HPV Infection: Symptoms, Transmission Routes, and Prevention Methods

What is HPV?

HPV (Human Papilloma Virus), also known as Human Papillomavirus, is a type of virus that infects the basal epithelial layer of skin and mucosal surfaces (such as the mouth, throat, and genital area). HPV is one of the most common infections that can be transmitted sexually. However, contrary to popular belief, it is not only transmitted through sexual contact. It can also be transmitted through shared toilets, objects with genital contact (underwear, towels, etc.), or environments such as airports, gyms, epilation centers, Turkish baths, and saunas.

Symptoms usually include warts in the genital area, mouth, or throat. In women, it can also cause symptoms such as irregular periods, painful periods (dysmenorrhea), or excessive bleeding (menorrhagia). HPV is also the most common cause of cervical cancer.

HPV is a type of double-stranded DNA virus from the Papillomaviridae family. More than 200 types have been identified, and approximately 40 of these can affect the genital area.

HPV infections often show no symptoms and are cleared by the immune system. However, some types of HPV, especially high-risk ones, can lead to persistent infections, which can contribute to the development of various types of cancer, such as cervical, anal, penile, vaginal, vulvar, and oropharyngeal cancers. Click here to read our article, where we examine HPV and the immune system in more detail and offer suggestions for strengthening immunity.

How is HPV transmitted?

HPV can infect individuals in many ways. More than 80% of people worldwide test positive for HPV at some point in their lives. Given this, many situations and environments create suitable conditions for HPV transmission. HPV is a virus that can be transmitted through sexual contact, shared underwear, and saliva. Public toilets, gyms, swimming pools, saunas, and epilation centers are places where transmission is high.

Is HPV sexually transmitted?

HPV is one of the most common sexually transmitted infections. The virus can be transmitted through direct contact with infected skin or mucous membranes during genital, oral, or anal contact. While condom use reduces the risk of transmission, it does not provide complete protection. Therefore, it is important to pay attention to hygiene in the genital areas before and after sexual contact.

Is HPV transmitted through clothing, shared underwear, and towels?

Yes, HPV can be transmitted through shared underwear, clothing, and towels. Therefore, you should especially avoid sharing underwear and towels.

Is HPV transmitted through saliva? 

HPV can be transmitted through saliva and mucus. However, transmission is only possible if there is an open wound in the mouth or throat and infected saliva comes into contact with this wound.

Is HPV transmitted through toilets? 

Yes, transmission can occur from public toilets. The virus can survive on moist surfaces for a short time. Taking hygiene precautions and using antiviral cleaning products can reduce the risk of transmission.

What places pose a risk for HPV transmission?

Places with the highest risk of HPV transmission include airports, public toilets, swimming pools, and epilation centers.

HPV

What are the symptoms of HPV? 

The infection usually does not cause symptoms. If there are symptoms, the most common finding is warts. These can appear in the genital areas, around the anus, in the mouth, or in the throat. They can be flesh-colored, raised, or flat. Warts are usually painless but can also cause itching, burning, or bleeding. The most common symptom is warts in the genital areas, which are called genital warts.

How is the HPV test performed? 

In women, an HPV DNA test is performed using a cell sample taken from the cervix during a gynecological examination. The HPV test can be done in conjunction with a Pap smear test. In men, there is no widespread screening test; diagnosis is usually made through warts.

Where is it performed? 

State hospitals, obstetrics and gynecology polyclinics, university hospitals, some family health centers, and private hospitals.

What is the difference between an HPV test and a Pap smear test?

A Pap smear test examines cellular changes in the cervix. An HPV test detects the virus itself. When used together, they are more reliable for diagnosis.

What does HPV positive mean? 

If your HPV test is positive, it means that one of the high-risk HPV types is present in your body. This does not necessarily mean you will get cancer, but it requires medical follow-up.

Don't panic, but take the situation seriously. Most often, the virus is cleared by the immune system within two years. However, some HPV types can persist in the body for a long time and may lead to cellular changes that set the stage for cancer development.

Is there a cure for HPV? 

Unfortunately, there is no definitive and complete treatment that clears the Human Papillomavirus from the body. However, symptoms and complications can be treated. Generally, most HPV infections are cleared by the immune system within 2 years. Nevertheless, regular screening and follow-up are very important. The persistence of high-risk types in the body can cause cancer.

HPV is an infection that can lead to serious consequences but can be prevented with timely diagnosis and follow-up. To protect yourself, be informed, do not neglect screenings, and follow your physician's recommendations.

• Warts: Creams, cryotherapy, laser or surgery,

• Pre-cancerous changes: Colposcopy, biopsy, abnormal tissue can be surgically removed.
  

HPV vaccine 

What is the HPV vaccine? 

The HPV vaccine helps the immune system develop defenses against the virus, offering protection against cervical cancer, warts, and other HPV-related cancers.

Who gets the HPV vaccine?

• 9-14 years: the ideal age group

• 15-26 years: vaccination recommended

• 27-45 years: decided after a doctor's evaluation

How many doses of the HPV vaccine are administered?

• 9-14 years: 2 doses (0-6 months)

• 15+ or immunocompromised: 3 doses (0-1-6 months)

Where is it performed? 

Private hospitals, family health centers, university hospitals, and obtained from pharmacies.

HPV infection during pregnancy

Pregnant women may become more susceptible to this virus due to changes in their immune system. Protection against HPV transmission must be carefully ensured during pregnancy.

Can HPV be transmitted to the baby during pregnancy?

The question of whether HPV can be transmitted to the baby during pregnancy is important. While HPV is generally a sexually transmitted virus, the risk of transmission from mother to baby during pregnancy is low. However, there is a possibility that the virus can be transmitted to the baby from an infected mother during birth. Therefore, regular check-ups and doctor's advice regarding HPV before and during pregnancy are crucial. It is vital for expectant mothers to be informed about this and take necessary precautions for both their own health and the health of their babies.

Diseases caused by HPV

Cervical Cancer

HPV is the primary cause of cervical cancer. It is known that HPV types 16 and 18, in particular, play a significant role in approximately 70% of cervical cancer cases worldwide. These high-risk HPV types can lead to abnormal changes in cervical cells, which can eventually develop into cancer. Cervical cancer usually does not cause symptoms in its early stages, so regular screening tests (Pap smear and HPV test) are important.

Genital Warts (Condylomas)

HPV types 6 and 11 are the most common causes of genital warts. These warts can appear in the genital and anal areas, and sometimes around the mouth. They are usually painless but can cause itching and discomfort. Genital warts are transmitted through sexual contact and carry a risk of spreading if left untreated. For detailed information about genital warts, please click here.

Cancers of the Vulva, Vagina, Penis, and Anus

HPV is not limited to cervical cancer but can also cause cancers of the external genitalia and anus. HPV type 16, in particular, plays an important role in the emergence of these types of cancer. These cancers usually present with symptoms in advanced stages, so regular check-ups for early diagnosis are important.

Head and Neck Cancers (Oral HPV)

HPV can also be a cause of cancers in the mouth and throat region. Oropharyngeal cancers (the middle part of the throat) are particularly associated with HPV. HPV type 16 is the most common type found in these cancers. Oral sexual contact is the primary route of transmission for oral HPV infections.

Is every wart HPV? 

No. Not every wart is caused by HPV. However, most warts are caused by HPV. Diagnosis requires evaluation by a specialist physician. Click here to review our article that focuses in more detail on genital warts.

Prevalence of HPV

HPV is known as one of the most common sexually transmitted infections worldwide. According to the World Health Organization, approximately 80% of sexually active individuals will be infected with HPV at some point in their lives.

In women: Almost all cases of cervical cancer are associated with high-risk HPV types.

In men: HPV infections can cause cancer in the penis, anus, and oropharyngeal regions. Additionally, men play a significant role in the spread of HPV.

HPV vaccines are an effective method for preventing infection. When administered before sexual activity begins, vaccines provide protection against high-risk HPV types, depending on the type of vaccine used.

Factors increasing the risk of HPV transmission

Various factors increase the risk of HPV infection:

• Multiple sexual partners: Having sexual relations with multiple partners increases the risk of HPV transmission.

• Early sexual activity: Starting sexual life at an early age increases the risk of infection.

• Weakened immune system: Individuals with a weakened immune system are more susceptible to HPV infection. Click here to read our article on foods that strengthen the immune system.

• Smoking: Smoking can weaken the immune system and thus increase the risk of HPV infection.

• Other sexually transmitted infections: Other sexually transmitted infections, such as chlamydia or HIV, can increase the risk of HPV transmission.

To reduce these risk factors, it is important to adopt safe sexual practices, strengthen the immune system, and undergo regular health check-ups.

How does Human Papilloma Virus infect the body?

Initial Contact and Binding

HPV cannot directly bind to epithelial cells in living tissue. Instead, it binds to the basal membrane (basement membrane) exposed as a result of mechanical or chemical trauma to the epithelium. The basal membrane is located beneath the epithelium and separates the epithelium from the dermis. At the beginning of the infection, HPV makes its initial contact with the cell by attaching to Heparan Sulfate Proteoglycans (HSPG) in the basal membrane via the L1 capsid protein. This binding causes structural changes in the viral capsid, exposing the N-terminus of a minor capsid protein called L2. An enzyme called furin protease cleaves this region. In this way, infection becomes possible.

Entry into the Cell

The furin protease cleaves the L2 protein, exposing a previously hidden surface in L1. This exposed surface allows binding to a secondary cell surface receptor that plays a role in binding to epithelial cells. Through this bond, the virus passes to keratinocytes that migrate over the basal membrane to repair the wound.

Endocytosis and Intracellular Transport

After attaching to the cell surface, the virus is taken into the cell via clathrin-mediated endocytosis. It then first reaches early, and then late, endosomes. In late endosomes, the virus partially uncoats its capsid, transferring the viral DNA and L2 protein into the cytoplasm.

Reaching the Nucleus and Transcription

The L2-DNA complex that enters the cytoplasm is transported to the cell nucleus. The viral DNA localizes to specific nuclear regions within the cell nucleus. The virus initiates viral transcription in this area to replicate its DNA.

Viral gene expression, meaning the production of proteins from the genes in the viral DNA, can take 1-2 hours.

In summary, HPV takes advantage of damage to epithelial tissue (e.g., microcracks caused by chemical or mechanical trauma) to initiate infection. Processes such as binding to HSPG, conformational changes in proteins, and cleavage of the L2 protein by furin are necessary for the infection to begin. This complex and lengthy process is also necessary for the high efficacy of HPV vaccines, as the immune system can effectively target the virus during this process.

Source: Current understanding of the mechanism of HPV infection. Gynecologic Oncology, 118(1). John T Schiller, Patricia M Day, Rhonda C Kines

Frequently Asked Questions

How else can HPV spread besides sexually?

It can also be transmitted through shared toilets, objects with genital contact like underwear/towels, and moist, shared areas such as gyms, swimming pools, and epilation centers.

Does being HPV positive mean we have cancer?

No, it absolutely does not mean you have cancer. It indicates the presence of a high-risk HPV type in the body, but most often, the immune system clears the virus. Nevertheless, medical follow-up is important.

For whom is the HPV vaccine the ideal method of protection?

The ideal age group is 9-14 years. It is also recommended for those aged 15-26; for those aged 27-45, the decision is made after a doctor's evaluation.

If you suspect you have an HPV infection, you should consult your family doctor as soon as possible.

This article was written by Pharmacist Nil Eker from the Primum Pharma team.