Cervical cancer is the first most common woman cancer in South Asia. (6), and almost all of them are caused by Human Papillomas Virus (4). A vaccination against HPV can protect effectively against infection by HPV and cervical cancer.

Hong Kong evolution and Sexual transmitted infections
Sexual behaviour among young people in Hong Kong has changed a lot in the past decades. The percentage of Chinese women who engage in premarital sex has increased in urban areas from 15 percent in 1990 to more than 50 percent in 2010, but attitude toward sex remains conservative and the average age for first intercourse is 17.7 years old. (1,2) While contraception use is high among Hong Kong adults aged 18 to 27, there is little information given on safe sexual behavior, especially to teenagers, and the risk of sexual transmitted infection (STI) is still important with the steadily increasing number HIV cases (3).

What is HPV?
Human papilloma virus is one of the most common sexually transmitted infections (STI). (4) Almost all men and women who are sexually active will get in contact with it in their life. In most cases, HPV goes away by itself without causing any major health problems. But we know that around 10% of women worldwide with normal cytological findings carry a detectable cervical HPV infection (5). When it does not go away, there is no efficient cure available and it can cause genital warts and cancers. There is no ways to know which person who has HPV will develop cancers and who will not, only the type of HPV can help determine the risk. There are more than 40 types of genital HPV, and only high-risk types are more likely to cause cervical and other genital cancers, while other types will cause only genital warts (condyloma). Genital warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like cauliflower. HPV has been linked to other cancers as well. (69% of the Vulvar cancers, 75 % of Vaginal cancers, 63% of Penile cancers, 72% of Oropharyngeal cancers and 91% of anal cancers).

HPV Vaccination, the solution against HPV and HPV related cancer
There is no effective cures for an HPV infection, but there are many ways of prevention: Use of condoms, limit the number of sex partners for people who are sexually active, and vaccination is the most efficient one. Different vaccines exist: Cervix: bivalent vaccine, Gardasil: quadrivalent vaccine, and a new one called Gardasil 9. By preventing HPV infection, the vaccination can decrease dramatically the risk of cancers, especially cervical cancer.
In the USA, HPV vaccination is part of the vaccination Health program for both boys and girls. In the UK, all girls are vaccinated between 11 and 12 years old. In Hong Kong, the vaccination is not part of the Public Health Vaccination program yet. (7). The vaccine is not available for free. The cost of vaccination at Family Planning Association of Hong Kong is $850 - $950 per dose and the Cancer Fund stated that it costs you an average $1500 per injection for a total of $4500 in Hong Kong. Like Hong Kong, a lot of countries in the world are not including the HPV vaccine in the Health vaccination program. This brings controversies as vaccine can decreases the risk of developing HPV related cancers by up to 99%, even 100% for the Gardasil9. But one of the restrictions is that even though studies showed that the protection should be long lasting, not enough data is available to confirm it yet (4).

Cindy Scarborough, Nurse Practitioner & Emilie Clairet, Doctor specialized in Medical Biology

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1. Burger, R. (2012). Behind the Red Door: Sex in China. Earnshaw Books, Hong Kong.

2. Yip, P.S.F, Zhang, H., Lam, T.H., Lam, K.F., Lee, A.M., John Chan, J. and Fan, S. (2013). Sex knowledge, attitudes, and high-risk sexual behaviors among unmarried youth in Hong Kong. BMC Public Health, 13:691

3. Hong Kong STD/AIDS Update (2015).http://www.chp.gov.hk/files/pdf/std13q1.pdf

4. United States Center for Disease Control (2015). http://www.cdc.gov/hpv/cancer.html and http://www.cdc.gov/std/hpv/stdfact-hpv-vaccine-hcp.htm.

5. Bruni,L., Diaz, M., Castellsague, X., Ferrer, E., Bosch, F.X., and de Sanjose, S. (2010). Cervical Human Papillomavirus Prevalence in 5 Continents: Meta-Analysis of 1 Million Women with Normal Cytological Findings. The Journal of Infectious Diseases; 202(12):1789–1799

6. FPAHK Youth Sexuality Study (2011). http://www.famplan.org.hk/fpahk/en/press/press/YSS2011_OutSch_PressRelease_Eng%20%28final%29.htm.

7. Centre for Health Protection (2013). http://www.chp.gov.hk/files/pdf/recommendation_on_the_use_of_human_papillomavirus_hpv_vaccine_r.pdf