HPV Awareness Day at UKZN’s Medical School

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As a feature during Women’s Month, UKZN’ Discipline of Obstetrics and Gynaecology hosted an HPV (human papillomavirus) Awareness Day at the Nelson R. Mandela School of Medicine, with some participants joining virtually.

“The event aimed to raise awareness about adult HPV vaccination, focusing on HPV and all its manifestations,” explained UKZN’s Head of Discipline, Professor Motshedisi Sebitloane.

A common sexually transmitted infection that affects the skin, genital area and throat, HPV is the name of a group of 200 known viruses which do not cause concern in most people but infection with some high-risk types is common and can cause genital warts or cancer.

The meeting focused on HPV awareness and screening, covering the virus’s prevalence, history and pathogenesis, along with various screening methods and guidelines in South Africa.

The discussion included details on HPV vaccination strategies and their implementation, highlighting challenges such as cost and vaccine hesitancy while emphasising the World Health Organizations’ global strategy to accelerate the 90–70–90 elimination of cervical cancer as a public health problem by 2030. The goals are:

•    90% of girls fully vaccinated with HPV vaccine by the age of 15 years

•    70% of women screened with a high-performance test by the age of 35 years and again by 45 years of age

•    90% of women identified with cervical disease receive treatment (90% of women with precancer treated, and 90% of women with invasive cancer managed)

The Academic Head of UKZN’s Clinical Medicine Laboratory, Dr Nathalie Abbai, presented on the relationship between STIs and HPV, reminding those at the event that STIs have serious health consequences and can be caused by more than 30 different bacteria, viruses and parasites, which are spread predominantly, by sexual contact, including vaginal, anal as well as oral sex. “If not detected and appropriately treated, several non-viral STIs can result in pelvic inflammatory disease, ectopic pregnancy and infertility - mostly chlamydia and gonorrhoea causing this type of havoc.”

Abbai said due to the heavy burden of bacterial vaginosis, HPV and cervical cancer in sub-Saharan Africa, it was essential to investigate their potential relationship with the incidence and severity of cervical intraepithelial neoplasia - a term used to describe abnormal cells found on the surface of the cervix when a biopsy is done - among women within our region.

Sharing positive insights regarding cervical cancer screening, Dr Atisha Maharaj UKZN honorary lecturer and specialist O&G Oncologist at Inkosi Albert Luthuli Central Hospital (IALCH), said: “I think we have seen an increase in screening, and what we have noticed in our clinics is our numbers are still quite high but the good thing is that we are now able to catch the disease at early stages, making treatment possible. We are not seeing that many advanced stage four diseases anymore; that is the overall majority we are finding within the realm of cure, whether it be with surgery or radiation therapy.”

Maharaj said: “One of the reasons we wanted to address academic faculty here today is that a lot of the time we feel ‘it’s not going to affect me’ because I am out of that group of low socio-economic groups, so is not going to happen. But HPV is a very common infection; nine out of 10 sexually active adults at some point in their lifetime will have this infection, and whether you develop disease or not depends on your ability to clear it. It depends on the immunity, so we will continue the fight on every platform we can.”

In his historical overview of HPV, gynae-oncology fellow at IALCH and UKZN O&G honorary lecturer Dr Sean Mould confirmed. “We have known about cervical cancer for about 70 years but HPV has certainly been known to us for tens of thousands of years. When we look at its different subtypes across the globe, we see that those subtypes, mimic or correlate with the patterns of human migration back tens of thousands of years, certainly, and possibly hundreds of thousands of years ago, which tells us that HPV has been infecting humans for as almost as long as humans have existed and it is really interesting to see that the subtypes across the globe are quite different to each other, and that is a very ancient phenomenon.”

Presenting on HPV vaccination, Victoria Mxenge Hospital O&G Consultant, Dr Nompumelelo Ntshangase-Mpanza, reminded participants that for most people, HPV clears on its own but for those who do not clear the virus, it could cause cancers including cervical, vaginal, vulvar, anal and penile as well as other related diseases.

Ntshangase-Mpanza said cervical cancer control was founded on primary healthcare principles which emphasise that prevention is better than cure; secondary prevention is achieved through the detection and treatment of the asymptomatic pre-cancer phase; and that tertiary prevention is tackled by the provision of timely treatment and palliative care for invasive cancer. She said despite high vaccine costs, there was hope since their coverage was improving worldwide and in Africa, adding that more awareness needed to be created around the availability and safety of efficacy of the vaccine in order for an increased number of mothers to consent for young girls to receive the vaccination.

The conversation ended with presentations on the global burden of sexually transmitted infections and their relationship to cervical cancer, including the need for further research on HPV genotyping and test-and-treat strategies in South Africa.

The day’s interactive proceedings were coupled with mobile mammogram screening facilities offered by the organisation, Radhiant Diagnostic Imaging, to women 40 years and older as a preventative and precautionary measure to breast cancer. Cervical cancer screening, as well as TB, HIV, cholesterol and blood pressure screening, were offered via the Medical School’s occupational health services under the auspices of Sr Nozipho Jali.

Sebitloane said: “Today it was important for us to put the spotlight on HPV since KwaZulu-Natal has embarked on a roll out of HPV testing as a means of screening all facilities, being ahead of every other province in the country. We believe that the partnership and collaboration between us as the academic department and Department of Health is bearing fruit in achieving these great strides towards cervical cancer elimination goals.”

Words and photographs: Lunga Memela