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HPV is a double-stranded DNA virus. Structurally, it resides inside cells and begins to exert its effect from the cell nucleus. In a cell infected with HPV, swelling and structural disturbances occur in the nucleus (cell nucleus). Not every HPV infection causes disease. Not all diseases caused by HPV lead to cancer. For example, warts are benign. HPV types 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, 89 are low-risk HPV types.
HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 58, 59, 66, 68, 73 are high-risk HPV types. Particularly, types 16 and 18 are responsible for the majority of cervical cancer cases.
About eighty percent of sexually active individuals in the population test positive for HPV, without necessarily being aware of the type. From this perspective, condom use and safe sexual practices are important.
The HPV virus is transmitted through sexual activity. Genital HPV is not transmitted through toilet or bath contact. For HPV to enter the body and cells, mucosal damage is required. During sexual activity, small tissue cracks allow the HPV to enter the intercellular space, and from there, it enters the cells.
The likelihood of transmission and infection is higher, especially in anal intercourse, where mucosal cracks are more likely to occur. This transmission pathway applies to both low-risk and high-risk HPV viruses. HPV types that cause warts on the hands and feet also spread through mucosal cracks.
HPV needs an organic and living structure to survive, so transmission occurs through human contact. Therefore, transmission does not occur through surfaces like those in toilets or baths, even after being used by someone infected with HPV.
HPV can cause:
Avoiding HPV infection helps prevent these diseases. Therefore, the HPV vaccine and safe sexual activity are very important.
HPV is a viral infection, so any condition that weakens the immune system increases the potential for it to cause disease, including cancers. Smoking is another important factor for the genital area. Women who smoke and are infected with high-risk HPV types, such as 16 or 18, have a 30-fold higher risk of cervical cancer. During pregnancy, immune responses are weaker, so the number of warts may clinically increase.
Unfortunately, HPV does not show symptoms after transmission, like other viruses. There are no symptoms such as discharge, fever, or fatigue. The patient may only realize the condition during check-ups and tests. After high-risk HPV transmission, the development of cervical cancer precursor lesions takes 3 to 5 years. Therefore, routine check-ups and HPV screening are essential.
In men, the presence of HPV cannot be determined without lesions. However, an HPV test performed on a urethral swab can detect HPV in 80% of cases. This means that there is a 20% chance that even if a man is carrying the virus, it may not show up in the test. Men are generally carriers. The primary disease occurs in women as genital cancer and its precursor lesions.
The benign types of HPV cause warts. Warts, or condylomas, have a high potential for growth, especially when the immune system is weakened. If a person with warts does not carry high-risk HPV types, there is no cancer risk.
When infected with HPV, there are no symptoms unless lesions develop. HPV is a risk factor for several genital cancers. Therefore, HPV screening and genotyping tests should be performed periodically to prevent cancer.
HPV presence should be checked through genotyping to identify the specific HPV types (high-risk and low-risk) involved. Based on the type, diagnosis and treatment plans should be tailored. For example, if HPV types 16 or 18 are detected, colposcopy should be scheduled promptly. If low-risk types are found, the path forward is determined based on the pap smear test. HPV tests are HPV-DNA tests. The tests performed at our clinic use DNA screening, which provides results the same day. The HPV-DNA genotyping test is a simple procedure similar to a pap smear.
There is currently no direct medication that eliminates the HPV virus itself, but research is progressing rapidly. Just 20 years ago, HPV vaccines were not a consideration, but now there are multi-type HPV vaccines that offer protection against cancer.
HPV is a DNA virus. Although there is no direct treatment, vaginal gels can support the removal of the virus by up to 70%. Many studies on this topic have been published by companies. To eliminate this cancer-causing virus, the immune system must be strengthened, and hygiene in sexual activity should be maintained.
If high and moderate-risk HPV is detected in gynecological screening, especially for high-risk types, colposcopy should be performed even if the pap smear result is normal. In the past, the pap smear was the primary test, but now it has become a reflex test. This means that a positive HPV-DNA test alone is sufficient for colposcopy. Since the reliability of the HPV-DNA test is between 70 and 80%, pap smear tests should not be neglected, and both HPV-DNA and pap smear tests should be taken during the same examination.
HPV-positive patients should be followed up annually and undergo colposcopy. Pap smear screening, followed by colposcopic biopsy, is the diagnostic test.
The HPV vaccine provides protection against the most common disease-causing and cancer-causing types, including types 6 and 11 (which cause warts) and high-cancer-risk types such as 16, 18, 31, 33, 45, 52, and 58. It helps prevent cancers of the cervix, vulva, vagina, and penis. In many countries, the national vaccination program includes children aged 9 to 15. Cervical cancer can be prevented with the vaccine. However, vaccination should ideally be done before the age of 30 to provide full protection.
The HPV vaccine is similar to the hepatitis vaccine in structure. The rate of side effects is very low. Common side effects like itching or rashes can occur, but the frequency is less than one in a thousand.
The HPV vaccine is recommended for all boys and girls between the ages of 9 and 15 to eliminate the transmission of the HPV virus and prevent many cancers. However, it can also be administered in the 20s. In individuals over 35, immune response decreases, so the vaccine will be 70% effective. Based on this information, the vaccine is recommended and administered to all age groups and sexually active individuals.
Cervical cancer requires the presence of the HPV virus. If there is no HPV transmission, the risk of cancer is eliminated. Therefore, those who receive the vaccine are protected from cervical cancer and many other cancers.
If the HPV vaccine has been administered, pap smears are still necessary, although less frequently. Although the vaccine provides protection against high-cancer-risk HPV types, it does not protect against all types, so pap smear screening should continue.
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