Head of the sexually transmitted infections (STI) unit of the Puigvert Foundation, andrologist Álvaro Vives Suñé insists on prevention and checkups as the best ways to escape the wave of increased cases. Promoter of vaccinating children against the human papilloma virus (HPV), he reflects on this disease, the most widespread venereal disease, which can affect 80% of the population during their lifetime. 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 itself, in certain cases it is a precursor to cancers. Cervical cancer is almost one hundred percent caused by this virus, there are few cancers caused by a virus. There are also cancers of the penis, vagina, vulva, anus and especially head and neck cancers, which are increasing a lot.
Girls have been vaccinated for 17 years and boys started in 2022.
While the rest of STIs can be easily diagnosed, in HPV the screening technique makes no sense because you find it everywhere and the mere presence of the virus means nothing. If we started analyzing all sexually active people, we would get a lot of positives and create unnecessary social alarm. Much more importance must be given to prevention with the vaccine.
Are there any results on vaccination in children?
Not yet, but in principle it has very good acceptability among parents and among children. We were the first to release a study on vaccination in children in 2015, and everyone jumped on us. They said 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 caused by HPV would decrease radically.
The problem will be the price.
It is relative. It is a lifelong vaccine. They are three doses, five hundred and one hundred euros; with less than 15 years it is two doses. Protection for the rest of my life against cancers, I see it even cheap. The chicken pox vaccine is usually included in the vaccination schedule, one year I think it was not included due to a series of problems and people had to pay for it and it is also a hundred and appropriate euros.
It will be difficult for it to reach anywhere in the world.
There are many countries that do not vaccinate women systematically, let alone men. It will be complicated. But we can drastically eradicate all the pathologies caused by 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 which says that treating vaginal warts caused by HPV cost the State 100 million euros; vaccinate men are 30 million.
How is it transmitted?
For contact, there need not be penetration or an exchange of fluids. Condoms protect less against these infections, especially because people don't put them on correctly. The correct placement is before I touch the person I'm with. I self-stimulate and put on the condom. What people do is play naked and put on a condom for the moment of penetration. But if there has already been contact, the transmission may already exist. There are boys and girls who have never had penetrative intercourse who are already infected with HPV.
Also oral?
Too. Transmission is oral or sex-genital, through intimate contact between genital areas. And then the hands can act as vectors. You can have genital warts, touch them, get remnants of them on your fingernails and spread them to another part of your body.
In a context of STI growth, what role does prevention play?
I've been doing this since the mid-1990s. Since then I haven't seen any STIs go down, they all go up. The only thing we had under control was HIV, which seemed to be going down, and now it's going up again. Even pathologies that we had eradicated reappear, such as lymphogranuloma venereum. Venereology is not just about 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 advocate. Seeing that we will not achieve much more condom use and understanding that there are many asymptomatic infections, regular check-ups are necessary.
What explains this increase?
First, we diagnose much more. Second, 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 used to not be such an established practice and now it is the most normal in the world.
Is there also unconsciousness?
Lack of information, because we rely a lot on the internet and there is a lot of informational terrorism. Sex education in schools is still very biased and very limited.
What is the most dangerous STI at the moment?
It's still HIV. But lymphogranuloma, which is a variant of chlamydia, if it progresses, can be very aggressive.
