What is the Human Papillomavirus (HPV)?

What is the Human Papillomavirus (HPV)?

General Description

The Human Papillomavirus (HPV) infection is a viral infection which commonly produce growths in the skin or in the mucous membranes (warts). More than 100 varieties of the virus exist. Some types of infection cause warts, and others can cause different types of cancer.

The HPV genital infections are very common. In fact, almost all the people who have an active sexual life get infected with HPV in some moment of their life. Most people with Human Papillomavirus do not have symptoms and they feel perfectly fine, because of this they usually do not know that they have it

Most Human Papillomavirus genital infections do not produce injuries and disappear alone. However, some virus types can cause genital warts or some types of cancer.

There are several types of Human Papillomavirus (HPV), the types 6, 7, 10 and 11, which cause most genital warts. Though the warts are not nice, they are a low risk type of Human Papillomavirus, because they do not provoke cancer or other serious health problems.

There are at least a dozen (12) of HPV types which, in some occasions, can provoke cancer. However, there are (2) particular types (the types 16 and 18) which cause most cancer cases. This is known as high risk Human Papilloma. The cervical cancer is usually related with the HPV, but the Human Papillomavirus can also cause cancer in the vulva, vagina, penis, anus, mouth and throat.

How is Human Papillomavirus spread?

The HPV is easily spread by skin to skin contact, when you have sex with a persona who already has it. You get infected when your vulva, vagina, cervix, penis, anus, the mouth and the throat are in contact with someone else´s genitals, normally during the sex. Human papillomavirus can even be spread if there is not any ejaculation and even if the penis does not enter in the vagina, anus or mouth.

Human Papillomavirus is the most common sexual transmission illness, but mot the time it is not a problem. It usually disappears by its own and most people do not even know that they have it. Remember that most the people who have sex get infected with HPV in some moment of their life. Because of this, if you have the virus, do not feel ashamed or scared, because it is very common. 

In most cases, the immune system of the body beats a HPV infection, before the warts get created. When the warts appear, these can change their appearance according to the type of HPV involved. 

The genital warts appear as flat injuries, small lumps with cauliflower-shaped or little bumps stem-shaped. In women, the genital warts appear mainly on the vulva, but they can also appear next to the anus, in the cervix or in the vagina.

*Extended warts in Mons pubis region and the surroundings of the labia minora and majora, as well as the proximity of perianal region.

*Warts in perianal region can appear in both genders. 

In men, the genital warts appear on the penis and srotum or surrounding the anus. The genital warts rarely cause discomfort or pain, though they can cause itching or have sensibility.

*Genital warts on male pubis region.

*Warts on penis body.

Cervical cancer

The HPV infections are the principal cause of cervical cancer, but the cervical cancer can delay 20 years or more to develop itself after a HPV infection. The HPV infection and cervical cancer at an early stage usually do not cause notorious symptoms. Get vaccinated against HPV infection is the best protection against the cervical cancer.

Because of the cervical cancer in an early stage does not cause symptoms, it is essential that women get realized regular detection test for detect any precancerous change in the cervix which can arrive to a cancer. The actual guidelines recommend that the 21 to 29 years old women get done the Pap smear test every three years as routine and other types of analysis can provide an early diagnosis, if cancer is developed. Measures can be taken for treat any type of cancer and avoid that it gets developed. 

When should you consult with a doctor?  

Do you have any type of warts that cause shame, discomfort or pain? Go to a consult with a doctor.

Causes

The HPV infection happens when the virus enters the body, generally through a cut, abrasion or a little tear in the skin. The virus is usually transmitted by skin to skin contact. 

The HPV genital infections are transmitted through the intercourses, anal sex or other type of contact with the genital region. Some HPV infections that cause oral respiratory or superior injuries are acquired through the oral sex.

The warts are contagious. They can be acquired through the direct contact with a wart. The warts can be also spread when someone touch something that has been in contact with a wart.

Risk factors

The HPV infections are common. The risk factors for HPV infection include:

Number of sexual couples: Even more sexual couples you have, more probabilities you will have to acquire a HPV genital infection. Having intercourses with a couple who has had many sexual couples increases the risk, too. 

The age: The common warts occur principally in children. The genital warts more frequently happen in teenagers and young adults.

Weakened immune systems: The people who have a weakened immune systems have more risk of acquire HPV infections. The immune system can be weakened because a maintained stress that can arrive to a depressive condition, have an associated illness which will interfere in the weakness of our immune system, be infected with the HVI/AIDS or because inhibitors medicines of the immune system that are used after an organ transplant.

Damaged skin: The skin areas which have been perforated or open are more prone to develop common warts.

Personal contact: Touch someone else´s warts or not use protection before have contact with surfaces that have been exposed to HPV, as public showers and swimming pools, could increase the HPV infection risk.

Complications

Superior oral and respiratory injuries: Some HPV infections cause injuries in the tongue, tonsils, soft palate or inside the larynx and nose.

Cancer: Some HPV strains can cause cervical cancer. These strains could also contribute to cancers in the genitals, anus, mouth and superior respiratory tract.

How can we prevent it?

Common warts

It is complicate prevent the HPV infections which cause common warts. If you have a common wart, you can prevent the propagation of the infection and the formation of new warts, if you do not touch the wart and do not bite your nails.

Genital warts

You can reduce the risk of have genital warts or other genital injuries related with HPV in these ways:

•Be in a mutually monogamous relationship. 

•Reduce the number of sexual couples.

•Use a latex condom, which can reduce the risk of a transmission of HPV.

•Vaccines against the HPV.

Treatment

The Food and Drug Administration from U.S.A has approved three vaccines against the Human Papillomavirus. The most recent was Gardasil 9, which is approved for be used in 9 to 45 years old men and women for protect them against the cervical cancer and genital warts.

The Centers for Disease Control and Prevention (CDC) recommend the routine vaccination against Human Papillomavirus for 11 and 12 years old girls and boys, though it can be administrated since the 9 years old. The ideal is that both girls and boys receive the vaccine before they will have sexual contact and they get exposed to human papillomavirus. According to the researches, the application of the vaccine in an early age is not related to an early beginning of the sexual activity.    

Once someone is infected with the Human Papillomavirus, it is possible that the vaccine will not be so effective or do not have any effect. Also, the reaction to the vaccine is better in early ages than in the advanced ones. But, if it is administered before someone gets infected, the vaccine can prevent most cervical cancer cases. 


Interferon injection: this is rarely used because the high risk of the secondary effects and the cost.


The medicines with prescription include:

Podopyllin (a chemical that is administered by a doctor)

What is it? It is an active substance presents in drugs which are used for provoke a cellular modification.

What is it for? It is used in the topical treatment of genital warts, condyloma acuminatum and perianal warts.

How is it used? The way of administration is topical. Wash and dry the area to treat and apply a small quantity directly. You can apply every 6 hours.


Imiquimod (Aldara®)

It is a chemical substance which acts on your immune system improving the body´s capacity for eliminate the actinic keratosis and some special types of cutaneous tumors (superficial basal cell carcinomas). It is also useful in the treatment of warts in genital area.

During the treatment with the Imiquimod cream, an inflammatory reaction will be produce in the area of the injury. Redness, erosions, inflammation and irritation usually appear, and in some cases the formation of scabs which can be extend outside the limits of the treated injury. Sometimes the sensation of stinging and pruritus can appear, usually quite tolerable.

These changes are almost constants on every treated people with Imiquimod and they usually initiate after a week of started the treatment.

Do not be alarmed because the starting of these symptoms. All that is normal and a relation exists between the inflammation stage and the injury´s rate of healing: even more the irritation of the treated area will be, the effectiveness of the medicine will be better and an intense irritation usually indicates a higher possibility for the injury of disappear definitely. These symptoms will disappear spontaneously once the treatment ends. 

Notwithstanding, if the inflammatory reaction is very intense, you should consult with your doctor in case you have to interrupt the treatment for some days.


Trichloroacetic acid or bichloroacetic acid at 80-90% (chemicals which are applied by the doctor) A small quantity is directly applied to the warts and it is left to dry. If an excess of acid is applied to the treated area, cover it with talcum powder, apply sodium bicarbonate or liquid soap for eliminate the acid. It is applied once every 1 or 2 weeks.


In specific situations, surgical interventions are possibly needed, and these ones include:

Cryotherapy: In this method, liquid nitrogen is used for freeze the abnormal areas.

The cryotherapy is also called cryosurgery, cryoablation, percutaneous cryotherapy, or targeted cryoablation therapy. It is a minimally invasive treatment that uses an intense cold for freeze and destroy an ill tissue, including the cancerous cells.


Electrocautery

The electrocautery is very frequently used in surgical interventions for remove harmful or unwanted tissues. It can also be used for cauterize and seal blood vessels. This helps to reduce or stop the bleeding during a surgery or after an injury.


Laser therapy

A laser can be used for destroy the genital warts.

The laser surgery can be done in a doctor´s office or in a clinic, a hospital or an ambulatory surgical center. Local or general anesthesia can be used according to the quantity of warts which will be eliminated or the size of the area that will be treated. 

Risks

The laser surgery can cause the following problems:

        •Pain, swelling or itching.

        •Vagina or penis´s secretion.

        •Sores in the treated area.

        •Tissue sticking together.

        •Peeling of death tissue.

        •Formation of the scar tissue.

Urination that happens with a strong and width jet, in the case of treatment made in the urethra. The formation of scar tissue in the penis is a possible side effect which can provoke problems with the urination and erection.


Surgical removal

Talking to a doctor about the best treatment is important, depending of the type and location of the wart which is being treated.


It is also important explain that, thought the warts and the cellular changes can be removed or resolved, the virus can appear in the body and can be transmitted to others. A treatment for remove the virus from the body does not exist.

Conclusions

As a conclusion we leave you this questionnaire:

How do I know if I have get infected?

Most time you do not know it; but some people who have had exposed to the HPV develop warts (bumps in the skin that, sometimes have the form of a cauliflower). These warts and other changes provoked by the HPV can cause itching or burning sensation. The people who suffer the disease in an advanced stage, as cancer, can have bleeding, pain and other symptoms.

How is the HPV test done?

The evaluation of samples from the cervix can be available to some women as a part of the cervical cancer detection test. There are not HPV test for men. There are not blood test for detect HPV.

If I get HPV, will I get cancer?

Just a little proportion of the people who are infected with HPV develop cancer, because of that, having HPV does not mean that you will have cancer! However, it is important reduce your risk getting vaccinated if you are eligible or if your health care provider considers that it could be beneficial for you, and doing the cervical cancer detection test.

If I get vaccinated against the HPV, should I still do the cancer detection test associated with this virus?

While the vaccine reduces significantly the risk of cancers associated with HPV, women who receive the vaccine should still realize a cervical detection test.

If a have contact with someone who has warts, will I get infected with HPV?

The warts has a big quantity of HPV that can be spread, because of that there is a great possibility that you get infected. It does not mean that you will certainly have warts, too, but you should talk with your health care provider about detection test and vaccination.

I am a male, should I be preoccupied for the HPV?

Men and women, there are all in risk of get infected with HPV. This can provoke genital warts in males, as well as cancer in the anus, penis and throat. The males can also spread the HPV to their sexual couples, because of that avoid the infection at first place is the most recommendable.

I have been tested and I do not have HPV, does it mean that I do not have any risk of acquire a specific type of cancer related to HPV?

It means that your risk of acquire cancer in the near future is much reduced. However, you must do the detection test in the future, according to your region and country´s detection policies. 

Is there any change that I can do in my life style for reduce my risk of acquire HPV?

Yes, there is! You can reduce the risk of getting infected with HPV by getting vaccinated, using condoms and reducing the quantity of sexual couples. You can also reduce the risk of acquire cancer, if you have already been infected with the HPV, making detection tests.

Is the HPV vaccine safe for my children?

Yes, it is. The HPV vaccines have extensively and independently been evaluated. All the scientific tests prove that the HPV vaccines are extremely safe. The World Health Organization (WHO) and in essence all the countries of the world now recommend the vaccination. With more than 20 million of distributed doses, no significant side effects other than temporary injection place reaction have been identified.   

How do the HPV conduce to cancer?

Once the body gets infected, it can or cannot eliminate the HPV infection. If the body does not get to debug the infection, the long-term persistence can provoke precancerous changes. The detection and the treatment of a precancerous condition reduce greatly the risk of develop a cancer.

If I have HPV during my pregnancy, does it affect to my baby?

The HPV does not spread from mother to baby easily. In rare occasions, babies born to mother with genital warts because some types of HPV (HPV 6 and 11) at the moment of delivery can infect them with the virus when they have contact with the birth canal. Babies can after develop warts in the larynx which can require surgical treatment. The women´s vaccination against the 6 and 11 HPV reduces the risk of mothers passing the virus to their babies drastically. 

How do I reduce the risk of a disease related to HPV infects me?

You can reduce it doing the detection tests and following the local guidelines related with the regularity of the controls. If you have clues of a precancerous affectation, near following and treatment must be offered to you. The vaccination for adult women will probably be considered in the future. Now a days, just a few countries have programs which routinely cover the vaccination for women older than 26 years old. The detection test is not useful for men. For the men, the continuous use of condoms can help to reduce the risk of an infection, but not its elimination. The vaccine is the best way to prevent the infection of HPV for both women and men.

I am over 26 years old, should I get vaccinated against the HPV?

In U.S.A, the vaccine is allowed up to the 26 years old, it is the age limit used in the clinic studies of the vaccine. In Europe, the vaccination is approved from 9 years old; while there is not an upper age limit, access may depend of local policies and guidelines in terms of health care. Some studies have proved that the women vaccine up to 45 to 50 years old is an important measure for the protection of the women who have not been infected with HPV before the vaccine application. Most countries have specific guidelines for the vaccination of adult women.

My mate told me that he or she had HPV. Is this mean that I also have the infection?

It is not necessarily, but a HPV infection usually affects to both members of the relationship in a few month. The HPV is almost always invisible, but if there are clues of HPV, as the genital warts, you should talk with your doctor; because you or your mate could have HPV without know it; if you are an active sexual woman, the reasonable is that you use all the opportunities for realize a cervical detection test. In some cases, the routine detection includes the HPV cervical test. A specific treatment for HPV does not exist yet, but it is important search and treat any precancerous cell found as a part of the detection process. Approved HPV evaluation or detection practices for men does not exist.

How can I prevent that my mate gets infected with HPV?

If you know that you have HPV because you have genital warts or you have done the HPV test, your only option is the constant use of condoms. It does not give you a total protection, but it really reduces the risk. If you are eligible, you and your mate should get vaccinated against HPV. More than 100 types of HPV exist; the vaccine can protect you from the types that you do not have, yet.

My mate told me he or she had HPV, I do not have it. Does this mean that he or she has been unfaithful to me?

No, it does not; the HPV can stay latent (inactive or without be detected) during a long time. Therefore, it is pretty difficult to determine certainly when the HPV infection was produced. 

I think that my mate could have infected me with HPV. Is this something that he or she could have avoided?

Almost all the time, people do not know that they have HPV, even when they have had it during a time. Because of this, the most probably is that your mate did not know that he or she was infecting you with the virus. Get more people vaccinated will reduce the risk of spread the virus to the person that you love. If you think that it is possible that you have the virus, you must verify it with your health care provider for check if you or your mate are eligible for do a cervical cancer detection test.

I am taking contraceptives pills. Does this increase my risk?

It has been determined that the long-term use of orals contraceptive pills slightly increases the risk of cervical cancer, but just for women who have a HPV infection. Most part of this comes from older studies; the actual pills have less levels of estrogen, and the risk, if there are any, is unclear at this stage. Having HPV is the principal risk factor of cervical cancer, and the prevention is centered in vaccination for prevent the HPV infection and the detection of precancerous cervical affections. If you have doubts, you can ask to your doctor. 

If I have HIV, can I receive the vaccine against the HPV?

Yes, you can. The HIV positive people will respond to the vaccine in a similar way to the people who do not have HIV. The vaccine of HIV positive people and others inmunocompromised patients is highly recommended up to the 26 years old because their higher risk of HPV-associated cancers. Some HIV positive people can be benefited with the vaccine after the 26 years old and they should talk with their health care provider. 

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