HPV Infection

HPV Infection

Epidemiology

The human papillomavirus (HPV) is the most common sexually transmitted infection: a large percent of the sexually active population will be in contact with the virus at some point in their lives.

It is estimated that it can affect up to 30% of women under the age of thirty. A number that drops to 12% above this age.

In fact, anyone can contract this infection, regardless of the number of partners and sexual practices they have had. Therefore, it is important to protect yourself properly by using a condom. However, once the virus is detected, it is impossible to determine when the infection occurred, since it can remain undetected by medical check-ups for years.

Although the prevalence of HPV in the male public is lower and studies confirming the data are lacking, it is estimated that 70% of men will be positive at some point in their lives.

Regardless of these numbers, in most cases there will be no serious consequences: 80% of them will spontaneously clear the virus within two years.

Classification

According to the World Health Organization (WHO), we can classify HPV into three broad categories, depending on its chance to cause cancer: low, medium or high-risk.

Furthermore, HPVs are numerically classified according to the order in which the different types have been discovered. At this time, the scientific community has detected more than 200 viral types, 40 of which infect the genital area, and 14 of them are high-risk and, therefore, have the potential to cause some type of lesions to the sexual organs that can progress into cancer.

LOW RISK HPV

These are the most common and those that can cause genital warts or condyloma acuminata, and mild changes in the female cervix. However, they do not have the potential to cause neither cancer nor serious lesions and, in most cases, gets cleared by the body on their own, within an average of two years. The most common are types 6 and 11.

MEDIUM RISK HPV
It has not yet been possible to determine whether the risk of causing some type of malignant change in the cells is high or low. Some types that can be included in this category are 26, 53 and 73.

HIGH RISK HPV

These are the least frequent but the most serious, since they have the potential to cause lesions on the cervix, which start out being less dangerous, but can progress to cervical cancer if they are not detected and treated properly on time.

High-risk serotypes are usually those most closely related to invasive pathology, being responsible for practically all cervical cancers; between 70% and 90% of those the vagina and anus; 40% of those the vulva and 20% of those the oropharynx. Only genotypes 16 and 18 are the most important, these are related to 70% of all cervical tumors.

What does the spontaneous HPV clearance rely on?

1. THE VIRAL TYPE:

There are many different types of HPV that are classified depending on whether they possess a high-risk for developing cervical cancer (types 16 and 18 are the most common) or low-risk (the most common types are 6 and 11). Some types, like 16, are more difficult to clear than others. The viral type is the only factor which cannot be modified.

2. IMMUNE STATUS:

When our natural defensive system is weakened, our body has a harder time fighting any external threat.

In most cases, our immune system will clear the virus within two years. However, sometimes our defensive system is not able to clear it since the structure of the virus can remain undetected for a long period of time. It is when HPV persists that it can give rise to lesions that, over time and without proper treatment, can progress to a more serious stage.

The reason for its difficult detection is that it is a small virus without a capsule, therefore, it does not have the envelope that would make it detectable by our natural  immune system.

Its infective capabilities are determined by some predisposing factors that can allow the virus to copy its genetic material in our cells and, therefore, cause some type of injury.

The elimination of HPV by our immune system depends on four factors:

3. THE BALANCE OF THE VAGINAL MICROBIOTA:
Unlike the intestinal microbiota, it is recommended that the vaginal microbiota is barely diverse and mainly composed of Lactobacillus crispatus, a beneficial species that is related to the remission of HPV. On the contrary, the microbial diversity with the presence of vaginal Gardanella has been related to greater persistence of the infection and more several stages of cervical lesions.

4. THE HISTOLOGICAL STRUCTURE OF THE UTERINE                    ECTOCERVIX:

HPV has more problems to infect the body if our cervix is well epithelialized and has non-existent transformation zones or limited extensions.

HPV prevention

There are four basic ways to prevent the human papilloma virus: the vaccine, regular gynecological check-ups, the use of condoms and a responsible sexual life

1. THE VACCINE:

It is estimated that the massive administration of any of the three existing vaccines against HPV in adolescent girls who haven’t started their sexual life will drastically decrease the risk of contracting the infection and, thus, of developing cervical cancer (the most complete vaccine protects against the nine most common types of viruses, including seven high-risk and two low-risk). Especially among the female population of countries in development, whose mortality from cervical cancer is much higher than in Western countries.

Although the effectiveness of the inoculation is at its peak before the first sexual encounter, it can also be administered afterwards.

In addition, vaccination in men is also recommended, since they are the major carriers of the virus.

2. GYNECOLOGICAL EXAMINATIONS

They are very important, since, by performing a cervical cytology, the gynecologist or expert in women’s health will be able to detect the presence of the infection, even in very early stages. This will allow an early treatment and a significant decrease in the probability of developing further serious stages of the infection that could pass silently and unnoticed.

3. THE USE OF CONDOM

It is essential to reduce the chances of transmission, although everyone must be aware that its use does not fully prevent the infection. It is important to bear in mind that, 40% of the time, condoms are not used properly, since they are often used only before the end of sexual intercourse to prevent ejaculating directly inside the vagina. A good use of the condom implies putting it on from the beginning of the sexual act and not taking it off until the end.

4. SEX EDUCATION
This is an essential prevention tool that should always be used in children and adolescents. The goal is to provide them with truthful information about the implications that the infection can have and how to lead a responsible sexual life.

In addition, maintaining healthy lifestyle habits that include a balanced diet and abstaining from the consumption toxic substances such as tobacco will help us reduce the chances of contracting HPV.

Transmission and myths about HPV

The main medium for the infection and transmission of HPV is through direct sexual contact, whether vaginal, anal or oral, or through the use of personal objects that have been used by an infected person. For example, in the case of sex toys that have not been properly disinfected.

Although there are many false myths about this virus, the truth is that, based on the scientific evidence collected so far, it can be concluded that:

  • Both women and men can contract and spread it
  • The virus could go unnoticed and show no symptoms whatsoever
  • The more sexual partners you have, the greater the risk of transmission, even though it is possible to contract it with just a single sexual relationship.
  • Although very rare, it is not impossible for a pregnant mother to transmit HPV to the baby at the time of delivery if she has warts in the birth canal, which could cause laryngeal papillomatosis to the newborn

The virus has not been shown to be transmitted through:

  • Swimming pools, hot tubs, gyms or any other type of sports environment.
  • Toilet seats
  • Kisses on the mouth
  • Hugs or other non-sexual physical contact.
  • Poor personal hygiene
  • Toys, food or utensils

HPV Symptoms

How to realize if you’ve been infected with HPV??

As stated before, on many occasions HPV acts silently and it is not possible to figure out it’s there. Which is why it is so important to go to regular gynecological check-ups, which include a cytology

If this test has a suspicious result, it will be necessary to carry out a medical follow-up, as well as any other tests that the specialist deems necessary

It is important to bear in mind that infection by the different types of HPV is very varied and that its clinical manifestations can appear in very different ways through:

  • Visible or clinical lesions.
  • Non-visible or subclinical lesions, but diagnosed by some method, usually cellular
  • Latent states, in which the infection is present, but in an inactive state

What can happen if you have HPV?

Human papillomavirus infection follows an evolutionary course and is not synonymous with cancer, so a positive diagnosis should not be cause for alarm.

In addition, as we have mentioned so far, the prognosis and evolution of the infection will depend on many factors such as the genotype of HPV that infects us, our immune system and our lifestyle.

Thus, when we are faced with an infection, very diverse lesions can appear, which can be symptomatic or asymptomatic depending on the HPV genotype that infects us. Therefore, going to the gynecologist or health specialist regularly is very important.

Condylomas or genital warts caused by low-risk HPV

These are visible lesions that can appear on the cervix as well as on other areas of the female or male genitalia such as the vagina, vulva, urethra, anus, penis, perineum, larynx or skin.

They appear as irregular lesions, often described as cauliflower-shaped. They can be the same color as the skin, pink or white, single or multiple, soft, variable in size, or confluent.

Although genital warts must be treated and may cause discomfort to the patient, their prognosis is not very serious and they rarely lead to cancerous lesions

Cervical lesions caused by high-risk HPV

The cervix is ​​the genital area which has a higher risk of persistent HPV infections.

Once the infection has occurred, the virus begins to divide within the cells of our cervix and change its morphology. The more cells that are altered, the greater the severity of the premalignant lesions that could lead to the appearance of cancer

According to the degree of affectation, we can distinguish between:

  • Low-grade lesions (LSIL) or less serious lesions, with a high probability of being spontaneously eliminated by our immune system
  • High-grade lesions (HSIL) or greater severity lesions, which are more likely to persist and possess a higher risk of progressing to cervical cancer.

In any case, the gynecologist or expert in women’s health will be the one to determine the most appropriate course of action to follow, depending on the specific conditions of each patient