Family doctor

 Key points:

• Different HPV strains can cause genital warts, genital cancers, and oropharyngeal cancers in both males and females.

• Infection with HPV often doesn’t cause any symptoms, making it hard to know if you have been infected with HPV before.

• There exists a safe and effective vaccine against certain types of the HPV virus (Gardasil ™). This greatly reduces the chance of genital warts and HPV related cancers. To date , the vaccine in use has been the HPV4 (against serotypes 6,11,16 and 18)

• From early 2017, there will be a vaccine HPV9, which will have extra coverage against more serotypes and gradually lead to even more protection against cervical cancer, as well as anal and oropharyngeal ( mouth and throat cancers ).

• It will be provided free to both men and women up to the age of 26 ,free on the national immunization schedule

• Two injections under the age of 14 should be effective, but over over 15 , 3 will be needed.

• Women aged 20-70 years in New Zealand are still advised to undertake regular (1-3 yearly) cervical smear tests to reduce their chance of developing cervical cancer, although the smear taking programme is changing to reflect greater knowledge of the role of HPV in the development of cervical cancer

What is HPV?

HPV stands for Human Papilloma Virus. There are over 100 different types of HPV, which can cause infections and disease in humans. In most cases an HPV infection will go away before it causes any health problems. In fact, many people with an HPV infection will not have any symptoms. In some people HPV does cause problems. The main problems that HPV cause are skin warts and genital warts.

In addition to causing warts, it is also known that infection with certain types of HPV results in an increased risk of developing certain types of cancer. In New Zealand, the most widely publicized of these is cervical cancer for which there is a nationwide screening and vaccination programme. Though less widely known, HPV also increases the risk of developing other cancers; namely oropharyngeal (the back of the throat), vulval, vaginal, anal, and penile cancers.

Overall HPV is thought to be the most common sexually transmitted infection worldwide. Genital HPV is usually passed on with skin-to-skin contact during sex with someone who is infected with the virus. As most people do not know they are infected HPV can be very easily spread.

It is known that the majority of sexually active females and males will be infected by HPV at some point in their lives, most of whom will have been infected within 5 years of becoming sexually active.

Some sub-types of HPV are known to more commonly cause certain conditions in humans;

• HPV types 1 & 2: subtypes of HPV most commonly causing skin warts

• HPV types 6 & 11: subtypes of HPV most commonly causing warts on external genitalia, in fact, over 90% of genital warts are caused by these two sub-types of HPV.

• HPV types 16 & 18: sub-types of HPV most commonly associated with causing cervical cancer. These sub-types cause around 70% of cervical cancers.

• The HPV9 vaccine includes serotypes (31,33,45,52 and 58) This should prevent up to 90 % of cervical cancer

   

 HPV associated cancer in New Zealand?

It has been found that somewhere between 70-80% of sexually active females will become infected with an HPV sub-type which is associated with the development of cervical cancer at some point during their lives. A persistent or lasting infection with one of these sub-types of HPV results in a 5-15% increase in the risk of developing cervical cancer 5-15 years after infection.

In New Zealand, on average, ~150 women are diagnosed with cervical cancer and ~50 women die from it annually.

Males are also very commonly infected by various HPV sub-types. Whilst males obviously do not develop cervical cancer, they can develop other HPV related cancers.

Other HPV related cancers are relatively common in New Zealand. These include;

• Oral cancers: ~ 300 cases (in males) & ~ 200 cases (females) in NZ per year.

• Throat cancers: ~ 250 cases in NZ per year (more common in males).

• Penile cancers: ~ 30 cases in NZ per year.

• Anal cancers: ~ 90 cases in NZ per year.

The HPV vaccine?

The vaccine against HPV used in New Zealand Gardasil ™. This vaccination involves an injection given into a muscle in your upper arm 3 times over a period of 6 months. The first dose can be given at a date that you and your doctor choose. The second dose should be 2 months after receiving the first dose. The third dose should be given 6 months after the first dose.

The Gardasil ™ vaccine contains molecules which are identical to some of those found in HPV subtypes 6, 11, 16, and 18. These are the sub-types of HPV which most commonly cause genital warts and some genital/mouth & throat cancers. Following vaccination, the bodies own immune system can recognize these types of HPV and effectively fight the virus. This means it will not cause an infection (genital warts or an infection you may not notice), and also reduce the risk of developing some genital/mouth & throat cancers.

Gardasil ™ does work best if it is given before any sexual contact has taken place. However, if you are under 26 years of age, even if you are sexually active Gardasil ™ can help offer protection. This is because it is unlikely that you would’ve been infected by all of the sub-types of HPV that Gardasil ™ covers. Therefore vaccination will prevent infection by these sub-types developing.

Receiving the 3 doses of the Gardasil ™ vaccine is thought to offer life-long protection.

Gardasil ™ is a safe vaccine. It does not contain the whole virus and will not cause infection. It will not give you or your child genital warts or cause cancer. There may be some soreness and redness where the injection was given and in some cases a fever may occur. These reactions are usually very mild and last only a few days.

HPV vaccination and screening for females in New Zealand?

Due to this significantly increased risk of cervical cancer with infection by certain types of HPV there is a nation-wide funded and recommended vaccination for all women aged 11-26 years. This means females aged from 11-26 years can receive the Gardasil ™ vaccine from participating schools or from your family doctor, local health centers and some Family Planning clinics free of charge.

In addition to the immunization programme there is also a nationwide cervical cancer-screening programme in New Zealand. This is another step, which you can take to prevent cervical cancer. The Gardasil ™ vaccine does not protect against all HPV types therefore it is recommended that women who have been vaccinated still get regular smear tests.

It is recommended that women between the ages of 20-70 years get a smear check every 3 years if they have ever been sexually active. The cervical smear test looks for abnormal cells in the cervix, which could be the precursors to cancer. This means with regular screening the pre-cancerous cells can be treated early to prevent cancer.

It has been shown that having regular smear tests reduce a woman’s risk of developing cervical cancer by more than 90%.

What is the current situation in New Zealand regarding vaccination of males against HPV?

It is well established that Gardasil ™ helps prevent genital warts and certain cancers (e.g. oral, throat, anal, and penile cancers) in males. Vaccination of males does also provide indirect protection to future female partners against HPV infection and cervical cancer.

Homosexual and bisexual males are thought to be at higher risk of developing HPV infections and HPV related cancers. This may mean that vaccination with Gardasil ™ may be even more important for this group of males.

Fortunately ,funding for male vaccination has been provided from 2017 in New Zealand. This will enhance and accelerate “herd” immunity  for both men and woman in the future .

The immunisation advisory service ( www.immune.org.nz), provides in depth information and an,

Excellent Pdf with more information.