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Complications of hpv. HPV Complications: Understanding Risks and Prevention Strategies

by alexxlab

What are the potential complications of HPV infections. How can high-risk HPV strains lead to various cancers. What preventive measures can reduce the risk of HPV-related health issues.

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The Prevalence and Transmission of Human Papillomavirus (HPV)

Human Papillomavirus (HPV) is a widespread sexually transmitted infection that affects millions of individuals worldwide. According to recent estimates, over 80% of people will contract HPV by the age of 45. This staggering statistic underscores the importance of understanding the virus, its transmission, and potential complications.

How is HPV transmitted? The virus spreads through intimate skin-to-skin contact, primarily during vaginal, anal, or oral sexual activities. An alarming fact is that HPV can be passed on even when an infected person shows no visible signs or symptoms. This silent transmission makes HPV particularly challenging to control and prevent.

Key Facts About HPV Transmission:

  • HPV can be contracted even from a single sexual encounter
  • The virus can spread without visible symptoms
  • Condoms reduce but do not eliminate the risk of transmission
  • Multiple HPV strains exist, with varying levels of risk

High-Risk HPV Strains and Their Cancer-Causing Potential

While many HPV infections resolve on their own without causing harm, certain high-risk strains pose significant health risks. These strains have been linked to the development of various cancers, making them a major concern for public health officials and medical professionals.

Which HPV strains are considered high-risk? Types 16 and 18 are the most notorious, accounting for approximately 70% of all cervical cancer cases globally. However, several other high-risk strains can also lead to cancerous changes in infected cells.

Cancers Associated with High-Risk HPV:

  1. Cervical cancer
  2. Oropharyngeal cancers
  3. Anal cancer
  4. Penile cancer
  5. Vaginal cancer
  6. Vulvar cancer

Understanding the link between high-risk HPV strains and cancer development is crucial for early detection and prevention efforts. Regular screenings and vaccinations play a vital role in mitigating these risks.

The Silent Progression: From HPV Infection to Cancer Development

One of the most insidious aspects of HPV infections is their potential for long-term, asymptomatic persistence. This characteristic allows the virus to quietly alter cellular DNA over extended periods, potentially leading to cancerous changes.

How long does it take for HPV to cause cancer? The timeline varies depending on the type of cancer and individual factors. For cervical cancer, the progression from initial HPV infection to invasive cancer typically spans 20 to 25 years. This extended timeframe emphasizes the critical importance of regular screening and early detection.

Progression Timeline of HPV-Related Complications:

  • Genital warts: 4 weeks to 8 months after infection
  • Cervical cancer: 20 to 25 years after initial infection
  • Other HPV-related cancers: Variable timeframes

The slow progression of HPV-related cancers provides a window of opportunity for intervention. Regular screenings can detect precancerous changes long before they develop into full-blown cancer, allowing for timely treatment and improved outcomes.

HPV-Related Complications: Beyond Cancer

While cancer is the most severe potential outcome of HPV infections, it’s not the only complication associated with the virus. HPV can lead to a range of health issues, some of which may significantly impact an individual’s quality of life.

What are some non-cancerous complications of HPV? Genital warts are a common manifestation of low-risk HPV strains. While generally harmless, these warts can cause discomfort, embarrassment, and psychological distress. In rare cases, HPV infections during pregnancy can lead to complications for both the mother and child.

Non-Cancerous HPV Complications:

  • Genital warts
  • Respiratory papillomatosis (in infants born to infected mothers)
  • Psychological distress and relationship issues
  • Increased susceptibility to other sexually transmitted infections

Addressing these non-cancerous complications is an essential aspect of comprehensive HPV management. Healthcare providers should be prepared to offer both medical interventions and psychological support to affected individuals.

Prevention Strategies: Vaccines, Screenings, and Safe Practices

Preventing HPV infections and their potential complications requires a multifaceted approach. Fortunately, several effective strategies are available to reduce the risk of contracting HPV and developing related health issues.

How can one protect themselves from HPV-related complications? The most effective prevention method is vaccination. The HPV vaccine, when administered before exposure to the virus, provides robust protection against the most high-risk strains. Additionally, practicing safe sex and undergoing regular screenings are crucial components of a comprehensive prevention strategy.

Key HPV Prevention Strategies:

  1. HPV vaccination (recommended for individuals aged 9-26)
  2. Consistent use of condoms during sexual activity
  3. Regular cervical cancer screenings (Pap smears and HPV tests)
  4. Limiting the number of sexual partners
  5. Open communication with sexual partners about STI history

Implementing these prevention strategies can significantly reduce the risk of HPV infection and its potential complications. Healthcare providers play a crucial role in educating patients about these measures and encouraging their adoption.

Treatment Options for HPV-Related Conditions

While there is no cure for the HPV virus itself, various treatment options are available to address the conditions and complications that may arise from HPV infections. The appropriate treatment depends on the specific manifestation of the virus and the individual’s overall health status.

What treatments are available for HPV-related conditions? For genital warts, topical medications or surgical removal may be recommended. Precancerous cervical lesions can be treated with various procedures to remove or destroy abnormal cells. In cases where cancer has developed, treatment typically involves a combination of surgery, radiation therapy, and chemotherapy.

Common Treatments for HPV-Related Conditions:

  • Topical medications for genital warts (e.g., imiquimod, podofilox)
  • Cryotherapy or laser therapy for warts and precancerous lesions
  • Loop electrosurgical excision procedure (LEEP) for cervical lesions
  • Conization (cone biopsy) for cervical abnormalities
  • Surgical excision of cancerous tissues
  • Radiation therapy and chemotherapy for advanced cancers

It’s important to note that while these treatments can effectively manage HPV-related conditions, they do not eliminate the virus from the body. Regular follow-up care and monitoring are essential to detect any recurrence or new complications.

Living with HPV: Psychological Impact and Support

An often overlooked aspect of HPV infections is their potential psychological impact. Receiving an HPV diagnosis can be emotionally challenging, leading to feelings of anxiety, shame, or fear about future health implications.

How does an HPV diagnosis affect mental health? Many individuals experience stress and worry about their relationships, fertility, and long-term health prospects. Some may feel stigmatized due to the sexually transmitted nature of the infection. These psychological challenges can significantly impact quality of life and may even interfere with adherence to treatment and follow-up care.

Coping Strategies for Individuals with HPV:

  1. Seeking accurate information from reliable sources
  2. Discussing concerns openly with healthcare providers
  3. Joining support groups or online communities
  4. Practicing stress-reduction techniques (e.g., meditation, yoga)
  5. Considering counseling or therapy if needed
  6. Maintaining open communication with partners

Healthcare providers should be prepared to address the psychological aspects of HPV infections, offering resources and referrals to mental health professionals when necessary. A holistic approach to HPV management that addresses both physical and emotional well-being can lead to better overall outcomes for affected individuals.

Future Directions in HPV Research and Management

As our understanding of HPV and its complications continues to evolve, researchers and medical professionals are exploring new avenues for prevention, detection, and treatment. These advancements hold promise for reducing the global burden of HPV-related diseases.

What emerging technologies are being developed for HPV management? Several exciting areas of research are currently underway, including the development of more effective vaccines, improved screening methods, and novel therapeutic approaches for HPV-related cancers.

Promising Areas of HPV Research:

  • Next-generation HPV vaccines with broader strain coverage
  • AI-assisted analysis of cervical screening images
  • Immunotherapy approaches for HPV-related cancers
  • Development of HPV-specific antiviral medications
  • Improved self-sampling methods for HPV testing
  • Integration of HPV screening with other preventive health services

These advancements have the potential to revolutionize HPV prevention and management, ultimately reducing the incidence of HPV-related complications and improving outcomes for affected individuals. Continued investment in research and public health initiatives will be crucial to realizing these benefits on a global scale.

In conclusion, understanding the potential complications of HPV infections is essential for effective prevention, early detection, and management of related health issues. By combining vaccination, regular screening, safe sexual practices, and prompt treatment of HPV-related conditions, individuals can significantly reduce their risk of developing severe complications. As research continues to advance, we can look forward to even more effective strategies for combating this prevalent and potentially serious viral infection.

Possible HPV complications for high-risk HPV infections – Blog

Medically reviewed by Rosanna Sutherby, PharmD on March 15, 2021. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

HPV, or human papillomavirus, is more common than you might think. In fact, it is estimated that more than 80% of people will have acquired HPV by age 45. However, if left untreated, there are several complications that could arise from having HPV.

Want to learn more about some of the main complications that can result from HPV? Read on—we break down HPV complications below.

Shop the Everlywell at-home HPV Test to screen for HPV from the comfort of your own home. You collect your own sample, mail it to a lab for testing, and receive your digital results in days. In the event that your HPV test result is abnormal, an associate from our physician network will contact you directly to discuss your particular case, as well as provide information about next steps.

HPV: an overview

According to the CDC, human papillomavirus is the most common sexually transmitted infection (STI). The disease is spread by having vaginal, anal, or oral sex with someone who is already infected, and over 40 million Americans contracted HPV in 2018.

HPV can be passed even when an infected person has no signs or symptoms, which means that even if you have had sex with only one person you are still able to contract this STI—or any other sexually transmitted infection. Although in most cases your body’s immune system defeats an HPV infection without the display of symptoms, in some cases certain types of HPV can lead to genital warts, which are fairly harmless.

Most HPV strains do not pose a serious threat to one’s health, but some HPV strains—referred to as high-risk HPV—are known to significantly increase the risk of cervical and other kinds of cancer. As a matter of fact, just two high-risk HPV strains—HPV types 16 and 18—have been linked to about 70% of all cervical cancer cases across the globe.

What HPV complications can occur?

Possible HPV-related complications include:

  • Cervical cancer
  • Oropharyngeal cancers
  • Anal cancer
  • Penile cancer
  • Vaginal cancer
  • Vulvar cancer

While there is no cure for the virus (HPV) itself, there are effective treatments available to combat health problems caused by HPV, including genital warts and precancerous cells that can lead to cervical cancer.

How dangerous is HPV?

According to the CDC, every year there are about 45,000 new cases of cancer in parts of the body where HPV is often found, and HPV is estimated to cause about 36,000 of these cases.

Because of the heightened risk of cancer developing, if you are infected with a high-risk HPV strain it’s vital that you consult with your healthcare provider as soon as possible to discuss next steps (such as potential treatment options and prevention measures to take).

What can happen if an HPV infection is not treated?

If you have unprotected sex with someone infected with HPV and you contract the infection, genital warts may take anywhere between four weeks to eight months to develop as a result of HPV. However, HPV can also replicate without causing symptoms for several years before genital warts appear.

On the contrary, cervical cancer typically develops 20 to 25 years after the initial HPV infection, which is why it’s important to catch an infection as soon as possible through HPV testing.

If HPV, and especially high-risk HPV, is left untreated, it can have long-lasting effects on your body and could lead to cancer in parts of your body where cells are infected. This includes the cervix, oropharynx (the part of the throat at the back of the mouth, behind the oral cavity that also includes the back third of the tongue, the soft palate, the side and back walls of the throat, and the tonsils), anus, penis, vagina, and vulva.

Is HPV a lifelong infection?

Generally speaking, the answer is “no.” Most HPV strains go away permanently without treatment after your body produces antibodies against the virus. This doesn’t always happen, however, and if high-risk HPV strains linger in the body undetected, certain cancers may be more likely to form.

You can protect yourself from HPV-related complications by:

  • Using a male latex condom every time you have sex. While condoms do not completely eradicate the risk of contracting any STDs, they’re highly effective in lowering your chances of getting or spreading HPV.
  • Routine screening with a Pap smear and/or HPV test. If you haven’t already, speak with your healthcare provider about the kind and cadence of cervical cancer screening they recommend.
  • Getting the HPV vaccination. The CDC recommends getting the HPV vaccination as early as age 9 and for everyone through age 26 years, if not vaccinated already.

Want to test for HPV without having to leave your home? Shop the Everlywell HPV Test to get an easy-to-use, at-home collection kit that includes everything you need for collecting your sample. After mailing to a CLIA-certified lab for HPV testing, you get your digital results in days, and in the event that your test results are abnormal, you’ll have the opportunity to connect with our independent physician network at no additional cost to discuss your particular case.

References

1. Genital HPV Infection – Fact Sheet. Centers for Disease Control and Prevention. URL. Accessed March 15, 2021.

2. Human Papillomavirus (HPV) Treatment and Care. Centers for Disease Control and Prevention. URL. Accessed March 15, 2021.

3. Warts: Diagnosis and treatment. American Academy of Dermatology. URL. Accessed March 15, 2021.

4. HPV and Cancer. National Cancer Institute. URL. Accessed March 15, 2021.

5. Chesson HW, Dunne EF, Hariri S, Markowitz LE. The estimated lifetime probability of acquiring human papillomavirus in the United States. Sex Transm Dis. 2014;41(11):660-664. doi:10.1097/OLQ.0000000000000193

6. Questions and Answers about HPV and the Vaccine. Children’s Hospital of Philadelphia. URL. Accessed March 15, 2021.

Human Papillomavirus – StatPearls – NCBI Bookshelf

Continuing Education Activity

The human papillomavirus (HPV) is a non-enveloped, double-stranded, circular DNA virus that is responsible for causing multiple epithelial lesions and cancers. It can manifest as cutaneous and anogenital warts, which depending on the subtype, may progress to carcinoma. This activity reviews the evaluation and management of human papillomavirus infection and explains the role of the interprofessional team in improving care for patients with this condition.

Objectives:

  • Identify the etiology of human papillomavirus infection.

  • Review the role of E6 and E7 protein in the pathophysiology of human papillomavirus infection.

  • Explain the management of human papillomavirus infection.

Access free multiple choice questions on this topic.

Introduction

The Human Papillomavirus (HPV) is the initiating force behind multiple epithelial lesions and cancers, predominantly cutaneous and mucosal surfaces.[1][2][3]

There are more than 100 subtypes of HPV. Individuals with persistent HPV infection and those who have multiple sexual partners are at very high risk for acquiring more HPV subtypes. The current classification of HPV infection is as follows:

  • Non-genital (Cutaneous)

  • Mucosal or anogenital

  • Epidermodysplasia verruciformis (EV)

The clinical lesions may be visibly obvious, but in some cases (latent lesions) may require testing for viral DNA. The majority of HPV infections are latent, and most clinical lesions present as warts rather than a malignancy.

Today, HPV has been implicated as a cause of laryngeal, oral, lung, and anogenital cancer. Subtypes 6 and 11 are low risk and usually present with the formation of condylomata and low-grade precancerous lesions. HPV subtypes 16 and 18 are high risk and are responsible for high-grade intraepithelial lesions that progress to malignancies. It is important to understand that HPV alone does not cause cancer but requires triggers like smoking, folate deficiency, UV light exposure, immunosuppression, and pregnancy.

Etiology

HPV is a non-enveloped, double-stranded, circular DNA virus of the Papillomaviridae family. The virus enters the epithelium through disruption to the skin/mucosa and infects basal stem cells. Its genome contains seven early (E) and two late (L) phase genes required for viral propagation. The viral DNA may remain as an independent episome for a period before integrating into the host’s genome. HPV preferentially integrates at fragile sites in the human DNA where the strand is prone to breakages.[4]

Risk factors:

  • Sexual activity, age of first sexual intercourse, and number of sexual partners

  • Smoking

  • Use of oral contraceptives (more than 5 years)

  • Chewing betel nut

  • Exposure to radiation and UV light

Epidemiology

HPV subtypes show a predilection for body sites they most commonly infect, and disease manifestations that result from infection may vary. Over 180 subtypes of HPV have been identified. Cutaneous warts of the hands and feet, such as verruca vulgaris or verruca plantaris, are most commonly caused by HPV subtypes 1, 2, 4, 27, or 57. Most anogenital warts, such as condyloma acuminatum, are caused by HPV subtypes 6 or 11 and termed low-risk HPV; these subtypes also are responsible for juvenile and adult recurrent respiratory papillomatosis. Pre-cancerous and cancerous lesions of the cervix, male and female anogenital areas, and oropharyngeal area are most commonly caused by HPV subtypes 16 and 18. However, subtypes 31, 33, 35, 45, 52, and 58 also fall in the high-risk HPV group as they are associated with cervical cancer development.

The HPV subtypes which cause cutaneous verrucae are spread by contact between skin with microscopic or macroscopic epidermal damage and a fomite-harboring HPV. The prototypical location for contracting warts of the feet is a locker room.

Both low-risk and high-risk HPV (sometimes referred to as alpha-papillomaviruses) are considered sexually transmitted but may be spread by other forms of intimate contact. According to the Center for Disease Control and Prevention (CDC), the most recent studies show the prevalence of genital HPV for adults aged 18 to 59 to be approximately 45. 2% in men and 39.9% in women.[5][6]

Pathophysiology

E6 and E7 are oncoproteins that inactivate p53 and pRb proteins, respectively; these inactivations lead to dysregulation of the cell cycle and neoplastic transformation of the affected tissue. The virus remains relatively inactive in early infection but keeps the cell from entering a resting (G0) state. As the infected cells grow and mature, E2 regulates the transition from early- to late-phase genes, and the virus increases the production of virions for dispersal. This increase in virion production in HPV-driven lesions typically manifests as hypertrophy of the infected tissue (discrete, thickened lesions, e.g., the common wart) with the potential for atypia and malignant transformation in those lesions infected with high-risk HPV.

Histopathology

The wart histology may reveal hyperkeratosis, papillomatosis, and parakeratosis. The long rete ridges usually point to the wart center, and the capillaries are often thrombosed.

History and Physical

Evaluation and treatment of HPV infection vary by body site and disease manifestation. For a more in-depth examination of each disease entity, please visit those specific topics.

History

  • Cutaneous warts (verruca vulgaris, verruca plantaris): Ask about potential infectious contacts and hygiene habits (e.g., “Do you wear shower shoes when showering at the gym?” or “Are the lesions painful and/or prone to bleeding?”)

  • Anogenital warts (condyloma acuminatum): Providers should ask about:

  1. Sexual history/infectious contacts

  2. Duration and location of the wart(s)

  3. Prior vaccination for HPV (Gardasil, Cervarix)

  4. History of wart removal/treatment

  5. History of diseases or medications that may cause them to be immunocompromised.

  • Pap smears (cervical for females, anal Pap smear for males), HPV testing, and sexually transmitted infections.

  1. Menses/prior Pap smears/HPV testing,

  2. Sexually transmitted infections/sexual history/infectious contacts,

  3. Prior vaccination for HPV (Gardasil, Cervarix), and

  4. Associated symptoms, such as bleeding/spotting outside of menses, pelvic or genital pain, pain/bleeding during intercourse, and/or palpable lesions felt on the cervix.

 Physical Examination

  • Cutaneous warts (verruca vulgaris, verruca plantaris): Examine hands and feet thoroughly, including between digits and the underside of the toes.

  • Anogenital warts (condyloma acuminatum): Examine the anogenital region. Patients may additionally require a speculum examination of the vaginal walls and/or anus. Men may require an examination of the urethra, depending on signs and symptoms. Depending on the history of sexual practices, an oropharyngeal examination may be prudent.

  • Cervical dysplasia (squamous and glandular): Perform a speculum examination of the cervix. Depending on the patient’s age and Pap smear history, an initial or repeat Pap smear may be warranted.

Epidermodysplasia verruciformis is an autosomal recessive trait that increases the susceptibility to specific warts that are not usually observed in the general population. EV is also seen in immunocompromised individuals and those who have undergone transplants. The condition starts in childhood and can affect any part of the body. The warts are flat and often mistaken for tinea versicolor. While warts have weak metastatic potential, they are locally destructive.

Evaluation

Patients with cutaneous, anogenital, and/or oropharyngeal warts may have them excised and submitted for histopathological examination if there is any question about the diagnosis or concern for dysplasia.[6][7]

Screening for cervical dysplasia/malignancy is typically accomplished through speculum examination and Pap smear with concurrent or reflex HPV testing, an assay test performed on cervical cells to evaluate the most common HPV subtypes associated with dysplasia. Treatment protocols stratify patients by age, HPV status, and Pap smear results. Depending on treatment stratification, patients with results concerning intraepithelial squamous or glandular lesions may proceed to colposcopy (a procedure in which the cervix is coated with acetic acid, acetowhite areas are evaluated with a colposcope, and concerning areas are biopsied to examine for histopathologic evidence of dysplasia or malignancy).

Treatment / Management

Individuals with cutaneous warts have numerous treatment options available, including surgical removal, cryotherapy (freezing the infected tissue), irritant or immunomodulating medications, and laser removal. Many of these treatments’ overarching purpose is to manually or chemically irritate the area, thereby invoking a host immune response to assist in clearing the infected tissue.[8][9][10]

To prevent lower anogenital tract HPV infection by the most common high-risk and low-risk subtypes, the CDC recommends that boys and girls be vaccinated for HPV starting at ages 11 to 12. It is further recommended that women get vaccinated through the age of 26 and men through the age of 21. 

Anogenital and oropharyngeal warts may be treated similarly to cutaneous warts as long as the patient is immunocompetent. Development of HPV-related carcinoma at these sites may require resection, chemotherapy, and/or radiation.

Cervical HPV-driven lesions may regress without any intervention. Young immunocompetent women with dysplasia are usually monitored at shortened intervals through Pap smears, HPV testing, and colposcopic examination. Persistent cervical dysplasia at any age, or high-grade dysplasia in older women, is treated with cryotherapy, loop electrosurgical excision procedure (LEEP), or cold knife cone (CKC) excision. Both surgical procedures (LEEP, CKC) involve resection of the cervical os and transformation zone. If the patient progresses to malignancy (e.g., squamous cell carcinoma, endocervical adenocarcinoma), further resection, chemotherapy, and/or radiation may be required. [11][12]

For a fuller explanation of the disease entities associated with HPV infection, please visit those topics specifically.

Differential Diagnosis

Prognosis

The prognosis after an HPV infection is good, but recurrences are common. Even though there are many treatments for warts, none works well, and most patients require repeated treatments. The HPV infection can also result in vulvar intraepithelial dysplasia, cervical dysplasia, and cervical cancer. Some women remain at high risk for developing vaginal and anal cancer. The risk of malignant transformation is highest in immunocompromised individuals. Finally, when a patient has been diagnosed with HPV infection, there is a 5-20% risk of having other STDs like gonorrhea and/or chlamydia.

Complications

  • Poor cosmesis

  • Depression, loss of self-esteem

  • Genital warts may cause urethral obstruction.

  • Condylomata may form ulcers and become infected.

  • Progression to malignancy

  • Transmission of HPV to others

Postoperative and Rehabilitation Care

Long term follow up is essential as recurrence of warts is common. In addition, all treatments for warts have side effects that need to be monitored

The sexual partner also needs to be examined for condylomata.

Because of the risk of cancer, DNA testing and screening is required in high-risk patients.

Consultations

  • Infectious disease to manage HPV infection in immunocompromised individuals

  • ENT to manage oropharyngeal papillomas

  • Urologist to manage urethral/penile warts and penile cancer

  • Colorectal surgeon to manage the anal disease

  • Dermatologist to help manage warts and EV

Deterrence and Patient Education

  • Avoid multiple sexual partners.

  • Use a condom

  • Practice safe sex

  • Undergo Pap smear screen

Vaccination

The 9 valent HPV vaccine is available to prevent certain cancerous lesions in males and females. The vaccine covers HPV subtypes 6,11,16,18,31,33,45,52 and 58. The effectiveness of the HPV vaccine has been inferred from several studies. It has been shown to prevent anal cancer, genital warts, cervical intraepithelial neoplasia, vulvar intraepithelial neoplasia, and anal intraepithelial neoplasia. The vaccine is most effective when administered before initiating sexual activity at ages 9-12.

Pearls and Other Issues

  • Boys and girls aged 11-12 should receive the HPV vaccine

  • To be effective, the vaccination should be completed by age 13

  • Studies show that the vaccine is effective after 2 doses in younger children

Enhancing Healthcare Team Outcomes

HPV is known to cause lesions of the mucous membranes and skin. There are over 100 subtypes of HPV, and some are associated with an increased risk of malignancy. HPV diagnosis and treatment is best done with an interprofessional team.

For the most part, HPV is sexually acquired, and one of the best ways to decrease the morbidity of this infection is the patient’s education. Both the nurse and the pharmacist are in a prime position to educate patients about safe sex, the use of condoms, and avoidance of multiple sex partners.

The pharmacist should provide information on the different treatments for warts, their benefits, and adverse effects. The pharmacist should also encourage the patients to be vaccinated against HPV.

 Further, the primary care provider should encourage these women to undergo the Pap smear to screen for cervical dysplasia and the presence of HPV. More importantly, patients should be told that if they have genital warts, sexual activity should be avoided until the lesions have been treated or have resolved.

Finally, patients need to be educated that if they have HPV, they should be screened for other sexually transmitted infections. The sex partner’s evaluation is vital if the cycle of spread is to be broken.[13][14][15](Level II) Only through such collaboration between team members will the morbidity of HPV be reduced.

Outcomes

Once HPV is acquired, recurrences are common. However, for most patients with genital warts, there are treatments. In about 60% of cases, genital warts resolve spontaneously. Irrespective of the treatment of genital warts, the risk of cervical cancer is not altered.

The biggest concern with genital warts is the risk of cervical cancer. HPV is also known to be associated with anal and head and neck cancers. Individuals who are immunocompromised are also at risk for developing dysplasia or cancer of the vagina and vulva.

Finally, in at least one-third of patients with HPV, there is the presence of other sexually transmitted infections.[16][1][17](Level II)

Review Questions

  • Access free multiple choice questions on this topic.

  • Comment on this article.

References

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Bradbury M, Xercavins N, García-Jiménez Á, Pérez-Benavente A, Franco-Camps S, Cabrera S, Sánchez-Iglesias JL, De La Torre J, Díaz-Feijoo B, Gil-Moreno A, Centeno-Mediavilla C. Vaginal Intraepithelial Neoplasia: Clinical Presentation, Management, and Outcomes in Relation to HIV Infection Status. J Low Genit Tract Dis. 2019 Jan;23(1):7-12. [PubMed: 30161052]

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Soe NN, Ong JJ, Ma X, Fairley CK, Latt PM, Jing J, Cheng F, Zhang L. Should human papillomavirus vaccination target women over age 26, heterosexual men and men who have sex with men? A targeted literature review of cost-effectiveness. Hum Vaccin Immunother. 2018;14(12):3010-3018. [PMC free article: PMC6343618] [PubMed: 30024823]

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Arrossi S, Temin S, Garland S, Eckert LO, Bhatla N, Castellsagué X, Alkaff SE, Felder T, Hammouda D, Konno R, Lopes G, Mugisha E, Murillo R, Scarinci IC, Stanley M, Tsu V, Wheeler CM, Adewole IF, de Sanjosé S. Primary Prevention of Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Guideline. J Glob Oncol. 2017 Oct;3(5):611-634. [PMC free article: PMC5646902] [PubMed: 29094100]

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Disclosure: Lynette Luria declares no relevant financial relationships with ineligible companies.

Disclosure: Gabriella Cardoza-Favarato declares no relevant financial relationships with ineligible companies.

what does it mean, how is it transmitted, causes, symptoms, signs, diagnosis, treatment, prevention

Causes

Classification

Symptoms

Complications

Diagnosis

Treatment

Pro phylaxis

forecast

The HPV that causes papillomavirus infection is the human papillomavirus. What does HPV mean as a diagnosis that doctors can sometimes write? This means that DNA-containing viruses have appeared in the cells of the body, which can cause both the appearance of warts on the skin or mucous membranes, and the development of precancerous diseases. The cervix is ​​most often affected, but according to statistics, many cancerous lesions of the mouth, tonsils, pharynx or anus have also been caused by this virus.

However, HPV does not always cause disease. With good immunity, the body is able to overcome the virus, and it will stop its vigorous activity, going into a dormant state. But in the event of a decrease in protective forces, the development of a serious illness or infection with HIV, the virus will again become active and begin to manifest itself with various symptoms.

Not so long ago, the human papillomavirus was considered harmless and does not bring any harm, except for cosmetic defects in the form of warts, papillomas and other growths. However, after careful research, it turned out that some types of HPV provoke the development of cancer. HPV types 16 and 18 are especially dangerous.

Causes and risk factors

Reliable statistics say that about 80% of the adult population is infected with this virus on the planet. How is HPV most commonly transmitted? Usually this is a sexual transmission and infection is possible with the onset of sexual activity. HPV can be passed from an infected mother to her baby during childbirth. There is also confirmation of the everyday way of transmission during the general use of various objects.

Therefore, HPV becomes the only cause of papillomavirus infection. Risk factors that contribute to the transition of pathology into a chronic form and the potential formation of a malignant formation in the future include:

  • immunodeficiencies of any kind;
  • early onset of sexual activity;
  • pregnancy;
  • promiscuity;
  • rejection of barrier contraceptives;
  • infection with different types of HPV at the same time;
  • the presence in the body of other viruses and microbes – herpes, cytomegalovirus and others;
  • hormonal disorders and diseases;
  • stressful situations;
  • smoking;
  • alcoholism;
  • lack of regular medical examinations for preventive purposes.

Especially high risks of contracting HPV are observed in women of childbearing age. Also, numerous births and abortions can be called provoking factors for the transition of the disease from latent to active.

Classification and stages of development

According to the ability to cause precancerous diseases, and later provoke cancer, HPV is divided into four large groups. The first is strains that will never cause oncology. These include numbers from 1 to 5. The second – strains that have a minimal oncogenic risk. The third is strains that are at medium oncogenic risk. And finally, the fourth group is the strains that cause precancerous and cancerous diseases most often, and especially these are types 16 and 18. It is this type of HPV that is usually diagnosed in women diagnosed with cervical dysplasia and other precancerous conditions of the internal genital organs.

According to clinical forms, the pathology is:

  • latent or hidden, when there are no manifestations, but the infection can be detected by laboratory tests;
  • subclinical, arising from a normal immune response, and the presence of the virus can only be determined by special methods;
  • manifest, in which symptoms of the disease begin to appear.

Lesions can be exophytic, when warts and papillomas can be seen with the naked eye, and endophytic, which are located inside the tissues and cannot be seen visually.

Symptoms

When infected with HPV, a person may not be aware of it. For a long time, the virus does not manifest itself. And not always the symptoms of HPV are visible in the form of warts and growths. If the cervix is ​​affected, only a gynecologist can detect this type of lesion after a professional examination.

Today, however, dermatologists and virologists warn patients that the signs of HPV that can be found on the skin require mandatory further investigation and treatment. The following symptoms may indicate the presence of infection:

  • the appearance of growths on the body, which can have a variety of shapes and sizes;
  • vulnerability and bleeding of papillomatous growths, which most often turn out to be genital warts, and with secondary infection they can suppurate;
  • itching and burning in the genital area, as well as the release of pathological whites;
  • intermenstrual bleeding or the release of a small amount of blood after intercourse;
  • discomfort during intercourse.

Warts most often form on the skin of the hands, and this skin variant of the pathology is one of the most common. Usually the formations disappear without treatment on their own. Some evidence suggests that HPV can cause lung cancer in men, especially if they have a habit such as smoking. But skin cancer when infected with this virus is unlikely.

However, the most alarming symptoms are persistent pain in the lower abdomen or back, weight loss without diet, weakness and lethargy, felt even after a long rest.

Complications

The most serious and dangerous complications of this infection is the development of cancer.

The connection between the appearance of cervical cancer and the virus has already been fully proven. Type 16 causes squamous cell carcinoma, and type 18 adenocarcinoma. Of all oncological pathologies, cervical cancer is in fourth place in terms of frequency. It does not happen in women who do not have this virus.

An increased risk of cancer of the anus, vulva, penis and oropharynx is usually associated with oncogenic strains. And, of course, the same infection provokes the development of multiple papillomatosis, which affects the upper respiratory tract and begins to manifest itself in childhood.

Diagnosis

Particular attention in the diagnosis of HPV is given to women of childbearing age 25-40 years, since it is they who are most often diagnosed with cervical cancer against the background of infection with the virus. Therefore, it is very important to visit a gynecologist every year for preventive purposes and undergo the following examinations:

  • classic gynecological examination;
  • Papanicolaou test;
  • samples with acetic acid and Lugol’s solution;
  • colposcopy;
  • ELISA;
  • PCR.

To prevent the development of oropharyngeal cancer, you should visit an ENT doctor every year and take tests to detect atypical cells of the oral mucosa.

HPV tests should be taken regularly, as this is one of the most contagious diseases. In addition, knowing about the presence of the virus, it is possible to prevent the development of cancerous complications in women and men.

Treatment

Unfortunately, today there is not a single drug for the specific treatment of HPV, which would be aimed at destroying the virus in the body. Therefore, today an integrated approach is used that does not help get rid of the cause of the disease, but eliminates its manifestations, and also prevents the development of precancerous and cancerous conditions.

What is the first thing to do with HPV? It is necessary to visit a doctor, take tests that confirm the presence of the virus, and then begin the therapy prescribed by a specialist. It will depend on what manifestation of the disease the patient has.

In the presence of warts, condylomas and other visible rashes, they must be removed. Then immunomodulatory therapy is prescribed, aimed at strengthening the immune system, which will help suppress the DNA-containing virus and prevent the disease from developing.

If necessary, general antiviral therapy is used with HPV drugs such as Cycloferon, Panavir, Viferon, Ingaron. In the presence of concomitant sexual infections, they should also be treated.

However, even with timely treatment in compliance with all doctor’s recommendations, the risk of developing a relapse of the disease is very high. Therefore, it is recommended that every year it is mandatory to take all the necessary tests and regularly visit a specialist for examination.

Prophylaxis

The HPV vaccine is a simple and affordable way to prevent the development of the disease. The modern HPV vaccine is designed to help protect a person from the most oncogenic strains, but the fact is that it is not included in the mandatory vaccination schedule and is done on a paid basis. Most often, doctors suggest vaccinating girls from the age of 13 who have not had sex before. The course consists of three vaccinations, which must be done in one year.

HPV prophylaxis can also be done in boys in this way. They are recommended to administer the vaccine from the age of 10. However, such protection helps prevent the development of infection after the virus has entered the body, but it is not a cure.

Forecast

If a person has no problems with immunity, and he is not subjected to constant stress, then the body copes with the virus on its own. This occurs in 90% of all infections and papillomavirus leaves the cells within two years. But lifelong immunity is not formed, so you can get infected again at any time.

Sometimes the disease takes a latent chronic form, with periods of relapse. It takes about 10 years from the moment of infection to the appearance of cancer. The only way to avoid the worst-case scenario is regular check-ups with a doctor. This should be not only cytology, but also a Papanicolaou test.

The author of the article:

Skidan Svetlana Valentinovna

infectious disease specialist

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