HPV prevention

A Comprehensive Guide to HPV Infection and Prevention

The human papillomavirus (HPV) is one of the most widespread pathogens today, attacking the cells of the skin and mucous membranes. The vast majority of sexually active people – almost everyone – have some form of HPV infection during their lifetime.

Although in most cases (80–90%) the body's immune system clears the virus on its own, without symptoms, within 1–2 years, infections that persist can lead to serious health problems. In structure, the virus has an outer coat (this helps the body recognise the pathogen) and an inner core, which contains the genetic material (DNA) responsible for infection and for changing the cells.

As there is no specific antiviral medicine for an established HPV infection, protection rests on conscious prevention, vaccination and precise, timely screening.

HPV types and their risk groups

At least 200 subtypes of HPV are known. We divide them into three main groups based on their ability to cause cancer (oncogenic potential).

1. Low-risk types

This group includes HPV 6 and 11, among others. They very rarely cause malignant tumours and occur only in mild cervical changes. However, they are responsible for 90% of genital warts (condyloma acuminatum). These are benign growths, but they are cosmetically and physically very bothersome, stubborn and often come back after treatment.

2. Intermediate-risk types

These strains are intermediate: they are found considerably more often in precancerous conditions of the cervix (dysplasias) than in tissue that has become a malignant tumour.

3. High-risk types

The most dangerous strains (for example HPV 16, 18, 31, 33 and related types), which have been proven to cause cancer. They are present in malignant tumours as often as, or even more often than, in precancerous conditions. HPV 16 and 18 alone are responsible for about 70% of cervical cancer cases.

How does the virus spread? Facts and myths

There are many myths about HPV infection. For prevention to succeed, it is essential to know exactly how it spreads:

• Penetrative sex is not needed: The virus is easily passed on through close contact of the skin and mucous membranes of the intimate areas, the perineum, the thighs or the mouth (including during petting and oral sex).

• Condoms do not give 100% protection: Although barrier protection is very important and greatly reduces the risk, HPV can also settle on areas of skin that a condom does not cover.

• The infection can stay completely hidden: Most carriers have no symptoms, so many pass the virus to their partner without knowing it.

• Long incubation period: The virus can be present in the body unnoticed for years, even decades. If one person in a relationship tests positive, it does not mean their partner has recently been unfaithful, as an earlier infection, even from years ago, may have become active.

• Vertical transmission (mother-to-child infection): A rare but serious case in which an infected mother passes the virus to her newborn as the baby passes through the birth canal during delivery. In the baby’s airways, this can cause life-threatening growths that block breathing (known as respiratory papillomatosis).

• What does not spread it: It is a medical fact that HPV is not spread by kissing, shared toilet seats, towels or cutlery, or by swimming pool water or blood.

Basic immunological facts

• There is no natural, lasting immunity: After the infection clears, the body does not develop lifelong protection. This means a person can catch the same HPV type, and be reinfected with it, several times during their life.

• Unpredictable course: Science cannot currently predict whose body will clear the virus on its own and in whom the infection will become chronic.

• The state of your immune system is decisive: People with a weaker immune system (e.g. due to chronic stress, smoking, cancer treatment or HIV infection) find it much harder to clear the virus, so they are much more likely to develop precancerous or cancerous conditions. Smoking has been shown to help the virus persist in the mucous membranes.

The 6 most serious tumour types caused by HPV, and their symptoms

Persistent high-risk HPV infection causes mutations at cell level, from which malignant tumours can develop over years or decades. Based on international statistics (for example US CDC data) and clinical experience in Hungary, HPV plays a key role in the development of the following tumours:

1. Cervical cancer (HPV can be detected in 91% of these tumours)

Worldwide, cervical cancer is the 4th most common tumour type in women. In Hungary about 900–1000 new cases are registered each year, and sadly we lose 400–500 women to it.

• Early symptoms: Often there are no symptoms at all, but warning signs may include vaginal bleeding outside the menstrual cycle (e.g. after contact), pain during or after sex, and an unusually heavy, unpleasant-smelling discharge.

• Late symptoms: In advanced stages, constant lower back or back pain (due to kidney involvement), blood in the urine, difficulty holding urine, constipation, swelling of one leg, bone pain, drastic weight loss and constant exhaustion.

2. Vaginal cancer (caused by HPV in 75% of cases)

A less common gynaecological tumour, which almost never causes symptoms at an early stage and is usually found only during routine screening.

• Symptoms: Spotting or heavier bleeding unrelated to periods, painful intercourse, a lump that can be felt in the vagina, painful or difficult urination, or chronic constipation.

3. Cancer of the vulva / vulval cancer (caused by HPV in 70% of cases)

It develops slowly, usually over several years, most often affecting the labia majora and, less often, the labia minora or the area around the clitoris.

• Symptoms: Persistent, stubborn itching or pain in the vulva, skin discolouration (whitish or darker patches), a lump that can be felt, thickened skin, a sore or ulcer that does not heal, and sometimes abnormal bleeding.

4. Cancer of the penis / penile cancer (caused by HPV in 63% of cases)

Although it is a relatively rare disease, it is extremely dangerous, because patients, out of shame, wait on average for months after the first symptoms before they see a doctor.

• Symptoms: Thickened skin, a growth, a loss of skin (sore) or discolouration, most often on the glans (48%) or the foreskin (21%). It is often accompanied by intense itching or burning in the affected area and painless swelling of the lymph nodes in the groin.

5. Cancer around the anus / anal cancer (caused by HPV in 91% of cases)

It is important to point out that this disease starts from the tissue of the anal opening, so it must not be confused with cancer of the colon or with classic rectal cancer.

• Symptoms: In the early stage it is easily mistaken for haemorrhoids or an anal fissure, which can delay diagnosis. Typical signs are discomfort or shooting pain around the anus, constant itching, a feeling of something in the anus, and fresh, bright red bleeding after a bowel movement.

6. Oropharyngeal cancer (caused by HPV in 70% of cases)

In recent decades, the number of tumours of the oropharynx (the back of the throat, the base of the tongue and the tonsils) has risen dramatically, almost in the manner of an epidemic. Modern research shows that the disease increasingly affects younger people who do not smoke and who drink little alcohol – because sexual habits have changed (oral sex). It is twice as common in men as in women.

• Symptoms: It goes unnoticed for a long time. Later signs may include a long-lasting, unexplained sore throat, difficulty or pain when swallowing, pain spreading to the ear, persistent hoarseness, unexplained weight loss and swollen lymph nodes that can be felt in the neck.

Genital warts (Condyloma Acuminatum)

Genital warts are the most common visible sign of HPV infection (caused by the low-risk types 6 and 11). Although they are benign, they spread and infect extremely quickly.

Where they appear:

• In men: The surface of the penis, the glans, the foreskin, the scrotum, the groin, the inner thighs, the area around the anus and, less often, the mouth (tongue, palate).

• In women: The vulva, the labia minora and majora, the vaginal opening, the vaginal wall, the cervix and the perineum, as well as the area around the anus.

Treatment principle: If new warts appear, it is not advisable to remove them immediately, hastily and with the most aggressive methods, because the virus may still be lying dormant in the surrounding skin and new ones may grow in their place. Treatment is a carefully planned process, often supplemented with immune-boosting therapy.

Modern clinical ways to remove them:

1. Electrocautery (burning off): Using a high-frequency electrosurgical device, the doctor burns off the growths in a targeted way.

2. Laser vaporisation: A high-precision laser beam practically vaporises the wart tissue. It gives an excellent cosmetic result with minimal scarring.

3. Surgical excision: Larger, more extensive or clustered condylomas need to be cut out with a scalpel or special surgical scissors.

Important warning for pregnant women:

If genital warts appear during pregnancy, consult your gynaecologist immediately! Pregnancy hormones can make warts grow rapidly, which can physically obstruct a natural birth, and they can also infect the baby in the birth canal. It is important to know that not all of the treatments and topical solutions above can be used safely during pregnancy.

Differences by sex: Why is it dangerous for men?

HPV is still wrongly treated, in the public mind, as a "women's problem". This is a serious mistake.

The three pillars of prevention

1. Vaccination (Primary prevention)

The most modern 9-component vaccine on the market (Gardasil 9) gives protection against the two strains that most often cause warts (6, 11) and the seven most dangerous cancer-causing strains (16, 18, 31, 33, 45, 52, 58).

• In childhood: It is best given before sexual activity starts. In Hungary, girls and boys in the 7th year of school can receive it free of charge, and voluntarily, through the school vaccination campaign.

• In adulthood: The CDC (the US Centers for Disease Control and Prevention) specifically recommends the vaccine for everyone up to the age of 26, and it is also extremely useful after 26 (up to the age of 45–50). In adulthood it still protects against types not yet caught, and it reduces the chance of infection passing back and forth with a partner (the ping-pong effect).

• Safety: According to official reports from the World Health Organization (WHO), HPV vaccines are extremely safe. In the several million cases studied, no serious complication was recorded apart from a mild reaction at the injection site, possible brief fainting, or a rare allergic reaction.

• Clinical note: Although the vaccines are officially licensed for preventing cervical, vaginal, vulvar and anal cancer, by preventing the viral infection they also indirectly help reduce the risk of other HPV-associated cancers.

2. Regular screening (Secondary prevention)

The aim of screening is to recognise precancerous conditions (precancerous changes) before a tumour develops from them. If a cervical change is found in time at screening, it can be fully cured with a routine, small outpatient operation (conisation/excision), avoiding larger operations and chemotherapy.

For women over 25, comprehensive screening is mandatory every 3 years (yearly is recommended). As well as cytology, which detects cell changes, it includes modern HPV DNA typing.

3. Awareness and screening for sexually transmitted infections (STIs)

A monogamous relationship, and limiting the number of sexual partners, has been shown to reduce the risk of infection. Looking after sexual health also includes regular checks for other sexually transmitted infections (for example Chlamydia, gonorrhoea, syphilis and HIV), because their presence and the local inflammation they cause make the mucous membrane more vulnerable, so HPV can enter the cells much more easily.

What happens at your HPV visit at Sabjanics Medical Center?

At our clinic, HPV screening and counselling take place in a completely discreet, non-judgemental and highly patient-friendly setting. We know that sexually transmitted infections are a sensitive subject, so we give particular attention to empathy.

The steps of the visit:

1. A detailed consultation: We talk through the medical history, the results of earlier screening tests, any symptoms, and current vaccination status.

2. Physical examination: Our specialist looks carefully, with a high-magnification optical device, over the affected skin and mucous-membrane surfaces (in the gynaecological, urological or proctological area), searching for hidden warts or suspicious patches.

3. Painless sampling: With a thin, soft brush developed especially for this purpose (a brush-like device), we collect surface cells from the surface of the cervix, from the vagina, from the skin of the penis, from the opening of the urethra or, if needed, from the anal canal. The process is quick and painless.

4. A personalised treatment plan: From the highly sensitive molecular HPV DNA typing test result sent by the laboratory, we set out exactly what to do. This may include precise removal of local changes (warts), targeted treatment to support the immune system, setting up a follow-up protocol, or starting the adult course of vaccination.

How should you prepare for the test? To keep the sample accurate, in the 48 hours before the test you must strictly avoid sexual intercourse and local products (vaginal pessaries, vaginal creams, intimate washes and antiseptic wipes), because these can alter the sample and lead to an incorrect laboratory result!

Why choose Sabjanics Medical Center?

• The most modern diagnostics: In our laboratory we use the most accurate, highly sensitive HPV DNA tests available on the market, which identify not only the presence of the virus but also its exact subtype.

• Immediate support across specialties: If we find a change, or a problem that needs treatment, during the test, you will not have to wait weeks with us for further appointments. Our gynaecology, urology/andrology, proctology and dermatology specialists work on site, in close collaboration, so combined treatment can be started straight away.

• A focus on prevention and on the patient: We believe that precise screening at the right time, or a properly given vaccine, can save a life. With us, you are not a queue number, but a patient who needs individual care.

Do not put off the decision, and do not wait until the infection causes serious symptoms that are hard to treat, or changes that cannot be reversed. Make the most important investment in a healthy future for yourself and your partner.

Book an appointment today at Sabjanics Medical Center for HPV screening, a comprehensive assessment, or vaccination counselling!