Some might believe that HIV/Aids is the worst Sexually Transmitted Infection that a person could contract, but HPV — the human papillomavirus is just as formidable and daunting. One of the most common sexually transmitted infections (STIs), HPV is passed on from infected persons through genital to genital contact, oral and anal sex.
Unlike HIV/Aids, condoms don't fully prevent HPV, since the disease is spread from areas that are not covered by condoms and not just bodily fluids. Carriers of the disease are not even aware that they have it because they show no symptoms. By the time they find out that they are have the disease, it is already at an advanced stage.
"HPV is easy to catch but it is slow growing and it could take years before it shows up in the body," said Tobago paediatrician Dr Maria Remy.
HPV is the leading cause of cervical cancer but it also causes vulvar, vaginal, penile, anal and oropharyngeal cancers (back of the throat including the base of the tongue and tonsils). Genital warts are usually outward manifestations of the disease. The warts appear as small bumps, group of bumps, they can be raised or flat, shaped like a cauliflower and found in the genital area.
Cancer takes longer to develop in the body but warts can appear within weeks or months following exposure of the disease, even if the person's partner has no symptoms. Left untreated, the warts either go away or increase in number. Although rare, warts can also appear in the throat and is called Reccurrent Respiratory Paillomatosis or RRP.
"Not even a blood test would show that a person has HPV. That's why I recommend to women that they do their regular pap smears. These tests show up abnormalities in the cells and cervical cancer is easy to treat when caught at an early stage."
Men are not so fortunate, Remy said. There is yet to be a test that helps men to find out their HPV status.
Approximately 20 million Americans are currently infected with HPV, with 6 million newly infected cases reported every year. Fifty per cent of sexually active men and women would get the virus at some point in their lives. Not all of the people who contract HPV would get cancer or genital wart. In some cases, the body fights off HPV naturally and the cells go back to normal.
Gays, bisexuals and people with weak immune systems (including those with HIV/Aids) are at higher risk for HPV-related health issues.
For years Dr Remy has been one of the voices advocating for young girls in T&T to be vaccinated against the disease. Last week she got a small victory when health minister Dr Faud Khan announced to the media that Government would provide the vaccine Gardisil free to young girls who have not yet been sexually exposed. The immunisation programme begins in November and would be given to girls 9 to 12 years old. The vaccine wards off strains 16 and 18 — the strains that cause cervical cancer.
In all, there are 100 strains of HPV, not all the strains are cancer causing, Remy said.
"Even though the vaccine protects from strains 16 and 18, there is cross protection of some other strains of the disease. For the vaccine to be effective, it has to be taken in three doses over a 16 month period."
The Government's immunisation programme will be voluntary but Khan hopes that through the Ministry's education of parents, they would see the benefits of allowing their daughters to take the vaccine. The vaccine has been administered to young boys in the US but for now, Khan said, it would be confined to girls.
Remy believes that the HPV vaccine would eventually lower the cervical cancer figures in T&T.
Cervical cancer is a major public health problem in Latin America and the Caribbean, with some of the highest incidence and mortality rates worldwide, the website PloS One — an international, peer-reviewed, open-access, online publication, said. In Tobago, the cervical cancer incidence rate is said to be two times higher than the worldwide rate according to the US National Library of Medicine, National Institutes of Health website.
"We have for the first time determined the prevalence and type distribution of cervical HPV infections among cancer-free Afro-Caribbean women from Tobago, and compared it with the HPV subtypes observed in their oral cavity. Thirty-five per cent of the women were cervical HPV positive" said the website.
Much like HIV, staying faithful to one partner is one way to lessen HPV exposure. The other recommended ways include cutting down on sexual partners and having sex with someone who has had a few or no partners. HPV can be caught by having sex with someone who has had sex with just one person. Abstinence, is the only sure way to prevent HPV.