Monique Rainford
THE COMMON culprit in cases of genital warts and abnormal Pap smears is the human papillomavirus (HPV). It is the most common sexually-transmitted infection in the United States with an estimated 75 per cent of the population being affected. The virus is most common in sexually-active teenagers and young adults.
Testing for the human papillomavirus is not routinely available in Jamaica at this time and current data on its prevalence are not available. However, a study published in 1999 suggests that the occurrence of HPV 16 infection in Jamaican blood donors was four times higher than infection in U.S. blood donors.
MANY TYPES
Already more than 100 types of HPV have been identified and experts suggest that more than 100 types have yet to be identified. About 40 of these types affect cells in the genital region but most infected women have no symptoms. About half of these HPV are called high-risk types because of their association with cancer of the cervix (the neck of the womb).
The large number of HPV types are classified by numbers. It is HPV 16 and 18 which are associated with about 70 per cent of the cases of cervical cancer worldwide; HPV 16 is responsible for more than half of these cases. Other HPV types associated with cervical cancer include 31, 45, 52 and 58. Low-risk HPVs, including viral types 6 and 11, cause minor abnormalities on Pap smears and more than 90 per cent of genital warts.
HPV is transmitted by direct skin-to-skin genital contact. Although infections in the vagina require intercourse, intimate sexual touching causes infection at external sites. The more sexual partners a woman has and the earlier she starts having sex, the higher her risk of developing HPV infection. Her risks are also increased with a new sexual partner or having sex with a man who has had at least one partner before her. Women with weak immune systems, such as HIV-positive women, are also at higher risks of being infected with HPV
HPV RISK IN MEN
Men can transmit HPV infection without having any symptoms. They have similar risk factors for getting infections as women. In addition, uncircumcised men and men who have sex with other men are at higher risk of HPV infection. The virus can also be transmitted among women who have sex only with other women.
Infection of the cervix with HPV can cause different levels of abnormalities - these range from minor cervical changes to cancer. A Pap smear can detect these abnormalities. If a woman has an abnormal Pap smear, she should discuss the appropriate treatment with her physician and ensure that she completes the prescribed therapy and maintain proper follow-up. This can effectively prevent cervical cancer in most women.
The use of condoms by men has been shown to reduce the transmission of HPV among sexually-active women, but the virus can still be transmitted with sexual activity even when a condom is used.
Recently, the United States Food and Drug Administration approved Gardasil, a vaccine for the prevention of HPV infection and ultimately cervical cancer. It protects against HPV types 16, 18, 6 and 11. This vaccine can be used in women and girls from ages nine through to 26 and is most effective if administered before they become sexually active.
Dr. Monique Rainford is a consultant obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.
