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Human papillomavirus infection guide for people – HPV

Human papillomavirus (HPV) infection is the most common sexually transmitted disease. This infection is the main cause of cervical cancer.

This article will discuss what HPV is, its symptoms, and the risk factors that can make you more prone to get it.

Another critical subject that will be discussed is its relation to cancer and how to prevent it. Continue reading to get all the information you need directly from a doctor.

What is sexually acquired human papillomavirus?

Human papillomavirus (HPV) is one of the most frequent sexually transmitted infections. It affects almost all people who have sexual relationships at one point in their lives if they don’t have adequate prevention measures or vaccination.

Both men and women can get this disease, but the number of infections is higher in women. In most people, it does not cause any serious issues, but in some, it can lead to skin bumps called warts and several types of cancer.

Although this is a sexually transmitted infection, unlike many of them, this disease doesn’t transmit through blood while having intercourse. Instead, it is by infecting the epithelial cells of the organ which has the HPV infection.

What are epithelial cells?

The epithelial cells are the lining of the organs or the ones that are in direct contact with the outside surface, serving as a defense mechanism. There are different types of epithelial cells throughout the whole body, as each has diverse functions and handles different types of threats.

The epithelium or lining of the vagina is nonkeratinized stratified, and squamous. This means there are living cells in direct contact with the exterior. This epithelial pattern is also present in the mouth, esophagus, and other predominately mucous parts of the body.

Another type is a keratinized stratified squamous epithelium, meaning the outside layer is not made of living cells. A prime example of this one is the largest organ in our body, the skin. Both types can suffer from an HPV infection having similar and other different consequences. 

The people who this disease affects the most are young people like adolescents and young adults. Some professionals link this fact to the decrease in risky sexual behavior as people get older. Therefore, this latter population suffers less.

Others associate that fact with an effective immune response to the virus in older people, as they fought it previously. Either way, a large part of the population is continually at risk of contracting the virus.

Are there different types of human papillomavirus?

Yes, there are, in fact, approximately more than 100 known types of Human papillomavirus. Doctors know the complete genetic sequence of about 80 of these different subtypes.

One of the main reasons to know this information is that different types infect distinct places on the body. Some varieties have a preference over nonkeratinized stratified squamous epithelium. At the same time, others tend to infect keratinized stratified squamous epithelium.

This means a mouth or oral HPV infection can happen in the oral cavity, causing lesions within it and similarly in the vagina. And others would predominantly affect the skin. Not only does HPV have a high affinity for these types of epithelium but also specific places of the body depending on the virus type.

Viruses damage cells by getting into them and replicating inside, changing their DNA. In this case, the Human papillomavirus infects the cells by disrupting the skin to skin contact of the tissue. It slowly replicates in the layers underneath the tissue. As it comes up to the epithelium, it replicates faster. This faster replication leads to a distortion of the shape of the epithelium and makes it more contagious.

Which carries more or less risk?

Another important reason to know this information is that there are different types of HPV. Notably, the type can define the infection’s severity. The HPV types 6 and 11 have a very low risk of forming malignant processes, as they are usually benign. This is because the virus replicates unconnectedly from the nucleus of the cell, reducing mutations on these. 

On the other hand, HPV types such as 16 and 18 are high-risk HPV types since they predispose people to form malignancies or cancer. This happens because these types use the DNA inside the cell’s nucleus to replicate, generating mutations. Studies show that in these higher-risk subtypes of HPV, viruses can reduce tumor-suppressing proteins that healthy cells produce.

What are the symptoms of human papillomavirus infection?

Most of the time, HPV infection doesn’t cause symptoms, and if so, it will depend on the place the infection occurs.

The disease classification is into three main clinical categories, also correlating them to the HPV DNA; anogenital disease, mucous nonanogenital disease, and nongenital cutaneous.

This infection’s main sign is skin bumps, which receive the name of warts by the medical community. Also, several other skin lesions exist with specific characteristics, and their location would vary depending on the strain and source of the infection.

It is important to note that genital warts could have three different outcomes. Firstly and without any treatment, they could go away. Secondly, they could remain the same without any change. Finally, these lesions could increase in size and become even more bothering. Luckily, more than half of the patients with warts located somewhere else than the genitals will see a regression of them like in the hands, although new ones could appear.

Anogenital and mucous nonanogenital disease.

The anogenital Human papillomavirus infection could involve the vagina, vulva, near the anus region, and the penis’ shaft. Similarly, the mucous nonanogenital disease could involve either the mouth, throat, esophagus and/or respiratory airways.

As we can see, all these different places in the body might produce some diverse symptoms. HPV infection manifests through several types of bumps, and each one of them with its own characteristics, in most cases where the patient does have symptoms. They predominantly have itching in those bumps, although pain is also possible.

This itchiness can also lead to bleeding since the patient scratches in places where the lesions are. Another prominent symptom is difficult to breathe and/or swallow if there are lesions on the mouth or throat. The mouth could have Verruca Vulgaris, a particular lesion on this place which has various, white and sharp edges. These are not always easy to identify since they don’t look as characteristic for a non-medical person.

File:Feigwarzen.jpg
Shaved base of a penis, with genital warts
Source

Nongenital cutaneous HPV.

Nongenital cutaneous HPV infection means it affects the skin, especially in the hands and feet. Also, it affects the fingers and knees. There are warts in this disease form, small bumps, usually with the same skin color, and they spread by touching.

Plantar warts are a very common type, and they cause discomfort or even could bother when walking, depending on the size. The virus can resist without a host for many hours and in cold temperatures. This meaning a person with plantar warts can leave the virus on the floor when walking barefoot and be contagious. Hence, they spread the virus to other people.

Large plantar warts
Source

These warts on the feet and hands most of the time causes an aesthetic embarrassment to the person. Physical symptoms are not common, but it leads to anxiety in patients due to the disease’s social stigma.

What are the signs and symptoms of genital HPV infections?

Genital HPV infection is the most common form of a papillomavirus infection since it is a sexually transmitted disease.

Condylomata acuminata is a very characteristic lesion of this disease, in which warts have a cauliflower-like appearance. These appear in the near the anus region, vagina, vulva, labia, and penis, basically in the genital area. As we know, HPV symptoms are not prominent, but itching can be found as well in this type of lesion.

Genital warts can be smooth papular or keratotic, the second being similar to the cutaneous ¨bumpy¨ warts. Another kind of lesion is flat condylomata (also called cervical intraepithelial neoplasia, as it can cause cervical cancer), which appears mainly in the cervix. Doctors use that latter term to describe the deepest portion of the uterus that is in close relation to the vagina.

Cervical cancer can manifest itself as bleeding in the period between menstruations. It can also happen as bleeding after sexual intercourse and an abnormal feeling of ¨fullness¨ in the lower abdomen. This lesion also grows on the anus, penis, and vulva as white plaques but is more common in the cervix.

If anal sexual relationships occur and the virus infects the anus, warts can reach this area. This might cause pain if they partially obstruct the way when evacuating and might also slightly bleed. Clothes can cause irritation and itching in these lesions constantly. When complications occur, and if the virus leads to anal cancer, more abundant bleeding can happen. There is too a mass-like sensation that people usually confuse with hemorrhoids (rectal veins inflammation). 

All these lesions don’t appear till a few months after getting the virus have passed, so they can easily go undetected. This is why it is always essential to see a healthcare professional if you have this infection and skin lesions.

What makes you more likely to get the virus?

As we previously mentioned, Human papillomavirus is a sexually transmitted disease (STD), so unsafe sex practices are a major risk factor.

People who don’t use condoms or vaginal condoms are prone to getting an HPV infection. This is because condoms function as barriers, preventing the virus from getting in touch with a healthy person’s skin.

Some people use oral contraception as their birth control method, but these do not stop STD’s from spreading. Although many people might get into a long term relationship, let’s remember HPV symptoms can be null. This means that a trusted partner can still have the disease without symptoms for years and pass it to the other without realizing it.

Additionally, even if people use condoms, a promiscuous person has more chances of getting the disease. This situation exists because sometimes they put the condom and leave a portion of the skin exposed to the other person’s skin.

Most people do not use protection while performing oral sex, making it easier to contract a mucous nongenital infection.

Men who have sex with men are another risk group to contracting the disease, primarily when lube is not used when performing anal sex. This causes micro-fissures that allow the spread of the infection, even more, if they don’t use condoms.

All of these risk factors are more prominent in people between 15 and 26 years old. They have multiple sex partners in a short time gap, making them the population with more infections.

Another group of people that commonly gets this disease are the ones who handle raw meat and fish. It is still unknown through what mechanism the virus infects this particular laborer group. They usually present warts in their hands after at least two continuous years in these jobs.

What is the relationship between HPV infection and cervical cancer?

There is a tight for not saying an exclusive correlation between HPV infection and cervical cancer. In fact, approximately 95% of all cervical cancers have the papillomavirus DNA present within the cells.

A cervical HPV infection can lead to cervical dysplasia. This is an abnormal growth of cervical cells, and it is a ¨pre-cancer¨ stage. Not all HPV types cause cancer. Not all women who get HPV and develop the disease will necessarily result in cancer.

Many factors determine whether the disease will become malignant or not, such as; smoking, X-Ray radiation, having a flawed immunological system, taking oral contraceptives for more than five years, and others.

When there is a persistent HPV infection due to inadequate treatment or no treatment at all, it can become cancerigenous or malignant easier. This situation causes a characteristic squamous intraepithelial lesion, which can turn into invasive cervical cancer.

In these cases, cancer reaches deeper and beyond the uterus’s epithelium, making it harder to treat. This is an important type of cancer to be aware of as it can be easily preventable through screening, especially nowadays.

Which are the complications of human papillomavirus infection?

The most common complication of human papillomavirus infection is cancer. As previously discussed, cervical cancer is the focal one on the list, but there are many other types.

Oropharyngeal cancer is not as common but can be very deadly, as cancer grows in the back of the tongue and tonsils. This can obstruct the airways depending on the lesions’ size and place and make it hard to swallow.

Anal cancer is a common complication of anogenital HPV in the anus. The disease in this place particularly affects men who have sex with men as they are the leading group with these kinds of lesions. Healthcare professionals frequently find together HIV and human papillomavirus infection in this group, which is the main reason it evolves to cancer.

Additionally, the vulva and the labia can also suffer from cancer in these specific places. When HPV infections occur and display lesions, it is easier for the person to contract other STDs. This complicates the prospect of a person’s health and treatment. 

Maybe you want to read about Bacterial Vaginosis

How is human papillomavirus infection diagnosed?

For most HPV infections, diagnosis of the disease can be clinical, based on lesions’ characteristics. This applies mainly to outer infections such as the ones in the anus, penis, vulva, and labia. That is to say that most of the time, the doctor with just looking at the skin lesions and asking the right questions will diagnose the disease.

For infections occurring more in-depth in the vagina into the cervix, this is not a choice. A gynecologist does a cervical screening test or Pap test. It is the gold standard or best test to screen for HPV infection, precancerous lesions, and cervical cancer.

The doctor scratches the surface of the cervix’s lining or epithelium, and it observes the sample later in a microscope looking for unusual cells. This has to be done without the women’s period at least five days prior, so the Pap smear or test doesn’t result inconclusive. 

There is also HPV testing when a Pap test is unsatisfying, for a follow up of an HPV infection previously diagnosed, and for identifying the HPV strain. Doctors do not commonly use them as they are expensive and previous methods can be just as effective. The HPV test surveys for the appearance of viral DNA on cells in the body.

Finally, the acetic acid test can mark genital warts that don’t look as classical. Doctors cover the lesion with this acid, and if there is a sign of malignancy, they will turn white. It presents false positives since it reacts to other diseases like psoriasis or candidiasis.

Regarding skin bumps or lesions. Doctors can sample the bump if the therapy fails or doubts that it is an HPV infection. Then, a special type of doctor called a pathologist would then see that sample under a microscope and determine a diagnosis.

How is this infection treated?

There is no cure for the virus; the treatment consists of decreasing the symptoms because of the lesions. There are topical solutions for cutaneous warts that can help reduce symptoms but don’t cure them.

Other pharmaceutical treatments can reduce them in size, so it is easier for the body to fight off the virus. Sometimes when the lesions are too big, like in condylomata acuminata, doctors perform surgery to reduce their size. This improves the patient’s life quality and helps the immune system by reducing the lesion’s size.

When a patient’s immune system is dysfunctional, like in HIV or patients who take immunosuppressing drugs, additional treatment needs to be implemented. On this type of patients, the disease constantly appears back again and can lead to cancer.

Can the sexually transmitted human papillomavirus infection be prevented?

Yes, sexually acquired human papillomavirus infection prevention is possible by a very simple method; HPV vaccination.

The HPV vaccine is a very recent one when we compare it to others, but it is already ground-breaking. It provides immunity from the subtypes of Human papillomavirus that are the most malignant.

The HPV vaccine’s importance can be seen in the fact that cervical cancer is the 3rd most common cancer in women worldwide. Applying this vaccine to as much population as possible can offer a great benefit to women, especially.

The HPV vaccination works by injecting the body with a harmless part of the virus, which exposes the immune system to create antibodies. These antibodies can last up to 10 years in the body and defend it from certain HPV types. The recommended age at which this vaccine should be given is between 12 and 13 years old. This is because the vaccine to be effective must be applied before they begin sexual contact and can contract the disease.

Do you have symptoms of this infection?

This tool is a Human papillomavirus Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for this infection. Therefore, the tool will help anybody who uses it to determine if their symptoms are because of Human papillomavirus infection. It is free and would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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