HPV infection – what you should know about vaccination and treatment

The human papillomavirus (HPV) is such a common viral infection that almost everyone who is sexually active will come into contact with it at some point in their lives. But what exactly is HPV? What causes it and how can you protect yourself? Read our article and find out everything you want to know! 

What is HPV (human papillomavirus)?

According to the Centers for Disease Control and Prevention (CDC), HPV is the most common sexually transmitted infection: virtually everyone who is sexually active – regardless of gender – will have at least one HPV infection in their lifetime.

More than 100 types of HPV are known, over 40 of which are transmitted through sexual contact. As a rule, HPV is harmless and clears up on its own. Some types, however, can cause genital warts and even cancer. 

HPV infection – symptoms. How do you recognise an HPV infection?

Most people who contract the virus have no symptoms. The infection can clear up on its own without any health consequences, particularly when the immune system successfully fights off the virus. If HPV remains in the body, however, it can be contagious and the infection can be passed on. That is why it is important to treat the virus as soon as you know it is there. Here are some symptoms: 

• Genital warts (condylomas). These are lesions, swellings or stalk-like growths; they appear on the vulva, near the anus, on the cervix or in the vagina; they don't cause discomfort or pain, but they can be itchy.
• Common warts. These are hard lumps on the hands and fingers; they can cause pain, injury and bleeding.
• Plantar warts (verrucas). These are usually hard, appear on the heels and soles of the feet and cause discomfort.
• Filiform or flat warts. They look like small lesions and can appear anywhere on the body. In women, they most commonly appear on the legs.

If you notice any of these signs, you should definitely book an appointment with your doctor.

Types of HPV

So which types of HPV are there exactly – the HPV types?

Most genital HPV infections are harmless and clear up on their own. Two HPV types (types 6 and 11) cause the majority of condyloma cases and are considered low-risk types, as they do not lead to cancer or other serious health problems.

By contrast, there are 16 high-risk types, 2 of which (18 and 16) are responsible for 70% of all cases of cervical cancer. Studies also show that around 99% of cervical cancer cases are attributable to an HPV infection.

HPV types

High-risk types for the development of genital cancer: 16 and 18, 31, 33, 33, 34, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68.

Types with possible risk: 26, 30, 34, 53, 66, 67, 69, 70, 73, 82, 85 and 97.

Low-risk types: 6, 11, 28, 32, 44, 43, 44, 54, 55, 57, 61, 62, 71, 72, 74, 81, 83, 84, 86, 87 and 89.

Causes and risk factors

An HPV infection occurs when the virus enters the body – usually during sexual intercourse. There are, however, risk factors you should be aware of:

• Number of sexual partners: while it isn't a hard and fast rule, having a large number of sexual partners can increase the risk of HPV infection. Regardless of the number of partners, though, the risk is there as soon as you are sexually active (even with just one partner).
• Age: common warts occur most frequently in children, while genital warts mainly affect adolescents and young adults.
• Immune system: if it is weakened, if you are receiving treatment that affects it, following a transplant or if you have an HIV infection.
• Skin injuries: scratches, lesions or wounds on the skin's surface, which may be more susceptible to HPV infection 

Direct contact with other people's lesions or warts, as well as touching surfaces that have come into contact with HPV – for example in public showers or swimming pools.

How is the HPV virus transmitted?

HPV affects the mouth, throat or genital area. Sexual contact is therefore not the only route of transmission. In fact, the virus can be transmitted via a cut, a graze or simply through skin-to-skin contact.

What's more, a person with HPV can pass the infection on even if they have no symptoms. You can catch HPV through:

• any skin-to-skin contact in the genital area
• vaginal, anal or oral sex
• sharing sex toys

Symptoms may only appear years after contact with the virus, which makes it difficult to determine the exact source and timing of the infection.

The HPV virus in women

In most cases, women have no symptoms. Sometimes, however, lesions can be found in the vagina, on the vulva or around the anus. A gynaecological examination is essential if you notice any such changes – and the simplest way to prevent complications is to have regular gynaecological check-ups.

The HPV virus in men

As with women, most cases are symptom-free, although warts sometimes appear on the genitals. Some types can lead to cancer (of the penis, anus or throat), and a weakened immune system makes infection more likely. 

The types of HPV that men can contract are the same as those affecting women.

 The HPV virus in pregnancy

If you contract the virus during pregnancy, symptoms may appear on the cervix. That is why routine cervical cancer screening is recommended: it can also be carried out during pregnancy, although doctors advise waiting until after the birth to begin treatment. 

In some cases, an HPV infection can lead to complications during pregnancy or delivery; in rare cases, the virus can be passed to the baby.

 How HPV infection presents

Current studies estimate that 14 million people contract HPV each year. The infection can also present in very different ways: some HPV types cause lesions in the vagina or on the cervix that are only detected through screening. In other cases, warts appear. Let's take a closer look!

Condylomas – genital warts

Condylomas, or genital warts, are growths on the vulva or near the anus; in men they can appear on the penis, the scrotum or around the anus. They are painless but can cause itching. 

Warts 

Warts can be divided into three types: common warts, plantar warts and flat warts.

• Common warts: small skin growths with a rough, irregular surface that can spread. They most commonly appear on the fingers and hands and can also develop beside or under the nail. They can be painful to the touch.
• Plantar warts or verrucas: these grow on the sole of the foot, particularly on the heel. They are usually painful.
• Flat warts: these can develop on the face, arms, hands or legs. They generally have a smooth surface and are therefore harder to spot. In women, they most commonly appear on the legs.

The difference between HPV and HIV

HPV is not the only infection transmitted sexually. HIV can also be passed on in this way, but medically speaking there is no connection whatsoever between the two. So you shouldn't confuse HIV with HPV. HIV is the human immunodeficiency virus and is an RNA virus – unlike HPV, which is a DNA virus. 

In addition, HIV is primarily transmitted via blood or bodily fluids during sexual intercourse, whereas HPV is transmitted via the skin, mainly through grazed areas of skin or during sexual intercourse.

Diagnosing HPV

How can you tell whether you have an HPV infection? There are several diagnostic methods:

• a physical examination and appropriate investigations
• the smear test (Papanicolaou test)
• colposcopy
• the HPV test
• cervical biopsy

Physical examination

A doctor can make the diagnosis through a simple physical examination if they identify changes to the skin or mucous membranes. They may also recommend further investigations, such as a smear test. 

The smear test

The gynaecologist takes a sample from the cervix for a smear test – a method of detecting cell changes when there are no visible warts or other physical symptoms. 

Colposcopy

This examination is also carried out by the gynaecologist: the cervix is examined using a special solution that makes HPV-infected cells visible. 

The HPV test

HPV genotyping is carried out when there are no visible symptoms and involves analysing a swab sample. It is similar to the smear test, so the gynaecologist can perform both tests at the same time. This test can detect the DNA of the high-risk types. 

Cervical biopsy

Depending on the results of the standard HPV tests and examinations, the gynaecologist may recommend further investigations. One of these is a cervical biopsy, to detect pre-cancerous or cancerous cells on the cervix.

HPV treatment

An HPV infection can clear up without treatment – simply through the work of your immune system. If the symptoms are bothering you, however, or if they trouble you for cosmetic reasons, the warts can be removed.

How do you get rid of HPV warts?

Warts can be removed at the patient's request or if they contain pre-cancerous cells. There are various methods and procedures for this. Firstly, there are topical medications that you apply directly to the lesions as treatment. These products can, however, have side effects and cause irritation. Other methods for removing warts include:

• laser therapy
• electrosurgical excision
• cryotherapy
• electrocautery

HPV complications

Not all types of HPV lead to complications or cancer, but lesions caused by high-risk HPV types can develop into cancer over time. 

Cervical cancer, for example, is the most common type of cancer associated with HPV infection. Unfortunately, the complications only cause symptoms at advanced stages, which makes treatment more difficult. This makes it all the more important to have regular gynaecological check-ups and smear tests.

Cervical and vaginal cancer

Cervical cancer caused by HPV is the fourth most common cancer in women worldwide. In the UK, thanks to NHS cervical screening and HPV vaccination, it is now one of the less common cancers: it ranks 14th among cancers in women, with around 3,300 new cases a year (Cancer Research UK).. Age is not a rule, however – the disease can occur at any time and considerably earlier.

How is the diagnosis made? A cervical biopsy is required, as is a clinical examination along with endoscopic and imaging procedures: X-ray, CT, MRI, cystoscopy and other specialist investigations.

But that is not the only cancer caused by the virus. Another is vaginal cancer. It occurs more frequently in people over 60; the most common symptom is unusual bleeding.

 Tests and tips for preventing HPV infection

Fortunately, you can significantly reduce your risk of HPV infection – it all starts with an open conversation between you and your doctor and an awareness of these risk factors. What can you do to prevent infection?

• Use a condom during sexual intercourse. Although it doesn't cover the entire genital area, it is an effective way of protecting against HPV transmission
• If you notice warts in the genital area on yourself or your partner, avoid sexual contact until they have been removed or treated
• Follow basic hygiene measures such as washing your hands and not sharing personal items
• Protect and strengthen your immune system with a balanced diet
• Have regular smear tests

"Cervical cancer is one of the leading causes of death in women. In 2020, around 604,000 women worldwide were diagnosed with cervical cancer and approximately 342,000 women died from the disease." (Source)

HPV vaccination

Fortunately, there are safe ways to protect yourself: the HPV vaccine – for both girls and boys – is considered the best protection against HPV-related cancers. 

How long does the HPV vaccine protect you for?

If the HPV vaccination is given before puberty, it can offer long-term protection without the need for a booster. The evidence base continues to develop, however, and the duration of protection is being studied according to the type of vaccine. Protection can last up to 10 years with Gardasil, 9 years with Cervarix and at least 6 years with Gardasil 9, for example. 

 You should be aware, though, that the vaccine becomes less effective with increasing age – and particularly if you have already had an HPV infection.

How many types of HPV vaccine are there?

The NHS offers one HPV vaccine, Gardasil 9, which protects against nine types of HPV.

The vaccine types are Gardasil, Gardasil 9 and Cervarix:

• All of them protect against infection with HPV types 16 and 18
• Gardasil also protects against infection with HPV types 6 and 11 (these cause 90% of vaginal warts)
• In addition to the types listed above, Gardasil 9 also protects against 5 further cancer-causing HPV types (31, 33, 45, 52 and 58)

Up to what age can you have the HPV vaccine?

Although vaccination as early as possible is recommended ,anyone who missed it at school can still have it free on the NHS from their GP until their 25th birthday; after that it can be had privately, and gay, bisexual and other men who have sex with men can get it free at sexual health clinics up to the age of 45. The HPV vaccine is not recommended for all adults in this age group, however – so it's well worth speaking to your doctor if you are between 26 and 45 years old. 

Effectiveness of the HPV vaccine

Current studies show that HPV vaccination reduced infections by 70% within 1–4 years of vaccination and by 83% within 5–8 years of vaccination.

Side effects of the HPV vaccine

Like any other vaccine, the HPV vaccine can have side effects. These are mild reactions: fever, nausea, headache and dizziness; the injection site may also be sore. In some people, however, severe allergic reactions can occur – so check with your doctor about any contraindications that might apply depending on your allergies. 

How safe are HPV vaccines?

Over the past 12 years, research into and monitoring of HPV vaccines worldwide has shown that the vaccines are effective and safe: more than 120 million doses of HPV vaccine have been administered.

Contraindications for the HPV vaccine

There are 2 main contraindications:

• If you are pregnant, vaccination must be postponed until after the pregnancy. If you have already been vaccinated, however, this is not a reason to terminate the pregnancy.
• If you have severe allergic reactions to any component of the vaccine, including yeast or latex.

The HPV vaccine and the national immunisation programme

In the UK, the Joint Committee on Vaccination and Immunisation (JCVI) advises HPV vaccination, and the NHS has offered it free to girls since 2008 and to boys since 2019, as a single dose in school year 8 (aged 12 to 13). What does that mean?

The HPV vaccine is free on the NHS and uses Gardasil 9: it is offered to everyone in school year 8 (aged 12 to 13) as a single dose. Speak to your doctor – and if you need any further information, drop us a line!