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The HPV story: sex, success and Hollywood

June 10, 2013
HPV has been put in the spotlight recently by Michael Douglas because of its role, or not, in his throat cancer. Bigger medical news is the publication of research from Australia showing that their national HPV vaccination programme is a runaway success. Dr Anna Pallecaros, Sexual Health Consultant at The Physicians’ Clinic, looks at what’s been happening and explains how some surprising new science about HPV can help us protect ourselves from getting harmed by the whole HPV family of viruses.

Why all this interest in HPV?

In early June, the Hollywood actor focused world attention on the link between HPV from oral sex and throat cancer. His public relations team later denied that his cancer was HPV-related... Not quite so widely reported was the publication of Australian research showing how rapidly their national HPV vaccination programme has slashed the number of cases of genital warts. In fact, in just five years of HPV vaccination, warts have been almost eradicated. “This is a major public health success,” says Dr Pallecaros. “Similar benefits from the UK HPV vaccination programme would save more than £50 million a year because we wouldn’t have to treat them. Plus, no genital warts means much less personal distress and fewer relationship problems. That’s priceless...

About HPV and the HPV vaccine

HPV is a common virus, spread by skin – to skin contact. It’s more correct to say HPVs as there are over a 100 different types, numbered simply in the order they were discovered. Most HPVs cause no harm to most people. It’s when we don’t process them properly that they can mess up our DNA. This can cause cells to start dividing abnormally, leading to harmless warty skin bumps and, much less commonly, cancer. The evidence for the link between HPV Type 16 and cervical cancer is so strong that many countries around the world, including the UK, have opted to vaccinate teenage girls. The HPV vaccine stops the virus getting into human cells in the first place and should prevent both genital warts and cancer. It’s now been used in Australia since 2007 and in the UK since 2008.

The Australian research and genital warts

The April 18 2013 issue of the British Medical Journal (BMJ) reported the findings of Basil Donovan’s group at the University of New South Wales, showing the effect of five years of national HPV vaccination on genital warts. They looked at the number of people diagnosed with genital warts between two time periods:
  • 2004 and mid-2007 – the period before HPV vaccination started.
  • Mid-2007 and the end of 2011 – the first four-and-a-half years where HPV vaccination was in place.
The results showed that HPV vaccination had drastically reduced the number of people getting genital warts. Two key findings are important:
  • Incidence of genital warts in women under 21 fell by 92.6%. Pre-2007, 11.5% of women in this age group had them. By 2011, less than 1% of the women in the study were troubled by genital warts.
  • Even though only women got the HPV vaccine, the incidence of genital warts also fell in men under 21 – by 81.8%. Before 2007 12.1% of men in the study had them; by 2011, only 2.2% of the men had developed warts through herd immunity.
Dr Pallecaros says: “The results show that the vaccine successfully interrupts HPV transmission in the real world, not just in clinical trials. We are now hoping to see big reductions in HPV-related cancers too.

How else can we protect ourselves?

The link between HPV and cervical cancer is very clear and direct but the virus is also related to other cancers, particularly of the anus and throat. The risk of oral cancer rises with the number of oral sex partners you have but it’s important not to muddle association with causation. Keep things in perspective too: most HPV in the mouth is harmless and most people who have oral sex will not get oral cancer. “We are beginning to find out the sophisticated science behind how and why only a few people develop cancer because of HPV,” explains Dr Pallecaros. “For example, changes in the type of bacteria in the vagina can affect how a woman processes cigarette toxins, which can then affect her risk of cervical cancer. Modern sugary diets, smoking and drinking excess alcohol can damage the bacterial balance in the mouth, making it easier for HPV to cause us harm.” Vaccination is only ever part of looking after ourselves. This is an opportunity to be as proactive as possible but not just by deciding if, when and with whom we share our HPV. We need to make sure the bacterial flora in the mouth is healthy by not smoking, drinking sensibly and eating healthily. This can reduce the risk HPV related cancer and so much more besides,” she says.

What about boys?

Oral cancer affects more men than women and HPV related cancers in men are on the rise. Australia now vaccinates boys routinely and the CDC (Centre for Disease Control & Prevention) recommends that boys receive the vaccine too. At The Physicians’ Clinic, we confidently personalise all screening and treatment. So, men can benefit from HPV vaccination, where clinically appropriate, too.”  

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