About 70% of people are exposed to the Human papillomavirus (HPV), the most common sexually transmitted infection (STI), at some stage of their life, states Dr. Marsel Coetzer, a gynaecologist. “Everyone should know about HPV,” she says, “and this is why it should matter to you too”.
Jane*, a 21-year-old Stellenbosch University (SU) postgraduate student, had to remove two centimeters of her cervix on 26 October, because she did not know about the effects of the Human papillomavirus (HPV).
“I thought stuff like this only happens to others or when you are much older, but then it happened to me and I’m 21,” says Jane.
HPV and all its strains
“HPV is a common infection. Testing positive for HPV does not mean that you are infected with the high-risk cancerous types. HPV is the same virus that gives a person warts on their skin,” Dr. Marsel Coetzer, a gynaecologist.
There are over 100 types of HPV strains. “In South Africa, commonly two types are found among most South Africans that are high-risk strains,” she explains.
The high-risk strains are types 16 and 18. These are the types most likely to develop into cervical cancer. “Testing positive for HPV does not mean that you are infected with the high-risk types. HPV is the same virus that gives a person warts on their skin,” says Coetzer.
Type six and 11 are the strains of HPV that create skin warts, according to the World Health Organisation (WHO).
“I thought it was a bit silly to have a pap smear at 21,” says Jane, a 21-year-old SU postgraduate student at SU.
The difference between exposure and infected
A mother can transmit HPV to her child during childbirth. It spreads from skin-to-skin contact, according to Coetzer. “This is why it is so important for people to talk about it,” she says.
99% of people are getting HPV from sexual intercourse, says Coetzer. “But it can also be transmitted through mere skin-to-skin contact,” she says.
If partners have been exposed to cancerous strains of HPV it is not a given that both partners will be infected with the cancerous stains, says Coetzer.
Both will be exposed, but might not get infected, she says. “When you are infected with cancerous strains, it does not mean that you will get premalignant cells, which causes cancer,” explains Coetzer.
Cervical cancer and the HPV vaccine
Men also get infected with HPV and give it to women, and vice versa. Women can give it to women and men can give it to men. From HPV, men can get penile cancer as well. It is rare though. Cervical cancer is common, according to Coetzer.
A pap smear can test three stages of possible infection of the Human papillomavirus (HPV). If a woman regularly goes for her pap smear, early prevention can be implemented, according to Dr. Marsel Coetzer, a Gynecologist. Graphic: Heléne Leonard
“If a man was exposed to type 16 or 18 HPV strains, which cause cervical cancer, it doesn’t mean his new partner will definitely transmit type 16 or 18 and develop cancer,” she explains.
Whether cervical cancer develops quicker depends on whether a person smokes and how well a person’s immune system can fight HPV, says WHO.
“So if you were exposed to a cancerous type, you should be vigilant, but it does not definitely mean that you are infected and that the cells will become malignant,” says Coetzer.
What to do if you get infected with HPV
Cervarix is one of two vaccines of HPV available in South Africa, which protects against the prominent cancerous strains of HPV, types 16 and 18, says Coetzer.
Life-threatening Human papillomavirus (HPV) infections can be prevented to an extent through implementing certain precautions. Graphic: Heléne Leonard
Gardasil is the other vaccine available in South Africa which protects against four types of HPV. Gardasil protects against types 16, and 18 and six, and 11 which creates warts. This vaccine requires three doses. It costs R 800 for one dose, says Coetzer. “Dischem and Clicks pharmacies provide more information on when and where the HPV vaccines are available,” she says.
Since 2019, girls in grade five can be vaccinated with the Gardasil vaccine, which protects against the two cancerous types of HPV and the wart types of HPV, according to the Western Cape Government website. The second dose of vaccination in Western Cape schools was from 6 September to 29 October, according to their website.
Campaigning for HPV awareness:
Lady Talk Matters is a foundation that was founded in 2019. The campaign promotes awareness of female reproductive issues, such as endometriosis and meiosis, and particularly, encourages young girls to go and have their cervical smear tests, according to Andrea Mason, founder of Lady Talk Matters.
People do not talk about “lady stuff”, says Mason. “[The pap smear] was something that I didn’t go and do. I always had an excuse for it. And it’s two minutes. The simple reality is it’s two minutes out of your life, to have this test that can save your life,” says Mason.
Mason had a full hysterectomy for other gynaecological conditions. She had cervical cancer at the time as well, she explains.
“I didn’t know I had cervical cancer because I hadn’t been for my [pap] smear tests, I hadn’t understood the importance of having my cervical [pap] smear tests. You don’t really associate it with something that can later happen to you. I started the foundation to promote reproductive health and awareness,” says Mason.
Andrea Mason, founder of Lady Talk Matters, promotes female reproductive health and education. PHOTO: Heléne Leonard
Breaking the stigma
Gerard Gous (60), director of Lady Talk Matters, says that older generations like his were not educated on STI’s and sex.
“I think it is important to create a space where taboo topics are not taboo anymore. The better educated we are, the more prevention we can implement,” says Gous. “Lady stuff matters to everyone because it does not only affect women, and that is the stigma that news to be broken. It should matter to everyone,” he says.
According to Coetzer, women do not want to go see a doctor when there is something wrong, because there is a stigma surrounding sexually transmitted infections (STI’) and sexually transmitted diseases (STD’s).
Similarly Jane “accidentally” discovered she had premalignant cells in her cervix, which develops into cancer, she explains.
Dr. Marsel Coetzer, a gynecologist, explains that the Human papillomavirus (HPV) is common and that there are multiple strains of HPV. Voice Clip: Heléne Leonard
She was advised by her Gynaecologist to go for a pap smear because she wanted to go on contraceptives. “I thought it was a bit silly to have a pap smear at 21,” she says.
A pap smear detects early abnormalities by taking a swap of the cervix. “This is to pick up early HPV and identify premalignant cells,” says Coetzer.
The pap smear results tested positive for four cancerous strains of HPV, Jane explains.
She has been sexually active since the age of 18 and she has had only a few sexual partners. She does not know who infected her with HPV.
Hope after testing positive for cancerous strains of HPV
It is still possible to get the vaccine after infection. When a pap smear tests positive for high-risk types of HPV, it means that it is dangerous, according to Coetzer.
Jane tested positive for the high-risk types. However, she went for an operation where a doctor removed a layer of her cervix. This operation is called the large loop excision of the transformation zone (LLETZ), according to Coetzer.
“LLETZ is an operation where you peel a small piece of the cervix. The fact that they peeled it means that the part that was infected is gone. Then you can stop cervical cancer,” says Coetzer.
After a LLETZ operation, the part of the cervical skin that was infected with high-risk HPV is no longer there. As long as a person is not exposed to HPV after a LLETZ and before the first dose of the vaccine, the vaccine will be effective, says Coetzer.
Jane has had her first dose of Gardasil, after her LLETZ procedure. This will protect her against any further premalignant growths in her cervix.
*Jane is a pseudonym.