What is HPV?

HPV (Human Papillomavirus) is an enveloped, double-stranded DNA virus from the Papovaviridae family that is transmitted through skin, oral, and genital contact. HPV infects mucosal linings, affecting both skin and the genital region. HPV infections persisting for over a year increase the likelihood of precancerous or cancerous lesions. There are over 200 types of HPV. HPV 6 and HPV 11 are classified as low-risk types, while HPV 16, HPV 18, HPV 45, HPV 31, HPV 33, HPV 52, HPV 58, HPV 35, HPV 59, HPV 56, HPV 51, HPV 39, HPV 68, HPV 73, and HPV 82 are considered high-risk. Low-risk HPV types cause genital warts and papillomatosis in the genital area. High-risk HPV types can lead to cervical, anal, penile, vaginal, vulvar, and oropharyngeal cancers in both men and women. Among approximately 200 HPV types, HPV 16 and HPV 18 account for 70% of cervical cancer cases worldwide, followed by HPV 45 and HPV 31.

HPV can remain asymptomatic for years. Therefore, regular HPV screenings are important. Additionally, getting an HPV vaccine is protective against 90% of genital warts and cervical, vaginal, vulvar, anal, oral, head, and neck cancers.

After entering the body, HPV goes through three stages: latent, subclinical, and clinical. In the latent stage, HPV DNA can be identified through an HPV DNA test, while in the subclinical phase, colposcopy can detect cytological and microscopic changes. Clinical stages manifest symptoms such as genital warts and invasive cancers.

HPV Transmission

HPV is most commonly transmitted through sexual contact. About 75% of sexually active women are known to have HPV. The infectivity of HPV is very high. Individuals with HPV infections transmit the infection to their partners about 60-66% of the time, and genital warts can appear in their partners after an average of three months. Vertical transmission can also occur rarely. Transmission can be direct or indirect, from virus-contaminated surfaces, skin lesions, or the birth canal.

HPV Risk Factors

• Having multiple sexual partners is a significant risk factor for both men and women.
• Lack of circumcision in men.
• Early onset of sexual activity (before 18 years old).
• History of sexually transmitted infections like chlamydia, herpes, or herpes simplex virus type 2.
• Having an immune-suppressing condition (such as HIV).
• Long-term combined oral contraceptive use (due to the indirect effect of not using condoms).
• Being of Black ethnicity.
• Genetics.
• Smoking.
• Poor personal hygiene.
• Poor diet (deficiencies in vitamins C, E, beta-carotene, and folic acid).

HPV Symptoms

In most cases, HPV does not show symptoms. Many sexually active adults become infected with HPV at some point in their lives and often remain unaware due to the lack of signs and symptoms. However, the most common symptoms HPV symptoms are genital warts, linked with HPV types transmitted through sexual contact. Warts can appear on the vagina, penis, anus, or the perineal area (the skin between the anus and the genital area). These may appear as small, skin-colored growths or in a cluster resembling cauliflower.

In women, HPV infection can lead to abnormal cell changes in the cervix. These changes can be detected through a Pap smear test. Usually, these cell changes do not progress to cancer and can self-resolve over time, but in some cases, treatment may be necessary.

High-risk HPV types can sometimes lead to cervical, vulvar, vaginal, anal, penile, and certain head and neck cancers. Symptoms in these cases may occur as the infection progresses and can vary based on specific findings.

In many types of HPV, symptoms may not be present, and the individual may be unaware of the infection. However, regular health check-ups and HPV screenings are recommended.

Diseases Associated with HPV

• Skin warts
• Anogenital warts
• Vulvar and vaginal cancer
• Penile cancer
• Anal cancer
• Head and neck cancers
• Cervical cancer

Methods of HPV Diagnosis

Physical examination is generally sufficient to detect genital warts for HPV diagnosis, but if uncertain, a doctor may conduct a biopsy. Common methods used for HPV diagnosis include:

• Pap smear test: Examination of cell samples taken from the cervix under a microscope. This test detects abnormal cells that may lead to cervical cancer.
• HPV DNA test: Investigates the DNA of the HPV virus in cell samples if the Pap smear test shows abnormalities. This test identifies HPV types that can cause cancer.
• Colposcopy: Examination of the cervix using a lighted instrument with magnification (6-40 times). This method is used to identify warts or abnormal cells on the cervix.
• Cervical biopsy: A small sample is taken from the cervix for pathological examination. This method is used to definitively diagnose cervical cancer.

HPV Treatment

There is no definitive cure for HPV, but there are treatment methods available for warts. In most cases, the infection clears up on its own. However, in some instances, physical intervention may be necessary. Cryotherapy, laser vaporization, electrocauterization, hot and cold coagulation, or excisional methods are used for HPV treatment.

HPV Vaccine

HPV vaccination is a preventive measure against HPV infections. This vaccine is an important protective treatment that can be administered to both sexually inactive individuals and those engaging in sexual activity.

The HPV vaccine is generally recommended in suitable doses for young people aged 11-12 to protect them before exposure. The vaccine can begin at 9 years old and is advised for anyone up to 26 years old. Depending on the risk, adults aged 27-45 may also receive the HPV vaccine.

The HPV vaccine is usually administered in two or three doses, varying based on the age at the first vaccination. Generally, those who receive the first dose before 15 years of age need 2 doses, while those who receive the first dose after 15 years or those with conditions affecting the immune system may require 3 doses.

During pregnancy, HPV vaccination is not recommended, and it's advised to wait until after completing childbirth. If pregnancy is detected after starting the vaccine series, it's recommended to administer the second and/or third doses after childbirth. This way, it ensures a more suitable time for the effectiveness and safety of the vaccine.