Human papillomavirus (or HPV) is a virus from the papillomavirus family that affects human skin and moist body membranes such as the throat, mouth, feet, fingers, nails, anus and cervix.
There are over 100 different species, 40 of which affect the genital area. Most HPV strains cause no symptoms in humans.
However, some strains can cause warts, while a small number may increase the risk of developing tumors, for example, on the cervix, penis, vagina, anus, and oropharynx (oral area of the pharynx – throat tumor).
According to recent studies, HPV infection can also increase the risk of cardiovascular disease.
HPV strains 16 and 18 are known to cause almost all cervical cancers and also increase the risk of developing oropharyngeal carcinoma (in the throat).
Most people recover from HPV infections without further consequences.
It’s not entirely clear why some people take a long time to develop infection, precancerous cells, or cancer from HPV.
Women with conditions that weaken the immune system have difficulty fighting infections and have an increased risk of cervical cancer.
Cigarette smoking also increases the risk of cervical cancer.
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How many people have a papillomavirus?
Genital HPV is one of the most common sexually transmitted infections in the United States. About 20 million Americans between the ages of 15 and 49 have the papillomavirus.
And half of all sexually active men and women have a genital papillomavirus at some point in their lives.
Who is at risk of papillomavirus infection?
Anyone who has sexual intercourse can have an HPV virus.
HPV is so common that almost all sexually active individuals, men and women, develop it at some point in their lives. This also applies to people who have sexual intercourse with only one partner in the course of their lives.
How to get sick with papillomaviruses?
HPV is transmitted through contact with the genitals and generally during vaginal and intercourse. HPV can also be transmitted through oral sex.
The papillomavirus also spreads among partners of the same sex, even if the infected person has no signs or symptoms.
Many people with papillomavirus are unaware that they are infected or that they have transmitted the HPV virus to their sexual partner.
You can have HPV even if it’s been years since you’ve had contact with an infected person.
It is also possible to have multiple strains of HPV.
In rare cases, a pregnant woman with genital papillomavirus may also transmit HPV to her child during childbirth.
The HPV can infect the skin that is not covered by the condom. Thus, a condom does not completely protect against the virus.
Vaccinations against papillomaviruses
The papillomavirus vaccine consists of a series of three vaccinations over a period of more than 6 months to protect against infection with HPV or health problems caused by it.
Two vaccinations (Cervarix and Gardasil) protect against tumors of the cervix in women.
A vaccination (Gardasil) also protects against genital warts and tumors on the anus, vagina and vulva.
Both vaccinations are available for women.
Only Gardasil is available for men.
HPV vaccinations offer the best protection for young women and men if they receive all three doses of the vaccine and have enough time to develop an immune response before having sex with another person.
For this reason, vaccination against HPV is recommended for boys and girls aged 11 or 12 years.
Who else should be vaccinated against HPV?
In addition to girls and boys ages 11 or 12, HPV vaccines are also recommended for teens and young women who were not vaccinated when they were younger.
The vaccination is also recommended for homosexual and bisexual men (or any man who has sexual intercourse with another man). It is also advisable for men and women with weakened immune systems (including people with HIV/AIDS).
Symptoms
In most cases, the immune system knocks down the HPV infection before there is a chance of a wart developing.
If warts appear, they can vary depending on the type of HPV virus involved:
Common warts
Common warts appear as rough imprinted bumps that usually appear on the hands and fingers or around the nails.
In most cases, ordinary warts are uncomfortable simply because of their aesthetic aspect, but can also be painful or cause bleeding or sores.
Plantar warts
Plantar warts are coarse and granulous growths that usually appear on the heels or soles of the feet because they occur in areas that are subject to greater pressure.
These warts can cause discomfort or pain.
Flat warts
Flat warts are flat, slightly raised warts that are darker than normal skin.
As a rule, they appear on the face, neck, hands, wrists, elbows or knees.
HPV infections that cause flat warts mostly affect children, adolescents and young adults.
Wart
Genital warts can appear as flat lesions, as small formations that are cauliflower-like, or resemble tiny protrusions such as a shaft.
In women, genital warts are more likely to develop on the vulva, but they can also form near the anus, cervix or vagina.
In men, genital warts may appear on the penis, scrotum or in the anus area.
Genital warts rarely cause discomfort or pain.
Can high-risk HPV cause cancer?
The papillomavirus infects the epithelial cells. These cells are organized into layers and cover the inner and outer surfaces of the body, including the skin, throat, genital tract and anus.
Because HPV does not enter the bloodstream, an HPV infection from one part of the body should not trigger infection in another part of the body.
Once the HPV enters an epithelial cell, the virus begins to produce the viral DNA.
Two of the high-risk proteins of HPV lead to uncontrolled cell division and avoidance of cell death.
Often these infected cells are recognized and destroyed by the immune system.
Sometimes, however, the infected cells are not destroyed and lead to a permanent
infection.
As these constantly infected cells continue to grow, mutations can develop that continue to promote cell growth and eventually lead to high-grade lesions and eventually a tumor.
Researchers assume that 10 to 20 years can pass before a tumor can develop from an HPV infection.
However, even high-grade lesions do not always lead to cancer.
The proportion of cervical lesions leading to invasive cervical cancer is less than 50%.
Cervical cancer caused by papillomavirus
Most cases of cervical cancer are caused by two special types of genital HPV. These two strains of HPV usually do not cause warts, the women are often unaware that they are infected.
The first phase of cervical cancer usually proceeds without signs or symptoms. Therefore, it is important for a woman to have a Pap test done regularly to detect possible precancerous changes in the cervix that could lead to cancer.
The high-risk papillomavirus can cause changes in the cells lining the cervix. These changes are known as intraepithelial neoplasms of the cervix.
Not all women with this type of HPV develop neoplasia.
For many women, HPV infection is temporary and cell changes recede over time.
Cervical intraepithelial neoplasia is not cancer, but in some women, if left untreated, it can degenerate into cancer after a certain number of years.
Tumors on the head and neck are more common in people who smoke, especially those who drink alcohol.
Similar to how papillomavirus affects other areas of the body, the virus can be latent for many months and even years before it causes changes in some people’s cells and develops into cancer.
Treatment of cervical intraepithelial neoplasia is very effective and the risk of neoplasia recurring after treatment is very low.
In general, treatment depends on how severe the pathological changes are.
The cell changes are divided into three stages.
- Treatment may not be required at the first stage, but the patient must be closely monitored by the doctor.
- In the second and third stages, treatments can be carried out with surgical intervention, during which the affected area of the cervix is removed.
- Abnormal cells can also be removed using laser treatment or cryotherapy (freezing the areas).
Cervical intraepithelial neoplasia usually causes no symptoms.
The symptoms of cervical cancer are:
- Abnormal vaginal blood loss
- Bleeding after sexual intercourse
- Abnormal vaginal discharge.
These symptoms can also be caused by many other things, so it’s important to see your GP.
Papillomavirus and cancer of the vulva or vagina
Infection by the high-risk papillomavirus can cause cell changes in the vulva (genitals of the woman).
The changes are called vulvar intraepithelial neoplasia (VIN) or vaginal intraepithelial neoplasia (VAIN).
Not everyone who has papillomavirus develops a VIN or VAIN.
Vulvar intraepithelial neoplasia is not cancer, but some women can develop vulvar cancer after many years. Intraepithelial neoplasia does not always lead to cancer, although high-risk papilloma infections are thought to cause vulvar cancer for more than half of all types.
Cancer of the vulva or vagina is very rare.
Therapy for this neoplasia depends on how severe the cell changes are.
Some mild cell changes (stage 1) only require medical observation.
Therapy may be required if the cell changes are more severe (stage 2 or 3).
In this case, removal of the cell mass is usually required by surgery, laser therapy or diathermy (this is a therapy that applies electric current to eliminate the affected part).
Symptoms of vulvar cancer include:
- Pain, discomfort and itching of the vulva
- Small lumps or swelling on the vulva
- Abnormal bleeding from the vagina or discharge
- Painful area or ulcers on the vulva.
Symptoms of vaginal cancer include:
- Vaginal blood stains
- Pain and discomfort in the vaginal area
- Bleeding after sexual intercourse
- Difficulty or pain when leaking urine.
These symptoms may be the same as with other non-cancerous conditions, so it is important to discuss any symptoms with your GP.
Diagnosis
How do you know if you have a high-risk papillomavirus?
Since HPV infection is very common and usually disappears spontaneously, there is often no reason to worry, even if you have been infected.
Most people don’t know when they became infected with a papillomavirus.
How do you know if you have a papillomavirus?
As a rule, a woman recognizes from the abnormal result of a Pap test that she has HPV.
The Pap test is an important test to detect abnormal cells on the cervix caused by HPV.
There is an HPV test for women, but it is only used in certain situations. The doctor may recommend this examination to women after a Pap test that detects abnormal cells or the result of which is inconclusive.
The HPV test is not advisable for all women because the disease is very common and usually
passes spontaneously without causing health problems.
In women over 30 years of age, testing for papillomavirus may be done along with a Pap test.
If both results are normal, the woman has a low risk of developing cervical cancer.
It does not need to repeat this test within five years.
Some women who are over the age of 30 prefer to have a Pap test every three years.
Papillomavirus in men
Virus that causes
abnormal cell changes Currently, there is no HPV test for men.
But men can be reassured because the papillomavirus almost always disappears without causing problems.
What is the therapy of infection caused by the papillomavirus?
Currently, there is no drug therapy for infections caused by the papillomavirus.
However, one can treat the condylomata and warts that arise in HPV infection.
The methods used usually consist in the treatment of condylomata and warts and are:
- cryosurgery (freezing, which destroys the tissue),
- LEEP (electrosurgical loop method),
- Surgical conization (surgically with the scalpel, laser, or both to remove a cone-shaped tissue part from the cervix and cervical canal),
- Laser vaporization (using the laser to destroy the cervical tissue).
Therapy for other types of precancerous lesions caused by HPV (lesions of the vagina, vulva, penis and area) and genital warts can be carried out with chemical substances or with drugs, with surgical excision, cryosurgery, electrosurgery and laser surgery.
Drugs used are retinoids, antivirals, immunomodulators and salicylic acid, which are applied directly to the affected area.
Doctors often recommend applying creams: podophyllotoxin, imiquimod (Aldara) and sinecatechins (Veregen).
People with papillomavirus infection who develop cancer usually receive the same treatment as patients in whom the tumors do not originate from HPV infection, depending on the type and stage of the tumor.
However, people diagnosed with oropharyngeal cancer who test positive for HPV may be treated differently than people with oropharyngeal tumors who test negative for papillomavirus.
Recent research has shown that patients with oropharyngeal tumors and positive HPV have a better prognosis and require less intensive therapy.
How to prevent the spread of papillomavirus?
Vaccination against HPV can protect women against two types of HPV, which lead to cervical cancer in 70% of cases.
Abstain from sexual intercourse, which involves skin-to-skin contact.
During vaginal or intercourse, a condom should be used.
A condom reduces the risk, but is less effective against HPV than for other infections such as chlamydia and AIDS.
- Warts or genital condylomata acuminata
- Pap smear
- Ovarian cancer
