What is HPV?

HPV (Human Papillomavirus) is a virus/viral infection that is commonly, but not exclusively, transmitted through sexual activities (including any form of penetration, oral sex, kissing in some cases, and more rarely, close skin to skin contact in other areas of the body).

The HPV infection, if not fought off by the body’s natural defences can cause warts or lesions on the skin. HPV lesions can sometimes develop into cancer. There are many (over 200!) different strains of HPV, and having or having had one doesn’t stop you from getting another. A lesser known fact is that all warts are caused by HPV infections, and HPV strains that cause warts are rarely cancerous. HSV-6 and HSV-11 are the two most common strains of HPV, they sometimes cause warts and don’t commonly cause cancer. The more dangerous HPV strains can cause precancerous lesions which sometimes develop into cancer.

HPV is most likely to cause cancer in and around the cervix, so while HPV can affect anyone, it is extra important for folks’ who have a cervix or are having sex with anyone with a cervix to understand the increased risk of not taking protective measures.

HPV is one of the most common STIs due to its ability to go unnoticed and be passed on. Around 85% of sexually active people will contract HPV in their lifetime. Luckily, most people who contract HPV will clear the viral infection in 1-2 years, but it can be life threatening for those who don’t, and they can pass it on to other folks during those years. Since, if you are sexually active, it’s more than likely you will contract HPV in your lifetime, it’s important to know how to keep an eye out for dangerous HPV and how to reduce transmission to and from yourself.

The Halifax Sexual Health Centre has created a fantastic resource on HPV that we recommend checking out to learn more.

How does transmission occur?

While the vast majority of cases of HPV are caused by infection through sexual contact/activity, there are still cases of non-sexual transmission. Doing things like wearing flip flops/bath shoes in public pools or showers can decrease your likelihood of catching common warts (caused by HPV). It can also, in rare cases, be passed down to a child during pregnancy, and so if you have HPV and are pregnant or trying to get pregnant you can talk to your doctor about the risks.

Sexual transmission of HPV happens through close skin to skin contact, most commonly either penetrative vaginal or anal sex, and oral sex.

How do I protect myself and my partner’s against it?

Since HPV is so common, and so commonly asymptomatic, it’s a good idea to think about HPV even in settings that seem low risk. Since you can have HPV and never develop symptoms, even if you are in a long-term monogamous relationship one partner may have HPV and be at risk of passing it on to their partner. Developing symptoms years into a sexually monogamous relationship also doesn’t mean that you were cheated on – symptoms can take years to develop, so you may have had it for longer than you realised, or just gotten it from your partner recently.

The more partners you have the more likely you are to be exposed to HPV. Which, as always, is not to say that you shouldn’t have all the sex that you want – just that it’s a good idea to consider you and your partners’ risk. Using condoms, and other forms of barrier protection are always a great way to reduce your risk of getting or passing along HPV. Washing your hands thoroughly after touching your partner’s genitals can also help prevent you from getting HPV.

There are also now vaccines that protect folks against a few common strains of HPV – including some of the strains more likely to cause cancer. Gardasil 9 has the broadest protection, and is the vaccine most commonly given in Nova Scotia. It includes protection against HPV-6 and -11 (the two most common kinds) and HPV-16 and -18 (the two strains most likely to cause cervical cancer).

In Nova Scotia, the vaccine series is often started around the age of 11 as a part of the School Immunization Program. The Gardasil vaccine is currently approved for folks with penises aged 9-26 and folks with vaginas 9-45. Doctors can give the Gardasil shot to folks of any age. It is additionally recommended for folks who are HIV+ or who are ‘men who have sex with men’ and are aged 26 – 45.

It is offered at no cost to children in schools in Nova Scotia through the School Immunization Program (which began in 2007). If you are unsure whether or not you received the vaccine in a school in Nova Scotia you can contact your Public Health unit. It is also covered for men who have sex with men 19 – 46, people who are HIV+ and 19 – 46, and anyone under 19. For folks paying out of pocket it can cost over 600 dollars to get the full 3 dose series. Some private insurance plans may cover it.
Gardasil is most effective when given before you become sexually active. If you are already sexually active, and/or have had an HPV exposure, this vaccine can still help reduce the risk of contracting other HPV strains and of developing certain HPV-related diseases. Having had a past HPV infection does not prevent you from getting future HPV infections, and those with an active HPV infection can still get other strains of HPV at the same time. The vaccine will still help protect you against other strains.

If you went to school in Nova Scotia and aren’t sure whether or not you received the Gardasil 9 vaccine as a part of the school immunisation program you can contact the Public Health Department(s) relevant to where you went to school. If you do not have a family doctor, you can look at booking an appointment at your local sexual health centre, or a walk-in clinic.

You can talk to your doctor, nurse, or local pharmacist about booking an HPV vaccine.

How do I know if I have it?

HPV is often asymptomatic which is why prevention methods are so important. Taking some time to explore the internet and photos of precancerous lesions and warts might be helpful, but a doctor will best be able to tell you if something on your skin is worrisome. If you notice any unusual bumps, lesions, growths, or sores, you should always get them checked out right away. Doctors may take biopsy’s (small samples of skin cells from the affected area) to look at more closely. There are tests that they can do to these cells to determine if they are infected with HPV or are cancerous.

If you have a cervix, getting routine cervical screening (or PAP tests) is important as you can’t otherwise see warts or lesions on or around your cervix.

What do I do if I get it?

Unfortunately, there is no cure for HPV. This is why preventative measures are so important.

The good news is that the vast majority of people will fight the virus on their own, but this can be less likely for folks that are immunocompromised, including folks living with HIV. If you find out you have HPV the best thing you can do is have regular check ups with your doctor to ensure your HPV doesn’t progress into something more dangerous.

If you have warts you can also have them removed at most doctor’s offices, walk-in clinics, or sexual health clinics, but it is important to know that just because the warts are gone it doesn’t mean that HPV isn’t still in your system.

How do I know if it developed into cancer?

The best thing you can do for your long term health with cancer is to catch it early, so if you have a growth or spot on your skin/mouth/genitals that you are at all worried about it is always a good idea to get it checked out by a doctor. You can go to a walk-in and ask for a referral, your family doctor, a sexual health clinic, or see a specialist. If they are worried they will likely take a small sample of the skin to test for cancer.

Check out the sections below to learn more about the common types of cancer caused by HPV.

You can learn more about where HEAL NS got this information from at:
https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/human-papillomavirus-hpv.html
https://hshc.ca/hpv-vaccine/#:~:text=GARDASIL%20is%20a%20vaccine%20to,cervical%20dysplasia%2C%20and%20genital%20warts
https://my.clevelandclinic.org/health/diseases/11901-hpv-human-papilloma-virus
https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer#:~:text=HPV%20is%20a%20group%20of,cause%20several%20types%20of%20cancer
*disclaimer: we do not necessarily endorse all of the information, content, or language used in these references.

Cervical Cancer

Cervical Cancer is most commonly caused by HPV. It occurs when Dysplasia (the abnormal growth of cells) turns into cancerous growth inside of the cervix. The cervix sits at the base of the uterus, connecting it to the vagina. If cervical cancer is left untreated, the mass of cells (the tumour) can begin to grow at a more rapid rate, and eventually even spread to other parts of the body.

If you are above the age of 25, and especially if you are sexually active, it is important to get regular cervical cancer screenings with a doctor. It’s a good idea to keep an eye out for the following symptoms that may indicate early stages of cervical cancer:

• Pain during penetrative sex
• Bleeding before or after sex
• Thin, watery, (sometimes bloody) discharge with a strong smell
• Pain urinating or during bowel movements
• Bleeding during urination or bowel movements
• Bleeding around your period or after menopause
• Swollen legs
• Persistent back ache
• Fatigue

* It’s important to note that all of these systems could be symptoms of something else – so don’t panic. If you are experiencing any of these it’s important to talk to your doctor, go to a walk in, or book an appointment at your local sexual health clinic to discuss your risk and determine next steps.

The prognosis of a cervical cancer diagnosis is greatly dependent on you and your body, as well as how quickly it is found and treated. The earlier you begin treatment, the greater your chances, which is why we recommend knowing what symptoms to look out for and getting regular cervical cancer screens.

In Nova Scotia, Pap tests / cervical screenings are covered by MSI through the Cervical Cancer Prevention Program. We would also like to note that the language used throughout this province is overwhelmingly gendered. You do not need to be a woman to have a cervix, (or have a cervix to be a woman), and cervical cancer screening is necessary for anyone with a cervix, especially those that are sexually active. You have a right to this care, regardless of your gender. Lots of healthcare providers in NS are gender-affirming, but unfortunately lots aren’t. You can check out this resource by the Community-Based Research Centre for tips on advocating for and taking care of yourself around healthcare appointments.

Folks who have had vaginoplasty do not need to be screened for cervical cancer as they do not have cervixes.

Folks who have had any sort of phalloplasty (creation of a penis) and vaginectomy where their vaginal opening was closed but have not had a hysterectomy are still at risk for cervical cancer however cannot get cervical screenings done since the cervix/uterus is not accessible. There are alternative methods for checking for cervical cancer including MRI, abdominal ultrasounds, serum biomarker testing, pelvic exams, and more. You can talk with a doctor to evaluate if any of these screens makes sense for you.

If you have a family doctor, they are a great person to ask about cervical screenings. You can also check out SUGAR Health to find out where to get a screening near you.

You can learn more about where we got this information from at:
https://sugarhealth.ca/
https://www.nshealth.ca/clinics-programs-and-services/cervical-cancer-prevention-program
https://transwellnessinitiative.ca/resources/health-care-self-advocacy-tip-sheet-for-2slgbtqia-community/
https://cancer.ca/en/cancer-information/cancer-types/cervical?gad_source=1&gclid=CjwKCAjwx-CyBhAqEiwAeOcTdef0sBnai8SmdvHed7Ilptw4Fan0V3m_1agjBOp-wPqU0wBpEYvX7xoCz_wQAvD_BwE
https://my.clevelandclinic.org/health/diseases/12216-cervical-cancer
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636588/
*disclaimer: we do not necessarily endorse all of the information, content, or language used in these references.

Vaginal Cancer

Most incidences of vaginal cancer are caused by HPV, however older folks and folks who smoke tobacco/cigarettes are at a greater risk of developing vaginal cancer. It is a very rare form of cancer that involves the growth of cancerous cells in the vagina, the canal between the vulva (the outer part of the reproductive system) and the cervix.

There are two main types of vaginal cancer:

• Squamous cell carcinoma. The vast majority of vaginal cancer cases are squamous cell carcinoma. Squamous cells are a thin flat cell that line your cervix, and this type of vaginal cancer often develops at the top of the vagina, close to where it connects to the cervix. This cancer often develops slowly, and can often be caught during a routine Pap test/pelvic exam.
• Adenocarcinoma. This form of cancer occurs in the cells that make up the glands of an organ. It is a less common type of vaginal cancer making up around only 10% of cases. It most commonly presents as clear cell adenocarcinoma; a type of cancer caused by exposure to the drug diethylstilbestrol (DES). This drug was used to prevent misscarriage in Canada and the US until 1971, meaning folks under the 50 are quite unlikely to have been exposed to DES.

Many of the signs and symptoms for vaginal cancer are the same as cervical cancer, however, in some cases you may also be able to feel the growth of a mass. Because vaginal cancer develops slowly many folks do not experience symptoms during early stages – which is why it’s so important to get routine Pap tests / cervical screenings.

It is also important to note that folks who have had hysterectomies / oophorectomy can still get vaginal cancer as the vagina is capped but largely still left un-altered.

If you have a family doctor, they are a great person to ask about Pap tests. You can check out SUGAR Health to find out where to get a Pap test and pelvic exam near you.
Vaginal cancer in vaginas created through vaginoplasty
Folks who have had vaginoplasty (surgically constructed vulvas and vaginas) the risk of cancer on their vulva or vagina is actually more similar to those with penises because the skin used to create the vulva/vagina is penile skin. This means that in this case vaginal or vulvar cancer functions and is treated as penile cancer. This is not because folks still have a penis, but because the skin cells are the same cells that created the penis prior to surgery.

Penile cancer is most commonly caused by HPV, but is less likely to occur than vulvar and vaginal cancer. Folks who have had vaginoplasty should still get regular exams.

Check out our section on Penile Cancer to learn more.

You can learn more about where HEAL NS got this information from at:
https://sugarhealth.ca/
https://my.clevelandclinic.org/health/diseases/15579-vaginal-cancer
https://cancer.ca/en/cancer-information/cancer-types/vaginal
https://www.medicalnewstoday.com/articles/trans-woman-cervical-cancer#is-screening-necessary
https://www.healthline.com/health/womens-health/vaginal-cancer-after-hysterectomy#:~:text=It%E2%80%99s%20possible%20to%20get%20vaginal%20cancer%20after%20a,share%20risk%20factors%20like%20HPV%20infection%20and%20smoking
*disclaimer: we do not necessarily endorse all of the information, content, or language used in these references.

Vulvar Cancer

The types of cancers described above can also occur in the vulva (the soft tissue around the vaginal opening, urethra (pee-hole), and clitoris. Similarly to the above cancers infection of certain HPV strains are a risk factor for developing skin cancer. Folks above the age of 50 are also more likely to develop cancer, and smoking can increase someone’s risk as well.

Similarly to other types of cancers near the pelvis, routine pap tests and pelvic exams are good ways to catch it early – something which can really increase your chances of recovery. If you aren’t sure where to do this check out the Sugar Health Registry and Warmline. If you notice pain while urinating, itching or bleeding on your vulva, changes to the skin on the vulva (colour or thickening) the development of a new lump, sore, or wart, it is a good idea to go get it checked out at your doctor, local walk in clinic, or local sexual health centre.

Similarly to vaginal cancer Squamous Cell Carcinoma is the most common and widespread form of cancer. Less commonly, folks can also develop Adenocarcinoma on their vulva. About 3% of vulvar cancer cases are a form of melanoma (the common skin cancer associated with sun exposure – that can in rare cases develop in places not commonly exposed to sun – like the vulva).

Vulvar cancer in vulvas created through vaginoplasty

Folks who have had vaginoplasty (surgically constructed vulvas and vaginas) the risk of cancer on their vulva or vagina is actually more similar to those with penises because the skin used to create the vulva/vagina is penile skin. This means that in this case vaginal or vulvar cancer functions and is treated as penile cancer. This is not because folks still have a penis, but because the skin cells are the same cells that created the penis prior to surgery.

Penile cancer is most commonly caused by HPV, but is less likely to occur than vulvar and vaginal cancer.

Check out our section on Penile Cancer to learn more.

You can learn more about where HEAL NS got this information from at:
https://cancer.ca/en/cancer-information/cancer-types/vulvar?gad_source=1&gclid=CjwKCAjwx-CyBhAqEiwAeOcTdcU81c7EuKpxgqNd4HAv6WzWUS9TNMSrHL0xB5Z6jJHKGJ7zioFgUhoCzXIQAvD_BwE
https://www.hopkinsmedicine.org/health/conditions-and-diseases/vulvar-cancer
https://www.medicalnewstoday.com/articles/trans-woman-cervical-cancer#is-screening-necessary
*disclaimer: we do not necessarily endorse all of the information, content, or language used in these references.

Penile Cancer

While HPV is less likely to cause cancer in people with penis’ however HPV is still the most common cause of penile cancer when it does occur. The other risk factor for penile cancer is precancerous infections. These conditions are rarely dangerous unless left untreated. Another factor that can increase your risk of penile cancer is the build up of smegma (a substance made up of dead skin cells) under the foreskin. This build-up can create irritation and infection which can increase your likelihood of developing penile cancer. Regular cleaning under the foreskin can prevent this build-up.

If you were circumcised as a child, you have a lower risk of developing penile cancer. Recent research suggests that whether a penis is circumcised does not significantly alter rates of cancer in adults.

Penile cancer often can be noticed through a combination of the following symptoms:

• Growths, bumps, or lumps
• Rashes, redness, or irritation, in some cases sores
• Production of a smelly discharge

Right now, penile cancer is not common enough for screenings to be recommended for Nova Scotians, however, if you notice any of the above signs go get it checked out by your family doctor, sexual health clinic, or a walk-in clinic. If they see any signs for concern they will give you a referral to a urologist.

Penile cancer in folks who have had phalloplasty (surgery to create a penis) has been seen only a very small number of times, but with such little research on this, it is definitely still possible to develop a type of skin cancer on the penis. As always,it is a good idea to see a doctor if you notice anything unusual.

You can learn more about where HEAL NS got this information from at:
https://cancer.ca/en/cancer-information/cancer-types/penile/risks
*disclaimer: we do not necessarily endorse all of the information, content, or language used in these references.

Oropharyngeal Cancer

Oropharyngeal cancer involves cancer of the squamous (skin) cells of the oropharynx. The oropharynx is made up of the back third of your tongue, tonsils, and soft palette, and the back walls of your throat – basically the tissue that makes up the back of your mouth and top of your throat. HPV infections (along with smoking) is one of the main triggers for this type of cancer.

While this is not one of the more common cancers caused by HPV, it is a piece of the risk folks can consider while performing oral sex. Oral sex performed on all genitals, as well as sex toys that have come into contact with another person’s fluids can pass on HPV. Barrier methods can be highly effective in reducing the chances of passing HPV through oral sex.

Oropharyngeal cancer can be asymptomatic in early stages. The following symptoms could point to cancer: ongoing sore throat or trouble swallowing, rapid weight loss, a lump at the back of the throat, ear pain, or blood coming up when coughing, or a spot (often white) at the back of the mouth or tongue. These symptoms don’t mean that you for sure have oropharyngeal cancer, but do mean it’s a good idea to see a doctor to get them checked out.

You can learn more about where HEAL NS got this information from at:
https://www.cancer.gov/types/head-and-neck/patient/adult/oropharyngeal-treatment-pdq#:~:text=Oropharyngeal%20cancer%20is%20a%20type,neck%20and%20a%20sore%20throat
*disclaimer: we do not necessarily endorse all of the information, content, or language used in these references.