Recently, we have been witness to an ongoing campaign to raise awareness of the possibility of early detection and prevention of cervical cancer. Many women ask whether there a vaccine against cancer, what is this virus, and what should I do? We All will try to answer all of these questions.
Human papillomavirus, or HPV, is a common virus. Until now, over a hundred different varieties of the virus have been identified, each with a different number and exerting its effects on different organs of the body. For example, HPV 1, 2, and 4 cause viral warts on the hands and feet, and types 6 and 11 can cause genital warts. About 30 strains of HPV are sexually transmitted and cause damage to the genitals.
Common, we said?
A large number of men and women will be exposed to the virus during their lifetime, and most of them are not aware of it at all for the simple reason that most infections disappear without symptoms and only a minority of people who were exposed will develop the phenomenon or significant disease.
Along with raising awareness, unfortunately anxiety has also increased.
What are the methods of transmission of the virus?
The virus is transmitted through sexual contact, vaginal contact, anal intercourse and oral contact; skin to skin contact of a hand or finger is enough to pass on the virus so it is possible to infect and be infected even via relations without penetration.
The most common age of infection is adolescence. The risk of contracting the virus increases the earlier age of onset of sexual intercourse. The highest risk is between the ages of 15-19, but the risk of acquisition of the virus exists throughout life.
Having multiple partners raises the risk of exposure and increases the possibility of encountering the virus. The sexual behavior of their partner can also increase the risk. Actually, in having sex, we meet the girlfriend of the boyfriend of the girlfriend and are exposed to all of them. The most high risk partners are widowers of women who have died from cervical cancer. A spouse who is not circumcised also raises the risk of infection with HPV.
Smoking is also a risk factor for infection with the virus and more importantly for the development of cervical cancer. One more reason of many to quit smoking!
Nuns are not an at risk group for HPV and complete avoidance of sexual intercourse ensures prevention of contracting the infection. Having sexual intercourse when both partners have never had sex with another partner also prevents infection, but one should remember that it does not require having sex with penetration to be infected with the virus.
Although condom use does not completely eliminate infection with HPV since it is also possible to be infected by skin to skin contact, their use significantly reduces infection and is essential for preventing other sexually transmitted diseases.
So what happens when you are infected, you ask? It's like an STD?
And again, we emphasize that for most people who become infected with the virus, nothing happens. And when there are medical consequences, these depend on the strain of virus the person has been infected by.
HPV types 6 and 11, for example, medically known as Condyloma acuminata, (venereal warts) may cause viral warts on the genitals and anus and passing and not very significant changes in the cervix. This is certainly not a dangerous disease and it has no significant health consequences, but we can see clearly that this is a bothersome situation, not aesthetic, unpleasant and in many cases makes the patient feel ashamed and even rejected.
There is currently a significant increase in the diagnosis of viral warts around the world as well as in Israel.
There is a possible risk of contracting Condyloma at any stage of your sex life, but in general, viral warts affect young people.
It is true that we know how to treat it but it is certainly worth avoiding...
Species such as 16 and 18 may in a minority of cases, at the first stage, result in pre-malignant changes in the cervix and even cervical cancer. These strains do not cause viral warts.
The strains that cause malignant transformation (oncogene species) such as 16 18 converge on the DNA of cells lining the cervix and cause abnormal differentiation of cells that could lead to malignant tumors. This event occurs only in a minority of cases.
Cervical cancer is considered to a certain extent as a form of sexually transmitted disease. But!!! Cervical cancer is a slow growing tumor and it is possible to diagnose it at a pre-cancerous stage by performing a Pap smear according to the guidelines of a doctor. The majority of women who developed invasive cervical cancer did not undergo routine Pap tests.
Even cervical cancer can be treated but it is better to avoid it altogether!
What is the vaccine?
The vaccine that has been approved for global use and more recently also in Israel for girls aged 9-26 is called Gardasil. This is a vaccine for use in the prevention of certain types of HPV, specifically HPV types 6 and 11 that cause viral warts, and types 16 and 18 that cause cervical cancer. There has been success in producing the protein that envelops these strains so there is no use for an attenuated virus that contains DNA that is part of an oncogene (cancer-causing).
So far, in studies conducted in recent years, the efficiency of the vaccine has been shown as close to 100% both in cervical cancer prevention and in prevention of the emergence of viral warts. It is important to emphasize that the vaccine is designed for prevention and not treatmenr for women who have already been diagnosed with cervical cancer. It is recommended to vaccinate a girl before she begins having sexual intercourse of any kind.
The vaccine is given in three doses: on the day of beginning the vaccine, two months later and the last dose is given after six months.
No serious side effects of the vaccine have been described, and only mild local pain or a low fever should be expected.
The vaccine was recently approved for use in Israel days but has not yet entered the immunization program of the State of Israel. To get a vaccine for a patient, approach your physician and ask for a prescription for the vaccine. A check-up with the doctor and conversation about the vaccine can also be coordinated in the Gynecology clinic at Hadassah.
Giving the vaccination does not exempt the patients from performing the Pap screening, and it is important to note that it does not prevent other sexually transmitted diseases, which can be prevented by using a condom.
They say, the clever person knows how to get out of dangers that the wise person would not have got into in the first place; that is, it is better to prevent a disease than to deal with treating it.
The author is Dr. Sagit Arbel-Alon, Gynecologist, Department of Obstetrics and Gynecology at Hadassah Ein Kerem.