Get tested for HPV: Dr Valeska Padovese on the importance of getting vaccinated at an early age

Malta’s GU clinic is your first reference if you’re worried about an STI (sexually transmitted infection)

The GU clinic deals with sexually transmitted infections. Some people who are more concerned and more aware of risks and come here for an asymptomatic check-up, and there are those who have symptoms and come here because they have been referred by their GP or because they spontaneously decide to call and ask for an appointment.

People are more aware of STIs, so you might have to be a bit patient before your check-up

In the last year there has been an increase in awareness due to media and awareness campaigns, although the clinic still sees a small number compared to the total population. Although understaffed, we can see all the patients with symptoms as they walk into the clinic, so there is no waiting list for symptomatic patients but unfortunately there is a waiting list for people who just ask for asymptomatic check-up.

HPV and related lesions are becoming a serious problem

One of the most common infections diagnosed at the GU clinic in Malta is HPV infection – genital warts, but also HPV-related cervical dysplasia, precancerous lesions. In selected cases, we carry out smear tests to diagnose HPV, while pathological smear tests are referred to the gynaecologist for colposcopy and follow-up. Once we have HPV patients, we trace the contact partners and we find other HPV positive patients, so our contact tracing and partner notification increases the number of infections that we detect in our patients.

HPV is actually a very common infection

For example boys are carriers of HPV high-risk types; only two types can give the manifestation which can give warts. Only if patients have these two types of HPV can they have genital warts. They go to their doctor and ask for a medical treatment. Women should periodically go to do a smear test at least every two years, for prevention of cervical cancer. In that case, now in Malta we have a combination test: a smear test which automatically tests for HPV.

Some HPV virus types cause cancer

With over 50 types of HPV virus, the ‘oncogenetic’ types can cause cancer. But this is only some of them, thankfully. Different types of cancer can be caused by HPV, including cervical cancer, anal cancer, cancer of the external genitalia, and laryngeal cancer.

Is it just women who have to worry about HPV?

The prevention programme should be addressed to women, but also high-risk men such as men who have sex with men (MSM), especially those who are HIV-positive. In other European countries, HIV-positive MSM are periodically tested for HIV in the anus, and they do a sort of anoscopy and an anal smear for the prevention of anal cancer.

Ideally, children under 12 should be vaccinated

All children at the age of 12 are being vaccinated. A recent nonavalent vaccine caters for more HPV types: it has resulted in a dramatic decrease in cervical cancer and genital warts, so it is extremely effective. Both girls and boys should be vaccinated to achieve this result. The ideal age to get vaccinated is before becoming sexually active, under 12.

It’s not just HPV… there’s also syphilis and herpes to worry about

The GU clinic offers a comprehensive screening for STIs, that includes HIV, hepatitis, syphilis, and it depends on sex, gender, and sexual orientation of the patient. Usually, doctors take a cervical and vaginal swab in girls and a urine sample in heterosexual men, and/or a throat swab and rectal swab in homosexual men. Chlamydia, gonorrhoea, trichomoniasis, and mycoplasma are tested from urine samples, throat swab, and rectal swabs.

One of the most common infections after HPV is herpes. Another is chlamydia – which is very often asymptomatic, especially in adolescents and people under 25. Chlamydia can be quite risky because it can affect the sexual and reproductive health of both girls and boys, resulting in infertility most of the time if the patient is untreated and develops complications. Prevention in this case is very important.

Safe sex works, but prevention is key

HPV is difficult to prevent because it’s a viral infection and although condoms prevent STIs, there is no such thing as safe sex. We always say there is safer sex with the use of condoms. Some infections can still be transmitted even with the use of condoms, especially herpes virus and HPV – or even through oral sex. People underestimate the role of oral sex in transmission of STIs, so there is always a risk. The prevention through periodical smear test is essential, and of course if anyone detects a change in the external genitalia, they should visit their GPs or call here.