Issue link: https://maltatoday.uberflip.com/i/1016519
15 maltatoday | SUNDAY • 19 AUGUST 2018 Valeska Padovese, MD, is Specialist in Dermatology and Venereology and Consultant at the Genito- Urinary Clinic of Mater Dei Hospital, Malta Dr Valeska Padovese on the importance of getting tested for HPV at an early age What is the GU clinic? What services do you offer and who do you serve? The GU clinic deals with sexually transmitted infections. It is the reference centre at Mater Dei Hospital for symptomatic patients but also for screening of asymptomatic patients. We test for STIs but also check conditions that pertain to the genital area, so not all people who come to the GU clinic have an STI. There are 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 are referred by their GP or because they spontaneously decide to call and ask for an appointment. Are you satisfied with the number of people who do in fact come to the GU clinic or do you think there isn't enough awareness? In the last year there was an increase in awareness due to media and awareness campaigns, but we are still seeing a small number compared to the total population. The problem is that our capacity to see more people is limited because we are understaffed at the moment. We have some trainees abroad who will be back soon, so I hope someday soon we will have more doctors and will be able to screen and to increase the capacity of testing people in our clinic. At the moment 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. Which infections worry you the most? One of the most common infections diagnosed at the GU clinic here 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. Vice-versa, gynaecologists test patients, and when they find them positive for HPV and genital warts, they refer them here. 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. That's why recently we've also seen an increase in the number of infections compared to the previous years. There is some confusion surrounding HPV… can it be treated? Are there any signs or symptoms? Most of patients with HPV infections remains asymptomatic. It is 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. What is the connection between HPV and cancer, as well as other diseases? There are more than 50 types of HPV virus, and some of them are called 'oncogenetic', which means that they 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. 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. How effective do you think the vaccine has been? Do you think that enough children are being vaccinated? There is a campaign – all children at the age of 12 are being vaccinated. Now we have a recent nonavalent vaccine which took over more HPV types. This vaccine was being used for some years, and 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. What is the ideal age to get vaccinated? Before being sexually active, and ideally under 12. What other infections are particularly worrisome? In the GU clinic we offer a comprehensive screening for STIs. Our test involves some blood tests, and we usually test for HIV, hepatitis, syphilis, and it depends on sex, gender, and sexual orientation of the patient. Usually, we 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 infection 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. Is there any way to prevent HPV? HPV is a bit more difficult 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.