General Information

HPV, human papillomavirus, is the name of a group of viruses that infect the skin and mucous membranes. There are more than 100 different types of HPV. Some cause no symptoms, others cause warts on the hands, and some on the genitals. Between 30 and 40 types of HPV can be transmitted through sexual contact. Some of these viruses can cause cellular changes in the cervix (which can be detected by colposcopy and Pap smear) and lead to local cancer.

HPV Transmission

Transmission occurs predominantly through sexual contact, but there is a possibility of vertical transmission (mother/fetus), and very rarely contagion through objects contaminated with HPV.

Once HPV invades a cell, the infection is established and the virus can be transmitted. It can take months to years for a skin lesion to appear and allow a diagnosis, making it very difficult to determine which partner was infected.

This is why periodic gynecological exams are important, in order to identify and treat these cellular changes early.

Most HPV infections in women are temporary and of little significance; 70% disappear within 1 year.

If the infection is persistent, it may cause precancerous lesions in the cervix and very rarely in the penis. Currently, HPV has also been identified in oropharyngeal tumors.

Approximately 14 million new cases of sexually transmitted HPV occur annually in the United States, and it is estimated that 79 million people are currently infected with the virus.

Most people infected with HPV do not know they are carriers of the virus.

It is one of the most frequent sexually transmitted infections; it is estimated that 80% of the sexually active population has had HPV at some point in their lives. Around 79 million people (men and women) are believed to have HPV at this moment (counting only the United States). A female college student with a different sexual partner each year for 4 years has an 85% chance of having HPV by the end of her course.

Facts

HPV can infect anyone who has had a sexual encounter.

Transmission is through skin-to-skin contact, not through bodily secretions.

Most of the time the virus is indolent (causes nothing), and most people have no symptoms. The human body is responsible for eliminating most HPV infections naturally.

HPV can infect a partner, remain dormant for a long period, and later be transmitted unknowingly to another sexual partner, such as a spouse,

years later

Certain types of HPV, known as high-risk types, can cause cervical lesions (in the cervix) in women that, without treatment, can develop into local cancer. Most women with HPV infection will not develop cervical cancer, but regular exams are very important.

Cervical cancer normally takes 10 to 20 years to develop, so even women who are no longer sexually active should continue their routine exams.

If HPV infection is persistent in women over 30 years of age, the risk of tumor is greater.

The exam known as the Pap smear, together with tests for HPV viral DNA (such as hybrid capture / PCR), can detect virtually all precancerous lesions, which should be treated early.

Vaccines

There are 2 HPV vaccines on the market: Gardasil (for viruses 6, 11, 16, and 18) and Cervarix (viruses 16 and 18). Viruses 16 and 18 cause the majority of tumors, and viruses 6 and 11 cause 90% of genital warts.

The vaccine does not act on or treat existing infections. The primary indication is for people, men and women, who have never been infected by HPV, therefore before the beginning of active sexual life. It has been used with less evidence for patients with recurrent lesions.

Diagnosis in Men

Genital warts caused by HPV have a very characteristic appearance and allow a presumptive diagnosis. These lesions can and should be treated with simple cauterizations, laser ablation, or cryotherapy, for example. They can appear on the penis, in the urethra, in the scrotal and pubic region, and in the oral (lips, mouth, vocal cords, etc.) and peri-anal regions.

When it is necessary to establish an HPV diagnosis and identify whether the type is high-risk for tumors, identification of the virus's "genetic signature" should be performed with tests such as hybrid capture or PCR (polymerase chain reaction). This is indicated when the patient has a steady partner, who should be informed of the diagnosis for eventual treatment.

If there are no identifiable lesions to the naked eye, peniscopy should be performed, an exam in which the penis is examined with 25x magnification after local application of acetic acid (which makes HPV-caused lesions appear whiter, facilitating their identification). If a suspicious lesion is found, a biopsy is performed and the virus is identified, or if there are no suspicious lesions, a "brushing" is performed on the balanopreputial mucosa (penis) and in the navicular fossa (urethra), which is examined and the "genetic signature" of the HPV virus is sought.

Only lesions identified/characterized in the man should be treated. A patient without lesions should be observed (not treated) and followed up later (in case the sexual partner has an identified lesion).

Recommendations

Remember that the use of condoms is an indispensable preventive measure for all other sexually transmitted infections as well. Prevention with condom use is not total, since there may be lesions at the base of the penis/scrotum, regions not protected by the condom. HPV can be transmitted during oral sex.

Normal delivery is not indicated when the pregnant woman is a carrier of HPV with active genital lesions.