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The Human Papilloma Virus (HPV) family includes more than 200 types of viruses, 12 of which (16/18/31/33/35/39/45/51/52/56/58/59) are associated with cancer or with precursor or high-grade lesions. Other types, such as HPV 6 and 11, are associated with benign processes such as genital warts or recurrent respiratory papillomatosis.
HPV is the most common sexually transmitted infection in the world. Several studies show that approximately half of women will be infected within 2-3 years after the onset of sexual activity. Risk factors include number of sexual partners, un protected intercourse and, most important of all, an early onset of sexual relations when the cervix is still immature and therefore vulnerable.
The risk of acquiring new HPV infections remains significantly high throughout life in sexually active people, and although it decreases with age, it is still high even after 45.
The persistence of HPV infection has also been shown to increase with age.
HPV infection is “necessary cause” of cervical cancer and is related to anus, vulva, vagina, penis, and oropharynx cancers
Globally, HPV is the causative agent of approximately 5% of human cancer cases.
HPV is transmitted through skin or mucosal contact. The main route of infection is the sexual (vaginal and / or anal penetration and, less frequently, skin-to-skin contact of the genital area and oral sex).
It is estimated that approximately 80% of sexually active women are in contact with at least one type of HPV at some point in their lives (this percentage is even higher in the case of men).
However, it should be noted that more than 90% of these infections are transitory and resolve within two years of infection.
HPV can remain inactive for a long time, so detection of the virus can go unnoticed for years after transmission.
Most of those infected have a transient infection that does not pose any risk, since the HPV ends up being completely eliminated.
In general, these infections go unnoticed. However, in a small percentage of cases (around 10-15%), HPV infection persists over time without its defenses being able to eliminate it.
It is important to note that being infected with a high-risk HPV does not imply that the cervical cells have premalignant transformation, in most cases it will be a temporary contamination.
The vast majority of HPV infections are asymptomatic, but sometimes symptoms occur such as:
Genital warts or condylomas: they are benign tumors that do not become malignant, but they represent a great concern for the patient and a great tendency to recur. We have different forms of treatment to stimulate the immune system and eliminate the injury without scars.
The absence of symptoms in cancer precursor lesions and missing gyn checkups is a major risk factor for developing cervical cancer.
There is currently no specific medical treatment for HPV infection.
Vaccines are highly effective against the main types of HPV that cause disease and are also very safe.
All marketed vaccines include HPV types 16 and 18, causing 70% of cervical cancers and a significant proportion the vulva, vagina, anus, and oropharynx cancers.
The vaccine prevents infection but is not effective against an existing virus.
Despite this, the vaccine can also be useful in people who have had intercourse or have been exposed to HPV, since, unlike what happens with other infections, the history of a previous infection does not completely protect against new infections by these same types of HPV.
Condoms are an important protection against infection. However, even when correctly used, protection is not complete, because the covered area is limited and all the skin in the perineum region is potentially infectious.
A correct use of condoms has shown a significant reduction in the incidence of both genital warts -or condylomas- and premalignant lesions.
Condom also protect against other sexually transmitted infections, such as HIV (Human Immunodeficiency Virus), syphilis or gonorrhea as well as unwanted pregnancies.
In Spain vaccination against HPV is financed in 12-year-old girls and the coverage is of 74.3%.
When HPV produces alterations, these can be seen on cytology. Hence the importance of periodic reviews so that, in the event of infection and alteration of the cells of the cervix, we can identify it and try to differentiate if it is a transient infection -in most cases- or produces alterations that will be detailed with the corresponding colposcopy.
Screening or early detection programs are being established for the entire cervical cancer population. This test should be performed every 5 years from 30-35 onwards.
Vaccinated women should also have regular check-ups.
In the case of persistent infection, HPV can cause cellular changes that lead to the development of premalignant lesions that can lead to cancer over time.
The persistency of an infection will depend on factors that prevent the immune system from doing its job; such as smoking, alterations os the immune system (immunosuppression) and the type of HPV.
The cervix is the genital area most at risk for persistent HPV infections. This is because it presents cells with great capacity for change, being the ideal entry point for the virus.
Other tissues in the anal-genital area – such as the vagina, vulva, anus, penis – or extragenital – such as the oropharynx, larynx, and esophagus – are less susceptible, but recent research shows thay the may also be affected.
Since the HPV infection is asymptomatic, the way to detect it will be based on the analysis of a sample that will detect the detection of the virus (HPV test), minimal cellular alterations indicative of the existence of infection at that time or more cellular alterations. important suggestive of premalignant lesions.
HPV vaccine is recommended in teenagers between 9 and 15 years old; only 2 doses are necessary. After this age, 3 doses are necessary to apply in your recommended regimen over 1 year. There are efficiency and safety studies up to 45 years old.
In the Spanish market 3 different vaccines are available, the most recent being indicated for the prevention of genital warts, precancerous vaginal and vulvar lesions, precancerous cervical lesions and cervical cancer related to HPV varieties.
Although it is advisable to administer it before the start of sexual intercourse, the vaccine can be administered after initiating intercourse. It is especially recommended in patients undergoing conization due to a high-grade injury.
The vaccine can never reactivate of the infection.
It is important to know that HPV infection does not confer immunity in the case of having been eliminated by the body, this means that we can be infected again by the same variety of HPV.
It is an effective and safe vaccine that offers almost total protection against viruses.
Vaccines are made up of virus-like particles, made from proteins, so they are not infectious.
It is a preventive, not a curative, vaccine. Vaccines generate good levels of immune
memory, which predicts a long duration of protection, probably lifelong.
It is given as an intramuscular injection, generally in the arm. Side effects are rare and mild, the include redness, slight muscle discomfort, and low-grade fever.
