What is HPV and the HPV vaccine? It's not just warts...

What is HPV and why is HPV vaccination so important? It is important to understand that this virus can be responsible for serious diseases.

The abbreviation HPV is derived from the English term Human papillomavirus. Human papillomavirus is a group of papillomaviruses that can cause disease in humans.

This virus has been with mankind for thousands of years. The earliest records date back to 4500 BC.

Hippocrates, 460-370 BC, described ulcerations of the cervix and observed the incurability of advanced stages of cervical cancer.

You may be asking: why another vaccine? Do I need to get vaccinated?

HPV doesn't have to be a harmless virus.

Advances in science and research have led to the discovery that HPV doesn't just cause harmless warts. It can cause a variety of cancers. There are more than 200 types of this virus. Different types have different biological characteristics.

Some HPV viruses have tumour potential. It is therefore more than desirable nowadays to pay due attention to this issue.

Misconceptions and myths

Many people mistakenly believe that this virus only affects women and causes them health problems.

Many people also mistakenly believe that this virus is only found in promiscuous people.

A large part of society mistakenly believes that HPV infection must occur only during sexual intercourse.

People mistakenly believe that it cannot be their problem at all.

Who can get HPV?

HPV infection affects women, men and children. Often there are no symptoms, so most people may not know they have HPV.

Many HPVs cause benign lesions on the skin all over the body and in the anogenital area (rectum and genital area), as well as on the mucous membranes of the genital, respiratory, digestive and excretory organs in men, women and children.

These types are referred to as low-risk HPV types 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, 89.

An increased incidence of these papillomas is seen in immunocompromised patients.

Which HPVs are particularly dangerous?

High-risk HPV types:

HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, 82.

These HPV types have a high oncogenic potential. This means that they have a significant ability to attack healthy cells and turn them cancerous.

These oncogenic HPVs can directly and irreversibly trigger the cancer process (carcinogenesis).

The process of irreversibly triggering the transformation (conversion) into cancer cells is complex and takes place in several steps. Oncogenic HPV types do not always immediately cause carcinoma (invasive cancer).

They can often persist in the cell in a special mode. They can be completely suppressed by the immune system within 12-24 months.

HPV infections therefore often do not need to persist.

However, if HPV infection persists for a longer period of time, various stages of malignant precursors develop. These then undergo serious changes.

To achieve persistence, the virus uses various mechanisms to evade the host immune response.

For example, the HPV virus can suppress the human immune response, so that when it multiplies (replicates) it lacks an inflammatory response.

When infected, HPV infects epithelial cells (special tissue covering different surfaces in the body, e.g. mucous membranes, skin).

HPV transmission options:

• The most common mode of transmission is sexual (genital) contact. The main risk factors are changing sexual partners and risky sexual behaviour (repeated HPV infections).
• Oral transmission
• Deep French kissing has been described as a risk factor for HPV transmission
• Intimate touching (skin/mucosal contact with the anogenital area required)
• During childbirth
• In the case of warts, infection usually occurs through direct contact with an affected person with warts, but also through indirect contact with an infected object, e.g. towel, visiting a swimming pool

Manifestations of HPV infection

What infections and their manifestations are we familiar with?

Overview of HPV diseases:

• Skin warts (verucae)
• Genital warts (condylomas)
• Nasopharyngeal cancer (oropharyngeal carcinoma)
• Cancer of the cervix (oropharyngeal carcinoma)
• Cancer of the vagina and external genitalia (carcinoma of the vagina and vulva)
• Malignant neoplasm of the rectum (rectal carcinoma)
• Malignant neoplasm of the penis (penile carcinoma)

Skin warts (verucae)

• There are several types of warts with different appearances
• On different parts of the body, most commonly on the hands and feet
• They can cause pain, especially in more sensitive areas
• They can also be painless
• Often in children and young adults
• Most of them disappear on their own within two years
• Most commonly caused by HPV 1, 2 and 4

What are warts and how to protect yourself from transmission (+ types of warts)

Genital warts (condylomas)

• Small growths
• May be flat to cauliflower-shaped
• In the rectal and genital area, also occur in the throat after oral contact
• Sexually (non-sexually) transmitted disease, but can be transmitted by fingers, mouth, intimate touch, self-transmission of infection
• Most commonly caused by HPV 6 and 11
• Rarely can cause Buschke-Lowenstein tumour, respiratory cancer

Symptoms:

• Discomfort (itching, burning) to pain
• bleeding
• painful sexual intercourse
• In women, the first symptom may initially be vaginal discharge
• odour in the case of swollen condylomas

Genital warts: what are their causes and symptoms, what do they look like?

Malignant tumour of the nasopharynx (oropharyngeal carcinoma)

• Dramatic increase in the incidence of HPV positive infection in the last thirty years
• Increasing especially among younger people, most of whom are HPV positive
• Traditional risk factors such as smoking and excessive alcohol consumption may be absent in these HPV positive younger persons
• Risk sexual behaviour, number of sexual and oral partners is key, smoking, excessive alcohol consumption, poor oral hygiene are also risk factors
• The most common sites of involvement are the tonsils and the root of the tongue
• More than 90% are proven HPV 16 positive

Symptoms:

• Painless swelling in the neck area (including painless swelling of lymph nodes), palpation to a lesion visible to the naked eye
• chronic mucosal ulceration, bleeding, halitosis
• voice disorders, hoarseness, difficulty breathing
• difficulty swallowing, tongue mobility
• foreign body sensation in the mouth or throat to chronic pain
• other general physical symptoms in advanced tumours, metastases of disease, e.g. cachexia (significant weight loss)

Diagnosis of nasopharyngeal cancer

The diagnosis of nasopharyngeal cancer is usually based on a clinical examination by a specialist doctor (ENT), an endoscopic examination (a modern examination using an optical device to view the internal cavities) and a biopsy (taking a sample).

Dental examination, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) help in diagnosis.

Molecular and biological testing for the presence of HPV.

Treatment

Treatment depends on the size, location and stage of the tumour.

Treatment options include surgery, radiotherapy (radiation), chemotherapy or targeted therapy.

cervical cancer

• Approximately 630,000 cases per year worldwide
• More than 24,000 new cases diagnosed in Europe each year
• The most common age of diagnosis is around 45 years
• Approximately 70% of cervical cancer cases are caused by HPV types 16 and 18
• In the early stages, cervical cancer is effectively treatable

Cervical cancer is a preventable disease.

Symptoms:

• Women in the very early stages may not experience any symptoms, called asymptomatic course
• changes in the menstrual cycle (off-cycle bleeding)
• pain in the sacrum
• pain in the lower abdomen and pelvis
• feeling of a bloated, full abdomen (flatulence)
• vaginal discharge
• painful intercourse
• bleeding after intercourse
• swelling of the abdomen (ascites),
  • women often mistakenly think they've just gained weight quickly in the abdomen.
• swelling of the lower limbs
• enlargement of local lymph nodes
• general symptoms of cancer such as weakness, fatigue, nausea, weight loss
• symptoms associated with the presence of distant metastases

Caution: A woman who lives with only one partner can become infected.

Unfortunately, a woman often presents with symptoms at an advanced stage.

Regular preventive gynaecological examinations or screening tests allow for early detection.

What is CIN and what does it mean?

CIN stands for abnormal changes of the cervix:

• C (Cervical) - cervical region
• I (Intraepithelial) - relating to the surface cells
• N (Neoplasia) - neoplasm

CIN I, II, III

III stages of precancerous changes (stages preceding malignant changes) according to the severity of the changes.

Diagnosis of cervical cancer

The diagnosis of cervical cancer is usually made on the basis of a clinical examination by a specialist doctor (gynaecologist), a colposcopy (an examination with an optical instrument to look carefully at the cervix) and a biopsy (taking a sample).

Other auxiliary examination methods are computed tomography (CT), magnetic resonance imaging and positron emission tomography (PET).

Treatment

Treatment for cervical cancer depends on the size, exact location and stage of the cancer.

Surgery is very important in the treatment of cervical cancer in the early stages. In advanced stages, chemoradiotherapy (a combination of chemotherapy and radiotherapy), chemotherapy, radiotherapy or targeted therapy may be used.

Support groups have been set up in Europe to help patients and their families navigate the issues and accompany them through the treatment of the disease.

A key role in prevention is played by:

Primary prevention - vaccination

Secondary prevention - screening

Vaccination - HPV vaccination

The HPV vaccine flushes the necessary antibodies into the body. Although antibodies are also flushed out during natural HPV infection, they are at much lower levels and the body's immune response is lower.

Vaccines do not contain the genetic material of the virus.

Vaccination against HPV infection is recommended.

Statistics show that HPV vaccination reduces the incidence of high grade cervical abnormalities.

Side effects of the HPV vaccine

The safety and efficacy of vaccines have been proven to be very high.

As with all medications, side effects can occur.

However, the most common are redness, itching and swelling at the site of administration. Headaches, muscle aches and fatigue may occur.

Transient discomfort of the digestive system, such as nausea, vomiting, diarrhea or abdominal pain, has also been described.

In practice, three types of vaccines are encountered:

• CERVARIX - a bivalent vaccine against two types of HPV 16 and 18.
• GARDASIL - a quadrivalent vaccine against four types of HPV 6, 11, 16 and 18.
• GARDASIL 9 - a nine-valent vaccine against nine types of HPV, referred to as HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58.

HPV vaccination is for children (girls and boys) aged 9 years and older.

Both women and men can be vaccinated.

Why should the vaccine be given at such a young age?

The immune response is heightened at this time and therefore the vaccine is most effective at this time.

The ideal time to get the vaccine is before you have sex, because there is a high chance that you will not get an HPV infection.

However, vaccination is also possible during life.

Why get vaccinated?

The vaccine is safe and effective.

High vaccination rates have led to a significant reduction in HPV-related infections (90% of HPV infections, 90% of genital warts, 45% of low-grade precancerous changes, 85% of high-grade precancerous changes).

As a result, the vaccine is expected to prevent more than 70% of cervical cancers.

Why should both women and men be vaccinated?

Both sexes have a significant burden of HPV-related cancers.

Their incidence is increasing in both men and women.

Read also: What are the results of HPV research?

• What is the prevention of cervical cancer? Risk factors and symptoms
• What is cervical conization and how is it performed? Recovery and pregnancy

Cervical cancer screening

What is screening?

It actively seeks out people (in this case women) who have no clinical signs of the disease or are in the preclinical stage of the disease.

The most commonly used method is cytological testing (PAP cervical smear test, named after the doctor Papanicolaou).

HPV DNA testing is also possible.

Cytological sampling is performed by gynaecologists and evaluated by certified cytology laboratories.

The first two samples are taken at one-year intervals, and if these samples are negative, screening continues at three-year intervals. If the last three cytology samples are negative, screening is stopped at the age of 64.

The aim of screening is to catch the disease at a stage when it is still curable.

A woman should have gynaecological examinations from the age of 18 or after starting sexual intercourse.

Remember the golden rule

1. Prevention comes first...
2. Listen to your body and don't ignore the warning signs.
3. And last but not least, don't be afraid to ask, talk and seek medical help.

...it could literally save your life...