HPV

Human Papilloma Virus

About HPV- The virus

HPV is a big family of viruses. It is a very common infection, probably second only to common cold in how common it is. Some 75-80% of the population will have had been infected by HPV at one point in time. This most commonly occurs around the start of sexual activity.
 
Before I go any further, I want to clarify something. MOst people when hen hear or know they have HPV, or have a lesion suggestive of HPV get so stressed, they do not sleep well. They worry about where they got it from and worry about giving it to their partners. I wish I can change how HPV is discussed in the media. They make it look like it is Herpes, or Chlamydia. It is not.

It is not an 'infection' in that sense. It is not seen as an STD or an STI. You do not need to talk to your partner about anything. More importantly, you do not need to worry about it. You do NOT need to get testes for HPV and you do not need to think more about it.
 
You need to make sure you follow up with your regular pap testing. Period.

We recommend the use of condoms at all times, to prevent pregnancy as well as STD's or STI's. Diseases like HIV/AIDS, chlamydia, gonorrhea, syphilis, etc. are preventable by the use of condoms. HPV is not. I hope that this does not imply that you should stop using condoms. On the contrary, safe sex dictates that you should use condoms at all times.

Now, HPV infection is known to be self limited. You will probably clear the infection on your own in about 18-24 months. In most cases, you do not even know that you got infected and clear it on your own.

There are different subtypes and each will cause a different problem. HPV mostly infects the skin and other linings of our cavities, including the vagina, cervix, mouth, etc. Some types will cause minor changes, other types may cause more serious problems. The thing with HPV is that we do not know we were infected. So, infection might have been a few months ago or a few years ago. On the same note, it is very difficult to trace your infection to one particular partner or the other.

The effects on you will depend on which type of HPV virus you got.

Warts are caused by HPV types 6 and 11. As ugly as they may look or sound, they will not really harm you. You know what, at least you can see them and go for a treatment. The treatment may be offered in different forms. You may be give a cream that you apply on your own, or your physician may use local freezing (called cryo-therapy). On other occasions you may have some special acid put on them (called TCA), or have them burned or surgically removed. Clearly, some of these methods may not be done in the office. You may be referred to colposcopy for this. You may need more than one treatment session until they are totally gone. Some of these treatment options cannot be used if you are pregnant, while others are safe.

If you have warts at the time of delivery you can still plan on a vaginal delivery. Only if they are large enough to may be come in way of the baby and obstruct labour that we may talk about a C Section.

Abnormal Cells

Some other types of HPV will cause some abnormal cells in the cervix. You do not feel anything different, and these can only be found by a Pap test. These abnormal cells can be divided broadly into two groups, Low Grade cells (called LSIL) and High Grade cells (called HSIL).

LSIL: In most cases, low grade cells will be cleared on their own. You will be referred to colposcopy for evaluation and to confirm that there no other changes. All you will need then is close follow up (usually by colposcopy) until you have cleared the cells. Visits are scheduled 6 months apart, and you will usually need 4 visits to so.

HSIL: High grade changes have a higher rate of becoming more abnormal and changing into cancer cells. This is why we prefer not to leave then, and actually will plan a treatment. See colposcopy for more details.

Vaccines: Abnormal cells in your cervix and anal canal may be caused by HPV types 16 and 18 (and a few more less common subtypes). This is why the vaccines that are now available target these types. Types 16 and 18 will cause changes in the cells called High Grade change (HSIL). If left untreated, this may cause cancer cervix. So basically, this vaccine prevents against cancer cervix.

Now there are other types of the HPV viruses that are similar to types 16 and 18 (you can think of them as their cousins) that may also cause these abnormal changes in the cells. The good news is that the vaccines that are available have some immunity against these other types as well. This is an added benefit that you get with the vaccine.

There are two vaccines for HPV, Cervarix and Gardasil, both are three doses, spread along 6 months. We strongly recommend that you do take the vaccine, one or the other. Please book your appointment for a discussion on which may be more appropriate for you.
 
Gardasil 9 is the recommended vaccine to take currently. Even if you were started on the 'old' Gardasil, you may continue your series with Gardasil 9.
 
Cervarix: I am not sure if it is still available. If you had it in the past, you are covered and do not need to take Gardasil.

You do not need a referral to have your vaccine with us. You do not even need a prescription. Just call to make sure that we are in the office, and we will arrange for you to get your protection with the vaccine.

Commonly Asked Questions

How many vaccines are there against HPV

In Canada there are currently Gardasil 9.


What if I am older than the recommended age by the vaccine manufacturer?

The manufacturers can only recommend women of a certain age to get the vaccine. This age is the age of the girls and women who were involved in the original study of the vaccine. Most practitioners, however, are in agreement that the vaccine is effective regardless of you age. You will still get immunity if you get vaccinated. So, if there is enough reason for you to want to be protected, we do recommend you get the vaccine, regardless of your age.
 
Currently this age is 45.

If I already have HPV, can I still get the vaccine?

Most physicians in the field agree on the answer. YES ! The idea is that there are many subtypes of HPV. You never actually know whish subtype infected you. You will still get protection against the other, and an added advantage is that you usually also get additional protection (cross-protection) against some of the subtypes that are not actually included in the vaccine itself.

Can my boyfriend get this vaccine?  

Gardasil has been approved by Health Canada to be used in boys and men.

Do the vaccines have other benefits?

Gardasil will also protect you against vulva and vaginal abnormal cells and cancers, as well as warts.

If I get one or two shots of one vaccine, can I get the remaining shots from the other one?

We do not have enough information to answer this question on scientific basis. We usually will encourage you to continue the series with one and the same brand of vaccine.

Do I need to get a booster dose later on?

So far, research does not show that you need a booster dose for either brands.

Are there any side effects to the vaccines?

Hardly any. May be a local reaction at the site of the shot.

© 2016 by Dr Abdel Hadi

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