Twenty questions about Human Papilloma Virus (HPV):

1. What is an HPV test and how is it performed?

– It is a test that is performed in a similar way as the Pap test. In our office, the test is performed by a gynecologist. She approaches the cervix by carefully placing a speculum in the vagina as you lie on the examination table. The material from the cervix is gently taken with a special stick. The collected material is sent in a special bottle to the laboratory where it is analyzed in virus detection machines.

2. Does the Pap test show the presence of the HPV virus?

– No, HPV is not visible on Pap smears. However, a Pap test can show us cellular changes caused by the presence of a virus.

3. What is the difference between a Pap test and an HPV test?

– A Pap test shows if there are changes in the cells of the cervix, but does not tell us if the virus is present, while an HPV test shows us if the virus is present, but does not tell us if there are cellular changes.

4. Can HPV be detected in the blood?

No, there are no specific blood tests for HPV in current practice.

5. Why is the HPV test important?

HPV has been identified as a cause of cervical cancer (in 100% of cases), vulvar cancer (40%), vaginal cancer (91-94%), anal cancer (88-94%), oral cavity and throat cancer (25%). HPV is thought to be responsible for 5.2% of all cancers in the world.

If we know that a woman is negative for the presence of HPV in a sample from the cervix, then we know that that woman currently does not have the possibility of developing cervical cancer.

6. Does it matter which HPV type I have?

– It does matter. There are over 100 different types of HPV. Most of them do not cause cancer. At least 80% of women are exposed to the HPV during their lifetime, and in most of them, the body’s immune system will get rid of the virus before it causes damage.

Researchers have identified HPV types as those with a high or low risk of causing cervical cancer.

● Low-risk HPV types: 6, 11, 42, 43 and 44 – rarely cause cervical cancer.
● High-risk HPV types: 16, 18, 31, 33, 34, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68 and 70 – Although most women infected with high-risk HPV types do not develop cancer , women who have tested positive for high-risk HPV for many years have a higher risk of cervical cancer. HPV types 16 and 18 are responsible for about 70% of all cervical cancers.

7. How is HPV transmitted?

– HPV is transmitted by direct skin-to-skin contact (sexual intercourse, oral sex, anal sex, hand-to-genital contact). It is not possible to become infected with HPV by touching an object, such as a toilet bowl.

8. Does HPV pass through a condom?

Since the virus is quite small, it has the ability to pass through a condom. The use of condoms will reduce the amount of HPV that will come in contact with the cervix, and thus a woman has a better chance of “fighting” this infection. So it makes sense to use a condom even though it doesn’t protect us 100%.
Most women will be exposed to the HPV virus during their lifetime. The presence of HPV does not mean that a woman will get cervical cancer.

9. What are the symptoms of HPV infection?

– Most people who are infected with HPV have no signs or symptoms of infection.

10. How is HPV treated?

– There is no medicine to cure HPV. Modern medicine has drugs against bacteria (antibiotics), but there are none that destroy viruses. That is why it is so important to prevent infection and to do regular tests that early detect changes caused by the virus.

11. What changes in the cervix does HPV cause?

– Most HPV infections are temporary and resolve within two years. The body’s immune system will get rid of the virus before it causes damage. If the infection continues to exist, which occurs in 10-20% of cases, there is a chance of developing precancerous lesions and then cancer. However, it usually takes 3 to 15 years for an HPV infection to cause cervical cancer.

Precancerous lesions are also called cervical dysplasias or cervical intraepithelial lesions (CIN). There are those at low risk for developing cancer (referred to as L-SIL or Low-grade squamous intraepithelial lesion) and those at high risk (H-SIL or High-grade squamous intraepithelial lesion). So, precancerous lesions are changes that can, if left untreated, turn into cancer. You can find more details about them and their treatment here.

12. Is HPV infection a barrier to pregnancy?

– The presence of HPV infection does not endanger fertility or pregnancy. Cesarean delivery is not necessary, unless there are viral lesions that disrupt the birth canal.

13. How should I treat my partner after learning that I have HPV?

– It is advisable to inform your partner that you have HPV and use protection during sexual intercourse. Partners who have been in a stable relationship for some time have probably become infected without knowing it, even if they have no symptoms. Although it is possible to test HPV in urine and semen in men, these tests are not accurate enough and can be negative even in the presence of infection. Having HPV does not mean that the partner has had sexual intercourse outside of a relationship. There is no way to know when the HPV infection occurred and who first got the virus. The infection could have occurred many years before the clinical diagnosis (and long before the relationship began).

14. What increases the chance of getting HPV?

• Because HPV is transmitted through sexual contact, more sexual partners are associated with an increased risk of cervical cancer.
• HPV can pass through a condom, but its use reduces the number of viruses that come in contact with the genitals.
• Smoking can increase the risk of cervical cancer by up to four times, as well as a damaged immune system.

15. Is there a vaccine that prevents HPV infection?

Yes. There are 3 different HPV vaccines on the market:

• nine-valent HPV vaccine (Gardasil® 9, 9vHPV),
• tetravalent HPV vaccine (Gardasil®, 4vHPV) i
• bivalent HPV vaccine (Cervarix®, 2vHPV)

Each of them protects against HPV infection types 16 and 18, which are responsible for the development of 70% of cervical cancers. The four-wave and nine-wave vaccines also protect against HPV types 6 and 11, which cause most cases of genital warts (condyloma). The nine-valent vaccine also contains an additional five types 31, 33, 45, 52 and 58 which are also causes of cervical cancer.

16. Who should be vaccinated?

– Different countries have different vaccination recommendations in terms of to whom and when vaccination is recommended.

In Greece, the HPV vaccine is recommended for girls aged 12 to 15, as well as for girls or young women aged 15 to 26 who have not been vaccinated before. It provides the best protection if performed before the start of sexual life. Vaccination is performed with three injections given over a period of six months.

17. Am I relieved of the need for a Pap test when I receive the vaccine?

– HPV vaccines, acting only against certain viral genotypes, do not provide complete protection, but successfully protect against the most aggressive viruses that cause the largest number of cervical cancers. Since they do not provide complete protection, the Pap test should be done regularly even by women who have been vaccinated.

18. Are HPV vaccines safe?

– Many years of experience have shown that these vaccines are safe, that they have not caused significant harmful effects and that they are extremely effective.

19. Can we treat precancerous lesions and cervical cancer by giving HPV vaccines?

– Research has not shown that the HPV vaccine has a therapeutic effect. That is why we use it exclusively in primary prevention.

20. Will cervical cancer be a rarity in the future in vaccinated countries?

-Vaccination against HPV is considered a great “strategy for the protection” of future generations against cervical cancer. The best example is Australia, which reduced the incidence of HPV in the general population from 22.7 to 1.1% over a period of 10 years. In that way, mass immunization created group immunity and minimized the risk of diseases.