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Cervical cancer: Human papillomaviruses (HPV)

Last Update: December 6, 2012; Next update: 2017.

Human papillomaviruses, or HPV for short, are so common that most men and women will become infected at some point in their lives. These infections do not usually cause any problems. But some types of HPV can cause harmless warts, and others increase the risk of cervical cancer.

Papillomaviruses are germs that can cause inflammation and changes of the skin. Some of them only infect humans, which is why they are called human papillomaviruses (HPV). They probably get into the skin and mucous membranes through small cuts or wounds and then multiply inside the cells. HPV is transmitted by direct contact with infected areas of skin or mucous membrane. HPV infection usually goes unnoticed, does not cause any symptoms and clears up on its own.

More than 100 different types of HPV are currently known. Some cause warts on the skin (also called papillomas). About 40 types of HPV infect the skin in the genital area and are transmitted sexually. They are called “genital HPV”. Other types infect the face, hands or feet.

Genital HPV viruses can be differentiated into high-risk types (hrHPV) and low-risk types (lrHPV). Low-risk HPV can cause warts in the genital area, which are also called condylomas. Although they are often unpleasant, they are not dangerous. The most common types of lrHPV are HPV 6 and 11.

Which types of viruses increase the cancer risk?

High-risk HPV (hrHPV) types often enter the cells of the mucous membrane around the opening of the cervix, where the vagina and cervix meet. There they can cause cells to change, which can be seen under a microscope. In rare cases, these abnormal cells can develop into a cancerous tumor over the course of years. Twelve hrHPV types are known to increase the risk of cervical cancer (cervical carcinoma). HPV 16 and 18 are the main ones, and also the type of HPV that are most often detected in tumor tissue.

The mucous membrane around the opening of the cervix can be infected with several different types of HPV, sometimes high-risk and low-risk types at the same time. A woman is considered to have a higher risk of developing abnormal cells if hrHPV is found.

How does HPV spread?

HPV is very common, so most men and women who are sexually active will become infected at least once in their lives. The body’s immune system usually fights off the viruses successfully, and they disappear without having caused any symptoms. But people can get infected with HPV more than once.

The skin and mucous membranes in the entire genital area can be infected with HPV, but the infection is not always visible. This means that any intimate skin contact can lead to an infection, not only sexual intercourse. Infection through body fluids like sperm, blood or saliva is considered to be rather unlikely. But viruses might be spread during oral sex if the mucous membranes of the mouth touch areas of skin infected with HPV.

The infection rate is probably the same for women and men. But the possible consequences of the infection, like cancer, are less common in men. The risk of infection in women is highest under the age of about 30.

An HPV infection can be diagnosed directly with an HPV test. Or indirectly with a Pap test, which detects abnormal mucous membrane cells.

How can you protect yourself from HPV?

Because HPV is so common, you can already become infected with HPV the first time you have sexual contact with someone. If you wanted to protect yourself from infection, you would either have to avoid sexual contact altogether, or have a partner who has also never had sexual contact with other people.

Condoms do not offer reliable protection against HPV because they do not cover all areas of skin in the genital area that might be infected. But they can reduce the risk of infection. And condoms provide protection against many other sexually transmitted diseases.

Girls and women who have not been infected with HPV yet can be vaccinated against HPV. The vaccines can protect women from infection with certain types of HPV. In this way, the vaccination might also reduce the frequency of cervical cancer.

How does HPV affect relationships?

An infection with hrHPV only rarely causes symptoms in men or women. Because women are examined more frequently than men, they are also more likely to be tested for HPV – for example, if a Pap test detects abnormal cells in the mucous membrane around the opening of the cervix. Some women find it difficult to tell their partner about their infection. Both partners usually have HPV anyway, even in steady relationships. It is usually not possible to find out who was infected first or how long ago they became infected. But that does not affect the course of this usually harmless infection.

It is not known whether partners infect each other again and again. But research suggests that cell changes on the woman’s cervix are more likely to go back to normal again if a couple regularly uses condoms when having sexual intercourse. The reason for this might be that it is easier for the immune system to get rid of an infection if it does not have to fight against viruses again and again.

What happens if the infection persists?

Most HPV infections clear up on their own because the immune system recognizes the viruses and kills them. If this does not work, the HPV infection lasts for a longer period of time. So far there is no treatment to fight the HPV viruses themselves.

Long-term HPV infections can cause cells to change. These abnormal cells can still be destroyed by the immune system, but they might also stay or continue to develop. Depending on the type of HPV, the cells of the mucous membrane can change a lot in some people. This is called high-grade dysplasia, and might turn into cancer after many years if left untreated.

Cervical cancer is the best-known and most common type of tumor caused by HPV. But HPV can also cause tumors that grow on the external female genitals, the penis or in the anal region.

What can be done against genital warts?

An infection with low-risk HPV types like HPV 6 and 11 can sometimes cause unpleasant but harmless warts (called condylomas) in the genital and/or anal area. Both men and women are affected by these. Many of these warts cannot be seen or felt, others form hard nodules with an uneven surface. Their sizes range from just a few millimeters to several centimeters, and they may be a reddish, brownish, or whitish color. They usually appear in clusters. Depending on their size and location, they can cause symptoms like itching or burning.

Genital warts can be treated locally with a medication (an ointment or a solution), or they can be removed surgically. Individual treatment options depend on the texture and the location of the warts, and on how far they have spread.

Sources

  • Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Benefit assessment of HPV test in primary screening for cervical cancer: Final report; Commission S10-01. October 5, 2011 [Accessed on: May 16, 2012] (IQWiG reports; Volume 106).
  • Krebsinformationsdienst (KID). Gebärmutterhalskrebs-Früherkennung: Ein Abstrich bietet Sicherheit. May 11, 2010 [Accessed on: September 26, 2011].
  • Krebsinformationsdienst (KID). Humane Papillomviren als Krebsauslöser. February 2, 2009. [Accessed on: May 16, 2012].
  • McCaffery K, Waller J, Nazroo J, Wardle J. Social and psychological impact of HPV testing in cervical screening: a qualitative study. Sex Transm Infect 2006; 82(2): 169-174. [PMC free article: PMC2564695] [PubMed: 16581749]
  • National Institutes of Health. Human Papillomvirus (HPV) and Genital Warts. [Accessed on: July 26, 2012].
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