Largest oral HPV study in England shows infection rates lower than expected

Infection rates of high risk human papillomavirus (HR-HPV) oral infection in England are lower than expected, compared to previous US studies.

The research, conducted by the University of Sheffield, also strengthens evidence that smoking and sexual behaviour were shown to be risk factors for oral HPV infection, which can lead to oropharyngeal (throat) cancer.

This timely study published in the British Medical Journal Open, led by Professor Hilary Powers, Dr Vanessa Hearnden and Dr Craig Murdoch and funded by the World Cancer Research Fund UK, coincides with the announcement of a new UK HPV vaccine programme for boys which will reduce the risk of HR-HPV related cancers.

Rates of oropharyngeal cancers are increasing worldwide, attributable to an increase in the rate of oral infection with HR-HPV.

This new study of 700 men and women in Sheffield, which is the largest of its kind in England, looked for HR-HPV infection and also asked participants lifestyle questions relating to their sexual history and tobacco use.

A total of 2.2 per cent of people were infected with oral HR-HPV infection with 0.7 per cent positive for HPV16 or HPV18. There are large variations in oral HR-HPV prevalence globally however this study showed lower rates compared to previous Scottish and US studies which both found 3.7 per cent of individuals positive for oral HR-HPV.

Former smokers were significantly more likely to be HR-HPV positive compared with those that had never smoked. The study also found that participants with a greater number of sexual or oral sexual partners were more likely to be HR-HPV positive.

Dr Vanessa Hearnden, from the Department of Materials Science and Engineering at the University of Sheffield, said: "Previous studies have been US-focused or in smaller UK studies in London or Scotland. This is the first study in the North of England and found lower rates of oral high-risk human papillomavirus infection.

"We fully support the newly announced HPV vaccination programme for boys which will reduce the risk of HPV related cancers including throat cancer in men and will also provide further prevention of cervical cancers through herd immunity.

"However, we found the majority of individuals testing positive for high risk strains of HPV were actually positive for strains other than those covered by the current vaccine (HPV 16 and HPV 18). This shows the need to consider newer vaccines which protect against more HPV strains in the future and for individuals to be aware of lifestyle risk factors such as number of sexual partners and tobacco use."

Dr Craig Murdoch, from the University of Sheffield's School of Clinical Dentistry, said: "Many people associate the HPV virus with cervical cancer but there is less recognition of the fact that HPV causes oropharyngeal cancer, and unfortunately, the prevalence of this cancer has increased dramatically in the past few years.

"The Sheffield Head and Neck Oncology Research Team are conducting research into HPV-related oral cancer in order to find better ways to treat this disease and improve quality of life."

Dr Kate Allen, Executive Director of Science & Public Affairs for World Cancer Research Fund International, said: "This study confirms the importance of lifestyle risk factors in prevention of the disease and sheds new light on the rates of oral HR-HPV infection in England."

Source: https://www.sciencedaily.com/releases/2018/08/180820094502.htm

Human Papillomavirus and Cancer

Human Papillomavirus (HPV)

The human papillomavirus, or HPV, is a type of virus that infects the skin and the cells lining body cavities. For most people, the infection will get better on its own and they will never know they had it. 

There are different types of HPV:

Some infect the skin, usually on the fingers and hands. These can cause minor problems, such as common skin warts and verrucas.

Others infect the genitals, mouth and throat. These can cause genital warts, or more rarely, cancer.

From this point onwards, the discussion is on genital and oral HPV, as these types are the ones which can cause cancer.

HPV is a very common infection. Around 8 out of 10 people will be infected with the virus at some point in their lives. It usually doesn’t cause any symptoms and most people will never know they had it. HPV spreads through close skin-to-skin contact, usually during sexual activity including oral sex. Having a high number of sexual partners does increase the chances of infection. 

HPV infection usually causes no problems at all. But in some people the infection will stay around for a long time and become persistent. Around 13 types of HPV can cause cancer. These are called ‘high-risk’ types. People with persistent infections with ‘high-risk’ HPV types are those who are most likely to go on to develop cancer.

HPV & Cancer

The main type of cancer linked to HPV infection is cervical cancer. Virtually all cases of cervical cancer are caused by HPV. About 3,100 cases of cervical cancer are diagnosed in the UK each year.

HPV can also cause cancer in other genital areas, like the vagina, vulva, penis, and anus. It can also cause some types of cancer of the mouth and throat.

The majority of vaginal, vulval, penile and anal cancers are caused by HPV. But they are less common than cervical cancer. Men who have sex with men may be at increased risk of anal cancer.

HPV infection also increases the risk of some types of mouth and throat cancers. Rates of mouth cancer, especially tongue and tonsil cancers, are on the increase, particularly in people in their 40s, 50s and 60s.30–34 And the evidence suggests that the proportion of cases linked to HPV is rising.

How HPV leads to Cancer

HPV can cause cells to divide more than usual. Fast cell growth can cause warts to develop, but often it doesn’t cause any symptoms at all. The types of HPV that cause warts are not the same types that cause cancer.

In persistent ‘high-risk’ HPV infections, the virus can damage DNA and cause cells to start dividing and growing out of control. This can lead to cancer.

HPV Vaccine

HPV can cause changes to the DNA in our cells that make them more likely to turn cancerous. So by protecting against HPV infection, we can help prevent those changes and reduce the risk of cervical cancer.

HPV Vaccination for Women

Since 2008, girls aged 11-13 have been offered a vaccination against the two most common ‘high-risk’ types of HPV, HPV 16 and 18. Together, these two types cause about 7 out of 10 cervical cancers. Girls up to the age of 18 can request vaccination through the NHS if they weren’t vaccinated routinely. The HPV vaccine has been proven to be safe and effective.

The HPV vaccine currently used in the UK (Gardisil) also protects against HPV 6 and 11, which are the HPV types that cause most genital warts.

The HPV vaccine doesn’t protect against all types of HPV, so screening is still important, even if you have been vaccinated.

HPV Vaccination for Men

As HPV is linked to cancers in men as well as women, offering HPV vaccination to men would help reduce the risk of disease. Men who have sex with men have a higher risk of anal cancer than men who don’t.

From April 2018, the vaccine is being rolled out men who have sex with men in all sexual health and HIV clinics across the UK.

The Joint Committee for Vaccination and Immunisation are also currently considering whether to offer HPV vaccination to all teenage boys as well as girls.

Cervical Screening for HPV

Cervical screening aims to pick up early cell changes that are caused by HPV and remove these cells before they have a chance to become cancerous. This is done by taking a sample of cells and sending them to a lab where they are tested to see if they are normal (cytology). If the cells look abnormal, they will be tested for HPV to see if they are more likely to become cancerous. If they test positive for HPV, the cells will be removed.

Source: https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/infections-hpv-and-cancer/hpv-and-cancer

Call for abstracts: https://std-hiv-aids.cmesociety.com/call-for-abstracts

Abstract submission: https://std-hiv-aids.cmesociety.com/abstract-submission

Registration: https://std-hiv-aids.cmesociety.com/registration

HISTORY OF SEXUALLY TRANSMITTED DISEASES

Sexually transmitted diseases (STDs) have been known to mankind for centuries. Before the advent of modern medicine, people's lack of awareness and understanding of STDs contributed to the widespread transmission of the infections while few or no treatments were available to treat the conditions.

In medieval times, syphilis and gonorrhoea were two of the most prevalent STDs in Europe. One theory suggest that syphilis was spread by crew members who picked up the disease on the voyages led by Christopher Columbus. They are thought to have contracted syphilis while in the Americas and to have then spread it on their return when docking at ports in Europe. Sailors are also thought to be responsible for the spread of gonorrhoea from Tahiti to New Zealand during the Cook voyages.

Some STDs can have severe, life-changing consequences; syphilis, for example, can eventually cause progressive destruction of the brain and spinal cord, leading to mental dysfunction and hallucinations, speech problems and general paresis.

Treatment over the centuries

In the 18th and 19th centuries, mercury, arsenic and sulphur were commonly used to treat venereal disease, which often resulted in serious side effects and many people died of mercury poisoning. The first known effective treatment for syphilis called salvarsan or arsphenamine was introduced in 1910.

In the 20th Century, the advent of penicillin and other antibiotics led to an effective cure of bacterial STDs. This led to the public perceiving the illnesses as less of a threat and promiscuous conduct continued. In the late 20th century, the transmission of viral STDs such as HIV and herpes arose, infections that are not curable and, in some cases, may be fatal.

Hospital treatment of venereal diseases

Due to the stigma attached to STDs, people would often hesitate to seek help when the disease was in its initial stages, while continuing to transmit the infection to unsuspecting sexual partners. In 1746, at the London Lock Hospital, the first treatment for venereal disease was made available for those who sought help.

In the second half of the 19th century, the Contagious Diseases Act was passed to arrest and treat suspected prostitutes.

Tracing sexual partners with STDs

It was in the late 19th and early 20th century that the importance of tracing the sexual partners of a person infected with an STD was recognized. Soon, sexual health clinics were set up to identify and treat individuals with STDs and their partners, to prevent spread in the general population.

Another major problem that arose was an increase in adolescent sexual activity in the mid-20th Century. This led to widespread infection among younger age groups and changed the way healthcare policy makers tried to raise awareness through campaigns.

Source: https://www.news-medical.net/health/History-of-Sexually-Transmitted-Disease.aspx

Abstract Submission: https:/std-hiv-aids.cmesociety.com/abstract-submission

Registration: https://std-hiv-aids.cmesociety.com/registration

Cervical Cancer and Human Papilloma Virus Infection

Human papillomavirus (HPV) is the most common viral infection of the reproductive tract. Most sexually active women and men will be infected at some point in their lives and some may be repeatedly infected.

The peak time for acquiring infection for both women and men is shortly after becoming sexually active. HPV is sexually transmitted, but penetrative sex is not required for transmission. Skin-to-skin genital contact is a well-recognized mode of transmission.

There are many types of HPV, and many do not cause problems. HPV infections usually clear up without any intervention within a few months after acquisition, and about 90% clear within 2 years. A small proportion of infections with certain types of HPV can persist and progress to cancer.

Cervical cancer is by far the most common HPV-related disease. Nearly all cases of cervical cancer can be attributable to HPV infection.

Though data on anogenital cancers other than cancer of the cervix are limited, there is an increasing body of evidence linking HPV with cancers of the anus, vulva, vagina, and penis. Although these cancers are less frequent than cancer of the cervix, their association with HPV make them potentially preventable using similar primary prevention strategies as those for cervical cancer.

Non-cancer causing types of HPV (especially types 6 and 11) can cause genital warts and respiratory papillomatosis (a disease in which tumours grow in the air passages leading from the nose and mouth into the lungs). Although these conditions very rarely result in death, they may cause significant occurrence of disease. Genital warts are very common and highly infectious.

Signs and symptoms

The majority of HPV infections do not cause symptoms or disease and resolve spontaneously. However, persistent infection with specific types of HPV (most frequently types 16 and 18) may lead to precancerous lesions. If untreated, these lesions may progress to cervical cancer, but this progression usually takes many years.

Symptoms of cervical cancer tend to appear only after the cancer has reached an advanced stage and may include:

• irregular, intermenstrual (between periods) or abnormal vaginal bleeding after sexual intercourse;
• back, leg or pelvic pain;
• fatigue, weight loss, loss of appetite;
• vaginal discomfort or odourous discharge; and
• a single swollen leg.

More severe symptoms may arise at advanced stages.

How HPV infection leads to cervical cancer

Although most HPV infections clear up on their own and most pre-cancerous lesions resolve spontaneously, there is a risk for all women that HPV infection may become chronic and pre-cancerous lesions progress to invasive cervical cancer.

It takes 15 to 20 years for cervical cancer to develop in women with normal immune systems. It can take only 5 to 10 years in women with weakened immune systems, such as those with untreated HIV infection.

Risk factors for HPV persistence and development of cervical cancer

• Early first sexual intercourse
• Multiple sexual partners
• Tobacco use
• Immune suppression (for example, HIV-infected individuals are at higher risk of HPV infection and are infected by a broader range of HPV types)

Scope of the problem

Worldwide, cervical cancer is the fourth most frequent cancer in women with an estimated 530 000 new cases in 2012 representing 7.5% of all female cancer deaths. Of the estimated more than 270 000 deaths from cervical cancer every year, more than 85% of these occur in less developed regions.

In developed countries, programmes are in place which enable women to get screened, making most pre-cancerous lesions identifiable at stages when they can easily be treated. Early treatment prevents up to 80% of cervical cancers in these countries.

In developing countries, limited access to effective screening means that the disease is often not identified until it is further advanced and symptoms develop. In addition, prospects for treatment of such late-stage disease may be poor, resulting in a higher rate of death from cervical cancer in these countries.

The high mortality rate from cervical cancer globally (52%) could be reduced by effective screening and treatment programmes.

Screening for cervical cancer

Cervical cancer screening is testing for pre-cancer and cancer among women who have no symptoms and may feel perfectly healthy. When screening detects pre-cancerous lesions, these can easily be treated and cancer avoided. Screening can also detect cancer at an early stage and treatment has a high potential for cure.

Because pre-cancerous lesions take many years to develop, screening is recommended for every woman from aged 30 to 49 at least once in a lifetime and ideally more frequently. Screening is only effective on cervical cancer mortality, if a high proportion of women participate.

There are 3 different types of screening tests are currently available:

• conventional (Pap) test and liquid-based cytology (LBC)
• visual inspection with Acetic Acid (VIA)
• HPV testing for high-risk HPV types.

HPV vaccination

There are currently 2 vaccines which protect against both HPV 16 and 18, which are known to cause at least 70% of cervical cancers. The vaccines may also have some cross-protection against other less common HPV types which cause cervical cancer. One of the vaccines also protects against HPV types 6 and 11 which cause anogenital warts.

Clinical trial results show that both vaccines are safe and very effective in preventing infection with HPV 16 and 18.

Both vaccines work best if administered prior to exposure to HPV. Therefore, it is preferable to administer them before first sexual activity.

The vaccines cannot treat HPV infection or HPV-associated disease such as cancer.

Some countries have started to vaccinate boys as the vaccination prevents genital cancers in males as well as females, and one of the two available vaccines also prevents genital warts in males and females. WHO recommends vaccination for girls aged 9-13 years as this is the most cost-effective public health measure against cervical cancer.

HPV vaccination does not replace cervical cancer screening. In countries where HPV vaccine is introduced, screening programmes may still need to be developed or strengthened.

Cervical cancer prevention and control: A comprehensive approach

WHO recommends a comprehensive approach to cervical cancer prevention and control. The recommended set of actions includes interventions across the life course. It should be multidisciplinary, including components from community education, social mobilization, vaccination, screening, treatment and palliative care.

Primary prevention begins with HPV vaccination of girls aged 9-13 years, before they become sexually active.

Other recommended preventive interventions for boys and girls as appropriate are:

• education about safe sexual practices, including delayed start of sexual activity;
• promotion and provision of condoms for those already engaged in sexual activity;
• warnings about tobacco use, which often starts during adolescence, and which is an important risk factor for cervical and other cancers; and
• male circumcision.

Women who are sexually active should be screened for abnormal cervical cells and pre-cancerous lesions, starting from 30 years of age.

Source: http://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer

Abstract submission are welcome, proceed for submission at: https://std-hiv-aids.cmesociety.com/abstract-submission