Human papillomavirus (HPV): symptoms, cause, treatment

The human papillomavirus (abbreviated ‘HPV’) is a virus that occurs on the skin and mucous membranes. As of 2020, more than 150 types of the virus are known. All types are numbered. Most types do not pose a health risk. But certain virus types are known to change the cells of the cervix during a long-term infection (of which you often go unnoticed), causing (a pre-stage of) cancer to develop. In most cases, the body clears the virus infection itself. About 15 types are known to cause cancer. A distinction is made between high-risk and low-risk types. Low-risk types cause genital warts, which pose little risk. However, high-risk types can cause cervical cancer (or a precancerous condition). This is because they disrupt cell growth.

  • What is human papillomavirus (HPV)?
  • High-risk HPV and low-risk HPV
  • Causes
  • Risk factors
  • Number of sexual partners
  • Age
  • Weakened immune system
  • Damaged skin
  • Personal contact
  • Symptoms and complaints of an HPV infection
  • No complaints
  • Cervical cancer
  • Prevent contamination
  • Long-term, mutually monogamous relationship
  • Condom use
  • Less HPV on penis after circumcision
  • HPV treatment
  • HPV vaccine
  • National vaccination programme
  • Vaccination for girls
  • Before you are sexually active
  • Complications
  • Oral and upper airway injuries
  • Cancer
  • Prognosis

 

The protein coat (capsid) of a papillomavirus / Source: Public domain, Wikimedia Commons (PD)

What is human papillomavirus (HPV)?

The human papillomavirus (HPV for short) is a virus that occurs on the skin and mucous membranes. This concerns a group of more than 150 related viruses. The virus is often present in the pubic area. It can be transmitted via skin-to-skin contact, skin-to-mucous membrane contact or mucous membrane-to-mucous membrane contact. One of the most common venereal diseases or sexually transmitted infections (STDs) are genital warts, which are caused by HPV. HPV itself is a virus and not a disease, but the virus is transmitted through sexual contact.

High-risk HPV and low-risk HPV

Sexually transmitted HPVs fall into two categories:

  • High-risk or oncogenic HPVs, which can cause cancer. 15 high-risk HPV types can be identified. Two of these, types 16 and 18, are responsible for most cases of cervical cancer. The HPV vaccination therefore focuses on these two oncogenic HPV types. The dangerous HPVs can also cause other cancers, such as those of the vagina, labia and anus.
  • Low-risk HPVs, which do not cause cancer but genital warts on or around the genitals or anus. Types 6 and 11 cause 90 percent of all genital warts. Low-risk HPVs can also cause warts on the hands and feet.

 

Causes

HPV infection occurs when the virus enters your body, usually through a cut, scrape or small tear in the skin. The virus is mainly transmitted through skin-to-skin contact. Genital HPV infections are acquired through sexual intercourse, anal sex, and other skin-to-skin contact in the genital area. Some HPV infections are contracted through oral sex. A pregnant woman who has genital warts can pass the infection to her baby. Warts are often very contagious. They can spread through direct contact with a wart. Warts can also spread when you touch something that someone with a wart has touched.

Risk factors

HPV infections are very common. Risk factors for HPV infection include:

Number of sexual partners

The more sexual partners you have, the more likely you are to contract a genital HPV infection. Having sex with a partner who has had multiple sex partners also increases your risk.

Age

Common warts mainly occur in children. Genital warts are most common in adolescents and young adults.

Weakened immune system

People with weakened immune systems are at greater risk for HPV infections. Your immune system can be weakened by HIV/AIDS or by immune-suppressing medications used after organ transplants.

Damaged skin

Damage to the skin makes the skin area in question more susceptible to developing common warts. Skin damage is a portal of entry for the virus.

Personal contact

Touching one’s warts or not wearing protection (for example, bath slippers) before coming into contact with surfaces exposed to HPV, such as public showers or swimming pools, can increase the risk of HPV infection.

Symptoms and complaints of an HPV infection

No complaints

If you are infected with HPV, you will not notice it. You don’t get any obvious complaints. You can get warts on the genitals from some types, but these are caused by HPV types that do not cause cancer. The culprit settles in the cells and is often cleared by (the body’s immune system). The body is not always able to clear the virus properly. It is not clear why this is so. It is known that you are more likely to remain infected for a long time if you smoke or if you take certain medications that weaken the immune system.

Cervical cancer / Source: Designua/Shutterstock.com

Cervical cancer

Symptoms may arise from cervical cancer. It only happens in a small number of cases that an HPV infection with a high-risk HPV type in the cervix leads to a pre-cancerous stage, which can then further develop into cervical cancer. This usually lasts about 12-15 years from the time of HPV infection; this is called the ‘incubation period’: the period between infection and the first symptoms. The incubation period is 2-3 years for a high-grade CIN lesion (a precursor to cervical cancer), and 12-15 years for cervical cancer. In the Netherlands, many thousands of women are treated every year for a precancerous condition caused by the high-risk types of HPV. Every year, more than 200 women die from cervical cancer in the Netherlands.

Prevent contamination

Long-term, mutually monogamous relationship

The most reliable way to prevent infection with either high-risk or low-risk HPV is to avoid skin-to-skin contact, skin-to-mucosa contact, or mucosa-to-mucosa contact through oral, anal, or genital contact with another person. If you are sexually active, a long-term, mutually monogamous relationship with an uninfected partner is the best strategy to prevent HPV infection. However, due to the lack of symptoms, it is difficult to determine whether a partner who has been sexually active in the past is currently still infected with HPV. You can find out whether you are infected by taking a smear test.

Condom use

Research has shown that correct and consistent use of condoms can reduce the transmission of HPV between sexual partners. It turns out that the chance of infection is 70% smaller if you always use a condom. But even if you consistently use a condom, you can become infected with the virus. This is because the virus resides in and around the vagina and on and around the penis and during sex the virus can reach other places, such as on the hands and in the mouth.

Less HPV on penis after circumcision

Men without a foreskin have HPV infections with a lower viral load (the amount of virus in your blood). The viral load also decreases faster in circumcised infected men. This may lead to less transmission of HPV to women, according to Virginia Senkomago and colleagues in The Journal of Infectious Diseases (2014; epub September 26).

HPV treatment

An HPV infection cannot be treated with medication. In most cases, the virus is cleared by the body without causing any problems. However, if the infection persists, only the abnormal cells that form can be treated. Furthermore, genital warts can be treated with a medicine in the form of a cream or one that you should apply to the warts regularly, a few days a week.

HPV vaccine

National vaccination programme

Since 2010, an HPV vaccine has been included in the Dutch National Vaccination Program for young girls. Cervical cancer is always caused by the human papillomavirus (HPV). There are many different variants of this virus. The HPV vaccine protects against two variants that together cause 70% of all cases of cervical cancer.

Vaccination for girls

All girls who are 12 years old are offered the vaccinations. The HPV vaccination consists of 3 vaccinations or injections, which are administered over a period of six months. The second injection is administered one month after the first, the third injection five months after the second injection. You will receive the vaccinations in your upper arm. The vaccinations are free and not mandatory. The vaccine Cervarix is used within the National Vaccination Program

Before you are sexually active

The vaccination works best if you have not yet come into contact with the virus. You can become infected with the virus through sexual contact. It is best to get the vaccination if you are not yet sexually active. That is why girls are vaccinated at a young age. The vaccination is given by the Municipal Health Service (GGD) or Center for Youth and Family (CJG) in your area.

Complications

An HPV infection can lead to the following complications:

Oral and upper airway injuries

Some HPV infections cause lesions on your tongue, tonsils, soft palate, or in your larynx and nose.

Cancer

HPV types 16 and 18 can cause cervical cancer later in life. These variants can also contribute to cancers of the genitals, anus, mouth, and upper respiratory tract.

Prognosis

HPV infection mainly involves the basal epithelial cells. As a result, both recurrences and regressions are common. The prognosis is good, and most cases of genital warts are amenable to treatment. Patients who do not develop immunity to HPV may suffer potentially serious consequences.

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  • Human papillomavirus and risk of (genital) cancer (HPV)
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  • Vaginal cancer: symptoms, causes, treatment and prognosis
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