Madrid, August 19 2019:- At present, the importance of vaccinating women against human papilloma virus (HPV) is undisputed, in fact, 10 years ago, the Public Health System included the vaccination in the ‘vaccinations calendar’ - in 2007, but only for females, and at around 12 years of age, depending on the autonomous region in question. However, males are still not included in the public system’s recommendations, although they can catch the virus and pass it on. “If we only vaccinate women, the number of cases of cervical cancer and genital lesions related to HPV will fall, but not as it would if men were included in the measure”, stresses Dr. Javier de Santiago, head of the Gynecologic Oncology Service at MD Anderson Cancer Center Madrid – Hospiten. Some autonomous regions currently include HIV patients and homosexuals in their vaccination programs. In addition to cervical cancer, HPV is associated with other types of cancer, like anal and penile cancer and many head and neck tumors.
This is a particularly sensitive subject as cervical cancer is really a sexually transmitted disease (STD) whose origin does not lie in genetics or family medical history, so the number of cases could be cut drastically by means of prevention policies covering all the groups at risk.
Furthermore, effective HPV prevention, not only for women, but for men too, would help reduce the incidence of penile, anal, oropharyngeal and vaginal cancers and genital warts. All these diseases are directly linked to the virus, “to which we are not paying enough attention”, states the doctor. Indeed, “along with precancerous lesions, genital warts are the most common lesion in Spain and have the biggest impact on public health spending”.
Another question to consider is that the problem in heterosexual couples lies in that HPV infection becomes a vicious circle - an infected woman will infect a man who will then infect a woman, but the case of male homosexual couples is more complicated, because there is no primary prevention plan with vaccinations.
Likewise, diagnosis is another problem when dealing with males. While woman have regular screening of their genital health (pap smear tests and HPV tests), men do not see the urologist regularly and, diagnosing HPV in men is further complicated by the fact that there are no specific tests other than examining the genital area for signs of warts or other lesions.
Once a man is diagnosed with HPV, the recommendations to follow are the same as those for a woman: monitoring oneself and partner, and the use of condoms. “This contraceptive method, when used correctly, can prevent HPV”, states Dr. De Santiago, who points out that the common belief the method is not effective stems from incorrect use of the condom. “It is important to use a condom every time you have sexual relations, before penetration to ensure effective prevention of the virus”.
More than 80% of women have been in contact with HPV
“Practically all women, more than 80%, have been in contact with HPV at some time”, states Dr. De Santiago, who says that having been in contact with the virus is not so important in itself, but how that contact came about and for how long. “The odds of developing cervical cancer after being in contact with the virus once is less than 1% and, in the case a person becomes infected, it is most likely the virus will be eliminated naturally”, he says, going on to explain that even if the virus remained in the body, the chances of it causing a lesion are small.
The key to evaluating risk in these cases is the type of virus involved, the number of times the patient has been in contact with the virus and the number of sexual partners he/she has had. In addition, regarding the latter and the stigma associated with promiscuity that continues in today’s society, Dr. De Santiago points out that there is more chance of infection with HPV through regular sexual contact with a stable partner carrying the virus. In fact, in these cases, the doctor recommends always using a condom to avoid the’ vicious circle’ of infection’.
Regarding vaccination, although this is best done before a person becomes sexually active, vaccination can be done up to 45 years of age. Although there are 150 different serotypes of the virus, commercialized vaccines so far only cover 9 serotypes. In the period when contact with the virus is most frequent, between 18 and 25 years of age, not all women come into contact with all the serotypes, so the vaccine may still be of use in later years. A significant number of women over 25 are infected with HPV 16 and 18. If we consider that the possibility of the virus persisting in the body increases with age, and that increases the risk of lesions forming, we must consider vaccination for older women. We also know that sometimes a person’s natural immune system cannot always prevent reinfection, making the use of vaccines more recommended. Therefore, in most cases where a woman is infected with HPV, the initial recommendation is vaccination.
Referring to a woman’s first gynecologic check-up, Dr. De Santiago says the ideal age is 25. “Carrying out HPV testing before the age of 25 is not helpful because it will likely give a positive result in most cases simply due to the fact that there is a high degree of exposure to the virus, but it is also true that in most cases the immune system will eliminate the virus anyway and will build antibodies to prevent future infection, which is known as the immunization process”.