Human Papillomavirus (HPV): Frequently Asked Questions
In a live video broadcast on the Instagram account of the Women's Unit at Ruber International Hospital , Dr. Alfonso Duque Frischkorn , a specialist in Gynecology and Obstetrics, answers questions from Dr. Isabel Rodríguez-Piñero Cebrián regarding the Human Papillomavirus (HPV). This provides answers to the most common questions about the most frequent sexually transmitted infection in men and women, and helps us understand the importance of preventing this disease.
What is HPV?
This is a virus that can infect skin and mucous membranes . When it infects the skin, it causes common warts, but although its name is Human Papillomavirus (HPV), it actually also has numerical identifiers. There are more than 200 types, 40 of which can affect mucous membranes.
Among these we distinguish between high-risk ones , which are the ones that worry us the most, because they can lead to significant alterations, and low-risk ones which, without producing such significant alterations, will still give us some annoying condylomas.
How is it transmitted?
The type of HPV we are discussing now, high-risk HPV, is transmitted through sexual contact , specifically through contact of infected mucous membranes, primarily through penetration, which is the most infectious method. We should also not rule out skin-to-skin contact or oral sex, as transmission can also occur in these cases, albeit to a lesser extent.
This is important: there must be contact. Sometimes our patients ask us if they could have been infected in a public restroom, and the answer is no. They also worry about transmitting the virus to their children, and the answer is also negative. It's not possible because this virus needs to come into contact with mucous tissue to infect, and this only happens through sexual contact.
How does cancer occur? Does having the high-risk virus mean I'll get this disease?
First of all, we must take into account several considerations. First, it is estimated that virtually everyone who has sex will come into contact with this virus at some point in their lives. But this doesn't mean, by any means, that there will be a problem.
We have an immune system that is our best weapon to defend ourselves against this virus, and practically 85%-90% of infections pass without the affected person noticing or will pass through in a transient way and without sequelae.
However, in 10-15% of cases, the problem isn't the infection itself, but rather its persistence. As time passes—we're talking years—and the immune system fails to eliminate the virus, it produces premalignant changes that progress through several stages: low-grade, intermediate-grade, and high-grade. What we need to do is detect these early stages to prevent serious complications.
What are the chances that the injuries will develop into cancer?
It has been described that, in many cases, low-grade lesions are the infected cell itself, which is fighting the virus. In 80% to 90% of cases, as we mentioned, the cell—the immune system—wins. Thus, these are lesions we monitor to ensure that the cell wins.
When we move on to high-grade injuries, that's when we need to take more concrete action.
How do we detect that we have HPV and these lesions?
Primarily, through two methods: ultrasound and testing.
This virus is asymptomatic ; as a patient, you won't know you have the human papillomavirus (HPV) because it won't alter your vaginal discharge, cause bleeding, or produce pain. However, it can be detected during routine checkups through conventional vaginal cytology and the HPV test, which is usually performed every three years.
If this test is positive, it doesn't mean we're going to have any problems; in fact, most of the time nothing happens. But we will be in a group of patients who need to be monitored.
Besides cervical cancer, what other cancers can HPV cause?
We focus on the cervix because the cells there are especially sensitive . There is an area within the cervix called the 'transformation zone' where the cells change, and it is during this rapid change that the virus enters and takes control of the cell.
It can also cause cancer in less sensitive areas, such as the vulva, vagina, anus, penis, oropharynx… although in these cases the incidence is much less significant.
Can we say that 100 percent of cervical cancers are caused by HPV?
Yes, practically all of them, 99%.
What treatment do we apply to a premalignant lesion?
It's important to understand that there is no treatment for the virus itself . The best way to combat it is to have a strong immune system, so we must avoid certain habits like smoking and alcohol consumption, which weaken the immune system and allow the persistent virus to cause harm. A good diet and appropriate vitamin supplements, along with natural remedies, can help us maintain a strong immune system.
Likewise, condom use is essential . This doesn't mean that using a condom prevents 100% of infections, but we're talking about close to 80%, because with a condom the viral load is contained and the immune system has an easier time fighting and defeating the virus.
What vaccines are currently available?
Without a doubt, the best way to prevent the virus is through vaccination. Currently, there are three vaccines available that are safe, effective, and combat HPV type 16/18 , responsible for 70-80% of cervical cancers. There is another vaccine that also protects against genital warts, and a new one that increases effectiveness to almost 90%.
It's best to get vaccinated before you start having sex, although you can also get vaccinated even if you've already had sex.
If we can get everyone vaccinated, we'll definitely win. Australia has practically eradicated cervical cancer thanks to strict vaccination criteria.
Why aren't boys vaccinated against HPV?
Fortunately, in Spain we have the option of administering an effective vaccine to girls around the ages of 12-14 . Boys are not vaccinated because resources are not unlimited and because HPV-related cancers are not as common in males. That's why we started with girls, although it will also be included in the boys' vaccination schedule . If we want to stop the transmission of the virus, we must also vaccinate men because, like women, they act as carriers.
Does it make sense to vaccinate after having a premalignant lesion?
Yes, that makes perfect sense because in 10-20% of cases the immune system can't overcome the virus. And for those people who have been infected and have developed severe complications, HPV has a known path. If we've managed to detect and treat a premalignant lesion in these individuals, the best way to prevent a new lesion is vaccination, which will prevent reinfection.
So, can reinfections occur?
Yes. Having had the disease gives you antibodies against the virus, but it has been proven that this amount of antibodies is minimal compared to what we get from the vaccine.
It should also be noted that the virus can remain silent for years and appear when you have a suppressed immune system.
What factors can help eliminate the virus?
If we've been diagnosed with health issues, I'd like to share a message: we can use this time of stress and chaos to change and improve our lifestyle habits . We can do moderate exercise, eat a healthy diet rich in fruits and vegetables, take certain natural supplements, use condoms, abstain from alcohol and tobacco, and get vaccinated. In general, it's a good time to rethink some things and start on the right path. We can turn adversity into a much healthier life.
Related articles
- Human Papillomavirus (HPV): Its Destructive Process
- Types of Human Papillomavirus (HPV)
- HPV prevention and regression: the Messi of the immune system
If you found this article interesting and would like to be seen by a specialist in Gynecology and Obstetrics, the Women's Unit at Ruber International Hospital has a specialized unit in this area. You can request more information by calling 917303673, schedule an in-person appointment , or book an online consultation if you prefer; always with top specialists.