Head of the sexually transmitted infections (STI) unit at the Puigvert Foundation, andrologist Álvaro Vives Suñé insists on prevention and check-ups as the best ways to escape the wave of increasing cases. Promoter of the vaccination of children against the human papillomavirus (HPV), he reflects on this disease, the most widespread venereal disease, which can affect 80% of the population throughout their lives. Today is International HPV Awareness Day.
Why should we worry about HPV?
Because it is one of the most widespread viruses, it is transmitted very easily; Although in most cases it heals on its own, in certain cases it is a precursor to cancer. Cervical cancer is almost one hundred percent caused by this virus, there are few cancers caused by a virus. There is also penis, vagina, vulva, anus, and especially head and neck cancers, which are increasing a lot.
Girls have been vaccinated for 17 years and boys will start in 2022.
While the rest of STIs can be diagnosed easily, with HPV the screening technique does not make sense because you find it everywhere and the mere presence of the virus does not mean anything. If we started analyzing everyone who was sexually active, we would get many positives and unnecessary social alarm would be created. Much more importance must be given to prevention with the vaccine.
Are there any results about vaccination in children?
Not yet, but in principle it has very good acceptability among parents and children. We were the first to publish a study on vaccination in children in 2015, and everyone was on us. They said that there was no scientific or economic evidence, and we proved the opposite. If we vaccinated the entire world population, in 20-30 years we would eradicate the first cancer in the history of medicine, which would be cervical cancer. And in 40-50 years all cancers due to HPV would radically decrease.
The problem will be the price
It is relative. It is a vaccine for life. There are three doses, five hundred and something euros; with less than 15 years there are two doses. Protection for the rest of my life against cancer, I see it as cheap. The chickenpox vaccine is normally included in the vaccination schedule, one year it seems to me that it was not included due to a series of problems and people had to pay for it, and it also cost a hundred or so euros.
It will be difficult to reach everyone
There are many countries that do not systematically vaccinate women, much less men. It will be complicated. But we can drastically eradicate all pathologies due to HPV in our environment, which also means, in economic terms – which I don't like, but the Government does – a significant reduction in spending. The Catalan Institute of Oncology did a study years ago that says that treating vaginal warts caused by HPV cost the State 100 million euros; Vaccinate men is 30 million.
How is it transmitted?
For contact, there is no need for penetration or fluid exchange. The condom protects less in these infections, especially because people do not put it on correctly. The correct placement is before I touch the person I am with. I stimulate myself and put on the condom. What people do is play around naked and put on a condom for the moment of penetration. But if there has already been contact, transmission may already exist. There are boys and girls who have never had penetrative sex who are already infected with HPV.
Also oral?
Also. Transmission is oral or sexual-genital, through intimate contact between genital areas. And then the hands can act as vectors. One can have genital warts, pick them, get debris on the nails and transmit them to another part of your body.
In a context of growth of STIs, what role does prevention play?
I've been doing this since the mid-nineties. Since then I have not seen any STIs go down, they all go up. The only one we had under control was HIV, which seemed to be going down, and now it is increasing again. Even pathologies that we had eradicated reappear, such as lymphogranuloma venereum. Venereology is just treating a patient. The first thing you have to do is prevention. Educate, try to raise awareness among the population to use condoms more for all practices, and vaccines. Then we would have secondary prevention, which is what I defend. Seeing that we are not going to get much more use of condoms and understanding that there are many asymptomatic infections, periodic check-ups must be done.
What explains this increase?
First, we diagnose much more. Two, the age at which sexual activity begins is lower: the skin and mucous membranes of young people are not as prepared against infections. But basically it is the number of sexual partners and the ease with which they have sexual relations today. And the trivialization of everything. And also the increase in certain sexual practices: oral sex in the past was not such an established practice and now it is the most normal thing in the world.
Is there also unconsciousness?
Lack of information, because we rely a lot on the Internet and there is a lot of information terrorism. Sexual education in schools is still very biased and very limited.
Right now, what is the most dangerous STI?
It's still HIV. But lymphogranuloma, which is a variant of chlamydia, if it progresses can be very aggressive.
