International HPV Awareness Day 

The 4th of March marks ‘International HPV Awareness Day’. This is a global initiative for raising awareness about human papillomavirus (HPV), its impact on health, and the prevention measures against it. Most of us have probably heard about HPV, and may have also heard that it can cause cervical cancer. However, in most cases, this is where our understanding of the virus ends. So what is HPV? How is it spread? How dangerous is it to our health? and how can we best protect ourselves from it? Below, you will find the most important facts about HPV:

HPV is a virus with more than 200 types

Globally, HPV is the most common sexually transmitted infection (STI). There are over 200 types of HPV, and around 13 of these are classed as ‘high risk’ due to their potential to cause cancer. The most frequently associated high-risk HPV types with cervical cancer development are HPV 16 and 18¹. The rest are ‘low-risk’ types that do not cause cancer, with some associated with the development of warts on the hands, feet, or genitals. 

HPV is different from other sexually transmitted infections (STIs)

HPV infects the skin and moist surfaces of the body (lining of the vagina, mouth, etc.), and is spread mainly via close skin-to-skin contact of the genital area, as well as during vaginal, anal, or oral sex². However, unlike many STIs, having protected sex by using a condom does not offer full protection against the virus³. “HPV is transmitted by skin-to-skin contact, meaning you don’t have to have penetrative sex to catch it,” explains Dr Angela Pine, Founder and CEO of 10zyme, “Although barrier protection may help, it isn’t 100% preventative”.

HPV does not cause symptoms in most cases

HPV infection is very common, in fact, 80% of people will have an infection with HPV at some point in their lives regardless of their gender⁴. Although some types of HPV may cause minor problems such as warts over different parts of the body, the vast majority of infections do not cause any symptoms at all. This means that most people will never know that they have an HPV infection and can potentially pass it on to another person, which highlights the important role of screening in the early detection of HPV infection.

HPV infection can be cleared by the body’s natural immune response

Usually, the body’s natural immune response will clear the vast majority of HPV infections within several years^2,3. However, infection with high-risk types of HPV can occasionally ‘persist’, which is when the body’s defence mechanism cannot get rid of the infection. This can be for many reasons and it is not fully understood why some people do not clear HPV infections. However, we do know that persistent infections with high-risk HPV can cause healthy cells to become abnormal (referred to as ‘cell changes’) and could eventually develop into cancer over time⁴. It is important to know that not all cell changes will turn into cancer, but it is still essential to monitor any changes and give treatment if necessary. 

HPV is not necessarily linked to promiscuity

Despite HPV infection affecting the majority of sexually active people at some point in their lives, there is still a certain level of stigma around the virus. This means that the diagnosis of an HPV infection can unfortunately lead to feelings of shame, fear, misjudgement, and even mistreatment which could potentially have a long-term impact on the dating and/ or sex life of those affected⁵. 

It is important to understand that HPV infection is not particularly the result of a certain behaviour or action, and can affect anyone from the very first sexual encounter². For this reason, having the right knowledge about HPV and knowing the facts will not only help to remove the negative label associated with the virus but will also help in the more effective prevention against its negative health effects.

HPV is the main cause of cervical cancer

While most cases of HPV infection do not cause significant health problems, almost all cases (99.8%) of cervical cancer are caused by HPV. Cervical cancer is the world’s fourth most common cancer in women and people with a cervix. In the UK, there is an average of 9 new cervical cancer cases every day, mostly affecting individuals under the age of 45⁶, and it is responsible for approximately 850 deaths per year. As the main cause of cervical cancer, this highlights the vital role of effective preventative measures against HPV through vaccination and cervical screening programmes.

HPV can also cause other types of cancer

In addition to cervical cancer, HPV is also associated with other types of cancer that are less common and can affect both men and women, such as cancer of the anus, penis, vulva, vagina, mouth, and throat (oropharynx)⁴, also called HPV-related cancers. The proportion of cancer cases found to be caused by HPV according to type is⁷: anal cancer (91%), vaginal cancer (75%), vulval cancer (69%), oropharyngeal cancer (70%), and penile cancer (63%).

HPV testing has become an integral part of cervical screening

Due to the important role that HPV plays in the development of cervical cancer, cervical screening now primarily looks for the presence of high-risk HPV in a test called HPV primary screening, which is more accurate at detecting who is at higher risk of developing cervical cancer⁸. Depending on the initial result, it will then be decided whether to look at the cells for any changes or send the patient for further tests (colposcopy), as well as when the next screening appointment would be arranged. Routine cervical screening forms a vital part of the cervical cancer prevention strategy, as it is estimated to save 4,500 lives in the UK each year⁹. It is currently offered to all women and people with a cervix aged 25 to 64 every 3 to 5 years, depending on the age and location within the UK.

HPV infection cannot be prevented or treated but cervical cancer can

Although we are not able to completely prevent an HPV infection or get treatment for the virus itself, the same cannot be said for cell changes and cervical cancer, which if caught early, can both be treated before they become a danger to health².

Since HPV is responsible for causing virtually all cervical cancer cases, having a good awareness of the virus as well as its associated health risks is crucial for the prevention of cervical cancer. The main preventative measures include HPV vaccination, which is offered to all school children aged 12-13 and currently helps to protect against 9 HPV types; and cervical screening, which helps to prevent cervical cancer through the early detection of HPV infection, the monitoring of cell changes, and early treatment. 

However, because the HPV vaccine does not provide protection against all the high-risk types that can lead to cancer, it is essential that individuals who are eligible also undergo regular cervical screening to maintain good cervical health and help prevent cervical cancer¹.

HPV self-sampling may be offered as an alternative option

Despite the importance of cervical screening in cervical cancer prevention, it is estimated that around 1 in 3 invited for screening still do not attend their appointment due to a variety of different reasons including fear, embarrassment, or issues with accessibility. This can result in the missed detection of HPV infections or cell changes that can put the individual at risk of developing cervical cancer.

Therefore, self-sampling (or self-collection) is currently being investigated in the UK as an alternative option alongside the traditional cervical screening test¹⁰. This could be a more effective way of ensuring those eligible attend their appointment by helping overcome some of the common barriers associated with the current cervical screening. As a result, self-sampling has the potential to detect more cases early on, meaning that they can be more successfully managed, and so helping to save more lives. However, while it is definitely a step in the right direction, self-sampling can also have its own set of issues or problems.

10zyme: Advancing women’s health

We’re developing a groundbreaking self-test with instant results to detect the main cause of cervical cancer: high-risk HPV. Detecting infections early prevents cancer ever developing.

By enabling self-testing, we aim to empower women, overcome stigma and anxiety, and help eliminate a disease killing hundreds of thousands a year globally. See our Education Section to find out more.Please follow and support us on social media: LinkedIn, Instagram, and TikTok.

References:

1. 1. Choi, S. Ismail, A. Pappas-Gogos, G. Boussios, S. (2023). HPV and Cervical Cancer: A Review of Epidemiology and Screening Uptake in the UK. Pathogens. 12(2):298. (Online). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9960303/ [Accessed 15/01/2024]
   2. National Health Service (NHS). (2022). Human papillomavirus (HPV). (Online). Available at: https://www.nhs.uk/conditions/human-papilloma-virus-hpv/ [Accessed 15/01/2024]
   3. World Health Organization (WHO). (2023). Human papillomavirus and cancer. (Online). Available at: https://www.who.int/news-room/fact-sheets/detail/human-papilloma-virus-and-cancer [Accessed 15/01/2024]
   4. Cancer Research UK (CRUK). (2024). Does HPV cause cancer? (Online). Available at: https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/infections-eg-hpv-and-cancer/does-hpv-cause-cancer [Accessed 15/01/2024]
   5. Jo’s Cervical Cancer Trust. (2020). Why we need to ditch the STI label around HPV. (Online). Available at: https://www.jostrust.org.uk/about-us/news-and-blog/blog/why-need-ditch-STI-label-hpv [Accessed 16/01/2024]
   6. National Health Service (NHS). (2021). Cervical cancer. (Online). Available at: https://www.nhs.uk/conditions/cervical-cancer/ [Accessed 16/01/2024]
   7. Cancer Research UK (CRUK). (2015). Statistics by cancer type. (Online). Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type [Accessed 16/01/2024]
   8. Cancer Research UK (CRUK). (2023). About cervical screening. (Online). Available at: https://www.cancerresearchuk.org/about-cancer/cervical-cancer/getting-diagnosed/screening/about [Accessed 17/01/2024]
   9. UK National Screening Committee (UK NSC). (2019). Cervical cancer. (Online). Available at: https://view-health-screening-recommendations.service.gov.uk/cervical-cancer/ [Accessed 17/01/2024]
   10. Mills, C. (2023). HPValidate cervical screening self-sampling study nears completion. UK National Screening Committee (UK NSC). (Online). Available at: https://nationalscreening.blog.gov.uk/2023/06/21/hpvalidate-cervical-screening-self-sampling-study-nears-completion/ [Accessed 17/01/2024]