Genital warts rising by 30 percent a year
The incidence of genital viral warts on the island is rising by 30% every year in both men and women.
That was the verdict of Dr Constantinos Demetriou, President of the Cyprus Society of Dermatology and Venereology yesterday.
“If the increasing global numbers of sexually transmitted disease carriers spread fear, the numbers in Cyprus are shocking, considering its size,” he said. “These statistics call for an immediate education of the population, for it has become a public health issue.”
A news conference yesterday was the start of an intensive campaign for educating the public regarding genital warts, which are a result of the Human Papilloma Virus (HPV).
“We do not have exact statistics for the island as diagnosis is difficult, with some people not even knowing that they are carriers until they are examined by a doctor.”
He then gave an example. “I am discovering warts in as many as 20 percent of women that come to me for laser hair removal of their bikini line.”
According to Demetriou, it has been estimated that 30 million people are infected every year, globally. “At the same time the problem in Cyprus is reaching disturbing levels due to the lack of education amongst the general public. The virus is not curable but there is prevention.”
The virus, which is mostly spread as a result of sexual intercourse, appears mainly in adults of both sexes with those aged 13-26 being more vulnerable. Symptoms of the virus include burning during urination, excretions of the urethra and vagina and unbearable itching or burning of the genital area during the night, and wounds, glandules and exanthema with or without symptoms in the genital area.
Nevertheless, the great majority of genital HPV infections never cause any overt symptoms and are cleared by the immune system in a matter of months.
Preventive measures against the virus include dermatological examinations once or twice per year, and women should have the Pap Test once every year. Therapeutic measures are taken with drugs, which mainly target the immune system of the carrier. Even though there is no cure, there is definite prevention with a quadrivalent vaccine against cervical cancer, which has the additional strength to offer complete prevention from HPV types 6 and 11, which cause genital warts. The vaccine has been available in Cyprus since January.
The Cyprus Society of Dermatology and Venereology highlights that the vaccine, against cervical cancer and genital warts, should be administered to boys and girls at the beginning of adolescence, as a protective measure against both diseases.
Monica Kyriacou is the medical advisor for Merck Sharp & Dohme, who hold the marketing authorisation for the Silgard vaccine against HPV.
“The vaccine is totally protective against the two main virus types that lead to genital warts,” she explained.
Human Papilloma Virus Vaccines May Decrease Chances of Oral Cancer
The Centers for Disease Control report that nearly 25 million women are infected with some form of the Human Papilloma Virus (HPV). Of those, more than three million are thought to have one of the four strains known to cause cases of cervical cancer and genital warts.
HPV is linked to oropharyngeal cancer and may be linked to oral cancers as well, and vaccines that have been developed to treat HPV might decrease the risk of these cancers, according to a study in the May/June issue of General Dentistry, the clinical, peer-reviewed journal of the Academy of General Dentistry (AGD).
James J. Closmann, BS, DDS, the lead author of the study, found that oral and oropharyngeal squamous cell carcinoma (OOSCC) have been linked to high-risk HPV strains, the same strains that cause cervical cancer.
Recently, a vaccine was developed to treat patients with HPV against cervical cancer, and this could have an effect on women’s oral health.
“More than 100 strains of HPV have been identified,” says Dr. Closmann. “They have been shown to cause other benign and malignant disorders, which now include those in the mouth. Nearly 30,000 new cases of oral and oropharyngeal cancer are reported each year. It’s possible that oral and oropharyngeal cancers could be reduced if vaccination were more widespread; however, additional research is needed.”
Additional research could result in a comprehensive test for dentists at patients’ semiannual visits. However, a dentist can perform a head and neck exam to detect early signs, despite the lack of a specific test.
A possible connection between HPV and oral cancers, and the stronger link to oropharyngeal cancers, is even more of an indicator that patients should visit the dentist twice a year to identify irregularities early.
“Visiting the dentist on a regular basis is an important factor in the detection of any oral health complication,” says Laura Murcko, DMD, spokesperson for the AGD. “Taking preventive measures is especially important, and your dentist can check for early signs of oral cancer.”
Oral Health Tips for Women:
- Keep your dentist informed about changes in oral health.
- Visit the dentist regularly, which will help them to detect changes in the mouth.
- Ask your dentist to take a full medical history to determine if you are at risk for certain problems.
- Ask your dentist to perform a complete head and neck exam to detect early signs of certain conditions.
Transmission of HPV in general
Transmission of HPV through routes other than sexual is definitely possible. One may be exposed to HPV simply by shaking hands as suggested in the finding of HPV virus under fingernails.
Sexually Transmitted Infections 1999 Oct;75(5):317-9:
Detection of human papillomavirus DNA on the fingers of patients with genital warts.
Sonnex C, Strauss S, Gray JJ, Department of GU Medicine, Addenbrooke’s Hospital, Cambridge, England.
“14 men and eight women with genital warts had cytobrush samples taken from genital lesions, finger tips, and tips of finger nails. Samples were examined for the presence of HPV DNA by the polymerase chain reaction.
HPV DNA was detected in all female genital samples and in 13/14 male genital samples. HPV DNA was detected in the finger brush samples of three women and nine men. The same HPV type was identified in genital and hand samples in one woman and five men.
This study has identified hand carriage of genital HPV types in patients with genital warts. Although sexual intercourse is considered the usual mode of transmitting genital HPV infection, our findings raise the possibility of transmission by finger-genital contact.”
Condoms offer little protection against HPV since any skin-to-skin contact can result in transmission of the virus.
Am J Epidemiol 2003 Feb 1;157(3):218-26:
Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students.
Winer RL, Lee SK, Hughes JP, Adam DE, Kiviat NB, Koutsky LA. Department of Epidemiology, University of Washington, Seattle, WA 98103, USA.
“Incidence data on human papillomavirus (HPV) infection are limited, and risk factors for transmission are largely unknown. The authors followed 603 female university students in Washington State at 4-month intervals between 1990 and 2000. At each visit, a sexual and health questionnaire was completed and cervical and vulvovaginal samples were collected to detect HPV DNA. At 24 months, the cumulative incidence of first-time infection was 32.3% (95% confidence interval: 28.0, 37.1). Incidences calculated from time of new-partner acquisition were comparable for enrolled virgins and nonvirgins. Smoking, oral contraceptive use, and report of a new male sex partner––in particular, one known for less than 8 months before sex occurred or one reporting other partners––were predictive of incident infection.
Always using male condoms with a new partner was not protective. Infection in virgins was rare, but any type of nonpenetrative sexual contact was associated with an increased risk. Detection of oral HPV was rare and was not associated with oral-penile contact. The data show that the incidence of HPV associated with acquisition of a new sex partner is high and that nonpenetrative sexual contact is a plausible route of transmission in virgins.”
Scand J Infect Dis 1996;28(3):243-6:
Transmission of genital human papillomavirus infections is unlikely through the floor and seats of humid dwellings in countries of high-level hygiene.
Puranen M, Syrjanen K, Syrjanen S Department of Pathology, University of Kuopio, Finland.
“To evaluate the transmission of genital human papillomavirus (HPV) through the floor and seats of humid dwellings, samples were collected with a toothbrush from the floor and seat surfaces of humid dwellings; showers, saunas and dressing rooms. The survey included 3 bathing resorts, 1 indoor swimming pool, 2 schools and 2 private homes. Polymerase chain reaction (PCR) was used to amplify the human beta-globin gene and HPV DNA. The results for HPV DNA amplification were confirmed by Southern blot hybridization under low stringency using a probe mixture of HPV types 6, 16, 18 and 31. beta-globin could be amplified only from 3 sample taken from a dressing room of and indoor public swimming pool. No HPV DNA-positive samples were found. These results indicate that transmission of genital HPV infection via floor or seat surfaces in the above dwellings in general or family use is highly unlikely.”
Rev Med Virol 1999 Jan-Mar;9(1):15-21:
High risk genital papillomavirus infections are spread vertically.
Rice PS, Cason J, Best JM, Banatvala JE. Department of Virology, Guy’s, Kings and St Thomas’ Medical School, Kings College London, St Thomas’ Hospital, UK.
“It is well recognized that high-risk human papillomaviruses (HPVs) are spread by sexual activity, but the possibility of non-sexual transmission remains controversial. We present evidence for vertical transmission from at least 30% HPV positive mothers to their infants, resulting in persistent infection in children. That the mother is the source of infant infection has been confirmed by DNA sequencing. We also discuss the evidence for oral HPV-16 infection in children.
In our own studies, HPV-16 DNA was detected in buccal cells from 48% children, aged 3-11 and transcriptionally active infection was confirmed in some children. Other studies have reported prevalences of 19%-27% among children less than 11 years of age. Studies that have failed to detect high-risk HPVs in children have used techniques which were insufficiently sensitive to detect the low levels of virus present. Serological studies also suggest that < or = 45% prepubertal children have acquired HPV-16. Thus, convincing evidence is now available for vertical transmission of high risk HPVs, which probably results in widespread infection among children. The consequences of such infections remain to be elucidated.”
J Med Virol 1998 Nov;56(3):210-6:
Presence of antibodies to human papillomavirus virus-like particles (VLPs) in 11-13-year-old schoolgirls.
Cubie HA, Plumstead M, Zhang W, de Jesus O, Duncan LA, Stanley MA. Regional Clinical Virology Laboratory, City Hospital, Edinburgh, Scotland, United Kingdom.
“To allow meaningful approaches to vaccine development, it is important to know the extent of exposure to human papillomavirus (HPV) within the general population, and particularly the age at which the at risk population is infected. The humoral response to human papillomavirus is directed largely to conformationally-dependent epitopes on the whole virion. Virus-like particles (VLPs) of HPV types 1, 2, and 16 were produced using a baculovirus expression system, and were used in the intact state as antigen in an indirect ELISA. Anonymised serum samples from a cohort of Edinburgh schoolgirls were tested for the presence of IgG antibodies directed against the VLPs. The reproducibility of the ELISA was assured by repeated testing of control samples, and by testing all samples in duplicate and, where possible, on several occasions.
Of 1,192 tested with the HPV16 VLPs, 90 (7.6%) were classified as clearly positive, and a further 87 (7.3%) were positive but close to the cutoff calculated by comparison with a group of consistently negative sera. Antibodies to HPV2 were detected in 37.5% (407/1,139) and antibodies to HPV 1 in 51.9% (558/1,076) of the schoolgirls. Antibodies to both HPV1 and HPV2 were found frequently, being present in 29.7% (295/ 993) of samples tested; 40 samples had antibodies to all three types. The significance of these results is discussed.”
J Clin Microbiol 1999 Jul;37(7):2270-3:
Detection of human papillomavirus types 6 and 11 in pubic and perianal hair from patients with genital warts.
Boxman IL, Hogewoning A, Mulder LH, Bouwes Bavinck JN, ter Schegget J. Department of Virology, Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands.
“Genital human papillomavirus (HPV) types 6 and 11 are of clinical importance due to their role in the development of anogenital warts. A pilot study was performed to investigate whether DNAs from HPV types 6 and 11 are present in hairs plucked from the pubic and perianal regions and eyebrows of patients with genital warts at present and patients with a recent history of genital warts. Genital HPV DNA was detected in 9 of 25 (36%) pubic hair samples and in 11 of 22 (50%) perianal hair samples by the CPI/CPIIg PCR. After sequencing of 17 of 20 samples, HPV type 6 or 11 was detected in 6 of 25 (24%) hair samples from the pubis and 8 of 22 (36%) hair samples from the perianal region. These types were not detected in plucked eyebrow hairs. In contrast, the HPV types associated with epidermodysplasia verruciformis were detected in similar proportions (62%) in both samples of pubic and eyebrow hairs.
Moreover, HPV type 6 and 11 DNAs were detected in pubic hairs plucked from two patients who had been successfully treated and who did not show any lesion at the time of hair collection; this finding is an argument that HPV DNA may persist in this region. The presence of genital HPV types in plucked pubic and perianal hair suggests that there is an endogenous reservoir for HPV which may play a role in the recurrences of genital warts.”
Can a vaccine treat my existing HPV infection?
By Dr. Judith Reichman
Q: I tested positive for high-risk HPV on my recent Pap smear. I’m freaked! If I get the HPV vaccine will it help cure me?
A: First, the good news. It’s most likely that your body will clear the virus by itself through your own immune reactions. But the bad news is that we don’t know how to help that process along and the vaccine won’t do it.
A recent article in the Journal of the American Medical Association (JAMA) detailed a study in which more than 2,000 women between the ages of 18 to 25 were followed for over a year. These women lived in Costa Rica and were found, on initial testing, to be positive for human papilloma virus (HPV). They were divided into two groups: Half the women got a vaccine that immunizes against HPV 16 and 18, the other half did not. There are over 30 types of HPV, but only some are high risk. Type 16 and 18 are found in (and felt to be the cause of) 70 percent of cervical cancers. (The vaccine currently available in the U.S. is called Gardasil. It’s a quadrivalent vaccine because it protects against four types of HPV: 16, 18, 6 and 11. These last two types of HPV are not involved in cervical cancer development but do cause genital warts.)
The women were then followed and tested for viral shedding at 6 and 12 months. The study found that there was no significant difference in viral clearance (i.e., the virus disappeared) between those who received immunization after becoming infected with HPV and those who didn’t. The clearance rate of HPV in the women who took the vaccine at six months was 33.4 percent vs. 31.6 percent in the control group. At 12 months, the rate of continued shedding of the virus was 48.8 percent in the vaccinated group and 49.8 percent in the control group.
The study didn’t evaluate the long-term progression of HPV infections, the extent of future abnormalities in cervical cells, or the development of cervical cancer in these women. There’s still a possibility that the vaccine may diminish the progression to cancer, but it seems unlikely since it didn’t cause the virus to disappear.
We do know that within two years of HPV exposure (and infection), most women clear these viruses on their own. Thank goodness for our cervical “powers of viral destruction.” HPV prevalence is frighteningly ubiquitous — 50 to 70 percent of sexually active young adults test positive for one of the HPVs within two years of initiating sexual activity, especially if they are not consistent in using condoms. (And even then there can be “oops” occurrences). Because of its overwhelming prevalence, the current recommendation is not to test for HPV infection in young adults (under the age of 30).
Those who have persistent viral infections are a small minority of women who are then at risk for cervical cancer. Finding a persistent HPV infection in women after the age of 30 should be a signal for careful follow-up.
Despite this study’s results, there are those who feel that it is worthwhile to give the quadrivalent vaccine (Gardasil) to young women aged 11 to 26 who have tested positive for one of the high-risk HPVs. This is because, in theory, the vaccine may provide immunity against HPV types that these young women were not exposed to and/or infected with. Whether it is cost-effective to do this, especially in a large population, is still under discussion.
Bottom Line: If you are infected with HPV, getting the HPV vaccine will not help you clear the virus; the vaccine should not be used to treat current infections.
Dr. Judith Reichman, the TODAY show’s medical contributor on women’s health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, “Slow Your Clock Down: The Complete Guide to a Healthy, Younger You,” which is now available in paperback.