Medical information – HPV
What is human papillomavirus?
The human papillomavirus, abbreviated as HPV, belongs to the group of small DNA viruses also belonging to the family of the Papilloma viruses. Of this virus, there are more than 100 different types described. HPV infects the skin and mucous membranes of humans. Some HPV viruses may cause benign warts, called papillomas, from which the virus takes its name. These benign types of warts are usually caused by HPV 6 and 11 which are low-risk HPV types. About 45 types of HPV can infect the mucosa (mucosal types). Of these mucosal types, there are 15 known types which may cause cervical cancer as a rare complication. Therefore, these are called high-risk HPV (hrHPV).
How common is HPV?
HPV infections are common. Approximately 80% of all men and women have been in contact with this virus. HPV is usually transmitted by sexual contact. Because the virus is so common, almost all sexually active women will come in contact with HPV in their lives. As young men and women are the most sexually active, the virus affects them the most. Research has shown that the risk of the transfer of an HPV infection drops with the use of a condom, but that alone can not completely prevent it.
Communication of the viruses
Although the HP-Virus is not – like the HI-Virus – communicated through seminal or vaginal fluid, sexual intercourse is still one of the most common ways of transmitting an HPV-infection. That is because the infection is usually transmitted through contact or smear infection during (oral) sex, when the infected area of the skin is touched directly. The risk of infection rises together with a rising number of sexual partners. That is why frequent sexual intercourse with changing partners as well as frequent unsafe sex are factors for an increased risk of infection. Also, the risk of an HPV-infection increases when the sexual life begins already at an early age. The virus can also be transmitted through close contact of bodies and skin during petting and bathing together. In rare cases, transmission through commonly used items, such as towels, is possible when these items are carrying HP-viruses. After the transmission, the virus can only actually enter the skin and lead to an infection, when the skin or mucous membrane has tiniest injuries. Especially during sex, these injuries occur without being noticed and thus make it easy for the virus to penetrate the skin. In addition to that, several factors and conditions have to prevail in order to enable the virus to prosper and reproduce within the body after the transmission. These are mainly existing inflammations and a weakened immune defence.
The effect of high-risk human papilloma virus on the cervix
High-risk HPV is the cause of cervical cancer. It has been shown that High-risk HPV can result in over 99% of all cases of cervical cancer. However, not every HPV infection leads to cervical cancer. A continuous infection, also referred to as a persistent infection with high-risk HPV, is necessary for the development of cervical cancer. As the cause for cervical cancer, the high-risk HPV types are mainly transmitted during unsafe sex, the world health organisation (WHO) even started to classify cervical cancer as an STD.
How should we imagine that?
After an infection of the cervix with high-risk HPV, the immune system of most the women will clear out the virus in 1 ½ to 2 years without these women ever noticing they were infected. This is because the infection causes little to no complaints. The virus stays in the body for some time without being noticed. During the time that the virus resides in our body, its presence can be made known, for example, with the administration of a test for the virus (HPV test). You can also see changes in the cells through a pap smear. A pap smear is not a virus test, but a test which will look for changes in cells through a microscope. In most cases, the cell changes will disappear again. In those cases an HPV test will also be unable to show the HPV.
Can the virus also go away?
In some cases, it seems that getting rid of the virus takes longer than usual (1 ½ to 2 years). Apparently, the immune system has trouble clearing the virus. The changes in the pap smear remain. In those cases, so-called precancerous cervical lesions arise. In summary, most women are not aware of the high-risk HPV. But only a small minority will keep the virus longer than usual.
Development of cervical cancer
If women carry an HPV infection with them for a long time, this may eventually, through preliminary stages, lead to cervical cancer. The development of cervical cancer takes about 10 to 15 years. Early detection of abnormalities of the cervix can be detected through a Pap or HPV test. The detection of cervical abnormalities through these tests makes treatment possible and ensures that the development of cervical cancer can be prevented.
How do you treat an HPV infection?
There are no drugs against HPV. It is possible to get a treatment of pre-cancerous cervical cancer. Pre-stages can be treated by removing the abnormality in the cells, which may be done surgically via a laser or by means of freezing. This is usually done as an outpatient without hospitalization. After treatment of the abnormality of the cervix, the HPV infection almost always disappears. In 7-12% of the treatments is there still an ongoing HPV infection (persistence of HPV) or a new infection. That is also the reason that check ups are necessary after a treatment. The following methods of treatment are described here:
This is the most commonly used and simplest treatment. Here a warmed, thin thread loop is used to remove abnormal cells.
With this treatment a laser is being used to remove abnormal cells.
Conisation (cone biopsy)
A cone shaped piece of tissue is cut out of the cervix to remove abnormal cells. This can be done with a loop (see above), a laser (see above) or regular surgery.
With this operation a small metal plate is cooled down to freezing temperature. Then, this plate is placed on the abnormal area of the cervix. It destroys the abnormal cells.
Especially women who have already been infected with HPV and with whom HPV-tests detected high-risk HPV in the past should do early detection screenings regularly. After a successful treatment, the infection can still keep recurring, especially at times when this is supported by factors like a weakened immune defence.
Can HPV infection be prevented?
To reduce the risk of HPV infection, the use of a condom during sexual intercourse is recommended. Moreover, condoms protect against several sexually transmitted diseases (STDs). However, condoms can not prevent the transfer of the HPV virus during sexual contact 100%.
Vaccination and early detection
Recently, it has become possible to vaccinate against certain types of HPV.If you are vaccinated, you get a kind of “empty” virus coat. It is empty because there is no viral DNA in it. The empty, artificial surface will be registered by our immune system. Antibodies will be made immediately to clean up the vaccine. The antibodies thus formed are so numerous that they remain in the body for a long time. At the moment that a vaccinated person (i.e. with antibodies against the outside of the virus) comes into contact with the real virus, the virus does not get the chance to come into a cell. It is immediately recognized by the antibodies. With the help of antibodies, the virus is cleared. In this way, approximately 70% of the cases of cervical cancer can be prevented. At age 12, girls get vaccinated before they have probably ever had contact with the real virus. Regular preventive checkups and early detection screenings are still advisable after an HPV-vaccination. For boys and men, who can also get infected with HPV and then transmit the virus to women, the HPV-vaccine has not been approved so far.
You are tested positive. And now?
If you are tested positive for HPV, you will have to contact your doctor or a gynaecologist to perform a colposcopy.
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