• More than 80 per cent of humans will inevitably get infected with HPV in their lifetime
• Condoms are ineffective in taming it; the only way to deal with it is through vaccines
Image: PIXABAY
The Human Papilloma Virus (HPV) is the only microorganism known to science today, with the capability to penetrate intact skin and mucosal membranes.
It’s more infectious than the dreaded HIV-Aids virus and equally the most determinate precipitant of cancer (squamous cell carcinoma) of the penis for men and cancer (squamous cell carcinoma and adenocarcinoma) of the cervix for women.
Available scientific literature ascertain that smoking, oral contraceptives, immunosuppressive conditions, promiscuity and other known risk factors will NEVER cause cervical and or penile cancer in the absence of oncogenic HPV infection, also termed High Risk HPV (HR-HPV).
Papilloma viruses are mainly transmitted through skin, mucosal or genital contact, circumventing the possible protection provided by condom use. During intimacy, naked body surfaces of the partners will always get into contact for a significant period of time to grant this aggressive virus opportunity to infect the other party.
Heterosexual, homosexual, anal, oral or any other innovative sexual encounter one is involved in, condom use notwithstanding, can lead to transmission. For example, during heterosexual intercourse, the scrotum naturally gets into contact with the labia of the female partner and the vaginal secretions. The pubic region of both partners is not spared as it is never covered by condoms.
It’s not just multiple sexual encounters. Infection with carcinogenic variants of HPV is certain even with a single condom used during sexual encounter with a widower whose wife died from cancer of the cervix, and vice versa. Meaning a single protected sexual encounter with a widow whose husband died from penile cancer will suffice to be infected with the caner-causing variants of HPV, especially if the ‘infectious’ partner has active HR-HPV infection.
Anal-genital warts, known as condylomata accuminata, are common and are as a result of papillomatous HPV infection, also referred to as Low-Risk HPV(LR-HPV). This occurs in celibate individuals, lesbians as in heterosexual partners, since intimate body contact and not necessarily penetrative sexual intercourse will suffice to be infected.
HPV naturally habours the epidermis, on all body parts of the human being. Skin to skin or mucosal contact with an infected person is adequate to get HPV infection, and not necessarily penetrative sexual encounter (Fernandes, Galvão de Araújo and Fernandes (2013).
Holding the naked body of the other infected partner against your naked one will suffice to be infected, making infection with the virus inevitable during one’s lifetime, especially sexually active humans.
The presumptive universal protection from sexually transmitted infections through condom use is a fallacy with regards to HPV infection, Oncogenic (HR-HPV 16/18) and papillomatous (LR-HPV 6/11) alike.
Celibacy and HPV infection are not mutually exclusive, especially for papillomatous (warts causing) HPV variants, since the social nature of man and ‘intimate’ interactions is a predisposition to infection with these LR-HPV.
Sexual intercourse is a natural human behaviour that will and must continue for eternity, contributing to continued transmission of this virus to present and future generations.
Getting infected with HPV does not automatically lead to warts or cancer, as this predicament affects only a section of the infected people, estimated as about 10 per cent. However, as speculated, more than 80 per cent of the human population will inevitably get infected with HPV in their lifetime.
The 10 per cent of infected individuals who fail to mount effective immune response to the virus is a huge number of people, placing cancer of the cervix amongst the leading causes of morbidity and mortality for women worldwide.
Of the 200 strains of HPV in existence, the main cancer-causing strains (HR-HPV) are the types 16, 18, 31 and 45, with the warts-causing types (LR-HPV) being majorly the types 6, 11 and 16.
An individual can acquire active infection with various strains concomitantly, so that both the oncogenic types and the papillomatous types can infect the same individual at the same time.
CUE THE VACCINE
The most reliable preventive measures against infection with carcinogenic HPV are vaccination of both men and women before they become sexually active.
Though very rare, primary and exclusively mutually monogamous sexual relationship and the psycho-socially expensive absolute abstinence from sexual intercourse, for normal humans, are certain effective alternatives to HPV vaccinations in repelling the HPV infection.
The prolonged latent period of cancer of the cervix and penis, spanning decades, is a great undoing to realising the magnitude of the infection since the cancer occurs several years after infection, strengthening the complacency of most individuals in taking up vaccination.
The World Health Organisation Newsletter of February 22, 2022 reported cervical cancer as the fourth-most common cancer among women globally, with an estimated 604,000 new cases and 342,000 deaths in 2020, and that about 90 per cent of the new cases and deaths worldwide occurred in low- and middle-income countries.
The Kenya Human Papillomavirus and Related Cancers Fact Sheet 2021 indicates that every year, about 5,236 women in Kenya are diagnosed with cervical cancer and 3,211 die from the disease.
These deaths exclude the socioeconomic loss resultant from the absence of the deceased, the catastrophic financial costs of the unsuccessful treatment of advanced stage cancers, and the debilitating mental trauma of the cancer patients’ dependants and caregivers.
Vaccination against HPV is the certain most cost-effective option to prevent active disease progression after HPV infection, with consequent prevention of HPV-caused cancers, not only of the genital organs but other body tissues as well.
According to Sofiani et al (2023), HPV infection has a causal relationship with other cancers beyond the genital organs, such as cancer of the oesophagus, colon, rectum, liver, urinary bladder, head and neck, liver, anus and gastric tumours, all of which occur in both males and females.
Bivalent vaccine is effective against the two HR-HPV types 16 and 18, and the quadrivalent vaccine is effective against four HPV viruses, two oncogenic (HR-HPV 16 and 18) and two Papillomatous variants (LR-HPV 11 and 35).
The vaccines will prevent but not eliminate an ongoing active HPV infection and must be administered to the minors before sexual debut. Sexual debut is the highest risk of primary HPV infection. For those already sexually active, a negative HPV DNA test to eliminate prevailing HPV infection is mandatory preceding HPV vaccination.
GARDASIL FOR GIRLS
Merk Sharp & Dohme successfully developed and graciously continues with the production of Gardasil 4, a quadrivalent HPV vaccine, which is a proven silver bullet in the elimination of HPV-triggered cancers and condylomas of the genital areas and other body parts.
In Kenya, the quadrivalent vaccine Gardasil-4 is provided free of charge to girls aged between 9 and 15 years as a donor programme co-financed by Gavi and the government.
The best gift other than education that parents should grant their children is ensuring that they receive Gardasil-4 vaccine so they are protected from sexually transmitted cancers triggered by HPV infection.
The future generation can only be safe from these cancers if they receive the vaccination today, and especially before 2029, when the logistical support to Kenya from Gavi will no longer be available and the associated high costs of vaccination will have to be borne by the state (Mwenda et al, 2023).
According to the Global Cancer Statistics 2020, cervical cancer is ranked fourth in the chronological order of burden and case mortality behind lung, female breast and prostate cancers, yet it receives the greatest public attention.
This is because cancer of the cervix is truly the only human cancer that is preventable with certainty through vaccination, an action that would prevent the hundreds of thousands of deaths experienced annually and the associated catastrophic socioeconomic costs.
HPV is resident in multiple body surfaces beyond the genital region. Vaccination of the eligible population will protect the public from these tumors other than the genital tract-specific cancers.
HPV vaccination has even been shown to reduce the risk of colorectal cancer in young people (Sofiani et al, 2023). Every living human has the power in their hands to get vaccinated against the HR-HPV and ensure minors under their care benefit, too, of course as medically prescribed appropriate to conform to eligibility requirements.
Dr Thedeus Owiti works with the Homa Bay County Department of Health