BEIRUT: Ninety to 100 cases of cervical cancer are reported each year to the country’s Health Ministry – all of which are caused by the human papilloma virus and could be prevented by regular trips to the gynecologist.
But social taboos surrounding sexuality have deterred the vast majority of women from seeing one.
“HPV is one of the fastest spreading diseases,” said Dr. Faysal el-Kak, an obstetrician and gynecologist at the American University of Beirut Medical Center. “For a sexually active person, in their lifetime 25-35 percent will have HPV.
“Officially 90 to 100 cases of cervical cancer are registered with the Health Ministry, but we believe there are around 250 cases each year. ... All I can tell you is that these things should not happen,” he said.
There are more than 100 strains of HPV and about half of them are sexually transmitted infections. Some of them cause benign genital warts, while other strains can lead to cancer in the cervix, anus and penis. The virus most recently made international headlines this summer as more research linked throat cancer and HPV contracted through oral sex.
For cervical cancer at least, regular pap smears are a safeguard against HPV’s deadliest effects. But social and religious taboos severely limit the number of Lebanese women seeing a gynecologist and put the population at unnecessary risk, doctors told The Daily Star. Growing concern in the country over HPV’s cancer-causing strains has made a strong case for standardizing gynecological checkups, and an even stronger case for vaccinating girls and boys.
Definitive numbers on the prevalence of HPV in the country are essentially nonexistent. Doctors are not required to report HPV diagnoses to the government, meaning there are no official statistics, doctors said.
Dr. Muhieddine Seoud, from AUB’s Department of Obstetrics and Gynecology, published a paper compiling literature on HPV in the Middle East and North Africa. Little data addressed Lebanon, specifically. But in a closing remark, Seoud noted: “Although the region currently has a low reported rate of STIs, HPV, and cervical cancer overall, without intervention, the rates are hypothesized to increase markedly.”
Kak estimated that 15 percent of sexually active women in Lebanon are seeing a gynecologist regularly. Increasing this percentage would help reduce the rate of cervical cancer, he said.
“We have to deal with it the same way we would flu in an airport. We cannot stop the planes from flying, we cannot stop people from flying,” Kak said. “The most important thing is to admit that HPV is a sexual infection and there are two main strategies to prevent it: primary prevention through giving the vaccine ... the second strategy is to continue having pap smears as soon as you become sexually active.”
HPV has spread rapidly in part because the STI is contracted through skin contact. Condoms, for example, are not a surefire way to stay safe. The only way to ensure you don’t contract HPV from an infected partner is not to have sex with that person, explained Dr. Nesrine Rizk, who specializes in infectious diseases at AUBMC.
HPV is a complicated infection. For example, some of its nonsexual strains are the cause of simple plantar warts many children have on their feet and fingers, Rizk said.
“Human knowledge of HPV is like the tip of an iceberg,” she said.
What doctors do know is that HPV is not just a concern for women.
Beyond cervical cancer, HPV can cause penile cancer or throat and anus cancers – also taboo subjects because of their association with homosexuality. Protecting the whole population requires more than just focusing on women and cervical cancer, Rizk said.
In men, cancerous HPV strains usually have no symptoms, and unlike women, they have no standard test for HPV in the penis, Rizk said.
Therefore one of the best ways to protect individuals and work toward protecting the general population is to vaccinate adolescents – both girls and boys, she said. “You have to vaccinate both men and women if you want to protect the whole population,” she said.
Two vaccinations are approved and available in the country: Gardasil and Cervarix, both of which protect against the highest risk strains for causing cancer. Gardasil also protects against two strains that cause genital warts.
And for those who missed the vaccination boat, pap smears for women will catch and prevent potential cervical cancer, she said. “Screening is very important. It’s the most important.”
There is some evidence that people are beginning to know more about HPV, said Dr. Jinan Usta, who specializes in family medicine.
The Internet and campaigns for the vaccines have encouraged more patients to seek testing and parents to vaccinate their daughters, she said.
“You have more girls coming and checking for most of the STDs,” she said. “There are more girls doing this now then when I used to practice.”
After all, as sexual habits become more liberal in the country, health practices and awareness must grow as well, Kak said.
“There’s more of an environment allowing for people to express themselves sexually and this is not accompanied by proper, professional resources that give people information, skills and knowledge to take care of their sexual health,” he said. “There is no point in developing a fear or phobia against HPV, the whole point is that if these infections are neglected, over time they put you at a high risk of developing cervical cancer.”