HPV

The human papillomavirus (HPV) is a highly contagious STD. Almost everyone becomes infected with HPV at some point in their lives. This is primarily due to having unsafe sex with multiple bed partners. Usually people do not get any complaints or symptoms after an infection. The body is capable of eliminating the virus on its own. When this doesn’t happen, HPV can lead to genital warts or even cancer, such as cervical cancer in women. That is why children from the age of ten are vaccinated against HPV.

The human papillomavirus (HPV) is a highly contagious STD. Almost everyone becomes infected with HPV at some point in their lives. This is primarily due to having unsafe sex with multiple bed partners. Usually people do not get any complaints or symptoms after an infection. The body is capable of eliminating the virus on its own. When this doesn’t happen, HPV can lead to genital warts or even cancer, such as cervical cancer in women. That is why children from the age of ten are vaccinated against HPV.

What is HPV?

The HPV virus is a very common virus. The virus is spread through sexual contact. HPV is an abbreviation for human papillomavirus. There are over 200 types of HPV, some of which can lead to genital warts or certain cancers like cervical cancer. The virus is highly contagious and can be transmitted through sexual contact, even when using a condom during sex. But the risk of getting HPV does get reduced when using a condom.

About 80 to 90 percent of the population will get an HPV infection at some point in their lives. An HPV infection is difficult to recognize because there are usually no symptoms and the immune system often breaks down the virus itself within two years. If this fails, the infection becomes chronic, and the virus gradually embeds itself in the DNA of the cell nucleus. In the cervix for example, where mucous membrane cells begin to deviate from normal cells and can gradually transform into cancer cells.

How do you get HPV?

The virus can be present in the vagina, penis or anus without visible symptoms. This results in unnoticed infections. Unlike other STIs such as chlamydia, condoms alone are not effective in preventing the HPV virus. The virus may be present on the skin surrounding the condom. Sometimes even on the buttocks or lower abdomen. Nevertheless, we recommend to always use a condom to reduce the risk.

Did you know? HPV is a very common virus. About 80 to 90 percent of people have had HPV at some point in their lives. Since the virus is sexually transmitted, it is a STD. However, STDs and HPV are frequently seen separately.

When the skin of an infected person’s penis, vagina, or anus touches the same body parts of another person, HPV is transmitted. Infections can also enter the body via the mucous membranes of the penis, vagina, anus, uterus, or throat. Infection is most common during sex (oral, anal, vaginal, fingering, jerking off). Touching each other, directly exchanging a vibrator or dildo, or even using the same towel can all result in an HPV infection. People with HPV are more likely to get other STDs. A regular STD test is therefore strongly recommended, also to protect previous bed partners.

Signs and symptoms of HPV

The body usually gets rid of HPV itself within two years. Most people have no symptoms during their infection. They are ‘silent’ or asymptomatic carriers of the virus. If there are any symptoms, it usually concerns genital warts on the penis, vagina or anus. They sometimes cause itching and irritation. Sometimes women experience vaginal discharge or unexpected bleeding after having sex outside of the menstrual period, or more than a year after the last menstrual period (menopause). These are fairly common complaints, so they could also be symptoms of another STDs or diseases, like chlamydia.

What are the risks?

You are more likely to contract HPV by having unsafe sex with different bed partners. There is a 50% chance of contracting HPV from unsafe sex with a bed partner who is infected. By using a condom, the risk of infection is reduced by 70%. Because HPV rarely leads to any complaints or symptoms, bed partners can infect each other without knowing it.

There are two categories of HPV: high and low risk types. Genital warts on the penis, anus, and vagina can occasionally be caused by HPV types 6 and 11, which are regarded as low risk. They typically appear between one and eight months after someone contracts the virus. Genital warts are harmless skin abnormalities that often disappear on their own. Unfortunately, this sometimes takes years. The high- risk types are HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68. These can cause cancer in the long term. In seven out of ten (positive) cases, it concerns types 16 and 18. This is quite rare, because the body is able to remove the virus itself.

Cervical cancer in women is the most frequent type of cancer caused by HPV. The cervix’s cells are attacked by the virus, which alters the structure of the cells. Fortunately, the body often knows how to clean up these abnormal cells itself. If this doesn’t happen, cancer cells can develop. Cervical cancer usually develops about 10 to 15 years after a woman has been infected with HPV. A combination of HPV and Chlamydia or HPV and Herpes increases the risk of cervical cancer.

HPV can also result in cancer in the mouth, throat, penis, anus, vagina, or labia. Michael Douglas, a well-known Hollywood actor, once developed oral cancer as a result of an HPV infection. Gay men in the Netherlands are more likely to develop AIN, the precancerous stage of anal cancer. This primarily affects people who are HIV-positive. Dutch research even shows that AIN can recur after being cured successfully, and even if someone has been vaccinated in the meantime. An HPV vaccination appears to be effective for people who haven’t previously been infected with the HPV virus.

Preventing HPV

Condoms do not prevent HPV infection, but they do reduce the risk. Vaccinating children (girls and boys) is another effective way to significantly lower the risk of infection. An HPV vaccine’s main objective is to prevent cancer. The Cervarix HPV vaccine provided to children by the National Vaccination Program protects against HPV types 16 and 18. This vaccine reduces the risk of certain types of cancer and ensures the virus spreads less quickly. The HPV shot does not protect against genital warts. This requires the Gardasil vaccine.

A vaccination is particularly helpful if someone hasn’t had an HPV infection before. That’s why children from the age of 10 have been vaccinated against HPV since 2022. In addition, children aged 12 to 18 can still be vaccinated in 2022 and 2023 via the National Vaccination Programme. The National Vaccination Program will soon start with a new campaign to vaccinate young adults between 18 and 26 years old free of charge.

The HPV vaccine contains deactivated particles of the HPV virus. It does not lead to an infection, but the body can make antibodies against HPV types 16 and 18 with these particles. Healthy cells won’t be damaged.  The vaccine does not entirely protect against HPV-related cancer. After all, additional HPV subtypes have been linked to cancer.

Women who turn thirty are invited to participate in the population screening for cervical cancer. They schedule their own smear test at their GP. When women turn 35 and 40 years old, they get a new invitation. Women from the age of 40 who do not have HPV receive an invitation every 10 years. Self-tests can be done at home by women who prefer not to have a pap smear taken at the GP. They take a swab of some mucous membrane from the vagina and a laboratory tests this mucosa for HPV. Abnormal cells in the cervix cannot be determined with a self-test (without laboratory analysis). The Health Council (Gezondheidsraad) has recommended to do more self-testing in the future.

Test yourself for HPV?

Men can’t get tested for HPV through the government if there are no complaints or symptoms. It’s best to see a doctor when genital warts first appear. Women take cells from the vaginal mucous membrane on their own. This mucous membrane is tested in the lab to see if the human papilloma virus is present. If this is the case, the general practitioner or gynaecologist will perform additional research into the unusual cells in the mucous membrane by taking a cervical smear for cell testing. Although they typically regenerate into healthy cells, these cells have the potential to develop into cervical cancer over time.

How often should you test for HPV?

An HPV test every five years starting at the age of 30 is sufficient for the average population of the Netherlands, according to epidemiological research. But, this may differ from person to person. Development of genital warts, having many different bed partners and having sexual contacts at a young age may be reasons to test for HPV more often. You may also want to test for HPV when getting into a serious, permanent relationship to gain certainty.

How does our test work?

The HPV test analyzes whether HPV material is present in the nuclei of the mucous membrane cells. This test analyses 14 different HPV types. The test has been formally approved internationally (CE IVDR) as a self-sampling method. The HPV test and the swab meet all quality requirements and will also be used as a technique in the government population screening for cervical cancer in The Netherlands from mid 2023. Testalize.me collaborates with LabPON in Hengelo, specialised in pathology and molecular research, working according to the quality standard applicable in the Netherlands (NEN ISO 15189).

Where to test?

HPV can result in genital warts or cancer. The doctor can diagnose genital warts without performing a test. The doctor checks the skin for abnormalities. A pap smear is used to check for the precancerous stages of cancer in female patients. Testing for HPV can be done at the GP, but also with a self-sampling kit. In that case, women themselves collect bodily material from home. The lab examines the body material and determines whether there may be an HPV infection. A new smear is required after a woman tests positive for HPV so that the cells can be examined under a microscope for cell changes (the classic PAP smear). This smear for cell testing is carried out at the GP. The pathology laboratory tests this new smear for abnormal cells. They may indicate a precancerous stage of cancer. In that case, additional examinations can be carried out at the gynaecologist.

In men, an HPV infection leads to cancer less often than in women. Still, there are high risk groups, such as gay men, who can get tested for changes in the tissue around the anus (AIN). These abnormalities may indicate a precancerous stage of anal cancer. Through AIN screening with a camera the doctor looks at the mucous membranes around the anus. Additionally, a tissue sample is taken to detect possible cell abnormalities.

What to do with the results?

In most cases (approx. 90%) no HPV virus will be found and the test will come out negative. With this result, it’s unlikely that you have a (precancerous) cervical cancer at that time. It’s recommended to get tested again after 5 years. Consult your doctor if you have any symptoms. In 10% of cases a type of HPV may be found. Although this does not necessarily indicate a deviation, more research into abnormal cell changes with a pap smear is necessary. In rare cases, the test results aren’t accurate. This is usually caused by insufficient cell material. The test must be repeated in that situation.

Treatment

The body typically recovers from HPV on its own. The likelihood of a cure is affected by a number of factors, including chlamydia or herpes infections, weakened immune systems, use of specific medications, frequent sex contacts, smoking and an infection of several HPV types at the same time.

There is no cure for HPV. However, there are medicines that help with conditions caused by HPV, such as genital warts. These are harmless skin defects that sometimes cause problems or are perceived as ugly. They usually disappear within two years. The GP will prescribe a cream or liquid such as podophyllotoxin, imiquimod or sinecatechin. The doctor can also remove the warts using liquid nitrogen, trichloroacetic acid or an electric loop or needle. When genital warts disappear, the virus does not. Contamination is still possible. Genital warts can also recur over time.

Women who have HPV with abnormal cells are referred to a gynaecologist. This doesn’t mean you have cervical cancer yet. The gynaecologist examines patients using colposcopy to determine the severity of the abnormal cells in the cervix. Sometimes symptoms and abnormalities will disappear over time. Possible treatments are loop excision, conization or, for example, laser treatment of the cervix or vagina.

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