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What every parent and teen should know about HPV, from an expert in the field.

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As a mother of four daughters aged from nine to 23 you’d think I’d know a lot about HPV.

As a woman who has had numerous sexual partners you’d think I’d know a lot about HPV.

As a woman whose grandmother was diagnosed with HPV related cervical cancer at 35 you’d think I’d know a lot about HPV.

But like many women and men, I don’t know very much at all about the Human Papilloma Virus.

After speaking with Professor Suzanne Garland – Lead Researcher for the Centre for Women’s Infectious Diseases Royal Women’s Hospital, Reproductive & Neonatal Infectious Diseases, Department of Obstetrics and Gynaecology, University of Melbourne and Vice President of the International Papillomavirus Society, I discovered there sure is a lot to know.

An expert in her field: Professor Suzanne Garland. Image: Supplied.

What is HPV and how is it actually transmitted?

For a start, there isn’t just one strain of HPV – over 100 have been identified to date.

"The HPV that infects humans are divided into those that have an affinity for infecting skin like hands and feet and causing skin warts, whilst those that have an affinity with the genitals can cause genital warts and even cancers," says Professor Garland.

"Some HPV strains are considered low risk for cancer. The two strains called HPV-6 and HPV-11 are the predominant cause of genital warts - around 90 percent- whereas HPV-16 and HPV-18 are considered high-risk strains for causing cancer and together they cause about 70 percent of cervical cancers in the world."2

For women, nearly all cervical cancer is caused by HPV - 99 percent to be precise, according to the WHO. But that's not the only cancer caused by HPV - men and women infected with HPV are at risk of developing cancers in other genital areas too.

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Professor Garland tells me that HPV is very easy to pass on from person to person. While it's commonly passed on via sexual intercourse, Garland notes it can be transmitted just by "genital-to-genital contact".

An interesting point she raised is that not all incidences of HPV infection will lead to cancer. For most people, the body’s own immune response will eventually deal with the infection, but there is the proportion of the population who will have a persistent infection, and a proportion of these can progress to cancer, although it takes decades to do so. However, genital warts can pop up much faster, usually taking months to appear after picking up the infection.

As with many other cancers, your risk increases if you are a smoker. "It's another good reason not to smoke," says Professor Garland.

Another group who are at increased risk are those who have a weakened immune system. HPV infection in people with HIV and those with transplants is more likely to develop into cancers compared to healthy individuals.

How is HPV detected?

I always thought that pap smears were able to detect HPV, but pap smears are detecting the abnormal cells that can develop after you’ve already contracted HPV.

An infected person who has had many sexual partners could have passed on the infection many times over before having it detected. For men, there is no screening program, which makes it even more challenging.

Professor Garland believes there is a need for more sensitive tests than the pap smear.

"The results of the pap smear are not as accurate when compared to HPV DNA tests, which is why the government in late 2017 changed over to HPV DNA tests for cervical screening," she tells me. "HPV-related conditions like genital warts and cervical cancer can be treated if you pick it up early."

It's important to be aware of HPV as a teenager. Image: Getty.
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How is HPV treated?

Professor Garland explains that "the treatment for high-grade cervical lesions is to remove the abnormal cells, either by surgery, laser or cauterisation".

"We obviously don't want to treat these abnormal cells unnecessarily as there is a link between those who have had the treatment and premature deliveries of their children at a later date," she advises.

Treatment for initial genital wart infections are still crude and uncomfortable, though.

"They get burned off, frozen off, cauterised, or if extensive may require laser and treatment in hospital," Garland adds.

How can we prevent the transmission of HPV?

To reduce and potentially prevent the transmission of HPV, the usual STI precaution of using condoms can help to reduce transmission, but unfortunately they don't provide complete protection. In fact, it has been shown that condoms may only be 40 percent effective in preventing genital warts in women.3

Regular screening together with safe sex and vaccination, may hold the key to eliminating cervical cancer and some types of HPV for future generations, as recently recommended in an article by the Cancer Council of NSW.4

As Professor Garland says, "if you reduce the infection that causes the cancer, you will reduce the disease".

Additionally, HPV vaccination, administered before men and women have become sexually active, may play a role in reducing transmission.

The highly successful and Australian Government funded National Schools Based Vaccination program provides high-school age boys and girls with free vaccines including the Diphtheria Tetanus Pertussis (dTpa), the Meningococcal ACWY vaccine and the HPV vaccine.

Of course, parents need to provide consent for this. I know because I've received the consent form from the school, which you just sign and return before the vaccinations. If you haven't heard about it, give your school a call and ask.

What if I have symptoms then?

As I've learned from talking to Professor Garland, there are a few things to do if you suspect you might be showing symptoms suggestive of genital warts, or experiencing other issues such as abnormal bleeding.

The number one takeaway point is that you should see your doctor, and ask for more information about HPV and about Government-funded treatment and prevention options. But for more info right now, have a look at www.hpv.com.au.

Garland SM et al. J Infect Dis. 2009;199:805–814.

2 de Sanjosé S et al. Lancet Oncol. 2010;11:1048–1056.

Manhart LE, Koutsky LA. Sex Transm dis. 2002;29(11):725-35.

4 Hall MT et al. Lancet Public Health. 2018;S2468-2667(18)30183-X.d

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Seqirus (Australia) Pty Ltd ABN: 66 120 398 067 63 Poplar Road, Parkville VIC 3052 www.seqirus.com.au; Seqirus (Australia) distributor for Merck, Sharp and Dohme (Australia) Pty Ltd. Seqirus Medical Information: 1800 642 865. SeqirusTM is a trademark of Seqirus UK Limited or its affiliates. Date of preparation: November 2018. SEQ/GAR9/1018/0042

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