Some Basic Facts about the Human Papilloma Virus

HPV stands for Human Papilloma Virus, which is the virus that causes warts in humans.   There are two types of HPV, one causes warts mainly on hands and feet, but really can on most parts of the body.  The other type of HPV causes warts in the genital area.   The general body HPV appears to be harmless, beyond the bother of having a wart.  But the genital HPV can cause cancer, and lots of it.   Overall, there are over 170 types of HPV.  Of these about 40 cause infection in the genital (including anal) area.

Infection with the genital HPV’s is amazingly common.  Prior to the invention of the HPV immunization, most people were infected with HPV as a sexually transmitted infection.  Current knowledge establishes that the actual number is in the range of 75-80%.    This makes infection with the genital HPV’s the most common of the STD’s, but way beyond common, almost universal!   To put this into perspective, the second most common cause of STD is chlamydia, where people have a roughly 20% chance of being infected.

For most of the 170 types of HPV, including the 40 that cause genital infection, the virus comes and goes without a problem.  In the genital area, that means even no warts appear.

But.  For some of the types of HPV, people can experience trouble.  Some genital HPV types cause warts to appear and remain for long periods of time.  And some HPV types cause cancer.  The main sites of HPV cancer are the cervix, anus, vagina, penis, and throat.  The most common cancer caused by HPV is cervical cancer which is a leading killer of women across the world.  Not so much in the US and other wealthy countries, because of the ability to screen for early signs with the Pap smear.  In the US, because of the Pap smear, HPV causes more cancers in men (throat mainly) than in women (cervix mainly).

Lucky for us, of the 40 genital HPV types, only two types (#6 and #11) cause 90% of all warts in the genital area.  And with regard to cancer, only two types (#1 and #18) cause 70% of all cervical cancers.  HPV type 16 causes much of HPV caused throat cancer, which in the US is the reason for 70% of all cases of throat cancer.

So, infection with genital HPV is beyond common, it reaches towards being part of the lives of nearly everyone who has had more than one sexual partner in their lives.   And the virus causes cancer, in fact, a rather impressive vast majority of genital and throat cancers.

The Immunization for HPV

Readers of Real Answers with Dr. Lavin may recall a number of prior posts on HPV, including one citing early evidence on whether immunization with HPV works, it does.

Because so few types cause such a great majority of cases of genital warts and genital and throat cancers, the door is open to preventing much of these troubles with an HPV immunization.  As that earlier post demonstrated, if you get the HPV immunization, you are indeed less likely to get HPV infections.

The new information comes from about 66 million people immunized with HPV immunization, and asks a bigger question- if you get the HPV immunization will you be less likely to get cancer?  The answer is now in, and is clearly yes.

Here’s the NY Times article on the new study: https://nyti.ms/2J4Edne

Here’s the study, published in The Lancet, one of the world’s top medical journals: https://bit.ly/2YpzeUA

The study found the following facts about people immunized with the HPV immunization:

• For the HPV types that cause 70% of all genital and throat cancers (#16 and #18), the risk of being infected drops by half in teenagers.
• The chance of developing a genital wart dropped by half in teenagers, boys and girls.
• With regard to cancer, the study found that girls who got the  HPV immunization saw the chance of developing a pre-cancerous lesion on Pap smear drop by 50%
• When enough people get the  HPV immunization, then even unimmunized people see their risk of getting infected with HPV drop

The authors of the study find that these data suggest that if enough people got HPV immunization, we could actually eliminate cervical cancer worldwide.  That is rather extraordinary, imagine wiping out completely one of the main reasons young women die across the world!

And, It’s Safe

The Times article cites data that show that even though over 100 million people have received the HPV immunization, there is no pattern of harm beyond mildly increased risk of fainting due to the experience of getting a shot.  As with all immunizations in the current era, rumors of harm abound.  As with all conspiracy theories, the tip off that they likely are not true is related to the high drama and wild variance of claimed harm.  Some groups promote the rumor that this immunization drives female sexual appetites into a frenzy, while others say getting the shot will paralyze you.  Which is it- frenzy or paralysis?  The actual data prove it is neither.  Now surely, there will always be reports that a person who had something done to them had an awful experience just afterwards, such stories cannot be denied.  The bigger question though is this.  Give 100 people the shot, don’t give 100 people the shot, are there really patterns of harm seen in the 100 who did not get the shot not seen in those who did not.  The look at the massive number of people who got the HPV immunization, 100 million and counting, demonstrates that people who got the HPV immunization did not actually experience harmful events like paralysis, and sudden death, any more likely than those who have not had the HPV immunization.

Which is to say, it is safe despite rumors to the contrary.

BOTTOM LINES

1. The Human Papilloma Virus (HPV) is common.  In populations without the HPV immunization, nearly everyone gets infected with the genital HPV types.
2. Most people infected with the HPV immunization have no troubles, not even any symptoms.  But some of the HPV types that cause infection in the genital and throat areas do cause warts to appear and most ominously cause cancer.  
3. Cancer from HPV is a big deal.  It is second only the breast cancer as the cause of death from cancer specific to women.  Across the world, cervical cancer is one of the main reasons young women die.  In the US, screening with the Pap smear prevents most death from cervical cancer, but not all.  And the many cases of HPV caused cancer that are caught in time by the Pap smear still cause tremendous trouble for hundreds of thousands of American women who are told they have lesions that could become cancer.
4. We now know that HPV immunization prevents cancer.   This is a fact worth thinking about.  Use of this immunization can now be relied on to dramatically drop the chance of a Pap smear going positive, of a young woman developing cancer, and likely of a young man developing cancer, too.
5. We also know that HPV immunization prevents genital warts from happening.
6. Actual facts are demonstrating the HPV immunization is safe.  Rumors abound, but the facts are extremely reassuring.  There are people who have had serious events happen after the HPV immunization, but study of those who have not show these serious events are no more likely in those who get the HPV immunization than in those who do not.  It is safe.

Hmm, a treatment that prevents an infection that almost everyone would get without the treatment, prevents warts, and most dramatically, prevents cancer, and is safe.  Should such a treatment be used?  We say yes.

To your health,
Dr. Arthur Lavin