How can HPV affect me?

HPV and cervical cancer

Did you know that cervical cancer is caused by certain types of human papillomavirus (HPV)?

Although most HPV infections go away on their own without causing any harm, there are over 30 different types of HPV that affect the genital area, and 2 of these cause approximately 70% of cervical cancer cases. When these types of HPV infect the cells of the cervix (the opening to the uterus), it's a possibility that the cells will become cancerous.

How could cervical cancer affect your life?

If precancerous lesions (abnormal cells that could become cancer but haven't yet) are caught early, they can most often be successfully treated.
If the cancer is not caught early enough, this may mean you need to undergo surgery or radiation therapy.
Basically, the later the cancer is detected, the lower the survival rate.
In Canada, cervical cancer is the second most common cancer among women between 20 and 44 years old.
Find out ways to protect yourself against cervical cancer:
Ask your doctor about having regular Pap tests and checkups to help detect any problems early.
Be sure to practice safer sex.
Talk to your doctor about vaccination.

HPV and abnormal cervical cells (cervical dysplasia)

Female reproductive system

Although most HPV infections go away on their own without causing any harm, there are some types of HPV that can affect the genital area and lead to abnormal cervical cells, or cervical dysplasia. Cervical dysplasia are cells that have changed in appearance. They may be called precancerous because they can develop into cervical cancer. These abnormal cells don't usually cause symptoms, and the best way for you to find out if they're present is by having regular Pap tests.

Regular Pap tests can find these abnormal cells before they turn into cervical cancer, so it's very important to have Pap tests on a regular basis. Ask your doctor how often you should be having a Pap test.

If your doctor says the results of your Pap test are abnormal, remember that this doesn't necessarily mean you have cancer. Stay calm! Your doctor may want to remove the cells and you may be asked to go for more frequent Pap tests for a while until you get the "all clear." Some physicians may choose to take a "wait and see" approach along with more frequent Pap tests for mild cases of cervical dysplasia as these cases may go away on their own. Whichever approach you undergo, remember that you're not alone.

HPV and genital warts

Did you know that genital warts are caused by only certain types of HPV?

2 types of the HPV virus cause 90% of all cases of genital warts.

Genital warts look like flesh-coloured bumps and they can be flat or look like a typical wart. You might hear some people describing them as "cauliflower-like." Some can be so small that you can't see them, others can be larger. They usually appear on the cervix (outer end of the uterus) or vulva (the external parts of the female genital organs), but can also be in surrounding areas, including the thighs. In men, they can be on any genital area and the thighs, too. Genital warts are highly contagious: 2 out of 3 people who have sex with an infected partner will develop genital warts.

How could genital warts affect my life?

If you're intimate with a partner, it can be pretty embarrassing to have to tell them that you have genital warts.
Genital warts can cause itching, vaginal discharge, and even vaginal bleeding after sex.
Genital warts can also cause problems during pregnancy and during childbirth. In rare cases, they can also infect the baby, causing warts to form in the baby's throat.
Genital warts can be treated with prescription cream medications, electric currents, freezing, or laser surgery, but because HPV cannot be cured, the warts may come back.

HPV and other health problems

Did you know that HPV can cause vulvar cancer (cancer of the external female genital area) and cancer of the vagina?
When certain types of HPV infect the cells of the vagina and vulva, they may cause the cells to change in ways that make them more likely to turn into cancer cells.
How could vulvar or vaginal cancers affect you?
If vulvar or vaginal cancer is caught early, it can be treated with surgery and the survival rates are good.
If the cancer is not detected until later, it's more serious. Survival rates are much lower, and treatments would involve surgery, radiation, and chemotherapy.

HPV and other cancers

HPV can also cause cancer of the uterus and colon (anus) in women, and cancer of the penis, scrotum, and colon in men. It's also been found to cause some head and neck cancers.
Fortunately, there are ways to reduce the risk of getting infected with HPV. It's also possible to detect these cancers early. Pap tests and other tests can detect abnormal cervical cells. Talk to your doctor about having regular pelvic exams and checkups, and find out how often you should be having them. If you're embarrassed, just call up your doctor's office and ask. Also ask about all the things that you can do to protect yourself.

Anal Cancer in Gay and Bisexual Men

Overview, Types, Symptoms, Diagnosis

Anal cancer is an uncommon, often curable cancer that produces slow-growing tumors and lesions in the anus and nearby anal anatomy. Most anal cancers are associated with human papillomavirus (HPV), which causes warts on the anus and genitals, similar to cervical and other cancers of the reproductive system. Providers recommend annual anal Pap smears to HIV-positive men who have sex with men (MSM), and biannual Pap smears to HIV-negative MSM.

Pap smears screen for HPV and abnormal tissue growth (dysplasia). Routine anal Pap smears may reduce the incidence and progression of anal cancer, as they have for cervical and uterine cancer. The prognosis is good if the cancer is discovered early.
Incidence and Prevalence Anal cancer affects men and women, but it is the only cancer with a greater prevalence among men who have sex with men (MSM) than in the general population. About 35 in every 100,000 MSM develop anal cancer, compared to less than one in every 100,000 heterosexual men. The risk for anal cancer in HIV-positive men is twice as high as that for HIV-negative MSM.

The American Cancer Society estimates that there will be 3,500 new cases of anal cancer among men and women in 2001 and 500 deaths resulting from it. Cancer of the perianal skin around the anus is more common in men, while tumors of the anal canal more often affect women.
Anal cancer accounts for only 4% of all cancers affecting the digestive tract.
Types Anal cancers are skin cancers. The majority of anal cancers are squamous cell carcinomas (in situ or epidermoid), which originate in the first layer of anal tissue and may spread to deeper layers. This type is associated with HPV. About 15% of anal cancers originate in the glands near the anus; this is called adenocarcinoma, or Paget's disease. The remaining anal cancers are basal cell carcinoma and malignant melanoma. Melanoma in the anus is difficult to see and is often discovered at a late stage, after the cancer has spread through layers of tissue.
Risk Factors The exact cause of anal cancer is unknown. Aside from general cancer risk factors, like smoking and alcohol consumption, certain risk factors increase a person's risk for developing anal cancer. HPV and anogenital warts are a significant risk factor. This includes past and current infections. Some strains of HPV that cause larger warts are not associated with cancer.
Most men that develop anal cancer are over 50 years old, although coinfection with HIV increases the chance of early development.

Symptoms

Many men have no visible symptoms of anal cancer. However, because the cancer is strongly associated with HPV infection, a history of anogenital warts is likely. Although most lesions are benign, any visible anal sore or bump should be examined. They may be a sign that others have developed in the anal canal.
Other signs include the following:

• Abnormal discharge from the anus
• Bleeding from the rectum and anus
• Itching of the anus
• Pain or pressure around the anus
• Sore around the anus that does not heal

All of these signs warrant an examination by a physician.

Diagnosis

Anal cancer is diagnosed with an anal Pap smear, in which a cotton swab is inserted past the anus and swirled to capture a tissue sample. The tissue cells are examined under a microscope for signs of dysplasia. An abnormal Pap smear shows signs of excessive cell growth and is followed by a colposcopy, the internal examination of specific lesions or areas of cell growth for biopsy. Acetic acid (vinegar) is introduced into the anal canal to prepare the cells before an anoscope, a plastic tube, in inserted. The provider inserts a colposcope through the anoscope to visualize the cells in the anus with magnification. The procedure is painless. During a biopsy, a biopsy forceps is inserted in the suspect tissue to obtain a sample for close examination. Lesions and tumors found during a colposcopy are typically biopsied.

Anal cancer may be discovered during a routine digital rectal exam (DRE), in which a medical professional inserts a gloved finger past the anus to feel for abnormalities.
Staging Staging is the evaluation of the size and location of a tumor to determine a prognosis and appropriate treatment. Initially, abnormal tissue growth is classified as high- or low-grade squamous interepithelial neoplasia (LSIN or HSIN; high- or low-grade abnormal cell growth), or as cancer. This is determined by the biopsy performed during colposcopy.

If cancer is detected, its stages are described in the following way:

Stage 0
Cancer is found only in top layer of anal tissue (squamous cell carcinomas).
Stage I
Cancer has metastasized (spread) beyond first layer of tissue but is smaller than 2 centimeters.
Stage II
Cancer is larger than 2 centimeters but confined to tissue.
Stage III A
Cancer has metastasized to nearby organs (bladder, reproductive) or lymph nodes.
Stage III B
Cancer has metastasized to organs and lymph nodes in the abdomen, groin, or rectum.
Stage IV
Cancer has metastasized to distant organs.

The TNM system is also used to stage anal cancer. In this system, T corresponds to tumor size, N refers to whether or not the lymph nodes are affected, and M refers to whether or not the cancer has metastasized (spread) to other organs.

What HPV is...

Human papilloma viruses are known as HPV. They can affect the skin and the moist membranes that line parts of the body, including

* The lining of the mouth and throat
* The cervix
* The anus

There are more than 100 different types (or ‘strains’) of human papilloma virus (HPV). Each type has a different number. HPV is common. About 3 out of 4 people (75%) have the virus at some time in their lives. For most people it causes no symptoms and goes away on its own. It is much more common in young people, probably because we develop immunity to the virus as we get older.Some types of HPV can cause changes in the cells of the cervix or the lining of the mouth and throat. They are known as high risk HPVs. Doctors call these changes in cells ‘dysplasia’. The changed cells have an increased risk of becoming cancerous.Other types of HPV can cause warts and verrucas. These types of HPV are sometimes called the ‘wart virus’ or ‘genital wart virus’ and they include types 6 and 11. Warts and verrucas are most common on the hands and feet, in the genital area and around the anus. But they can be on any part of the body. Types of HPV that cause warts and verrucas do not usually cause cell changes that may develop into cancer. They are called low risk HPVs.

HPV and cervical cancer

Some types of HPV can increase the risk of developing cervical cancer, particularly types 16, 18, 31, 33 and 45. They are called high risk types. Almost all women with cervical cancer have at least one of these types of HPV in the cells of their cervix.Of the different types of HPV, types 16 and 18 cause about 7 out of 10 (70%) cancers of the cervix. The other types cause most of the remaining 30% of cervical cancers. Do remember that most women with high risk HPV don’t develop cervical cancer. We know from research that other factors affect whether you develop a cancer, such as how well your immune system is working or whether you smoke. Women who smoke and have a high risk type of HPV infection are more likely to go on to get cervical cancer.Remember that regular cervical screening will pick up abnormal cervical cells before they become cancerous. So even if you have HPV and smoke, you can prevent cervical cancer if you go for screening when you are invited.People with low immunity also have an increased risk of cervical cancer. Your immunity may be low because you take certain medicines for another condition, or because you have an illness that affects your immunity, such as HIV AIDS. If you have low immunity, it is particularly important to have regular cervical screening.

How you get HPV

Types of HPV that affect the skin can be passed on by skin contact with an affected person. The types of HPV that affect the mouth and throat can be passed on through kissing.Genital HPV is usually spread through intimate, skin to skin, contact during sex.You can have the genital HPV virus for years and not have any sign of it. So it isn’t unusual to have a long term partner and then be told you have the virus after medical tests such as cervical screening. Many people then worry that their partner has been unfaithful, or will think they have been unfaithful. But finding out you have HPV doesn’t necessarily mean that you or your partner have been unfaithful. There is no way of knowing how long you have had the virus. It could be weeks, months or years.

HPV Virus in Men

Much of the information about HPV virus (human papillomavirus) centers on women, since having the virus increases their risk of getting cervical cancer. But HPV virus in men can cause health problems, too. So it's important for men to understand how to reduce the risks of HPV infection. It can increase a man's risk of getting genital cancers, although these cancers are not common. HPV can also cause genital warts in men, just as in women.More than half of men who are sexually active in the United States will have HPV at some time in their life. Often, a man will clear the virus on his own, with no health problems.

Risks of HPV Virus in Men

Some of the 30 or so types of HPV associated with genital cancers can lead to cancer of the anus or penis in men. Both of these cancer types are rare. In those with a healthy immune system, they are even rarer. About 1,530 men in the U.S. were diagnosed with cancer of the penis in 2006, according to American Cancer Society estimates. About 1,910 men got a diagnosis of anal cancer.The risk of anal cancer is about 17 times higher in sexually active gay and bisexual men than in men who have sex only with women. Men who have HIV (human immunodeficiency virus) are also at higher risk of getting this cancer.Other types of HPV virus rarely cause cancer in men, but they do cause genital warts. At a given point in time, about 1% of sexually active men in the U.S. will have genital warts.

Male HPV: The Symptoms

The types of high-risk HPV that can cause cancer rarely present any symptoms in men or in women. Genital warts are the first symptom you may see with low-risk HPV strains that cause warts but not cancer.

Tests for HPV Virus in Men

To diagnose genital warts in men, the doctor will visually check a man's genital area to see if warts are present. Some doctors will apply a vinegar solution to help identify warts that aren't raised and visible. But the test is not foolproof. Sometimes normal skin is mistakenly identified as a wart.There is no routine test for men to check for high-risk HPV strains that can cause cancer. However, some doctors are urging anal Pap tests for gay and bisexual men, who are at higher risk of anal cancer caused by HPV. In an anal Pap test, the doctor collects cells from the anus, and then has them checked for abnormalities in a lab.

Treatments for HPV

There is no treatment for asymptomatic HPV infection. Instead, doctors treat the health problems that are caused by the HPV virus.When genital warts appear, a variety of treatments can be used. The patient can apply prescription creams at home. Or a doctor can surgically remove or freeze off the warts.Early treatment of warts is discouraged by some doctors because genital warts can go away on their own. It can also take time for all warts to appear. So a person who treats warts as soon as they appear may need another treatment later on.Anal cancer can be treated with radiation, chemotherapy, and surgery. The specific treatments depend on the stage of cancer - how big the tumor is and how far the cancer has spread.

HPV Vaccine for Men?

The HPV vaccine Gardasil, approved for use in women in 2006, is not yet approved for men. Studies are still being done to determine if the vaccine works in males. Eventually, public health experts say, boys and men may be vaccinated.

How to Manage HPV in a Relationship

If a man's long-term sexual partner has HPV, chances are good HPV transmission has already occurred and he also has it. HPV in men may clear from the body more easily than in women. Women, in general, often clear the virus in two years or less.The HPV types associated with cervical cancer usually do not cause health problems for a heterosexual man having sex with an HPV-infected woman.If a partner has HPV, it does not necessarily mean they have had sex with someone else recently. The virus can lay dormant in the body for years without causing noticeable symptoms.

How to Prevent Transmission of HPV

Abstinence is the only sure way to prevent HPV transmission. Risk of transmission can be lowered if a person has sex only with one person who is not infected and who is monogamous.To lower the risk of HPV transmission, men can also limit the number of sex partners and pick partners who have had few or no partners in the past.Condoms can provide some protection against HPV transmission. But they aren't 100% effective, since HPV is transmitted primarily by skin-to-skin contact. The virus can still infect the skin uncovered by the condom.In a recent study of young women who had just become sexually active, those whose partners used a condom each time they had sex were 70% less likely to get an HPV infection than were women whose partners used a condom less than 5% of the time.

How common is HPV infection?

HPV infection is now considered to be the most common sexually-transmitted infection (sexually transmitted disease, STD) in the U.S., and it is believed that at least 75% of the reproductive-age population has been infected with sexually-transmitted HPV at some point in life. It is believed that over 6 million people become infected with HPV every year in the US, and approximately 50% of those infected are between the ages of 15 and 25.

HPV infection is common and does not usually lead to the development of warts, cancers, or even symptoms. In fact, the majority of people infected with HPV have no symptoms or lesions at all. Determination of whether or not a person is infected with HPV involves tests that identify the genetic material (DNA) of the virus. Furthermore, it has not been definitely established whether the immune system is able to permanently clear the body of an HPV infection. In many cases, a person will test positive for HPV infection and then have negative HPV tests for months to years, only to have a positive test result at a later time. It is presently unclear if this is due to a latent (continuing but hidden) viral infection or if the person has become re-infected with the virus.

Asymptomatic people infected with HPVs (those without HPV-induced warts or lesions) are still able to spread the infections to others through sexual contact.
It is important to note that in the U.S. and other developed countries, screening and early treatment of precancerous changes of the cervix have dramatically reduced the incidence of cervical cancer. In developing countries lacking the medical infrastructure or financial means to implement a screening system, the incidence of cervical cancer resulting from HPV infection is much higher. In fact, cervical cancer develops in around 500,000 women each year worldwide, and, in many countries, it is the most common cancer to kill women.

What are human papillomaviruses (HPVs)?

There are over 100 types of papillomaviruses (HPVs) that infect humans. Of these, more than 40 types can infect the anogenital tract (genital tract and anus) of men and women and cause genital warts (known as condylomata acuminata or venereal warts). A subgroup of the HPVs that infect the anogenital tract (genital tract and anus) can lead to precancerous changes in the uterine cervix and cause uterine, cervical cancer. HPV infection also is associated with the development of other anogenital cancers in women. The HPV types that cause cevical cancer also have been linked with both anal and penile cancer in men as well as a subgroup of head and neck cancers in both women and men. Genital warts and HPV infection are transmitted primarily by sexual intimacy, and the risk of infection increases as the number of sexual partners increase.

The most common HPV types that infect the anogenital tract are HPV types 6, 11, 16, and 18 (HPV-6, HPV-11, HPV-16, and HPV-18), although other HPV types can also infect the anogenital tract. Among these, HPV-6 and HPV-11 are most commonly associated with benign lesions such as genital warts and mild dysplasia of the cervix (potentially precancerous changes in the appearance of cervical cells under a microscope) and are termed "low-risk" HPV types. In contrast, HPV-16 and HPV-18 are the types found in the majority of cervical and anogenital cancers as well as severe dysplasia of the cervix. These belong to the so-called "high-risk" group of HPVs.
Other, different HPV types infect the skin and cause common warts elsewhere on the body. Some types of HPVs (e.g., HPV 5 and 8) frequently cause skin cancers in people who have a condition known as epidermodysplasia verruciformis.

HPV and other cancers

Some types of HPV can increase your risk of developing cancers in other parts of the body, not just the cervix. Not everyone with these types of HPV will go on to develop cancer. These cancers are rare and other factors are necessary before cancer will develop.

History of papillomavirus research

Papillomavirus research has passed through several phases. The field began slowly with the experimental transmission of human and animal warts prior to 1930. Greater interest in these viruses was stimulated in the 1930s by the demonstration that filtered extracts from cutaneous papillomas of wild cottontail rabbits could induce lesions with malignant potential in cottontail and domestic rabbits. Although investigations in the 1930s and 1940s were limited to in vivo studies in outbred rabbits, many principles of papillomavirus biology were estab­lished by observations made during this period.

The availability of infectious extracts permitted the reproducible induction of lesions whose natural history could be followed or be experimentally modified. Interest in papillomaviruses diminished during the 1950s and 1960s. This change was attributable to several factors, including the inability of papillomaviruses to propagate in culture at a time when the life-cycle and transforming activity of other oncogenic viruses could be studied in vitro, permitting rapid advances in molecular understanding of these processes in the more tractable systems. In addition, human papillomaviruses (HPV) were believed to have limited medical importance because the conditions they induced were thought to be limited to benign lesions with little or no potential for malignant progression.

The advent of molecular cloning during the 1970s led to a resurgence in papillomavirus research. As in other areas of biology, this technical revolution was critical to progress in the investigation of papillomaviruses. The unlimited availability of wild-type and mutant viral genomes made it possible to study the function of viral genes and their products, to use viral sequences as molecular probes to detect papillomavirus sequences in tissue, and to identify and molecularly clone new viral genotypes. Application of these molecular techniques led to the identification of HPV as the necessary infectious cause of a major public health problem, cervical cancer. These studies also provided insight into the pathogenesis of HPV-induced disease, established new paradigms for cellular transformation by viral genes, and identified candidate antigens for protection against papillomavirus infection.