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.