Papilloma virus (HPV): symptoms, causes, diagnosis and treatment

By Cristiano Antonino On Jun 7, 2023

Human Papilloma Virus (HPV) infection is extremely widespread among the population and is mainly transmitted sexually

In most cases it is transient and without manifest symptoms, but in some cases it can present itself through benign lesions of the skin and mucous membranes (such as warts, warts or papillomas).

In rarer cases, when the immune system is unable to quickly eradicate the virus, Papilloma can induce precancerous cellular transformations (dysplasias) which, if not treated appropriately, can evolve into cervical cancer.

HPV infection is considered the most important risk factor for the onset of this neoplasm, for women the second most frequent after breast cancer.

In the early stages, cervical cancer often causes no signs or symptoms.

However, the pathology is characterized by a slow evolution, which makes it treatable if diagnosed in time.

It is therefore clear that it is of fundamental importance to undergo regular gynecological visits and screening tests (such as Pap test and HPV test), useful for identifying precancerous lesions linked to papilloma virus infection and intervene before they evolve into carcinoma.

HPV Papilloma Virus: the different strains

There are over 100 strains of HPV and not all of them have oncogenic potential.

Some serotypes (so-called low-risk) are only responsible for the appearance of benign lesions of the skin and mucous membranes, while some strains, called high-risk, are capable of general dysplasia, which in turn, if left untreated, may evolve further into tumor.

Of the 12 strains classified as high-risk, two (HPV 16 and 18) proved to be the main architects of the tumor evolution of the infection, while among the low-risk strains, which normally generate genital lesions with a lower risk of malignant transformation, the serotypes 6 and 11 alone are responsible for about 90% of genital warts.

As far as the spread of HPV infection is concerned, as already mentioned, it is really very wide: it is estimated that around 80% of sexually active women contract the infection at least once in their life – an even more relevant figure in the between 25 and 35 years of age – and that approximately 50% come into contact with a “high risk” serotype.

Specifically, what does it mean to contract the Papilloma Virus?

In most cases, the infection can generate lesions or other non-visible but transient manifestations that remain for a few months and then disappear spontaneously without causing problems.

More rarely, some forms of infection, on the other hand, have invisible and transient manifestations, but which, if persistent and untreated, can in fact involve the risk – in any case in a small percentage and over a rather long period of time – of evolving to the tumor stage.

Papilloma viruses and tumors

This is the reason why many women are infected with Papilloma Virus, while only a few develop tumors.

Furthermore, it is important to underline that the identification of high-risk strains does not necessarily imply the future occurrence of cervical cancer.

In most cases, in fact, it is a transient infection that lasts for a few months and resolves spontaneously without complications: about 90% of women diagnosed with high-risk HPV are already negative within a year .

About 1% of HPV positive women at high oncogenic risk develop cervical cancer; from the moment of contagion to the onset of cervical neoplasia there is a latency period of several years, quantifiable in at least a decade.

During this period, the woman generally does not report particular symptoms, which is why the identification of the early infection first, and then of the pre-cancerous lesions, through pap-test and HPV DNA test, allows doctors to intervene before the cancer occurs .

HPV symptoms

Symptoms vary according to gender.

In men, the infection very often remains asymptomatic, and only in the rare cases in which it causes urethritis or prostatitis, signs such as:

scanty or moderate urethral discharge
burning during urination and ejaculation

At the level of the cervix, HPV does not produce obvious manifestations, unlike, for example, condylomas (induced by low-risk serotypes). Genital mucosal mutations are often asymptomatic.

This circumstance, however, facilitates its diffusion, since most of the affected subjects are not aware of the ongoing infection. The symptoms caused by HPV are influenced by the reference serotype and the resulting lesions.

Symptoms in low-risk strains

After the early stages, almost always asymptomatic, the infection typically manifests itself with the appearance of warts in the genital area on the cervix, vulva, vagina, perineum or anus, or extragenitally at the level of the nose, mouth or larynx.

Sometimes these lesions can manifest themselves as growths even a few centimeters large and with an appearance similar to the crest of a rooster (the so-called condyloma acuminata).

Typically harmless, in some cases warts and warts can cause minor itching, discomfort and pain.

The presence of condylomas or warts is common and should not be considered comparable to an increased risk of tumor onset.

Symptoms in high-risk strains

We are in the presence of sub-clinical manifestations, i.e. not identifiable with the naked eye but verifiable only through ad hoc tests.

Cervical cancer can be totally asymptomatic or present symptoms so slight as to go unnoticed.

However, as the disease progresses, clinical signs may arise such as:

bleeding after intercourse
slight pain during penetration
watery or bloody vaginal discharge (sometimes foul smelling)
vaginal bleeding outside the menstrual period or after menopause.

Causes of papilloma virus

HPV is infected through the skin and mucous membranes: sexual transmission is considered the main and also the most probable route.

It is difficult to determine from whom you contracted the infection: the papilloma virus may have been transmitted from your current partner or from previous partners.

The incubation, in fact, can be very long and last a few years.

Transmission occurs through vaginal, anal and more rarely through oral intercourse.

However, as already mentioned, penetration is not necessary for contagion, so the condom reduces the risk of exposure to infection but does not cancel it.

In relatively recent times, other transmission routes have also been demonstrated, although they are rather rare and sporadic:

the use of infected underwear
maternal-fetal transmission at the time of delivery
contagion in places such as swimming pools, gyms, public toilets, etc

How to cure the papilloma virus?

There are currently no pharmacological treatments capable of eliminating the virus from the body.

If the infection does not regress spontaneously, warts and warts can be treated with creams with antiviral or immunomodulatory action (i.e. capable of modifying the immune response) which are generally very effective.

Alternatively, it is possible to proceed with the removal of the growths through local surgical treatments such as laser therapy, diathermocoagulation or cryotherapy.

Types of surgery:

Surgical removal is also used for precancerous lesions located in the uterine neck, a procedure that ensures excellent results without affecting the reproductive functions of the woman.
the abnormal area, identified by colposcopy, is eliminated with techniques that exploit heat, such as Dia-Thermo-Coagulation (DTC) and laser-vaporization. In this case we speak of “destructive treatment” as the tissue is destroyed and therefore cannot be subjected to histological examination.
the abnormal area, identified by colposcopy, is removed with electric loops (LEEP – Loop Electrosurgical-Excision Procedure), with a laser or, increasingly rarely, with a scalpel. This procedure allows the histological examination of the removed tissue to be performed, therefore the treatment is called “excisional treatment”.

In the majority of cervical dysplasias, even in the case of severe lesions, it is possible to perform the surgery in the clinic and under local anesthesia.

The latter, practiced on the neck of the uterus, can generate discomfort or slight pain at the time of injection.

The operation has a rather short duration, about 10-20 minutes, and the woman can immediately return home.

If, on the other hand, the condition found was a real tumor, other treatments will clearly be used, which will vary according to the severity: removal (partial or total) of the uterus, chemotherapy, radiotherapy.

What exams to do?

Is it possible to prevent the possible evolution of pre-cancerous cells to the tumor stage? Is there a way to prevent the contraction of HPV infection upstream?

Cervical cancer can be effectively prevented both through early diagnosis and adherence to screening programs, and with the use of HPV vaccination.

Cytological analysis of cervical tissue (Pap test) is in fact capable of reducing mortality from this tumor by up to 80%, while the HPV-DNA test, which identifies the possible presence of the virus, revealing a situation of increased risk of developing a precancerous disease, allows the pathology to be identified in very early stages.

As a general rule, unless otherwise indicated, the PAP test should be performed every 3 years from 25 to 64 years of age.

Following the screening test, in the event of anomalies, we proceed with colposcopy, an outpatient examination that allows us to identify any alterations at the level of the uterine cervix through the magnified view of the tissues.

If appropriate, targeted biopsies are also performed at this stage to obtain more in-depth investigations.

The importance of vaccination

Without a doubt, the most effective and safest way to combat the risk of HPV infection is represented by vaccination.

There are three vaccines available today: bivalent, quadrivalent and, since 2017, 9-valent.

All protect against strains 16 and 18, responsible for the formation of neoplastic lesions in the cervix.

In addition to guaranteeing this defence, the quadrivalent and 9-valent vaccines prevent the formation of male and female genital warts caused by the respective viral strains (HPV 6 and 11).

The ideal condition is to administer the vaccine to subjects who have not yet started sexual activity: the protection offered decreases considerably if the subject has already come into contact with one of the strains against which the vaccine is directed.

Net of this evidence, the results of clinical investigations attest to a significant preventive efficacy of vaccines (about 98%). The vaccination profile is completed by a high level of safety and tolerability.

In any case, it is essential to continue to undergo regular gynecological check-ups and screening.

Human papilloma virus

We speak very often of HPV in reference to women, but what does the papilloma virus mean for men?

The most common sexually transmitted infection in men ends up causing no symptoms in most cases.

And, over time, it can be cleared by the immune system without even realizing it.

However, it is clear that the spread of the infection is responsible for the increase in the number of “healthy carriers”: a risk for women who have intercourse with them, without the use of a condom (which in any case does not protect 100% in this case) and the vaccine.

Until a few years ago, attention to the Papilloma Virus was focused almost exclusively on the relationship between HPV and cervical cancer, with a view to preventing female cancer.

In reality, the evidence according to which the human papilloma virus also has an impact on human health is increasing and constantly updated.

It often happens that, in humans, the problem is underestimated since in most cases the infection is asymptomatic.

However – although these are rare cases – HPV can cause diseases and tumors that also affect men (anus, penis and oropharyngeal region).

What exams to do?

What penalizes men is mainly the lack of an infection screening test similar to the one available for women (Pap test / HPV test).

Anoscopy, anal swab, acetic acid test and peniscopy are possible tests, but they are almost always carried out in the face of a clinical suspicion.

In conclusion, an optimal approach should involve both sexes, not forgetting the need to provide complete and correct information to men on the risks of papilloma virus infection and on the possibility of protecting themselves in a conscious way.

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