HPV Infection: Human Papillomavirus

Human papillomaviruses, better known by the abbreviation HPV, are the most common sexually transmitted viruses worldwide. There are over 200 known types of this virus, which can cause different diseases. HPV is best known for causing cervical cancer, but the virus can also cause other forms of cancer as well as warts, such as genital warts. How do you recognize the symptoms of an HPV infection, how is the test done and how can you prevent an infection with the human papilloma virus? You can read this and more below. Discharge: normal, heavy or colored – what does it mean?

What is HPV?

HPV is the abbreviation for the human papilloma virus (also: papillomavirus). These viruses are widespread, so most women and men will contract the virus at least once during their lifetime. Only in the rarest cases does such an infection cause symptoms, and it usually heals without consequences. Women and men are infected with the virus about equally often, but as a result, a woman is more likely to develop cancer than a man.

HPV infection: what are the possible consequences?

When infected with the human papillomaviruses, the viruses penetrate the cells of the covering tissues of the skin and mucous membranes, settle in the cell nuclei and multiply there. In most cases, such HPV infections go unnoticed and heal on their own without consequences, as the immune system successfully fights the viruses. However, some of the HPV types produce skin changes and warts, i.e. growths. Possible forms are the genital warts (genital warts or condylomas) and the skin warts (papillomas), which can affect the face, hands or feet, for example. The tissue changes caused are usually benign, but can also degenerate and lead to the development of cancer. For example, cervical cancer can occur decades after HPV infection. However, cancer of the external female reproductive organs (vulvar and vaginal cancer), anal cancer, penile cancer, and oral and pharyngeal cancer (head and neck tumors) are also among the possible consequences of HPV infection.

Types of human papillomavirus

There are about 200 different types of HP virus that can cause different diseases. A person can be infected with several HPV types at the same time. About 40 virus types are sexually transmitted and cause infections of the skin and mucous membranes in the genital area (genital HPV). Genital HPV infections are among the most common sexually transmitted infections. Depending on which parts of the body are affected, different types of HP viruses are distinguished. In principle, all locations of the body can be affected by an HPV infection where skin or mucous membrane is present.

  • Predominantly in children, cutaneous types occur, i.e. viruses that affect the skin. They particularly like to settle on the hands and feet, but the face, arms and legs can also be affected.
  • The other large group of mucosal types mainly infect the mucous membranes, usually in the genital or anal region.

Depending on how great the risk is that they lead to the development of cancer, the genital virus types are divided into “low-risk types” (Low risk) and “high-risk types” (High risk). Important to know: Infection with a high-risk type does not mean that cancer is necessarily the result, only that the risk of it is increased:

  • The low-risk types include the pathogens of the genital warts, because these warts are annoying, but harmless and sometimes even disappear on their own without treatment. This group includes, among others, the types HPV 6 and HPV 11.
  • The high-risk types include the HPV types that are somewhat more likely to cause cancer. They often settle in women at the cervix, the lower end of the cervix, and cause tissue changes (dysplasia) there, which can develop into cervical cancer over the years. High-risk types include a total of twelve types, mainly HPV 16 and HPV 18.

HPV infection: how does the infection occur?

HPV is transmitted by direct contact with skin or mucous membrane affected with the virus. At the same time, infection can probably also occur through objects, such as a shared towel or toilet.Some species are sexually transmitted, although intimate contact may be sufficient for infection even without actual sexual intercourse. Infection via anal or oral sex is also possible. If a pregnant woman suffers from genital warts, this can lead to transmission to the baby during birth, who may subsequently develop warts in the mouth and throat. It is possible to become infected with HPV several times in a lifetime. Basically, the risk of HPV infection increases with the number of different sexual partners. Early sexual intercourse or immune deficiencies are also risk factors for HPV infection.

Symptoms of HPV infection

Often, HPV infection occurs without any corresponding signs. However, if symptoms of infection with HPV do occur, they differ depending on the type of infection. Skin warts usually appear in groups and can be further spread by scratching. In the two most common forms of papillomas, they are either grayish, hard, raised with a fissured surface (verruca vulgaris = “common wart“) or flat and reddish (verruca plana = flat wart or plan wart). Plantar warts (Verucca plantaris) are found under the sole of the foot or on the heels, grow inwards and are therefore often painful. The pathogens of genital warts (Condylomata acuminata) like it moist and warm and therefore settle especially in the anus and genital area, but also in other body folds. They can cause symptoms such as itching or burning. The incubation period, i.e. the time between infection and the appearance of symptoms, for genital warts is between three weeks and eight months, usually lasting two to three months. Several forms of genital warts are distinguished, which have different pathogens:

  • Pointed condylomas are pale or reddish nodules that often stand in groups and are found on the labia, vagina, cervix, penis, urethra, anal canal, and rectum. They are very contagious.
  • Flat condylomas (Condylomata plana) appear as flat lumps and are found mainly on the female reproductive organs. They increase the risk of cervical cancer up to 130 times.
  • Giant condylomas (Condylomata gigantea = Buschke-Löwenstein tumors) grow into huge structures and destroy the surrounding tissue. In rare cases, they can degenerate and lead to cancer (squamous cell carcinoma).

Infestation of the mucous membranes in the upper respiratory tract is also possible and can occur in the form of recurrent papilloma formation (recurrent respiratory papillomatosis). In addition, the conjunctiva of the eyes, for example, may also become infected, resulting in pinkish, pedunculated growths. More difficult to detect are invisible infections of the skin, which the physician can only see with tools such as acetic acid (which causes discoloration of the warts) or the microscope. In addition, the virus may have already taken up residence in the cells without showing any tissue changes. In this case, only the virus itself can be detected and it is called a latent infection, i.e. the presence of pathogens but without symptoms. After the initial infection, this phase can last weeks to months.

HPV test: detection of HPV infection.

A test for HPV infection is performed in women as part of normal cancer screening by a gynecologist. During the gynecologic exam, a swab is taken from the mucous membrane at the cervix or cervix; this is called a Pap test. This Pap smear is examined for tissue changes to detect precancerous lesions of the cervix. In addition, an HPV test can be performed, in which cell material from a mucosal smear or tissue sample is tested in the laboratory for certain HP viruses. However, this only detects HPV infection of the affected area, but does not indicate whether tissue changes have already occurred. Therefore, the HPV test is particularly useful in combination with the Pap test and can help to detect precancerous stages of the cervix at an early stage. If an HPV test is positive, this is not yet a cause for alarm, as HPV infections are relatively common but only rarely lead to cancer. Regular check-ups are recommended to detect tissue changes at an early stage.Conversely, a negative test result is only a snapshot in time and does not allow any statement to be made as to whether there was an HPV infection in the past that was successfully fought off by the body. In men, there is no screening in which an HPV test is routinely performed. If there is a relevant cancer, an examination of the tumor can determine whether HPV infection underlies the cancer.

HPV: treatment of infection

In most cases, HPV infection does not require treatment because it heals on its own and the viruses are then no longer detectable. However, if this is not the case, the infection can be prolonged and persist for several months or years. There is currently no drug that can treat the actual HPV infection and completely destroy the papillomaviruses. However, treatment of warts that have developed reduces the number of viruses, so that in many cases the immune system can fight the remaining viruses and sufferers can get rid of them. In some cases, the HPV pathogens survive and can cause symptoms again and again. Various methods are used to treat skin and genital warts, depending on the size, spread and location of the warts. Thus, therapy can be carried out by means of cold treatment (icing), electrocoagulation, laser therapy or chemical agents such as trichloroacetic acid, podophyllin or 5-fluorouracil, for example in the form of ointments or solutions. Sometimes surgical ablation is also necessary. In the case of changes in the mucous membrane of the cervix, conization, i.e. surgical removal of the tissue, is usually the first step. In the case of genital warts, the partner should also be examined and treated if necessary. If cancer has already occurred, it is treated accordingly, for example by surgery, chemotherapy or radiation.

Prognosis in HPV infection

The prognosis depends mainly on the type of pathogen and its spread. It is usually good, except for giant condylomas and cases in which a cancer develops.

Prevention and early detection

To prevent HPV infection – and especially the development of cervical cancer as a result – HPV vaccination against certain types of the virus is available and recommended for girls and boys up to the age of 18. Various vaccines are available for this purpose. Protected sexual intercourse with a condom and good personal hygiene can also help prevent papilloma viruses, but do not provide absolute protection. For early detection of cervical cancer, women can also have a Pap test, i.e. a smear test of the cervix and the cervical canal. Between the ages of 20 and 34, they can take advantage of this examination every year, and from the age of 35 every three years in combination with an HPV test. The costs are covered by health insurance. Urine: This is what the color means