Health

The Truth About HPV and How to Prevent It

Epidemiology Around the world, it’s estimated that the human papillomavirus infects roughly 12% of women. It is also the most common sexually transmitted disease in the… Trista - October 13, 2019

Taking care of our bodies and keeping them in healthy condition can sometimes feel like an exercise in futility. Just when you think everything is going well, something else “breaks down” that you have to fix. It can be an exhausting experience trying to battle all of these conditions and keep everything running like a well-oiled machine. Even the healthiest of individuals experience health issues. You never know when your health will be affected by a serious condition like cancer.

That’s why it’s essential for you to consider the ramifications of the human papillomavirus infection and how it can affect your life. This infection is prevalent and affects nearly all people at some point in their lives. HPV presents itself in a wide variety of forms, including warts and cancerous lesions. Because of this, practicing safe sex and regularly getting tested for sexually transmitted infections is essential. Here’s what you need to know about HPV and what you can do to keep yourself healthy, whether you’ve been afflicted with the virus or not.

What is HPV?

HPV stands for human papillomavirus and is the most common sexually transmitted disease in the United States. What’s even more interesting is that there isn’t just one type of HPV: there are 40 different strains that can affect the genital area.

The different strains can affect the rectum, the anus, the vulva, the linings of the vagina, the cervix, and the skin of the penis. These strains can also be transmitted to the mouth and the throat through oral sex. Human papillomavirus typically results in precancerous lesions and genital warts. Medical experts state that almost all cases of cervical cancer are caused by HPV.

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How Is HPV Transmitted?

Since HPV is a sexually transmitted disease, it can be transmitted through vaginal intercourse, anal and oral sex, and any intimate skin contact with the infected area. Those that are sexually active, beginning at an early age, smoke, and have multiple sexual partners have an increased risk of developing the virus.

Practicing safe sex, such as using condoms and dental dams, reduces the chances of contracting HPV, but they are not foolproof methods to prevent infection entirely. Before engaging with a new sexual partner, it’s advised that everyone must get tested to ensure that there are no concerns.

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History of HPV

The human papillomavirus was first associated with skin cancer and lesions by a dermatology professor from Poland in 1972. In 1978, that professor, Stefania Jablonska, was working at the Pasteur Institute and along with another expert, discovered HPV 5 in skin cancer.

German professor Harald zur Hausen formed the theory that human papillomavirus was the main factor in the development of cervical cancer in 1976 and published a paper on it. He and his colleagues identified two types of HPV, HPV 16 and HPV 18, in cervical cancer. Since then, many researchers have begun studying the effect human papillomavirus has on our health, specifically when it comes to cancer.

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Virology

The HPV infection stays solely in the basal cells of tissue known as the stratified epithelium. This is the only tissue in which HPV cells can replicate. HPV does not bind to live tissue. It typically takes between 12 and 24 hours for the infection to occur after the virus is transmitted.

HPV lesions come from infected outermost skin cells. These cells most commonly become disturbed, making them vulnerable to the transmission of the human papillomavirus. This generally happens after minor skin abrasions and during sexual intercourse. HPV can survive without a host and in low temperatures for months at a time.

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What are the Symptoms of HPV?

Low-risk HPV is not going to show any symptoms other than the growth of warts. High-risk HPV is even worse: you’re not going to see any symptoms at all. Even the precancerous cell changes aren’t going to reveal any signs of an infection.

It is only when precancerous lesions form that you know there’s a problem. The chances of them developing into cancer at this point are very high. The sooner you notice an unusual lesion on your body, the faster you need to get it examined. It’s essential to begin treatment for human papillomavirus quickly before it can develop into cancer.

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HPV Warts

A skin infection associated with human papillomavirus is widespread. HPV infections can lead to noncancerous growths called verrucae, but they’re better known as warts. Warts occur due to the rapid growth of cells on the top layer of the skin.

Warts have been described since Ancient Greece, but their viral cause was discovered in 1907. It’s common for warts to show up in childhood. They tend to appear and disappear randomly over the course of several weeks or months. Don’t be surprised if warts you had several years ago returned all of a sudden. There are several different types of warts, including plantar warts, common warts, flat warts, and periungual warts.

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HPV Cancer

Around one dozen types of human papillomavirus are considered high risk because they have been linked to many types of cancers. Types 16, 18, 31, and 45 are factors in developing oral, vaginal, penis, anus, cervix, and larynx cancer. All of these cancers were due to a sexually transmitted HPV infection.

A study found that more than 5 percent of all new cancer cases around the world were due to HPV. Because of this, human papillomavirus is considered one of the leading infectious causes of cancer. Throughout the world, more than eight percent of diagnosed cases of cancer are because of HPV. Instances of this are higher in developing countries where HPV leads to nearly 500,000 cases of cancer annually.

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Immunocompromised People

In rare situations, those with a weak immune system may develop a severe condition epidermodysplasia verruciformis (EV) caused by HPV. EV is also known as treeman syndrome and is a high-risk form of skin cancer. Uncontrolled HPV infections cause scaly growth on the skin, mostly on the hands and feet.

This condition is mostly caused by HPV 5 and HPV 8. EV has a typical onset between the ages of 1 and 20 years old. Flat warts, horn-like lesions, and scaly reddish-brown macules are symptoms of this rare condition. Unfortunately, no cure has been found for the EV infection. Doctors typically remove as many of the lesions as they can and prescribe a retinoid ointment.

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High-Risk and Low-Risk

With all the strains that exist, the strains of HPV are categorized into two main types: high-risk and low-risk. These categories are based on whether the type can increase the risk of cancer later on.

Low-risk HPV tends to primarily cause warts, which are pretty easy to remove and treat. These warts can grow around the throat, mouth, genitals, and anus, which is pretty embarrassing. In some rare cases, low-risk HPV can lead to recurrent respiratory papillomatosis, where benign tumors grow in the respiratory tract and affect breathing. High-risk HPV strains have been known to cause cancer in the vulva, vagina, larynx, penis, and anus.

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The Tragedy of High-Risk HPV

Scientists have discovered that there are at least 13 types of HPV that can lead to cervical cancer, while other types can lead to various diseases of the genitals, anus, head, and throat.

The real tragedy is that most people aren’t aware that they’ve even contracted HPV. The immune system of the body naturally removes it two years after infection. This can be very dangerous since you may not be aware that you’ve been exposed to a high-risk HPV infection until it’s too late. Individuals with HIV and HPV will have a higher risk of developing anal or cervical cancer.

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Epidemiology

Around the world, it’s estimated that the human papillomavirus infects roughly 12% of women. It is also the most common sexually transmitted disease in the world. Experts agree that nearly all sexually active men and women, about 75 to 80 percent, will get a genital HPV infection at some point in their lives.

By the time they reach the age of 50, more than 80 percent of women will have contracted at least one form of genital HPV. 10% of the United States population has an active HPV infection, 4 percent has a virus that has led to abnormalities, and 1 percent has genital warts due to HPV.

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How High-Risk HPV Leads to Cancer

When there is an infection, the immune system goes into overdrive to get rid of it. However, with high-risk HPV, the body can’t get rid of it, so the immune system will always be working. This can lead to healthy cells being turned into abnormal ones, which is how cancer develops.

Cell changes that occur for an extended time can lead to precancers, which may develop into cancer if they’re not taken care of right away. Cervical cancer is the biggest and most common of all high-risk HPV infections. Nearly one dozen types of HPV lead to cervical cancer, including 16, 18, 31 and 45.

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Cervical Testing

Since the rate of cervical cancer cases due to HPV has steadily risen over the past few decades, the American Cancer Society has made recommendations of who should be getting tested and when. They state that women between the ages of 25 and 65 should get cervical cancer screening every five years. It’s essential for them to get both a Pap test and an HPV test.

They also have the option only to get a Pap test if they have not been diagnosed with abnormal cells. The only time you would get a blood test is if your Pap test revealed unusual cell patterns or if your doctor decides to pair a cervical cancer screening with a Pap test after you’ve turned 30.

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Mouth Testing

Since HPV can lead to oral cancer, there is a way to test for abnormal cells in your mouth. The American Dental Association recommends a routine visual examination. This can work in some cases, but it can be hard for doctors to see deep into your throat, leading to them missing out on any abnormalities.

This is not good because cancer in the throat is most often diagnosed only in later stages. After the visual test, a biopsy of the abnormal cells is completed. At this point, you may also be tested for HPV to see if the cancer is related to an infection. Research shows that those with the disease in the mouth and throat have a heightened occurrence of human papillomavirus in their mouths.

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Testing Men

Although HPV is common around the world, there aren’t many options for testing men. Researchers use testing methods that aren’t available to the general public. Additionally, they rely on the HPV vaccine being administered early on.

Many researchers believe that it’s imperative to reduce HPV infection in both men and women, even when they are exhibiting no symptoms. This is seen as being necessary for reducing the development of cancer. There are some kits that test the blood and genital areas of men for HPV, but they’re not available for public testing. In some cases, self-collection by a patient has been successful, as well.

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Other Testing

Testing for HPV is still relatively new. Researchers believe that it is possible to test for HPV in other infections, but no testing methods have been approved by the FDA for general screenings in the United States or Canada. This is because testing is thought of to be medically unnecessary as well as inconclusive.

Genital warts are typically diagnosed with a visual examination. Some warts and other growths are tested with an acetic acid mixture, but this type of testing works best in moist areas like the female genital region. Although it would be nice to have a less invasive blood test available for HPV, no test like this has been approved for public testing.

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High-Risk HPV is Prevalent Around the World

Altogether, HPVs make up at least 5% of the types of cancer throughout the world. On average, about 570,000 women and 60,000 men are developing HPV-related cancer each year. The number 16 type of HPV is the type that is the most likely to cause cancer and is the cause of nearly 50 percent of all cervical cancer cases.

These numbers can be staggering, but with vaccines in circulation, these numbers have been decreasing every year. That’s why it’s so important to get a checkup and be vaccinated before the worst occurs. If you are sexually active, aim to get tested for sexually transmitted infections between one and three times per year.

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HPV Prevention

The best way to prevent the transmission of human papillomavirus is to get vaccinated. Unfortunately, the optimal time to get treated is before you have gotten infected, so pre-teen age is recommended. Because that’s not realistic for most people, getting screened early and often is best.

Cervical cancer screenings like a Pap test or acetic acid test are used to detect early cancer or abnormal cells that can eventually turn into cancer. Because of cervical cancer screenings, the number of people diagnosed with cervical cancer and deaths due to cervical cancer has dropped significantly. Getting a Pap test every three to five years can reduce your risk of developing cervical cancer by nearly 80 percent. For warts caused by HPV, freezing is the recommended treatment method.

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Vaccinations Can Prevent Cancer

However, even if it’s impossible to tell whether you’ve been infected with HPV, some vaccinations can prevent both high and low-risk HPV infections from occurring in the first place. HPV vaccines are designed to avoid the more common types of human papillomavirus.

That means no development of warts and no increased risk of HPV-related cancers in the future. Moreover, all it takes is a simple injection. However, the downside is that vaccination will not treat or cure those who have already been infected with HPV. These vaccines work best for individuals between the ages of 9 and 13 who most likely have not contracted HPV.

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Condoms

According to the Centers for Disease Control and Prevention, using male condoms can help to reduce your risk of contracting the genital human papillomavirus infection. On the other hand, condoms offer less protection from HPV than it does for other sexually transmitted infections. This is because HPV can infect exposed areas besides those protected by condoms.

Female condoms provide more coverage than male condoms, so they are more effective in protecting from HPV transmission. Even though condoms aren’t 100 percent effective in preventing the spread of HPV, they can limit the spread of HPV to additional areas on a person that is already infected with human papillomavirus.

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Disinfection

Unfortunately, human papillomavirus is a hardy infection and does not respond to many common disinfectants. It’s the first virus that has shown resistance to glutaraldehyde, which is one of the most potent disinfectants used in hospitals. A practical solution is sodium hypochlorite bleach, but this substance is not safe for certain types of reusable equipment like ultrasound transducers.

Since it’s difficult to kill HPV with disinfectants, hospitals are concerned with transmitting the infection with reusable equipment, especially gynecological tools that cannot be cleaned in an autoclave. Experts recommend sanitizing these types of devices with UV disinfection, hydrogen peroxide solution, or chlorine dioxide wipes.

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What to Know About Cervical Cancer

Almost all cervical cancers are caused by HPV. It’s vital that you conduct routine screening at your OBGYN to ensure that there isn’t an infection going on. Because of the recent scare in the past decade, the rates of developing cervical cancer have dropped immensely.

However, getting a regular checkup is still recommended, as well as getting the vaccine when possible. In 2018, over 500,000 new cases of the human papillomavirus were recorded. Nearly 320,000 people died from cervical cancer around the world, as well. Eighty-five percent of these cases came from low and middle-income families. Each year in the United States, more than 30,000 cases of cancer that are due to HPV occur.

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History of Cervical Cancer

Cervical cancer dates back to 400 BCE, when Hippocrates, the father of medicine, hypothesized that cervical cancer was incurable. In 1925, the device used to examine the cervix, the colposcope, was invented. The first Pap test was administered in 1941.

As we mentioned before, HPV was found to cause cervical cancer and genital warts by Harald zur Hausen. Zur Hausen would eventually go on to win a Nobel Prize for his research. In 2006, the first vaccine for human papillomavirus was approved by the FDA, and by 2015 it was proven to have protected against HPV infection at numerous body sites.

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Symptoms of Cervical Cancer

Because the human papillomavirus is mainly free of symptoms, you may end up experiencing no symptoms in the early stages of cervical cancer. The presence of a malignant growth may be indicated by vaginal bleeding, contact bleeding after sex, or a rare vaginal mass. Other symptoms include vaginal discharge and pain during and after sex.

Once cervical cancer has advanced, you may experience more extreme symptoms. Weight loss, fatigue, loss of appetite, and bone fractures may occur. Pain is common, especially pelvic, back, and leg pain. Legs can become swollen and bleeding from the vagina and anus can happen in severe cases.

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Causes of Cervical Cancer

The most significant risk factor for developing cervical cancer is being infected with the human papillomavirus. Seventy-five percent of cervical cancer cases around the globe are due to HPV 16, 18 or 52. Another 10 percent of cases are caused by HPV 31 and HPV 45. Women who have many sexual partners or sleep with men who have had many sexual partners have an even higher risk of getting HPV.

Fifteen strains of HPV are considered high-risk and most likely to lead to cervical cancer. Although genital warts are associated with human papillomavirus, the strains that cause warts will not cause cervical cancer. Following HPV, being a smoker, and having HIV can increase your risk of being diagnosed with cervical cancer.

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Smoking

Smoking is terrible for your health in more ways than one. Not only can it lead to lung and heart issues, but it can increase your risk of developing cervical cancer. Both active and passive smokers are susceptible to getting cancer.

Research shows that current and former smokers who have HPV are 2 to 3 times more likely to develop invasive cancer like the cervical kind. Smokers have an increased risk of developing cervical issues that can directly lead to cervical cancer. Smoking also makes you more likely to contract HPV in the first place. When you smoke, your risk of becoming infected with HPV and getting cervical cancer is extremely high.

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Oral Contraceptives

There are many forms of birth control. Those include male and female condoms, intrauterine devices, diaphragms, shots, vaginal rings, and oral contraceptives. Known as “the pill” many women take oral contraceptives every day for many years to prevent unwanted pregnancy. Did you know that taking oral contraceptives for an extended period can lead to cervical cancer?

Studies have shown that women who have taken oral contraceptives for between 5 and 9 years have three times the risk of developing invasive cancer like cervical cancer. Women who use oral contraceptives for a decade or longer have nearly four times the chance of getting cancer.

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Multiple Pregnancies

You might not realize it, but having numerous full-term pregnancies can also raise your risk of developing invasive cancer. Women who have human papillomavirus, and many children need to be cautious and get screened frequently for HPV and cervical cancer.

HPV-infected women who have had seven or more full-term pregnancies have about four times the risk of getting cancer than a woman who has never been pregnant. These women will also have two or three times the chance of a woman who had had just one or two full-term pregnancies. This could be due to the transmission of HPV and hormonal changes, as well as what the cervix undergoes during pregnancy and labor.

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Cervical Cancer Diagnosis

The primary method for diagnosing cervical cancer is a Pap test. This screening process is standard, but it can be somewhat unreliable. Nearly 50 percent of cases of cervical cancer will result in a false negative Pap test. Additionally, Pap tests are expensive, so many areas of the world cannot afford to administer them.

To confirm a diagnosis of precancer or cervical cancer, a biopsy of the cervix is performed. With this method, a diluted solution of acetic acid is applied to the cervix and examined. Acetic acid is used to highlight any abnormal cell patterns. Several other procedures examine the inner lining of the cervix for abnormalities.

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Precancerous Lesions

The precursor to cervical cancer is cervical intraepithelial neoplasia or CIN. These lesions are typically diagnosed following a pathologist’s examination of a cervical biopsy. There are many grades of precancerous lesions of the cervix.

The term dysplasia is used to refer to abnormal cell growth. In CIN, mild dysplasia is referred to as CIN1, moderate dysplasia is CIN2, and CIN3 is severe dysplasia. A pathologist will examine a biopsy and grade the results according to this scale. This staging differs from the results of a Pap test. Findings from the CIN and Pap tests are not related and do not need to match.

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Staging

Various tests are used to determine the stage of cervical cancer. These tests include inspection, palpation, colposcopy, hysteroscopy, proctoscopy, Pap test, and X-ray. There are currently four stages of cervical cancer.

Stage 1, 2, 3, and 4 each have two separate divisions. Stage 1A is growth so small that it can only be seen with a microscope. Stage 1B is a more substantial growth that is only in the cervix tissue. In Stage 2A, the cancerous growth has spread to the top of the vagina. Stage 2B is when the cancer is in the tissue surrounding the cervix. During Stage 3A, the cancer is in the lower third of the vagina but not in the pelvic wall; that occurs in Stage 3B. The most serious stage of cervical cancer is stage 4. In Stage 4A, cancer begins to spread to surrounding organs like the bladder or rectum. In the final stage, Stage B, cancer metastasizes to organs far away from the cervix, like the lungs.

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Increased Risk of Developing Cervical Cancer

For women infected with high-risk HPV, certain factors can increase their likelihood of developing cancer in the future. This can be terrifying, as it can take ten to twenty years for HPV-infected cells to develop into cancerous tumors.

These factors that increase the risk of an infection developing into cancer include smoking cigarettes, giving birth to many children, or using oral contraceptives for an extended period. Those with a weak immune system or who have many sexual partners are also at a higher risk of developing cervical cancer. If you fall into one or more of these categories, get tested regularly for sexually transmitted infections.

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The Screening Process for Cervical Cancer

These tests are focused on the comparison and examination of cervical cells to see if there are any changes. First, there is the HPV test that checks whether it is the presence of high-risk HPV within cervical cells.

Secondly, there is a Pap test that detects whether there are any cervical changes that could have been caused by an HPV infection. The Pap test is conducted every three years before the age of 30, and then five years afterward until the age of 65. If cervical cancer is detected early, there is a 68 percent chance of having a five-year survival rate.

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Screenings for Other HPV-Related Cancers

Unlike cervical cancer, there are no FDA-approved tests for other HPV-related diseases. However, there are other means of examining and screening them. There is an acetic acid test that is administered to identify genital warts if a visual check is not sufficient enough. Scientists are working on a possible way of testing blood for HPV, but currently, it’s not a reliable method.

For men who engage in sexual intercourse with other men or who are HIV-positive, regular anal Pap tests can help to determine whether there are any precancerous cells or cell changes to determine whether an infection exists.

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Already Infected? Treatment Options

As stated, once infected, there are no known ways to remove the HPV infection thoroughly. However, there are treatment options to prevent the condition from getting worse. For precancerous cervical cell changes, women can undergo a loop electrosurgical excision procedure, called LEEP for short.

This is a method that removes the abnormal tissue from the body to hopefully prevent them from turning into cancer cells or transforming healthy cells into precancerous cells. If you have genital warts, roughly 90 percent of cases tend to disappear within two years from the point of infection naturally. Even though you may be safe, getting follow-up care is essential.

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Hysterectomy

When a case of cervical cancer becomes severe, a woman may need to have a hysterectomy. When a hysterectomy is performed, the uterus is surgically removed. In some instances, the herbicide, Fallopian tubes, and ovaries are also excluded.

Roughly 400,000 are performed in the United States each year. When a woman has her uterus removed, she is no longer able to bear children. Having a hysterectomy is an option for preventing the spread of cervical cancer. Be advised that getting rid of the ovaries leads to early menopause in many cases because of the sharp drop in estrogen levels.

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Prognosis

The prognosis of cervical cancer depends on what stage of cancer a woman has. Women with microscopic forms of cervical cancer have a nearly 100 percent survival rate. The five-year survival rate of the earliest stage of cervical cancer is 92 percent with treatment.

The five-year survival rate for all other stages of cancer is close to 70 percent. 80 to 90 percent of women with stage 1 cervical cancer and 60 to 75 percent of women with stage 2 cervical cancer who receive treatment will be alive five years after they get diagnosed. Roughly 35 percent of women who have cervical cancer will experience recurrent disease after completing treatment.

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Cervical Cancer By Country

In the United States, 71 percent of white women diagnosed with cervical cancer have a five-year survival rate. For black women, their five-year survival rate is 58 percent. Regular screening is essential, and because of it, many cases of early-stage cervical cancers have been diagnosed and treated as early as possible.

In the United Kingdom, cervical screening saves more than 5,000 lives every year due to the prevention of cervical cancer. Cervical cancer kills roughly 1,000 women annually. In Nordic countries like Finland, Denmark, and Norway, many cervical cancer screening programs have been in place for decades.

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Epidemiology

Cervical cancer is the fourth most common cause of cancer in the world. It’s also the fourth most common cause of death from cancer in women. Last year alone, over 570,000 cases of cervical cancer were recorded along with 311,000 deaths.

This type of cancer is the second most common cause of female-specific cancer following breast cancer. About 80 percent of cervical cancer cases happen in developing countries. Cervical cancer is also the type of cancer that is most often diagnosed during pregnancy and occurs in up to 12 out of 100,000 pregnancies. In 2019, it’s estimated that over 13,000 new cases of cervical cancer will be diagnosed, and 4,250 deaths will occur.

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Treatment for Other HPV-Related Cancers

For precancerous cells found in other areas of the genitals, treatment options usually include LEEP, cryosurgery, topical medicines, and surgical excision. For HPV-related cancers, they receive the same treatment as patients who have tumors. The only difference is for those who have HPV-related oropharyngeal cancer, as they need a different kind of therapy for their growth.

There’s no need to deal with an HPV infection by yourself, either. Many people are embarrassed about it and so refuse to get it looked at, but this is the worst thing that they can do. Consulting with a doctor to see what can be done is the best course of action for everyone involved.

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