Are you human

Over 75% of Canadians will have one form or another of this virus in their lifetime. People come into contact with this virus through any skin-to-skin sexual contact below the waistline with fingers, mouths or other body parts – even without penetration. Condoms offer good protection against sexually transmitted infections (STIs), unwanted pregnancies and HPV in general BUT do not fully protect people from transmitting this virus because there is still direct skin-to-skin contact.

 

 

HPV

The letters H P V stand for the Human PapillomaVirus. This virus has over 180 different strains that are numbered, HPV 1, HPV 2, and so on. A person comes into contact with this virus through any skin-to-skin sexual contact below the waistline with fingers, mouth or other body parts – even without penetration. Condoms do not fully protect people from giving/getting this virus because the condom only covers the length of the penis; there are still other parts below the waist that will have direct skin-to-skin contact. This certainly includes inserting a penis or an object into a vagina or anus, as well as rubbing skin-to-skin against each other below the waistline without any penetration. This type of touching puts people in direct contact with this virus due to the skin-to-skin touching and exchange of bodily fluids (pre-cum and semen that comes from a penis each time a male ejaculates and vaginal discharge from a female). Unfortunately, there typically are no signs or symptoms of this virus for either partner, regardless of sex or gender.

A person can contract HPV simply through sexual contact between the genitals and the fingers, mouth or other body parts… even without penetration

This virus could appear as genital warts or lead to certain cancers. Genital warts can be found anywhere from the waist down to the knees, at the front and back of a person’s body. Genital warts are small, raised, hard lumps that grow in clumps. They are usually painless but may cause itching, burning, or light bleeding. This virus can manifest itself as genital warts and spread below the waistline through any skin-to-skin sexual contact.

There are also some strains of this virus that can lead to cancers of the head, neck, throat, tongue, cervix, vagina, anus, and penis. It can be asleep in a person’s body for up to 30 years. This means what we do in our teens, 20s, 30s, or 40s can affect us in our 50s, 60s, 70s and 80s simply because it can take up to 30 years before developing symptoms. It is clear that HPV is highly contagious. The good news is that there are preventative methods. I strongly recommend that you and any partner be protected from this virus with the HPV vaccine. Your health care provider can give you more information about a vaccine called Gardasil 9. It is given in 3 doses over a 6-month period.

Human Papillomavirus (HPV) is an extremely common virus. At some point in our life, most of us will catch the virus. The world over, HPV is the most widespread sexually transmitted virus; 80% (four out of five) of the world’s population will contract some type of the virus once [1]. If you catch HPV, in the majority of cases, the body’s immune system will clear or get rid of the virus without the need for further treatment. In fact, you may not even know that you had contracted it.

There are over 100 identified types of HPV; each different type has been assigned a number. HPV infects the skin and mucosa (any moist membranes such as the lining of the mouth and throat, the cervix and the anus). Different types affect different parts of the body causing lesions. The majority of HPV types infect the skin on external areas of the body including the hands and feet. For example, HPV types 1 and 2 cause verrucas on the feet [2].

Around 40 of the HPV types affect the genital areas of men and women, including the skin of the penis, vulva (area outside the vagina), anus, and the linings of the vagina, cervix, and rectum [3]. Around 20 of these types are thought to be associated with the development of cancer. The WHO International Association for Research on Cancer (IARC) identifies 13 of these types as oncogenic (cancer causing). This means there is direct evidence that they are associated with the development of cervical cancer and are considered high-risk [4]. These high risk types of HPV are: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68 [5]. A person infected with high-risk HPV will show no symptoms so they may never even know they have it.

Additionally there are nine HPV types that may also be associated with the development of cervical cancer these are types: 26, 53, 64, 65, 66, 67, 69, 70, 73, 82. However, currently there is not enough evidence to indicate that these types are high risk for cervical cancer [6].

The remaining HPV types have been designated low-risk as they do not cause cervical cancer but they can cause other problems such as genital warts.

The Cervix

The cervix (or neck of the uterus) is the lower, narrow part of the uterus which connects to the top end of the vagina. The opening of the cervix is called the os. The cervical os allows menstrual blood to flow out from the vagina during menstruation. During pregnancy, the cervical os closes to help keep the foetus in the uterus until birth. During labour, the cervix dilates – or widens – to allow the passage of the baby from the uterus to the vagina. Approximately half the cervix length is visible with appropriate medical equipment; the remainder lies above the vagina beyond view.

The cervix is covered with a layer of skin-like cells on its outer surface, called the ‘ectocervix’. There are also glandular cells lining the inside of the cervix called the endocervix; these cells produce mucus. The skin-like cells of the ectocervix can become cancerous, leading to squamous cell cervical cancer. As well, the glandular cells of the endocervix can become cancerous, leading to an adenocarcinoma of the cervix.

The ectocervix and endocervix have a three main skin layers or zones:

The Basal Layer – cells are produced here. Older cells are pushed up towards the surface. If you contract HPV, the virus will attack the basal layer cell.
Midzone – the middle layer of cells. As cells move up from the basal layer they lose their capacity to divide making them fully mature cell.
Superficial Zone – The uppermost surface of the cervix where mature cells eventually die and shed in the normal process of skin shedding [1]. Cervical screening takes cells from this area.

The area where cervical cells are most likely to become cancerous is called the transformation zone. This is the area just around the opening of the cervix that leads on to the endocervical canal (the narrow passageway that runs up from the cervix into the womb). The transformation zone is the area that your doctor or nurse will concentrate on during cervical screening.

The vagina is the tube extending from the outside of the body to the entrance to the womb. The skin-like cells that cover the cervix join with the skin covering the inside of the vagina; so, even if you have had your womb and cervix removed, you can still have screening samples taken from the top of the vagina.

The HPV Vaccines and Preventing Cancers

HPV causes 9 different types of cancers and genital warts. HPV vaccination is the best protection from this virus. There are benefits for people of all ages. The vaccine protects people from being affected by different types of the virus with which they have not already come into contact. If a person has cleared an HPV-related infection (genital warts or an HPV-related pre-cancer), the vaccine will help against reinfection. Furthermore, if you have a cervix, getting routine screening, whether vaccinated or not, can help detect cervical cancer.

Cervical Screening (Smear Test)

Cervical screening is NOT a test to find cancer. It is a screening test to detect abnormalities (pre-cancer) at an early stage in the cells of the cervix.

Cervical screening is the process of taking a sample of cells from your cervix, which are then examined to detect abnormalities that could develop into cancer in the future. The sample of cells is placed in a liquid so that it can be analysed in the laboratory. This process is called Liquid-Based Cytology (LBC). Screening can detect precancerous/abnormal cells. The detection and successful treatment of these cells usually prevent the occurrence of cancer. Changes in these cells are generally caused by certain types of human papillomavirus (HPV). Testing for the HPV virus itself can also be done on the same LBC sample that is examined under the microscope. For more information on HPV testing click here.

Around 1,408 new cervical cancer cases are diagnosed annually in Canada [1]. Regular cervical screening provides a high degree of protection against developing cervical cancer. Not receiving cervical screening is one of the biggest risk factors for developing cervical cancer.

Abnormal Cervical Cells and Treatment

The cervix is covered with a layer of skin-like cells on its outer surface, called the ectocervix. The results of your cervical screening test are based on the examination of the cells from the surface of the ectocervix. The test detects whether abnormal cells are present.

Cells that are found in the cervical canal are called endocervical cells (glandular cells); these are different from the ectocervix. The transformation zone is the area from where the endocervix meets the ectocervix. This is where glandular cells normally change to squamous cells of the ectocervix. Rarely, some women have endocervix cells that are abnormal and these abnormal areas are called glandular changes.

Cervical Cancer

Cervical cancer forms in the tissues of the cervix. The cervix is an organ that connects the uterus and vagina. It is usually a slow-growing cancer that may or may not have symptoms but can be prevented through regular screening (a procedure in which cells are taken from the cervix and looked at under a microscope).

Cervical cancer is not thought to be hereditary. [1][2][3]

99.7% of cervical cancers are caused by the persistent high risk human papillomavirus (HPV) infection which causes changes to the cervical cells. HPV is an extremely common virus; around four out of five people are exposed to the virus. Anyone who is sexually active can be infected with HPV at some time and the body’s immune system will usually clear it up. Generally, most people don’t even know they have contracted the virus.

Cervical abnormalities are caused by persistent high-risk HPV infection. These abnormal cells found through cervical screening are not cancerous but, given time (often years), they may go on to develop into cancer. However, the cells often return to normal by themselves.

The most effective method of preventing cervical cancer is through regular cervical screening which allows for the detection of any early changes of the cervix. For younger women, the HPV vaccination can help prevent seven out of ten cervical cancers (70%). Cervical cancer is largely preventable and, if caught early, survival rates are high.

Colposcopy

If you have received an abnormal cervical screening result or if your practice nurse has visually noticed changes in your cervix, you may be invited to attend a colposcopy clinic.

Colposcopy is simply a more detailed look at the cervix. Instead of looking at the cervix with the naked eye, the person performing the colposcopy will use a special microscope to see the changes at high magnification and with good lighting. Don’t worry about the sound of this! The microscope stays outside of your body. All that is inserted is the speculum, which is the instrument the GP or practice nurse uses to see the cervix during the cervical screening. Some clinics may be equipped with video equipment so that you can watch the examination, if you wish. The examination may take a little longer than a standard cervical screening test but the colposcopist (a doctor or nurse specifically trained to undertake a colposcopy) will talk to you during the examination and tell you what is happening.

You should be looked after by the dedicated staff of the colposcopy clinic. They will understand that you may be worried and will take the time to discuss your screening result before the examination. You will be examined on a purpose-built couch. The cervix is viewed using a speculum (the instrument inserted into the vagina, which was also used when you had your cervical screening test taken) and then examined with the colposcope at low magnification (4-6X). The colposcopist will put a number of different solutions on the cervix and look for changes that indicate the presence or otherwise of changes to the cells. The medical term for cervical changes is cervical intra-epithelial neoplasia (CIN).

Read more about the tests done at colposcopy, click here.

After a diagnosis, Support and LifeStyle.

References

HPV.

  1. Koutsky L. 1997. Epidemiology of genital human papillomavirus infection. The American Journal of Medicine, 102 (5A), 3-8.
  2. Lacey CJ et al., 2006. Chapter 4: Burden and management of non-cancerous HPV-related conditions: HPV-6/11 disease. Vaccine, 24 (3), S3/35-41.
  3. Giuliano AR et al., 2008. Epidemiology of human papillomavirus infection in men, cancers other than cervical and benign conditions. Vaccine, 26 (10), K17-28.
  4. Walboomers JMM et al.,1999 Human papillomavirus is a necessary cause of invasive cancer worldwide. Journal of Pathology, 189 (1), 12–19.
  5. Szarewski A. 2012. Cervarix: a bivalent vaccine against HPV types 16 and 18, with cross-protection against other high-risk HPV types. Expert Review Vaccines 11(6), 645 – 657.
  6. Bouvard et al., 2009. A review of human carcinogens – Part B: biological agents. Lancet Oncology 10, 321 – 32

Cervix.

  1. Dunleavey R (2009) Cervical Cancer: a guide for nurses. Wiley-Blackwell, UK. pp

Cervical Screening.

  1. Bruni L, Barrionuevo-Rosas L, Albero G, Aldea M, Serrano B, Valencia S, Brotons M, Mena M, Cosano R, Muñoz J, Bosch FX, de Sanjosé S, Castellsagué X. ICO Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in Canada. Summary Report 2014-12-18.

Cervical Cancer.

  1. Magnusson P et al., 1999. Genetic link to cervical tumours. Nature 400, 29-30.
  2. Walboomers JMM, et al., 1999. Human papillomavirus is a necessary cause of invasive cancer worldwide. Journal of Pathology, 189 (1), 12–19.
  3. Bosch FX et al. 2002., The causal relation between human papillomavirus and cervical cancer. Journal of Clinical Pathology 55, 244-265

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