HUMAN PAPILLOMAVIRUS (HPV). WHAT YOU NEED TO KNOW.

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Human Papillomavirus (HPV) is a group of more than 100 related viruses and is among the most common sexually transmitted infections worldwide. HPV is transmitted through direct skin-to-skin contact and can affect various parts of the body, including the genitals, mouth, and throat. Nearly every person who is not vaccinated will become infected with HPV at some point in their life.

Most HPV infections proceed without symptoms and clear up on their own within two years. However, certain high-risk types of HPV can lead to more serious health problems. These viral strains can cause warts or develop into different types of cancer, including cervical, anal, penile, and throat cancer.

Although HPV is very common, effective preventive measures are available. The HPV vaccine offers strong protection against the most dangerous types of the virus and is recommended for children aged 11 to 12. Early vaccination can significantly reduce the risk of HPV-related cancers.

KEY TAKEAWAYS

• HPV is a common viral infection that is transmitted through skin contact and affects nearly everyone.
• Most infections clear up on their own, but high-risk types can cause cancer.
• Timely vaccination provides effective protection against the most dangerous HPV strains.

CONTENTS

1. FUNDAMENTALS OF HUMAN PAPILLOMAVIRUS (HPV)

• DEFINITION AND VIRUS FAMILY
• HPV TYPES: LOW-RISK AND HIGH-RISK
• TRANSMISSION ROUTES

2. SYMPTOMS AND PROGRESSION OF HPV

• SIGNS AND SYMPTOM PROFILE
• GENITAL WARTS
• PROGRESSION AND SPONTANEOUS HEALING

3. COMPLICATIONS AND HEALTH RISKS

• PRECANCEROUS STAGES AND CELLULAR CHANGES
• CERVICAL CANCER AND OTHER CANCERS
• DIAGNOSTICS: HPV TEST AND SCREENING
• THERAPY OPTIONS AND CONIZATION

4. PREVENTION AND PROTECTION AGAINST HPV

• THE HPV VACCINE: PROTECTION AND EFFICACY
• RECOMMENDED PREVENTIVE MEASURES

HPV is a large family of DNA viruses with over 200 different types, primarily transmitted through direct skin contact. These viruses are categorized into low-risk and high-risk types based on their potential to cause cancer.

Human Papillomaviruses (HPV) are small, double-stranded DNA viruses that infect epithelial tissue. They belong to the Papillomaviridae family.

Scientists have identified more than 200 different HPV types. Each type is distinguished by its specific genomic sequence.

Most HPV types infect the skin, causing common warts on the hands, feet, or face. Approximately 40 types affect the mucous membranes.

These 40 mucosal types can infect the genitals, rectum, and oral cavity. They are primarily responsible for sexually transmitted HPV infections.

HPV is the most common sexually transmitted infection worldwide. Most sexually active people will become infected with HPV at some point in their lives.

HPV types are classified into two main categories based on their cancer risk:

• Low-Risk HPV Types:
• Types 6 and 11 are the most common.
• They cause over 90% of all genital warts.
• They can trigger benign cellular changes on the cervix.
• They rarely lead to cancer.

High-Risk HPV Types:

• Types 16 and 18 are the most dangerous.
• Type 16 causes approximately 50% of all cervical cancer cases worldwide.
• Types 16 and 18 together are responsible for 66% of all cervical cancer cases.
• Other significant high-risk types include 31, 33, 45, 52, and 58.

These high-risk types can cause precancerous lesions and cancer of the cervix, vulva, vagina, penis, anus, and throat. However, an infection with a high-risk type does not automatically lead to cancer.

HPV is mainly transmitted through direct skin-to-skin contact with an infected person. Humans are the only natural reservoir for the virus.

The most common transmission routes are:

• Vaginal intercourse
• Anal intercourse
• Oral intercourse
• Intimate skin contact without penetration

Condoms reduce the risk of transmission but cannot prevent it completely. HPV can infect skin areas that are not covered by a condom.

Studies show that many people become infected shortly after their first sexual intercourse. Among female college students, the infection rate was 40% after 24 months.

Rare transmission routes include transmission from one part of the body to another and, very rarely, from mother to child during birth.

Most HPV infections proceed without any visible symptoms and resolve on their own. When symptoms do occur, they primarily manifest as warts in the genital area or other skin changes.

HPV infections often go unnoticed. The immune system typically fights off the viruses successfully without the affected person being aware of it.

When visible symptoms are present, doctors differentiate between three forms:

• Latent infection: No symptoms; detectable only through laboratory tests.
• Subclinical infection: Changes are visible only with special techniques.
• Clinical infection: Symptoms are visible to the naked eye.

The symptoms depend on the HPV type. Common signs include warts on the genitals, anus, or mouth.

Some people experience itching or a burning sensation. Bleeding after sexual intercourse can also occur.

In women, changes often appear on the labia or cervix. In men, they usually affect the penis and anal area.

Genital warts typically develop three to eight weeks after infection. They appear as small, reddish, or whitish skin growths.

The warts vary in size. They can be as small as a pinhead or grow to several centimeters. They often merge to form clusters.

In women, genital warts primarily occur:

• On the labia
• In the anal region
• Sometimes in the vagina or on the cervix

In men, they mainly affect:

• The penis
• The anal region

Most genital warts do not cause pain. Some people may experience a feeling of dampness or mild itching.

In rare cases, large, cauliflower-like growths can develop. These can damage the surrounding tissue.

In most cases, the immune system eliminates HPV infections on its own. This usually happens within two years of infection.

Approximately 90 percent of all HPV infections clear up without treatment. The body produces antibodies against the specific virus types.

However, some infections persist. These can lead to permanent cellular changes. High-risk HPV types, such as HPV 16 and 18, are particularly capable of causing cancer.

Factors that influence healing include:

• The age of the affected person
• The state of the immune system
• The HPV type
• Smoking and other risk factors

A cleared infection usually provides protection against reinfection with the same HPV type. However, infection with other types remains possible.

HPV infections can cause a variety of health problems, ranging from harmless skin changes to serious cancers. The severity of the complications depends on the HPV type and the duration of the infection.

A persistent infection with cancer-causing HPV types leads to abnormal cell growth. These cellular changes most often occur in the cervix but can also affect other areas.

Precancerous stages develop slowly over several years. The cells alter their normal structure and growth patterns.

These changes are classified into different grades:

• Mild dysplasia (CIN I)
• Moderate dysplasia (CIN II)
• Severe dysplasia (CIN III)

Not all precancerous stages develop into cancer. Many resolve on their own. HPV types 16 and 18 cause the majority of severe cellular changes.

Cervical cancer is the most common type of cancer caused by HPV. HPV types 16 and 18 are responsible for over 70 percent of all malignant cases.

In Austria, approximately 400 women are newly diagnosed with cervical cancer each year. Between 130 and 180 women die from it annually.

HPV can also cause other types of cancer:

• Vulvar and vaginal cancer in women
• Penile cancer in men
• Anal cancer in both sexes
• Throat and larynx cancer

These cancers are less common than cervical cancer. They are caused by the same cancer-causing HPV types.

The HPV test directly detects the virus in the body. It identifies the DNA of cancer-causing HPV types in cell samples.

Women over the age of 30 should have a regular HPV test. It is often performed along with the Pap test.

Screening examinations include:

• Pap test (cervical smear) to detect cellular changes
• Colposcopy for suspicious findings
• Regular gynecological check-ups

In Austria, the Pap test identifies suspicious results about 60,000 times per year. Early diagnosis significantly improves the chances of recovery.

In cases of severe precancerous stages, surgical treatment is often necessary. Conization is the most common procedure for this.

During a conization, the doctor removes a cone-shaped piece of tissue from the cervix. Approximately 6,000 conizations are performed annually in Austria.

Treatment options for HPV-related changes include:

• Surgical removal of precancerous lesions
• Chemotherapy for advanced cancer
• Radiation therapy in severe cases

Conization can increase the risk of premature birth in future pregnancies. Nevertheless, it is often necessary to prevent cancer.

The HPV vaccine offers the best protection against dangerous HPV types and can prevent cancer. Additional preventive measures, such as using condoms and attending regular check-ups, supplement this protection.

The HPV vaccine protects against the most significant cancer-causing HPV types. It is most effective when administered before the first sexual contact.

Protection against HPV types:

• HPV 16 and 18 (responsible for 70% of all cervical cancer cases)
• HPV 6 and 11 (cause 90% of all genital warts)
• Other high-risk types, depending on the vaccine

The vaccine is recommended for girls and boys between the ages of 9 and 14. At this age, only two doses are necessary.

Older individuals up to the age of 26 can also be vaccinated. They will require three doses for complete protection.

The efficacy rate is over 90% against the HPV types included in the vaccine. The protection lasts for at least 10 years.

Condoms reduce the risk of HPV transmission by about 60%. They do not offer complete protection, as HPV can also be transmitted through skin-to-skin contact in areas not covered by the condom.

Important preventive steps:

• Using condoms during every sexual encounter
• Regular check-ups (Pap test every 3 years)
• Limiting the number of sexual partners
• Having open conversations with partners about sexual health

Early detection through regular screening is crucial. The Pap test can identify cellular changes before cancer develops.

Smoking increases the risk of HPV-related cancers. Quitting smoking strengthens the immune system in its fight against HPV infections.