more, each year, about six percent of men will contract a new infection of the strain that is most associated with cervical cancer in women -- HPV 16.
Although the overall rates of cancer are declining, according to the latest research from the National Cancer Institute, HPV-associated cancers are on the rise. That was at first confounding to doctors who expected oral cancer rates to decline alongside smoking rates (another risk factor). In particular, HPV-positive oropharyngeal cancer now accounts for 70 percent of that cancer type.
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