HPV (Human Papillomavirus)

What is HPV?

HPV (human papillomavirus) is not a single virus but a group of more than 200 known viruses. It can affect the skin, the genital area and the throat. The types are divided into two groups according to the problems they can cause:

• Low-risk types (most often 6 and 11): they do not cause cancer; they are the cause of genital warts (condylomas) — see Genital Warts.
• High-risk types (most often 16 and 18): when the body does not clear them and they become persistent (long-lasting), they are the cause of cervical cancer (cancer of the neck of the womb); they are also linked to cancers of the vulva, vagina, mouth and throat, penis and anus.

Cervical cancer is the most common of the cancers caused by HPV; in women it makes up more than 90% of HPV-related cancers.

How common is it, and how is it passed on?

According to the World Health Organization, HPV is one of the most common sexually transmitted infections: almost everyone who is sexually active meets HPV at some point in their life, and most of the time it causes no symptoms at all.

• It is passed on through sexual contact and skin-to-skin contact. Transmission outside sexual intercourse, through skin contact and shared objects, has also been documented.
• Condoms reduce transmission but do not give full protection; they do not cover all of the skin in the genital area.
• Smoking increases the chance that the infection becomes persistent; stopping smoking reduces this risk.
• In people whose immune system is suppressed (people living with HIV, those who have had an organ transplant, those taking medicines that suppress the immune system) HPV is more common and more often becomes persistent.

Does HPV go away on its own?

Mostly, yes. In about 90% of people the immune system controls the infection on its own; the virus is usually cleared within 1–2 years without leaving any lasting trace.

The problem is when a high-risk type is not cleared and becomes persistent. A persistent infection can cause changes in the cells of the cervix, and these, if not treated, can lead to cancer. This process is slow: after an HPV infection, cervical cancer usually takes 15–20 years to develop. This is why screening works — the changes can be caught and treated before they turn into cancer.

What are the symptoms?

HPV infection most often causes no symptoms at all. When there are symptoms:

• Genital warts: small, rough bumps on the vagina, the vulva or around the anus; they can cause itching or irritation.
• Early cell changes in the cervix cause no symptoms. This is why screening is done without waiting for complaints.
• In cervical cancer, bleeding between periods or after sex and foul-smelling discharge may be seen. These symptoms can also have other causes; even so, they should be assessed.

HPV testing and screening

An HPV test looks for the high-risk HPV types that can cause cancer in a sample taken from the cervix. A smear (Pap) test, on the other hand, looks at the cells themselves. For the difference between the two, the intervals recommended by guidelines and testing on a sample the person takes themselves, see Smear and HPV Testing.

• Türkiye: the Turkish Ministry of Health national cervical cancer screening programme offers an HPV-DNA test every 5 years to women aged 30–65.
• World Health Organization: an HPV test every 5–10 years from the age of 30; in women living with HIV, every 3 years from the age of 25.
• Your own screening plan may differ according to your previous results and your risk situation.

At the practice in Muratpaşa, Antalya, samples are taken for HPV testing and smears, and colposcopy and genital wart treatments are carried out.

My HPV test is positive: what happens now?

The next step is decided by which type was found and by the result of the cell examination of the same sample:

• If HPV 16 or 18 was found, or if the cell examination shows a change, the cervix is examined under magnification — see Colposcopy.
• If other high-risk types were found and the cell examination is normal, usually no procedure is done straight away; the test is repeated after a certain time (most often 1 year). This is how it becomes clear whether the virus has been cleared.
• If a precancerous change (a change that can turn into cancer) is found at colposcopy, the changed tissue is most often removed with a small procedure — see LEEP.

For questions about your partner, see HPV in men: testing, vaccination and what partners should do.

The HPV vaccine

Vaccination is the most effective way of protecting against HPV infection and HPV-related cancers. The vaccine contains no live virus and no viral DNA; for this reason it cannot cause an HPV-related disease. The vaccine does not treat an existing infection; it prevents new infection and the development of cancer.

• Most suitable age: the World Health Organization recommends vaccinating girls aged 9–14, before sexual life begins. The vaccine is more effective at a younger age.
• Later ages: it is recommended up to the age of 26 for people who have not been adequately vaccinated; between 27 and 45 it may be considered through a decision made together with the doctor.
• The number of doses depends on the age at which vaccination starts and on the state of the immune system.
• In pregnancy the vaccine is not recommended; vaccination is started after the pregnancy. A routine pregnancy test is not needed before vaccination.
• The vaccine does not replace screening: people who have been vaccinated should also follow the screening recommendations.

For details see The HPV vaccine: what it is, who it is for and when it is given and Do I still need a smear test after the HPV vaccine?

Is there a treatment for HPV?

According to the World Health Organization, there is no treatment that removes the HPV infection itself; the body clears the virus. What is treated are the problems that HPV causes:

• Genital warts: treated by freezing (cryotherapy), cautery (burning treatment), surgical removal, laser or medicines applied to the skin. Coming back is common — see Genital Warts.
• Precancerous changes in the cervix: treated by destroying them with cold or heat, or by removing them surgically — see LEEP. Treating a precancerous change prevents cancer.
• Cancer: treatment is more effective when it is recognised early.

Prevention

1. Vaccination — if possible, before sexual life begins.
2. Regular screening — without waiting for symptoms, at the recommended intervals.
3. Condoms — reduce the risk, but do not give full protection.
4. Stopping smoking — reduces the chance that the infection becomes persistent.

Articles about HPV

• A positive HPV test: what should be done?
• HPV infection and the HPV vaccine
• What is the difference between a smear test and an HPV test?
• Does an abnormal smear result mean cancer? ASC-US and LSIL
• How is a smear test done? What does an unsatisfactory sample mean?
• Genital warts (HPV): symptoms and treatment methods
• Cervical cancer
• What is a colposcopy, and what happens during it?
• What to expect after a colposcopy and biopsy