HPV — what vac­ci­na­tion is all about

Human papil­lo­ma virus­es, or HPV for short, are among the most com­mon virus­es trans­mit­ted through inti­mate con­tact. To date, more than 200 types of virus are known. Some of these virus­es are respon­si­ble for the for­ma­tion of benign gen­i­tal warts, oth­er types are sig­nif­i­cant­ly involved in the devel­op­ment of cer­vi­cal can­cer and oth­er types of can­cer of the vul­va, vagi­na, anus, the orophar­ynx or the penis. That’s right, the virus can also pose a can­cer risk in men.

Risk of contagion

Human papil­lo­ma virus­es (HPV) are wide­spread. They are pathogens that can cause inflam­ma­tion and skin changes. Some only occur in humans. They are there­fore called human papil­lo­ma virus­es (HP virus­es or HPV). They pen­e­trate the skin or mucous mem­brane, pre­sum­ably through small cracks or injuries, and mul­ti­ply there inside the cells. HP virus­es are trans­mit­ted through direct con­tact with affect­ed areas of the skin or mucous membranes.

Almost all peo­ple become infect­ed with HPV at some point in their life. Girls and boys as well as women and men can be affect­ed. Human papil­lo­ma virus­es are trans­mit­ted from per­son to per­son through direct con­tact. The infec­tion does not occur through body flu­ids such as blood, semen or vagi­nal flu­id, but through skin and mucous mem­brane con­tact, i.e. direct con­tact with infect­ed skin and mucous mem­brane areas. Trans­mis­sion in a non-sex­u­al way is also pos­si­ble, but rarely occurs. An exam­ple is trans­mis­sion from moth­er to child at birth. Con­ta­gion with­out con­tact with the mucous mem­brane does not seem to be possible.

The dif­fer­ent types of HPV influ­ence the risk of can­cer. Cer­tain types of HPV often set­tle in the cells of the mucous mem­brane on the cervix, in the tran­si­tion area between the vagi­na and the cervix. Here they can lead to tis­sue changes (dys­plasias). A malig­nant tumor can devel­op from a tis­sue change over the years. How­ev­er, that rarely hap­pens. Twelve types of virus are con­sid­ered cer­tain to increase the risk of can­cer of the cervix (cer­vi­cal can­cer). The most impor­tant are HPV 16 and 18. They are also most com­mon­ly detect­ed in tumor tissue.

Ear­ly can­cer detection

Cer­vi­cal can­cer is the fourth lead­ing can­cer and the fourth lead­ing cause of can­cer death in women, with an esti­mat­ed 604,000 new cas­es and 342,000 deaths world­wide in 2020. The goal of can­cer screen­ing tests is to iden­ti­fy can­cer before it devel­ops or before it becomes uncomfortable.

Can­cer screen­ing for cer­vi­cal cancer

Every woman between 20–34 years in Ger­many can go to the gyne­col­o­gist once a year free of charge for ear­ly can­cer detec­tion, i.e. for exam­i­na­tion for cer­vi­cal can­cer and its pre­lim­i­nary stages. From the age of 35, women are offered a com­bined exam­i­na­tion (co-test­ing), con­sist­ing of a Pap smear and an HPV test, every 3 years.

Pap test

The so-called “Pap test”, a cell swab from the cervix, is the most impor­tant exam­i­na­tion for ear­ly can­cer detec­tion. The aim of this inves­ti­ga­tion is to detect cell changes in the cervix. This increas­es the chance of iden­ti­fy­ing and treat­ing pre­can­cer­ous lesions — even before cer­vi­cal can­cer develops.

HPV test

In addi­tion to the Pap test, the HPV test can also be used for the ear­ly detec­tion of cer­vi­cal can­cer. With the HPV test, pos­si­ble can­cer pre­cur­sors may even be bet­ter dis­cov­ered. An HP virus test (HPV test) can be used to find out if a woman is infect­ed with HPV and there­fore at increased risk of devel­op­ing cer­vi­cal can­cer. How­ev­er, the HPV test itself can­not detect cell changes. There­fore, if the result is abnor­mal, the Pap test and pos­si­bly fur­ther exam­i­na­tions are necessary.

Treat­ment options

Treat­ment for cer­vi­cal can­cer depends on the stage of the tumor. In the ear­ly stages, a small oper­a­tion (coniza­tion) is often suf­fi­cient and / or oth­er fer­til­i­ty-pre­serv­ing oper­a­tions such as tra­ch­elec­to­my (removal of the cervix and sur­round­ing tis­sue) are pos­si­ble. A major oper­a­tion (rad­i­cal removal of the uterus and the lymph nodes in the pelvis) is nec­es­sary if the tumor is already larg­er and may have spread to the sur­round­ing tis­sue. Here, the pro­tec­tion of the blad­der and intesti­nal nerves is of great relevance.

So far, there is no treat­ment that can fight HP virus directly.

Vac­ci­na­tion is the best prevention

Vac­ci­na­tions can offer pro­tec­tion against cer­tain infec­tious dis­eases and have led to dis­eases such as polio no longer occur­ring in Europe. HPV is wide­spread and can lead to cer­tain pre­can­cer­ous stages and can­cer, among oth­er things. There are around 60,000 cas­es of HPV-relat­ed cer­vi­cal can­cer pre­cur­sors and around 7,000–8,000 can­cers in women that are caused by HPV each year. Vac­ci­na­tion against HPV can pro­tect against the pos­si­ble con­se­quences of infec­tion with cer­tain types of HPV. The experts of the STIKO (Stand­ing Vac­ci­na­tion Com­mis­sion) rec­om­mend vac­ci­na­tion for girls and boys between 9 and 17 years, ide­al­ly before a pos­si­ble infec­tion with HPV.