Fortunately, there is a multi-strain vaccine for HPV, suitable for girls and boys, women and men.
An estimated 75 - 85% of adults will encounter HPV during the course of their sexually active lives. Approximately 50% of those adults are men, as recent research reveals that the virus is as common in males as it is in females.
"HPV is not a gender-specific virus," says Professor Hennie Botha, Head of Gynaecological Oncology at the University of Stellenbosch. "It affects men and women, young and old. It is transmitted via skin-to-skin contact, not only via sexual contact. It is at least as old as human civilisation and it is ubiquitous. It is crucial that we educate ourselves and our children - both boys and girls - that it is the cause of certain cancers that may potentially be fatal."
There are over 190 different strains of HPV 6 with the results of infection ranging from harmless planters warts and persistent genital warts, to fatal cancers. About 30 to 40 strains of the HPV virus affect the genital area - two of which (Types 6 and 11) cause 90% of genital warts cases, and another two (Type 16 and 18) which are directly related to 70% of cervical cancer cases, as well as over 80% of anal cancers.
HPV Type 16 has also been linked with 90% of HPV-related oropharyngeal cancer and there is increasing evidence that high-risk genital HPV types are causally linked to cancers of the head, neck and even skin.
"One in four cases of head and neck carcinomas in men can be linked with HPV."
Perhaps the primary reason that health providers have focused on HPV infections in women as opposed to in men is the close causal link between HPV Types 16 and 18 and cervical cancer. This has been directly responsible for the development of two very specific vaccines - one bivalent vaccine that protects against Types 16 and 18, and the other a quadrivalent vaccine that protects against Types 16 and 18, as well as 6 and 11.
"Unsurprisingly, these vaccines are both aimed predominantly at girls and women, but there is no reason that we should not vaccinate boys and men - not only to protect our male population from HPV-related diseases but also to prevent infection to females."
The Department of Health currently has a vaccination programme available to Grade 4 girls across South Africa, as part of the HPV Vaccine Campaign, which was launched in 2014. This programme aims to administer the vaccine to Grade 4 girls in over 17,000 schools across the country. Boys are currently not included in the national vaccination programme in South Africa.
Parents can have the vaccine administered privately and Professor Botha would recommend this course of action. "If enough boys and girls, men and women are vaccinated, we could wipe out some of the worst cancer-causing HPV viruses."
Another reason that HPV tends to be associated more with women than with men is that high-risk HPV infection can be revealed via a pap smear, while there is no definitive test for HPV in men.
"Women are often screened for HPV by default, while men do not undergo regular screening, nor is there currently anything on the market that could be used to test men for HPV. This is one of the primary reasons for the prevalence of HPV - it is a silent virus, and all too often those who are infected are not even aware of it, because it doesn't always result in disease, or in any visual signs of disease.
"In most cases, the virus goes away on its own without detection, destroyed by the body's immune system. It is a silent, often transient, infection."
Because many people do not experience any signs or symptoms of infection, HPV can lay undetected for years and in that time, the infected person can pass it unknowingly onto others - in whom it might present quite differently.
The presence of genital warts is one of the very few signs of HPV infection. Although they can be seen with the naked eye, they are difficult to diagnose because they present very differently on different people, ranging from small to large, smooth to rough, raised to flat, alone or in clusters.
"While genital warts aren't fatal, they can be uncomfortable and painful, and cause immense emotional distress to those who suffer from them. Genital warts are particularly difficult to treat, with 60% of patients reporting a recurrence in symptoms after treatment."
In addition, HPV is an incredibly hardy virus, able to survive not only on human skin but also on inanimate objects such as clothing for an indeterminate time. It is also not uncommon to find genital HPV under fingernails and on fingertips, and because transmission is skin-to-skin and not limited to sexual contact, this can result in infection.
"Because there is no cure for HPV-related diseases, prevention is the only protection available," says Professor Botha.
The virus is spread via skin-to-skin contact, which means that condoms offer only partial protection and, while studies have proved that uncircumcised men are more at risk of contracting HPV than circumcised men, circumcision will not prevent HPV infection.
"While vaccinating offers the best possible form of protection against the most harmful strains of the virus, it does not protect against all HPV types," Professor Botha warns. "The number one risk factor in HPV infection is the number of sexual partners. If you want to limit your chances of HPV infection, then the best means to do so is to limit your number of sexual partners," Professor Botha concludes.
