Human papillomavirus (HPV)

What is it about ?

These are a group of viruses that can infect the skin and walls around the anus and genitals of both men and women and cause warts genitals (condylomas). They can also infect the mouth or throat. Lesions may be benign, but they can also develop into early cancers. HPV infection is spread through intimate or sexual contact. There are over 100 different types of the virus, most of which are harmless. There are only a few types of HPV that cause cancer.

Where and how often?

Human papillomavirus (HPV) infection is common. Three in four people will get it in their lifetime. It is usually caught between the ages of 20 and 25. Infection is more common in people who have weakened immune defenses, such as infection with HIV, chemotherapy, taking medicines that decrease immunity, or in the elderly. Most infections will go away on their own. In Belgium, in 2017, 622 new cases of cervical cancer were registered. Of all cancers that appear in women, about one in 50 cancers is cervical cancer. In 2017, this cancer occupied the 13^e position in the ranking of the most frequent cancers in women.

How to recognize it?

Most infections are symptomless and heal on their own. The virus can remain present for years without causing symptoms. The most common sign is the presence of warts on the penis, the lips of the vulva and around the anus (condyloma). If these lesions extend into the conduit for urination (urethra), it may be painful when passing urine or even blood in the urine. Precancerous lesions can also develop on the walls of the vagina and on the cervix. These are unfortunately not visible from the outside.

How is the diagnosis made?

The doctor can easily see the warts genitals (condylomas) to the naked eye. For lesions of the cervix, a smear to determine if they are precancerous lesions. If the first smear finds abnormal cells, the doctor will do a second smear. If the result remains suspicious, the doctor will take a piece of tissue (biopsy) to examine it under a microscope. By applying diluted vinegar (acetic acid) to the cervix, some lesions will turn white, which can help the doctor identify where to take the biopsy. A biopsy is also done on warts that do not heal after treatment and on lesions that look like a mole.

What can you do ?

If you or your partner notice warts on the genitals, around the anus or in the mouth, see your doctor. Don’t wait for it to pass. The warts could get bigger, and you (or your partner) could also have precancerous lesions in the cervix.

HPV vaccination is offered free of charge to adolescents between 12 and 18 years old in the Wallonia-Brussels Federation to help prevent cancers caused by HPV. This mainly concerns cancer of the cervix but also other cancers in the genitals, anus, mouth and throat. Vaccination is most effective if it is done before the adolescent has come into contact with the virus. Since contamination is possible through intimate and sexual contact, vaccination is started as soon as possible. The complete vaccination consists of 2 or 3 injections into the arm over a period of 6 months.

The vaccine does not cure. It does not diminish existing lesions. It also does not protect people who are already infected against developing cancer.

All women between the ages of 25 and 64 can take a smear free for screening cancerous or precancerous cells. This smear should ideally be done every 3 to 5 years. To do this, you can simply go to your general practitioner. There is no need to take the exam every year. The smear is still absolutely necessary, even if you are vaccinated. It is indeed not possible to completely prevent the transmission of the virus. An HPV test can be done in addition to the smear. This test can directly detect the virus in the cervix. The big advantage of this test is that it only needs to be done every five years and women can do it on their own, without anyone’s help. In Belgium, however, the HPV test is not yet reimbursed as a means of screening (it is reimbursed if smear abnormalities are discovered).

Wearing a condom does not offer complete protection against HPV, but it decreases the risk of contamination by 70% and therefore clearly has a usefulness. Not to mention that it also protects against other sexually transmitted infections (STIs), and, if used correctly, from the risk of unwanted pregnancy.

What can your doctor do?

The warts genitals (condylomas) are usually treated topically with cream, laser or cold burn (cryotherapy). Larger warts can also be removed surgically.

Since genital warts signal HPV infection, a smear is done to detect the presence of lesions on the cervix (unless a smear has already been done in the past 12 to 24 months). If the smear is normal, there is no need for treatment, as the infection usually clears up on its own. However, if the doctor finds any atypical or suspicious cells, he will refer you to a gynecologist for an exam that shows the cervix (colposcopy) and to remove a piece of the lesion (biopsy). In the presence of highly precancerous cells or cancer, a conization will be performed in the cervix. This intervention, carried out by means of a laser or a small metal wire crossed by an electric current (diathermic loop), consists in removing part of the cervix in the shape of a cone. From smear control will be planned thereafter.

Want to know more?

• Screening for cervical cancer: simple and effective – mongeneraliste.be – SSMG – Société Scientifique de Médecine Générale
• Screening for cervical cancer (smear, colposcopy) – Fondation contre le cancer
• Colposcopy – Erasme ULB Hospital
• General gynecology exams – UZ Brussels

• Cervical cancer – Foundation against cancer

• Human papillomavirus (HPV) infections – Vaccination-Info.be
• Sexually transmitted infections – Loveattitude.be
• The external condom – Mon Contraceptif – O’Yes
• For the vaccine, I hesitate … Is it serious doctor? – Health question

Sources

• Foreign clinical practice guide ‘Human papillomavirus (HPV) infection’ (2000), updated on 08.10.2017 and adapted to the Belgian context on 12.10.2017 – ebpracticenet
  
• Cancer figures – the Cancer Registry Foundation
• CBIP – Belgian Center for Pharmacotherapeutic Information