HPV is a virus that can infect many areas of the body. There are over 100 strains and the majority are low risk and reside on the skin and can cause conditions such as warts. While this isn’t pleasant it can be easily treated. Approximately 40 HPV strains can be passed on through sex but 12 to 14 of these are considered high risk for certain types of cancer.
The primary cancer of note is cervical cancer with just 2 strains (16 and 18) causing 70% of all cervical cancers.
A further 5 strains pushes this number to 95%. However, these high risk strains may also cause, anal, penile and throat cancer, although the incidence is much lower.
Currently testing only applies to high risk strains of HPV and even then most laboratories in Singapore are limited to testing individually for 16 and 18 and then grouping other high risk strains together. Accurate testing can only be performed for women and this can be done together with a regular Pap smear (which looks directly for cancerous cells). While swabbing can be done for men, it is not accurate and currently not fully recommended.
Women should be testing regularly if they are sexually active, particularly if they have different partners and it should be done even if they feel normal without any symptoms. Once a year is the general recommendation but if you have a positive result or an abnormal pap smear this may be shortened to 6 monthly until resolution. If HPV remains present and Pap smear results are worsening then review by a specialist is the next step.
Low risk strains of HPV may produce warts. Those that are passed on sexually may produce genital warts which are fleshy growths from the skin around the genital and anal region. These growths are often pain-free but are unpleasant to see.
High risk strains often have no symptoms until it is too late. If we take cervical cancer as an example, many women who are developing this cancer due to HPV have no symptoms at all. Sometimes there may be some vaginal spotting but this may be overlooked. Symptoms that appear later are often do with advanced cervical cancer that has spread to other organs and if this occurs the prognosis is poor.
Currently warts can be treated by removing them via freezing-therapy, acid solutions or direct surgical removal. However, this may not cure the virus as it may still be present but in a dormant state. Most people’s immune system can cure the virus on its own but this may take several years.
As with low risk strains, high risk strains have no direct cure. Once it is present then the only hope is that the immune system can eliminate it on its own. In certain cases for cervical infection a procedure may be performed to remove part of the cervix that aims to remove the infected tissue as well but there is no guarantee that this will be 100% successful so regular screening is still required after.
If warts are present and left untreated then they may continue to spread. While they can still be removed, wider spread can appear unpleasant and may lead to scarring of the area should more aggressive surgical intervention be needed.
High risks strains are a different matter, particularly for cervical cancer. While there is no specific treatment, regular screening (such as pap smear) can monitor the progress of disease.
If results remain stable and clear then regular screening can be continued. If there is evidence that cervical cancer may be developing then a specialist may remove part of the cervix. In more advanced cases the entire cervix and uterus may be removed. If no screening is performed at any stage then cervical cancer could develop and it may not exhibit any symptoms. The cancer will eventually spread to other organs and the survival rate of this, unfortunately, is very poor.
Potential HPV infection in the throat and rectal area will have to be monitored visually for any evidence of cancer as there is no accurate screening method currently.
Low risk strains are a challenge as they can pass on through skin to skin contact even if there was no sex. But regular visual checks can help identify warts so they can be treated early.
The highest risk strains can be prevented with a vaccine. Three are available and the latest is Gardasil 9. As the name suggests it protects against 9 strains of HPV, two wart causing strains and seven cancer causing strains. The vaccine is given as 3 doses over 6 months and current evidence shows that there is no need for further boosters. Once complete the vaccine can reduce the risk of cancer by 95% particularly in the case of cervical cancer. We cannot stress the importance of this vaccine as it is one of the only types of its kind that can reduce the risk of cancer. Both men and women can take this vaccine.
However, if those at risk screen and treat infections regularly, the overall chance of infection is significantly reduced.
Feel free to come and speak to our friendly and approachable doctors about any issues you may be having. Remember we still cover all the GP stuff as well.
Gonorrhoea is a bacterial infection that is commonly passed on through unprotected sex (vaginal, anal and oral).
Chlamydia is another bacterial infection exclusively passed on during sex (oral, vaginal and anal). As with gonorrhoea the risk is much higher in unprotected sex but if protection is not used correctly then the risk is increased as well.
Herpes/Herpes Simplex Virus (HSV) is a virus that affects the skin. There are two major types known as type 1 and type 2. Typically HSV type 1 affects the mouth area and is associated with cold sores (passed on through kissing). HSV type 2 typically affects the genital area and is associated with sexual transmission.
HSV presents as painful/burning blisters that are often clustered together on the skin. For some the initial symptom will be a tingling sensation in the affected area before visual symptoms appear. Symptoms are very similar to shingles which is a condition caused by another member of the Herpes family.
Syphilis is a bacterial infection primarily passed on through sex. However, if an infected person has symptoms and that comes into contact with damaged or broken skin then it is possible to pass on even in the absence of sex.
The first stage of Syphilis presents with sore(s) at the location the infection entered the body, typically around the genital region but it can present on the anus or mouth as well. The sores tend to be round and are painless which can lead to a delay in identifying them.
The second stage usually presents with a widespread rash that can be anywhere on the body but the typical areas tend to be the hands/feet and torso region. The rashes are not itchy and they can appear quite flat, sometimes making them easy to miss.
Both are bacteria that can potentially be present on the skin, particularly around the genital region. They can be passed on through skin contact of contaminated areas as well as through sex.
HIV is a virus that can pass on primarily through sex and sharing of unsanitised drug needles. The former is the primary mode of transmission particularly unprotected vaginal or anal sex. Thankfully oral sex is considered negligible risk for HIV.
This is an important point because HIV often has no symptoms in the early stage. Some may experience severe symptoms such as high fever, marked body aches, chills, runny nose, sore throat and fatigue approximately 3 weeks after infection but there is considerable overlap with other conditions such as the flu and Covid 19. Therefore symptoms at the early stage are unreliable and should not be used to exclude or diagnose HIV. Testing is the only accurate way to do this.
Trichomonas is a fairly common parasite passed on through sex and affects women more often.
In a majority of people with Trichomonas, symptoms can be absent making it difficult to identify without testing. However, if symptoms are present then the below list shows the common presentation:
You should consider screening if you have symptoms of a possible STD, if you have had a recent risky exposure (unprotected sex with a casual partner), or both.
Yes, you can. The common misconception is that oral sex is not considered ‘real’ sex and therfore has no risk but the opposite is true. Often oral sex is performed without protection and this is why infections such as chlamydia and gonorrhoea can pass on through oral sex.
Thankfully the majority can be cured but there are some such as Herpes and HIV that can be treated but not cured. This is why prevention is better than cure and ensuring safe sex goes a long way to reduce your risks.