HPV Infection – Human Papillomavirus

Human papillomaviruses, better known by the abbreviation HPV, are the most common sexually transmitted viruses worldwide. More than 200 types of this virus are known, and they can cause different diseases. HPV is best known for causing cervical cancer, but the virus can also cause other forms of cancer, as well as warts, such as genital warts. How do you recognize the symptoms of HPV infection, how do you test, and how do you prevent human papillomavirus infection? You can read that and more below.

What is HPV?

HPV is the abbreviation for the human papillomavirus (also: papillomavirus). These viruses are so widespread that most women and men will contract the virus at least once in their lifetime. Such an infection only causes symptoms in rare cases; it usually heals without consequences.

Women and men are about equally likely to be infected with the virus, but as a result, women are more likely to develop cancer than men.

 

HPV infection: what are the possible consequences?

In the case of an infection with the human papillomaviruses, the viruses penetrate the cells of the skin and mucous membrane covering tissue, settle in the cell nuclei and multiply there. Such HPV infections usually go unnoticed and heal by themselves without consequences since the immune system successfully fights the virus.

However, some of the HPV types produce skin lesions and warts, i.e. growths. Possible forms are genital warts (genital warts or condylomas) and skin warts (papillomas), which can affect the face, hands or feet.

The tissue changes caused are primarily benign but can also degenerate and lead to the development of cancer. For example, cervical cancer can develop decades after an HPV infection. But also cancer of the external female genital organs (vulva and vagina cancer), anal cancer, penis cancer and mouth and throat cancer (head and neck tumours) are among the possible consequences of an HPV infection.

Types of human papillomavirus

There are about 200 different types of the HP virus that can cause different diseases. A person can be infected with several types of HPV at the same time. About 40 types of viruses are sexually transmitted and cause infections of the skin and mucous membranes in the genital area (genital HPV). Genital HPV infections are among the most common sexually transmitted infections.

Different types of HP viruses are distinguished depending on which body regions are affected. In principle, any part of the body with skin or mucous membranes can be affected by an HPV infection.

• Cutaneous types, i.e. viruses that infect the skin, mainly occur in children. They particularly like to settle on their hands and feet, but their faces, arms and legs can also be affected.
• The other large group of mucosal types primarily infects the mucous membranes, usually in the genital or anal region.

Depending on how significant the risk is that they lead to the development of cancer, the genital virus types are divided into “low-risk types” (low risk) and “high-risk types” (high risk). Important to know: An infection with a high-risk type does not mean that cancer must be the result; it just increases the risk:

• The low-risk types include the pathogens that cause genital warts because these warts are annoying but harmless and sometimes even go away on their own if left untreated. This group includes the types HPV 6 and HPV 11.
• The high-risk types include the HPV types, which are somewhat more likely to result in cancer. In women, they often attach themselves to the cervix, the lower end of the cervix, where they cause tissue changes (dysplasia) that can develop into cervical cancer over the years. The high-risk types include a total of twelve types, primarily HPV 16 and HPV 18.

 

HPV infection: how does it get infected?

HPV is transmitted through direct contact with skin or mucous membranes infected with the virus. The infection can also occur through objects like a shared towel or toilet. Some types are sexually transmissible, and intimate contact, even without actual sexual intercourse, can be sufficient for infection. Infection via anal or oral sex is also possible.

If a pregnant woman suffers from genital warts, it can be transmitted to the baby at birth, which can then develop warts in the mouth and throat.

It is possible to get infected with HPV several times in one’s life. The risk of an HPV infection increases with the number of different sexual partners. Early sexual intercourse or immune deficiencies are also risk factors for HPV infection.

Symptoms of HPV infection

HPV infection often occurs without any visible signs. However, if symptoms of an infection with HPV do occur, these differ depending on the type of infection.

Skin warts appear in clusters and can be spread further by scratching. In the two most common forms of papillomas, they are either greyish, hard, raised with a jagged surface (verruca vulgaris = “common wart”) or flat and reddish (verruca plana = flat wart or planar wart). Plantar warts (verruca plantaris) are found under the soles of the feet or on the heels, grow inwards and are, therefore, often painful.

The pathogens of genital warts  (Condylomata acuminata) like it moist and warm and therefore settle particularly in the anus and genital area, but also in other body folds. They can cause symptoms such as itching or burning. The incubation period, i.e. the time between infection and the onset of symptoms, is between three weeks and eight months for genital warts, usually two to three months.

Several forms of genital warts have different pathogens:

• Pointed condylomas are pale or reddish nodules that are often clustered and are found on the labia, vagina, cervix, penis, urethra, anal canal, and rectum. You are very contagious.
• Flat condylomas (Condylomata plana) appear as flat nodules and are found primarily on the female genital organs. They increase the risk of cervical cancer up to 130 times.
• Giant condylomas (Condylomata gigantea = Buschke-Löwenstein tumours) grow into immense structures and destroy the surrounding tissue. In rare cases, they can degenerate and lead to cancer ( squamous cell carcinoma ).

Infection of the mucous membranes in the upper respiratory tract can also occur in recurring papillomas (recurrent respiratory papillomatosis). In addition, the conjunctiva of the eyes, for example, can also become infected, resulting in pink, stalked growths.

More difficult to spot are skin infections that aren’t visible, which doctors can only see with tools such as acetic acid (which causes warts to become discoloured) or a microscope.

In addition, the virus can also have already settled in the cells without showing any changes in the tissue. Then, only the virus itself can be detected, and one speaks of a latent infection, i.e. the presence of pathogens but without symptoms. After the initial infection, this phase can last weeks to months.

HPV test: Detection of an HPV infection

A test for HPV infection is carried out in women as part of routine cancer screening by the gynaecologist. During the gynaecological examination, a swab is taken from the mucous membrane of the cervix; this is called a Pap test. This Pap smear is examined for tissue changes to detect early stages of cervical cancer.

In addition, an HPV test can be carried out in which cell material from a mucous membrane swab or a tissue sample is tested in the laboratory for specific HP viruses. With this, however, only an HPV infection of the affected area can be detected, but no statement can be made as to whether tissue changes have already occurred. Therefore, the HPV test is instrumental in combination with the Pap test and can help to detect the early stages of cervical cancer.

Having a positive HPV test is nothing to worry about, as HPV infections are relatively common but rarely lead to cancer. Regular check-ups are recommended to detect tissue changes at an early stage. Conversely, a negative test result is only a snapshot and does not allow any statement to be made as to whether there was an HPV infection in the past that the body successfully fought.

For men, there is no screening that would routinely include HPV testing.

If there is a corresponding cancer, an examination of the tumor can determine whether an HPV infection is the cause of the cancer.

 

HPV: treating the infection

In most cases, HPV infection does not require treatment as it will clear up independently, and the virus will no longer be detectable. If this is not the case, the infection can last longer and persist for several months or years.

There is currently no way by which the HPV infection can be treated, and the papillomaviruses can be completely destroyed. However, treating warts that have developed reduces the number of viruses so that, in many cases, the immune system can fight off the remaining viruses, and those affected can get rid of them. In some cases, the HPV pathogens survive and can cause symptoms again and again.

Various methods are used to treat skin and genital warts, depending on the size, spread and location of the warts. The therapy can be carried out using cold treatment (icing), electrocoagulation, laser therapy or chemical agents such as trichloroacetic acid, podophylline or 5-fluorouracil, for example, in ointments or solutions. Surgical removal is sometimes necessary. In the case of changes in the mucous membrane of the cervix, conization, i.e. surgical removal of the tissue, is usually the first step.

If you have genital warts, your partner should also be examined and treated if necessary.

If cancer has already developed, it is treated accordingly, for example, with surgery, chemotherapy or radiation.

Prognosis for HPV infection

The prognosis depends primarily on the type of pathogen and its spread. It is mostly good, except for giant condylomas and those cases where cancer develops.

prevention and early detection

To prevent HPV infection – and in particular, the development of cervical cancer as a result – an HPV vaccination against certain types of virus is available, which is recommended for girls and boys up to the age of 18. Various vaccines are available for this. Protected sex with a condom and good personal hygiene can also help prevent papillomavirus but do not offer absolute protection.

For early detection of cervical cancer, women can also have a Pap test, i.e. a smear from the cervix and cervical canal, done. Between the ages of 20 and 34, you can have this test every year, from the age of 35, every three years in combination with an HPV test. The health insurance companies cover the costs.