Human Papillomavirus (HPV) is a group of viruses that can infect the skin and mucous membranes. There are more than 100 different types of HPV, and they are categorized into low-risk and high-risk types based on their association with certain diseases. HPV infections are extremely common and are usually spread through direct skin-to-skin contact. In fact Canadian estimates suggest that more that 70 per cent of sexually active men and women will have an HPV infections at some point in their lives (1).

HPV infections are mainly transmitted through:

• Sexual Contact: The most common way HPV is spread is through sexual contact, including vaginal, anal, and oral sex. Both genital-to-genital contact and skin-to-skin contact in the genital area can lead to transmission.
  Skin-to-Skin Contact: HPV can also be transmitted through non-sexual skin-to-skin contact, particularly in areas such as the hands, fingers, and feet. This can happen through activities like shaking hands, holding hands, or touching surfaces that have come into contact with infected skin.

Mother-to-Child Transmission: It is also possible for an infected mother to transmit HPV to her newborn during childbirth, though this is relatively rare (1).
HPV infections are usually asymptomatic and go away on their own. However, some types of

HPV can cause various health problems:

• Genital Warts: Certain low-risk types of HPV can cause genital warts, which are growths on or around the genitals or anus.
• Cancer: Some high-risk types of HPV are strongly associated with the development of various cancers, including cervical, anal, vaginal, vulvar, penile, and oropharyngeal cancers. Persistent infection with high-risk HPV types can lead to changes in cells that may eventually become cancerous.

To prevent HPV infection and its associated health issues, vaccination is recommended. The HPV vaccine is highly effective in preventing infection with the most common and dangerous types of HPV. It is usually given to adolescents before they become sexually active, but can also be given to adults who have not been vaccinated.

Reference:

1. Human Papillomavirus (HPV) – Canada.ca
2. Syrjänen S, Rintala M, Sarkola M, Willberg J, Rautava J, Koskimaa H, Paaso A, Syrjänen K,Grénman S, Louvanto K. Oral Human Papillomavirus Infection in Children during the First 6 Years of Life, Finland. Emerg Infect Dis. 2021 Mar;27(3):759-766. Doi: 10.3201/eid2703.202721. Epub 2021 Jan 29. PMID: 33513331; PMCID: PMC7920652.

HPV (Human Papillomavirus) can lead to cancer by causing persistent infections in certain high-risk types of the virus. The virus itself does not directly cause cancer but instead increases the risk of cancer development by interfering with the normal cellular processes and promoting abnormal cell growth. Here’s how HPV can lead to cancer:

• Viral DNA Integration: In some cases, the HPV virus can integrate its DNA into the DNA of the host cells it infects. This integration disrupts the normal regulation of cellular processes and can lead to uncontrolled cell growth and division. This is more commonly seen in high-risk HPV infections.
• Evasion of Immune System: HPV has evolved mechanisms to evade the body’s immune response, allowing the virus to persist within the body for a longer period of time. This prolonged infection increases the chances of DNA damage and genetic mutations in infected cells, which can contribute to cancer development.
• Inactivation of Tumor Suppressors: HPV produces proteins that can inactivate certain tumor suppressor genes, such as p53 and pRB. Tumor suppressor genes normally prevent cells from growing uncontrollably and becoming cancerous. When these genes are deactivated by HPV proteins, it can lead to unregulated cell division.
• Dysregulation of Cellular Processes: HPV proteins can interfere with the normal regulation of cell cycle checkpoints, apoptosis (programmed cell death), and DNA repair mechanisms. This disruption can allow damaged cells to survive and proliferate, increasing the likelihood of cancerous changes.

In the context of specific cancers:

• Cervical Cancer: The most well-known association between HPV and cancer is cervical cancer. High-risk HPV types, particularly HPV16 and HPV18, are responsible for the majority of cervical cancer cases. Persistent infection with these types can lead to the gradual transformation of cervical cells from normal to pre-cancerous to cancerous stages.
• Other Cancers: HPV is also linked to other cancers, including anal, vaginal, vulvar, penile, and oropharyngeal cancers. In these cases, the virus can similarly contribute to genetic changes that promote cancerous growth.

Regular screenings, early detection, and vaccination against HPV can significantly reduce the risk of developing HPV-related cancers.

The HPV vaccination is a cancer prevention tool that is nationally recommended with no upper age limit. The ideal time to administer the vaccination is during the school-based vaccination program – (age 11/12) prior to commencement of sexual activity (and therefore HPV exposure) and when the immune system is robust enough to provide a good response with only 2 doses.

However, for those who were not immunized during the routine program – there is always time
to get vaccinated, even if they have already been exposed to the virus. Even those in
monogamous relationships and hypothetically won’t have any new partners and therefore no
“new exposures” – can benefit from vaccination. In 2016 the National Advisory Committee on Immunization (NACI) amended their guidelines to include “no upper age limit” to the recommendation of HPV-9 vaccination in adults to reflect this (1).

Reference:

Update on the recommended Human Papillomavirus (HPV) vaccine immunization
schedule – Canada.ca – Summary of information contained in this NACI Statement ,
scroll down to “2. Who”

Historically, the burden of HPV-related cancers has focused solely on cervical cancer in women. This is still a major concern with cervical cancer being the leading and often the only cause of cervical cancer globally. HPV is also a leading cause of head and neck cancer in Men, and as a result, the HPV9 vaccine has received indication from Health Canada (2021) for the prevention of HPV-related head and neck cancer. HPV-related Head and Neck cancer has significant morbidity (always requires aggressive treatment, increased risk of suicide). Males are also less apt (due to anatomical differences) at naturally clearing the HPV infection than females. Scientifically there is a much greater risk of HPV transmission from female to male than from male to female (1). Demonstrated by a decreased ability to produce antibodies naturally against the virus (2). Finally, the evidence of HPV infection in males demonstrates no significant association with age, meaning that men of all ages are showing evidence of HPV infection, indicating that the risk for acquiring HPV infections and associated diseases is life long, even between 45-70 years of age (3). Finally a recent study by the Lancet Global Health journal found that “one in five men worldwide” could be infected with potentially cancerous HPV (4). Making males an important demographic for HPV vaccination, and subsequent reduction of HPV infection and transmission.

References

1. Hernandez BY, Wilkens LR, Zhu X, et al. Transmission of human papillomavirus in
   heterosexual couples. Emerg Infect Dis. 2008;14(6):888-894.
   doi:10.3201/eid1406.070616
2. Giuliano AR, Viscidi R, Torres BN, et al. Seroconversion Following Anal and Genital HPV Infection in Men: The HIM Study. Papillomavirus Res. 2015;1:109-115. doi:10.1016/j.pvr.2015.06.007
3. Giuliano AR, Lazcano-Ponce E, Villa LL, Flores R, Salmeron J, Lee JH, Papenfuss MR, Abrahamsen M, Jolles E, Nielson CM, Baggio ML, Silva R, Quiterio M. The human papillomavirus infection in men study: human papillomavirus prevalence and type distribution among men residing in Brazil, Mexico, and the United States. Cancer Epidemiol Biomarkers Prev. 2008 Aug;17(8):2036-43. doi: 10.1158/1055-9965.EPI-08- 0151. PMID: 18708396; PMCID: PMC3471778.
4. Goldstone SE. Human papillomavirus (HPV) vaccines in adults: Learnings from long-term follow-up of quadrivalent HPV vaccine clinical trials. Hum Vaccin Immunother. 2023 Dec 31;19(1):2184760. doi: 10.1080/21645515.2023.2184760. Epub 2023 Mar 13. PMID: 36916016; PMCID: PMC10038021.

Like other immunizations that guard against viral infection, HPV vaccines stimulate the body to produce antibodies that, in future encounters with HPV, bind to the virus and prevent it from infecting cells.

The HPV vaccine works very well. Studies in Canada and other countries with HPV vaccine programs have shown that the vaccine prevents:

• Cancer-causing HPV infections.
• Cervical pre-cancers.
• Genital warts.
• Most cancers of the anus, mouth and throat, penis, vagina, and vulva.

Reference: Immunize BC , “The HPV Vaccine Works!” HPV (human papillomavirus) vaccine | Immunize BC

For complete protection you will need three doses at 0, 2 months, and 6 months. The Immunize.io team can provide you with an email reminder when you are due for your next dose to help you keep track.

Side effects of the HPV vaccine are similar to other vaccines and can include:

• Pain, redness, or swelling in the arm where the vaccine was given.
• Fever.
• Nausea.
• Headache or feeling tired.
  Muscle or joint pain.

These side effects are usually mild and go away in a day or two. Serious side effects, like a severe allergic reaction, are very rare.

There is no evidence that HPV vaccines cause infertility, autoimmune diseases, or other health problems.

Reference: Immunize BC, “HPV Vaccination Side Effects” HPV (human papillomavirus) vaccine | Immunize BC

The HPV vaccine has been provided to school aged children starting with girls in 2005, and then expanded to boys in 2017. You may have recieved this vaccine in grade 6 during this time period. Adults can certainly still benefit from the HPV vaccination, event if you have been exposed to the virus the vaccine can protect you from other types you do not have. The HPV vaccine also prevents new HPV infections.

You can check your BC Healthgateway Health Gateway (gov.bc.ca) , or check your immunization records from school. Feel free to reach out to info@immunize.io if you need help navigating your vaccination records.

HPV9 vaccine is offered for free to all students in grade 6.

Males (born in 2005 or later) and females who did not get the vaccine in grade 6 can still get the vaccine for free if they:

• Get their first dose before they turn 19, and
• Get their last dose before they turn 26.

Adults can still purchase the vaccine at a pharmacy for approximately 650-700$ for the complete series ($200-$220 per dose). As of July 1st 2023 , School district staff with the BCTF union have coverage for the HPV under their Pacific Blue Cross Extended Benefits Plan.