Human papilloma virus: 32 questions and answers to know everything about HPV

Fonte: Alexey Kotelnikov / Alamy / IPA

Un extremely widespread virus, often harmless but potentially also very dangerous because it can cause, in some circumstances, the onset of cervical cancer and other cancers. Here is a brief identikit of the HPV, the human papilloma virus.

The infection it causes cannot be cured, but it can easily be prevented with a effective and safe vaccine, although still little used in Del Paese. And to ensure maximum protection, in addition to the vaccine we must not forget it screening with HPV test or Pap Test, to identify the presence of infections or the possible presence of pretumor lesions.

Let's take stock of all these aspects with the help * of the document The 100 questions on HPV, formulated by the Del Paeseno Group for cervicocarcinoma screening (Gisci) and updated in May 2022.

March 4, World HPV Day

On Monday there will be the second edition of the International Day to raise awareness against the papilloma virus (HPV)

1. What is HPV and what causes it?

HPV is an acronym that stands for human papilloma virus. It is therefore a virus or, better, a group of viruses (more than 200 are known) that cause very frequent infections.

In general, theHPV infection it does not cause any changes and resolves on its own within a year or two. In a minority of cases it can cause injury to the genitals or other parts of the body, for example warts or warts (genital warts). In women, it can also provoke lesions at the level of the cervix which generally heal spontaneously. If left untreated, however, some of these injuries can slowly progress towards tumor forms.

HPV is also involved in the development of other forms of cancer, particularly rare, such as cancer of the mouth, anus and, in males, penis.

Read also: Papilloma virus, what science says

2. So is it true that HPV causes cervical cancer?

Yes, but only very few HPV-infected women actually develop cervical cancer. It also takes many years for this to happen.

3. What are genital warts?

Also known as "cockscombs”, Are small growths that can appear on the genitals of women and men. They cause burning and itching but are not dangerous. They are generally treated with the laser, but when they are small they can also be treated with creams to be applied regularly for a while.

4. Is the HPV virus that causes cervical cancer the same virus that causes genital warts?

They are viruses from the same family, but the ones that cause warts and warts do not
cause the tumor.

5. How do you distinguish cervical lesions that will heal on their own from those that could give rise to cervical cancer?

At the moment it is not possible to distinguish them. This is why it is very important keep all cervical injuries under control, treating those above a certain gravity (what specialists call in jargon CIN2 and CIN3, while milder injuries are called CIN1).

6. How do you get HPV infection?

Sexually, although not necessarily following full sexual intercourse. Since you can remain a carrier of the HPV virus for many years without symptoms, you cannot know the exact timing of the infection. Therefore, having the infection may have nothing to do with the current partner.

Unfortunately, the condom is not completely effective in prevention transmission, possibly because the HPV virus is also found on skin not protected by condoms, in the mouth and under the nails.

However, remember that the condom is essential to reduce the transmission of HPV, especially in casual intercourse, and is very effective against other sexually transmitted infections.

7. How common is HPV infection?

Very common, especially in young people: it is estimated that about 80% of the sexually active population contract it at least once in their lifetime.

8. How is HPV infection treated?

There are still no medicines to cure it. In particular, it was seen that not
antibiotics, pessaries or douches are needed.

The most important thing though is identify in time the alterations caused by the virus, which are the ones you are looking for with the PAP test, in case of a positive HPV test: here's why participate in the screening it is the most effective thing a woman can do to protect herself. In addition, of course, to get vaccinated to prevent the risk of infection.

9. Can HPV infection be prevented?

Yes, with the HPV vaccination, which serves to break the chain of events that leads from infection to cancer in the bud.

Read also: HPV vaccine: 13 answers to the most common questions

10. Who should get the vaccine?

Vaccination is recommended and free for all girls and all boys over 11 years old. The vaccine is also very effective for girls up to 25/26 years who have not had sexual intercourse.

For girls and women who have already had sexual intercourse and in any case up to 40-45 years, the benefit could be only partial: they have probably already come in contact with one or more types of HPV, and in this case the vaccine would not be useful. At the same time, however, this could protect them from infections against types they haven't yet come into contact with, contained in the vaccine itself. In these conditions Whether or not to have the vaccine should be discussed with your doctor.

11. Do males also have to be vaccinated?

The new National Vaccine Plan 2022-2022 has included vaccination of 11-year-olds among the recommended interventions. This is to protect boys from the fearful consequences, although very rare in men, of HPV infection (cancer of the penis, anus and oropharynx), and for reduce the circulation of the virus. In this way, in fact, infections are reduced even in unvaccinated women, who continue to have the greatest burden of disease.

Read also: HPV vaccination: why it makes sense to do it in males too

12. What vaccines are these?

There are currently 3 HPV vaccines available:

  • Gardasil targeting four types of HPV virus (quadrivalent vaccine): two of these viruses (16 and 18) are responsible for over 70% of cervical cancer cases; the other two (6 and 11) are responsible for genital warts (condylomas);
  • Cervarix, effective against the two types of HPV (16 and 18) which are responsible for cervical cancer (bivalent vaccine);
  • Gardasil 9 (most recent), a 9-valent vaccine that in addition to types 16, 18, 6 and 11, also protects against infection of high-risk types 31, 33, 45, 52, 58. It is estimated that, alone, these seven high-risk types account for nearly 90% of cervical cancers.

13. Are the available vaccines effective?

Studies have shown that the various vaccines available are very effective (almost 100%) against the types of papilloma virus against which they are directed. And it appears that some may also provide some degree of protection against infection with certain types of HPV not contained in vaccines.

14. How long does the vaccine last?

For now we know the protection given by the vaccine lasts at least 9 years, that is for the entire observation period made so far for the first vaccines widespread in the country and aimed at types 16 and 18. For the 9-valent vaccine the observation period was shorter (5-6 years).

15. How is the vaccine made?

The timing of vaccinations - experts speak of a "schedule" - varies according to the type of vaccine and age. Generally, these are two doses up to 13/14 years, and three doses within a few months of each other after 14/15 years.

Typically the injection is given in the upper arm.

16. After the first three doses of the vaccine, do I need to have boosters?

For now we know that the protection given by the vaccine lasts at least 8-9 years. In the next few years we will know if, and if so when, it will be necessary to make recalls.

17. What reactions can you have after getting the vaccine?

The HPV vaccine quite often causes some symptoms like fever, pain, swelling and redness in the area where the injection was given, or headache or muscle aches. These symptoms go away on their own in a few days.

18. Are these vaccines safe?

These are vaccines produced from just the empty envelope of the virus, so there is no possibility that they can cause infection.

As for any adverse effects, it is recalled that since 2006, HPV vaccines have been authorized in more than 110 countries and have been distributed more than 270 million doses. Studies conducted after the introduction of the vaccine confirmed a high level of vaccine safety, i.e., rarely observed serious events have been shown not to occur more frequently among vaccinated than in unvaccinated.

Even a very recent review by the Cochrane Collaboration pointed out that these vaccines do not increase the risk of serious side effects, nor do they increase the risk of abortion if by chance they are carried out during pregnancy. On the other hand, data on the effect of this vaccination possibly carried out in pregnancy on the risk of fetal malformations are still scarce.

Read also: Vaccines for childbearing age and pregnancy: the recommendations of the Ministry of Health

19. Is the vaccine mandatory? It's free?

The vaccine it is not compulsory, but it is recommended and free for young girls and boys who are in the 12th year of life (i.e. they have turned 11 years old). In some regions, the vaccine is also free for other age groups under 25. Women wishing to get the vaccine outside these age groups will have to pay for it.

20. Do you still need to screen after the vaccine?

Absolutely yes: vaccinated women will also have to continue screening, with the PAP test every three years from the age of 25 and a HPV test every 5 years from 30-35 years.

21. What is the Pap test?

The Pap test consists of a simple sample of cells from the uterine cervix (another term for the cervix). These cells are then analyzed under a microscope to detect changes very early - experts call them "lesions" - that could turn into cancer in the long run. However, early elimination of the lesions avoids this possibility.

22. What is the HPV test?

The HPV test consists of the research of the types of virus responsible for cervical cancer on cervical material taken in a similar way to the Pap test. In this case, we do not go looking for any lesions but the viral infection that could cause them, which means that we move even earlier and even more promptly. And with lower costs for the health service.

Read also: HPV test instead of Pap test for the prevention of cervical cancer. Let's be clear

23. How does HPV screening for cervical cancer work?

Until very recently - but in many regions this is still the case - screening was carried out with the Pap test, performed every three years starting from the age of 25. The National Prevention Plan 2022-2022 of the Ministry of Health, however, provided for the replacement of the Pap test with the HPV testing as the primary screening for women between 30 and 64 years old. The Pap test remains as the second level screening in this age group and as the first level between 25 and 30 years.

24. Why can HPV screening be done instead of Pap smears?

Because many studies have shown that the HPV test is more effective than the Pap test in find cervical lesions and is therefore more protective. One of the latest studies in this regard was published in the prestigious Journal of the American Medical Association (Jama) in July 2022. In addition, the HPV test finds these lesions earlier, and therefore is sufficient repeat it every five years instead of every three years as is done with the Pap smear.

25. Why is HPV screening recommended after the age of 30-35?

Because HPV infections are very common in younger women, but in most cases they regress spontaneously. Doing this screening under the age of 30-35 could therefore lead to identifying - and consequently treating - lesions that would instead regress spontaneously.

Pap smear screening is currently recommended.

26. How is HPV screening performed?

A sample similar to that made for the Pap test is made, with the material taken which is analyzed in the laboratory for the virus. In reality, in addition to the withdrawal for the HPV test, the Pap test is also taken: this material, however, will only be analyzed if the HPV test is positive.

If the HPV test screening is negative screening returns after five years. There is no need for a Pap smear during this time. If, on the other hand, the HPV screening test is positive the Pap test will also be performed. If this shows any changes, the woman will be asked to do a colposcopy. If, on the other hand, the Pap test is normal - which means that the virus has not caused any changes - the HPV test will be re-tested after a year to understand if the infection is still present: in fact we know that most infections disappear spontaneously within a year.

If after a year the HPV test is still positive, the woman will be asked to have a colposcopy, even if her Pap smear is normal.

27. What is colposcopy?

It is a check similar to the gynecological examination in which the gynecologist uses an instrument (the colposcope) that allows better see the cervix. If any changes are seen, the gynecologist directly performs a small sample of tissue (biopsy), which will be analyzed in the laboratory.

If the lesions found are minor, it will be enough to do periodic checks. Otherwise the injuries will need to be treated.

28. How are injuries treated?

They are typically dealt with minor surgeries, done in the clinic and with local anesthesia. Some interventions involve the destruction of the altered area, but they are little used, others - more frequent - allow to remove the lesion together with a small area of ​​surrounding healthy tissue (we speak of conization).

HPV and pregnancy

29. If I have the HPV virus, are there any risks to the baby if I am pregnant?
No, no risk to the baby has been shown to date. If cervical lesions are found during pregnancy, it is usually chosen to keep them under control and to postpone therapy after delivery.

30. If I have genital warts, are there any risks to the baby if I am pregnant?
The main risk is that of having to make a Caesarean section. In reality, having genital warts is not in itself an indication for caesarean section: in most cases these can be easily treated with local anesthesia and after the therapy you can give birth normally vaginally.

Sometimes, however, a caesarean section can be recommended if there are many warts in the vagina or vulva. Also, although very rarely, in these cases the HPV virus could pass to the baby and cause breathing problems. The gynecologist will advise what is best to do on a case-by-case basis.

31. If I have undergone treatment for cervical injuries, will I still be able to get pregnant? Will there be any problems if you are pregnant?
The treatment has no consequences on the future sex life and, in most cases, it does not affect subsequent pregnancies either. Depending on the amount of cervical tissue removed with the treatment, however, there may be a increased risk of preterm birth. This is why it is very important to always communicate to your gynecologist if any treatments have been done on the cervix in the past.

32. If I have the HPV virus, can I breastfeed my baby?

* Some answers have been partially edited

Updated on 01.03.2022

  • papilloma virus
  • human papilloma virus
  • 6-14 children years
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