By Annie Freeda Cruez

TALK on human papillomavirus (HPV) mostly centres on women since it increases their risk of cervical cancer.

But Dr Suresh Kumarasamy, a consultant obstetrician and gynaecologist, says the virus can infect men, too.

"All types of HPV can be transmitted between men and women. There's also a rare form of non-sexual transmission from mother to child during delivery," says Dr Suresh, who is also a gynaecological oncologist at Gleneagles Medical Centre in Penang.

In most cases, he adds, the transmission is done unknowingly because the infection is asymptomatic. although there's no data on the incidence or prevalence of HPV infection in the country, data from the WHO/ICO (Institut Catalia d'Oncologia) HPV Information Centre estimates that it's about 6.2 per cent at any one time in the general female population.

Among women who have undergone pap smear, the prevalence of HPV infection is 8.4 per cent. but there's data on the different HPV types in patients with cervical cancer in Malaysia.

Dr Suresh Kumarasamy. Photo: NST

Among these patients, 73 per cent have evidence of HPV Type 16 and 65.2 per cent with HPV Type 18.

"most men don't know that they can be infected by HPV. the most deadly disease women can get from HPV infection is cervical cancer while men are at risk of other diseases as well as cancers," says Dr Suresh, who is also an adjunct associate professor at Penang Medical College.

Although the vast majority of HPV cases show no symptoms, some may develop warts in their genital region.

"although easily treated, they can cause anxiety, embarrassment and long-term psychological, sexual and relationship problems," says Dr Suresh. Warts are generally asymptomatic.

But they can sometimes cause symptoms, depending on their location.

For example, warts in the vulva can cause pain during sexual intercourse, itchiness and a burning sensation while vaginal warts can cause discharge and bleeding.

Warts can also cause itchiness in the penis.

Genital warts: found on shaft of penis (male), vagina, vulva, cervix (female) and around anus. Photo: NST

Those that occur in the urethral meatus (opening of the urethra at the tip of the penis where urine is passed out) can cause blood in the urine or impairment of urinary stream.

Cancers are a different matter altogether.

Female patients who have cancer of the cervix may experience bleeding after intercourse, irregular vaginal bleeding, bleeding after menopause or pelvic pain.

Dr Suresh says HPV can infect married couples and singles who are sexually active.

"Prostitutes have a higher risk of infection." in the United States, it is estimated that between 50 and 80 per cent of the adult population have had HPV at some point in their lives.

And although HPV infection is rare in virgins, it's not impossible.

The virus can spread from hand-to-genital, hand-to-anal and mouth-to-genital contact.

Condoms may reduce the risk of infection, but they don't completely eliminate it.

Although HPV infection is common, the majority of men and women clear the virus from the body and don't suffer from any squealae of the infection, says Dr Suresh.

Only one per cent of men with HPV get warts while of a million women with HPV, only 1,600 get cancer if not screened.

Dr Suresh says vaccination programmes should be aimed at as many people as possible and not only those at risk.

"the focus should be on effectiveness and safety, and not method of transmission." some types of HPV can infect the mouth and throat, called the aerodigestive tract.

HPV Types 6 and 11, the same types that cause genital warts in men and women, can also cause an uncommon but serious condition in infants and children called recurrent laryngeal papillamatosis.

"the virus is transmitted from mother to baby through the birth canal during delivery.

The risk of infection in the child has been estimated to be one in 500 women," says Dr Suresh. He adds that children with recurrent laryngeal papillamatosis can develop an obstruction of the respiratory tract, causing breathing difficulties. "They may require surgery to relieve the obstruction.

Some children need as many as 10 operations per year.

One to three per cent of children with this condition die from it." There is an extremely rare variation of this condition which occurs in adults which is thought to be transmitted by oral sex. HPV infection is also implicated as the cause of a number of head and neck cancers.

Dr Suresh says: "HPV infection is implicated in 36 per cent of cancers of the oropharynx and 24 per cent of mouth cancers.

As far as oropharynx cancers are concerned, Types 16 and 18 account for 89 per cent of HPV infections.

In mouth cancers, 95 per cent of HPV infections are due to Types 16 and 18." Two types of vaccine available locally can provide protection against HPV Types 16 and 18.

The quadrivalent vaccine, or Gardasil, can also protect against HPV Types 6 and 11.

"although no research has been done to see if these vaccines can protect against head and neck cancers or mouth cancers, their potential to prevent diseases caused by HPV infection is tremendous," says Dr Suresh. currently, both vaccines are licensed by the US Food and Drug Administration for the protection against pre-cancer and cancer of the cervix.

The quadrivalent vaccine is also licensed against genital warts and pre-cancer of the vulva and vagina in women, and genital warts in men aged between nine and 26.

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