HPV 101.
So what’s the deal with HPV? Human. Papilloma. Virus.
More important than what it is, or what it does — more important than how you prevent yourself and others from getting it — is that HPV matters to everyone of every age. HPV is not something that only affects women, not something that only affects men, not something that only affects other genders. It matters to all of us, and we all play a role in keeping each other healthy and happy.
HPV is a virus. Viruses are a branch of pathogens that aren’t quite alive, or quite dead. Pathogens (viruses, bacteria, parasites, etc.) are micro-organisms that infect things. Most of the time, infection is when something is living and multiplying inside of you when it normally shouldn’t. Great! You’re a pro now.
There are close to 200 Papilloma “viridae” (the plural of virus), but only some of them infect humans (hence human papilloma virus, clever). Each of those types is called a strain, which is really how you refer to the different species of virus within a particular family — strains of the common cold, the flu, even Ebola. Of those that infect humans, some strains are pretty harmless, some can cause cancer, and those cancers can and do kill people. Most of the time, your immune system does a heck of a good job of dealing with HPV.
Now, Immunity is super neat. It is super complex and is pretty much the result of an arms race between our ancestors and the millions of pathogens that have ever existed, ever. Tens of different types of cells, hundreds of different types of proteins, thousands of different types of molecules, and we are still learning about how the whole thing works. We kill it! Literally and figuratively. But, that arms race has two sides, and pathogens are trying their hardest to not get eaten. It is a life and death situation, and they choose life — which can mean our death. Tricky.
One thing I want to stress is that we are very good at not dying. We are under near constant assault and shrug it off like — no problem; however, things can slip through the cracks. Generally speaking, sometimes you know when you get sick, and sometimes you don’t. It all depends on the particular pathogen, in the particular host (the thing that gets infected — like me when I get sick, for example), in the particular environment. For HPV, productive (successful) infection leads to lesions, which is a fancy word for “tissue (skin, organs, etc.) that isn’t quite right”. We will go into this in more depth for a later post, but the most pathogenic (worst) strains of HPV lead to weird-looking, or uncontrolled cell growth that most often manifests on the cervix — cancer. I recognize that cancer is a super scary word, but let’s break it down later and explore what it actually means. Because it means a lot of things in a lot of different contexts.
Currently, there is no cure for HPV. But, luckily for you (and me) it is pretty easy to manage the outcomes of HPV (i.e. lesions) when you notice it early enough. And possible to treat when you identify it later, but that gets more difficult. Timing, as always, is key.
There are a bunch of ways to do testing: genetically (looking for DNA), molecularly (looking for immune responses), and cellularly (looking for lesions). They all have different benefits and drawbacks. Speed, complexity, cost, accuracy, specificity, etc. Over the last 10 years in Canada, testing has been done by PAP smear (named after the bro who invented it, not the virus). PAP smears are typically done annually, to look for the lesions caused by HPV. Those lesions are pretty far downstream of infection (after), which is why there is a current push towards genetic HPV testing in Canada — a practice that is already a standard in other parts of the world. Genetic testing identifies the virus itself, not the lesions, which are the consequence of infection. It is much more sensitive, and can distinguish between the less and more harmful strains of virus. PAP smears, however, require substantially less technology and are particularly important in countries with fewer resources. Globally, both methods are extremely important. While genetic HPV tests are increasingly becoming the standard, it is really a matter of availability. All testing is good testing, because we stay healthy as a community.
So. HPV. Its a virus. Its testable. The outcomes are manageable. The whole thing beatable.
We’ll be going over a handful of other concepts for the month of October (HPV prevention week & cervical cancer awareness week).
- HPV. How it is shared. How it is not.
- HPV and Cancer. Probability and Consequence.
- Does it ever go away? How?
Stay tuned and stay safe.
Matthew German. MSc, Molecular Virology.
Matthew is currently at BlueDot, a B-Corporation that develops public health and consumer technologies to prevent the spread of infectious disease through global epidemic prediction, preparedness and response. On the side, Matthew is also exploring how we can change the way we interact with technology to align with our biology and psychology, through his project Veni.
Izabella Kaczmarek. MPH candidate.
Izabella is responsible for education and community coordination at Eve Medical, a social venture that is extending women’s health screening beyond the clinic into the privacy and comfort of women’s homes. Motivated by the 500,000 cases of cervical cancer that occur worldwide each year, Eve Medical developed and launched Canada’s first Eve Kit, the do-it-yourself at-home HPV screening service. On the side, Izabella is completing her Master of Public Health at the University of Waterloo with particular interests in addressing inequalities within the Canadian health system.
