Human Papillomavirus: Background and Stigma

Human Papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. It is estimated that 75% of sexually active people will have at least one infection in their lifetimes, and this number increases to almost 100% for those that are unvaccinated against HPV. Most of these infections can be cleared by the body, but around 10% of people will have a persistent, chronic infection. There are many strains of HPV which vary in their risk for different manifestations of the disease, which means someone can be infected more than once. HPV is spread through oral, vaginal, or anal sex 1 . Many HPV infections are asymptomatic and will resolve on their own, so people often don’t realize they have the virus. The most common symptom is genital warts, which are raised, “cauliflower-like” lesions that are often painless. HPV causes almost all cases of cervical cancer, because the virus’s genetic information gets integrated into cervical cells and causes them to grow uncontrollably. It is also associated with cancer of the throat, mouth, penis, anus, vagina, and vulva, but to a lesser extent. The low risk strains of HPV are linked to genital warts, while the high risk strains are more closely linked with cervical cancer. It is important to note that while only those of the female sex can get cervical cancer, everyone can be infected and spread the virus 2 . The best ways to protect against HPV infections is to get immunized and practice safe sex. In Canada, there are 3 approved vaccines for HPV, and are recommended for all people older than 9 and younger than 27. It is also recommended for those older than 27 that are at higher risk for infection, if they have not already been vaccinated. The vaccines offer almost 100% protection against some high and low risk strains, but not all of them. However, the two high risk strains they do protect against are the ones responsible for most cervical cancers. The vaccine is still recommended for people who have known HPV infections, because the infection can be due to a different strain than the ones protected by vaccines, and can protect against future infections. There is also more specific information for those in special populations (immunocompromised, pregnant, etc.) that can be found here 3 . Papanicolaou tests (often known as Pap smears) are the best way to screen for cancerous changes in the cervix. It involves using a small brush to remove cells from the cervix in order for them to be examined under the microscope. Health Canada recommends that testing start at around ages 21-25, and be done every 3 years until ages 65-70. These recommendations vary between provinces, and more information can be found here here. If cancerous changes are found, there are treatment options available, which means cervical cancer is preventable. Although most sexually active people will get at least one HPV infection in their lifetimes, it is still a heavily stigmatized disease. This is mostly due to a lack of understanding of the science behind the disease, where people don’t realize how common infections actually are. People often fear social judgement, and can experience self blame and shame, as with all sexually transmitted diseases. The negative belief that infections are only due to incautious behaviour and having many sexual partners drives the stigma. Studies have found that the knowledge that HPV is sexually transmitted is the leading cause of shame and internalized stigma 4 . In reality, anyone who has had sex has been exposed to HPV, as it is a highly infectious virus. Individuals with HPV may feel uncomfortable talking about their diagnosis to people around them, including their doctors. In order to decrease this stigma, there must be more public education and positive motivation to get vaccinated and screened 5 . Individuals who are more knowledgeable about the disease often have a more positive reaction to a positive test result. Doctors are encouraged to openly discuss the implications of an HPV infection, and help educate the patient on their treatment options. This has been found to improve self care and preventative behaviours, and provides the patient with a sense of support and community 6 .

References

1. Government of Canada. (2017). Human Papillomavirus (HPV). https://www.canada.ca/

en/public-health/services/diseases/human-papillomavirus-hpv.html 

2. Centers for Disease Control and Prevention. (2022). Genital HPV Infection – Basic Fact Sheet. https://www.cdc.gov/std/hpv/stdfact-hpv.htm#:~:text=Human%20papillomavirus%

20(HPV)%20is%20the,answers%20basic%20questions%20about%20HPV.

3. Government of Canada (2021). Human papillomavirus vaccine: Canadian Immunization Guide. https://www.canada.ca/en/public-health/services/publications/healthy-living/

canadian-immunization-guide-part-4-active-vaccines/page-9-human-papillomavirus-vaccine.html

4. Waller, J., Marlow, L. A. V., Wardle, J. (2007). The association between knowledge of HPV and feelings of stigma, shame and anxiety. Sexually Transmitted Infections. 83(2), 155-159. https://doi.org/10.1136/sti.2006.023333

5. Peterson, C.E., Silva, A., Goben, A.H., Ongtengco, N.P., Hu, E.Z., Khanna, D., Nussbaum, E.R., Jasenof, I.G., Kim, S.J., Dykens, J.A. (2021). Stigma and cervical cancer prevention: A scoping review of the U.S. literature. Preventative Medicine. 153, 106849. https://doi.org/10.1016/j.ypmed.2021.106849 

6. Nagpal, T. S., Blake, J. (2020).Stigma as a Barrier to Care for Human Papillomavirus: A Commentary Summarizing Literature and Presenting Recommendations for Health Care Providers. Journal of Obstetrics and Gynaecology Canada. 43(10), 1276-1278. https://doi.org/10.1016/j.jogc.2020.02.116