GynecologyNewsMyths and truths about HPV

28/09/2020

Particularly useful notes on HPV, from the Hellenic Society of Papillomavirus Research and Treatment.

MYTH 1: Anyone who is infected with HPV will have it forever.

TRUTH: The molecular test that detects the presence of the virus (HPV DNA test) in most people gets negative after years, unless it causes cancer. As a result, it is most likely that the person “gets rid” of the virus after another time, depending on the immune response of their body. However, there is virtually no risk for women in whom the cervical HPV DNA test is negative.

MYTH 2: Anyone infected with HPV will have cancer.

TRUTH: What is true is that e.g. Of the 100 women infected with HPV, only 1-2 women are at risk of developing a precancerous or cancerous lesion in the uterine cervix, provided that they do not go to the doctor regularly and do not undergo the required tests. > In the vast majority of cases the so-called “defense” of the body is fights the infection and the virus does not cause any damage to cells, or causes mild lesions, which automatically go away after a few years. So, what is needed is 1) maintaining a strong body defense and 2) going on regular visits to the doctor.

MYTH 3: Anyone who develops warts is at risk of developing cancer.

TRUTH: Warts have nothing to do with cancer. They are minor lesions of the skin and epithelium and are due to the action of the so-called “low-risk” types of the virus (usually types 6 and 11). It affects women and men, often relapses and recedes automatically. They are the most frequently sexually transmitted disease, psychologically negatively charged, and the association with cancer is due to the fact that people with warts are more often at the same time carriers of other “high risk” HPV types as well. One of the two current HPV vaccines protects against the “high risk” types 16 and 18 at the same time and the “low risk” types 6 and 11.

MYTH 4: Any woman who has a Pap test regularly cannot have cervical cancer.

TRUTH: The Pap test is a good test for screening women for the prevention of cervical cancer. However, the experience of the last 50 years or so has shown that applying the Pap test does not fully cover the woman’s risk of this disease. The sensitivity of the Pap test is about 50-75%, i.e. out of 100 women with pre-cancerous or cancerous lesions, the test will be pathological at 50-75, i.e. the rest will have “false negative” results. This is why it is possible in the coming years to replace the Pap test with the so-called “HPV DNA test”, i.e. the virus detection test with a sensitivity of over 90%. Thus, Pap test, HPV DNA test, colposcopy and biopsies (when needed) are all tests of so-called secondary prevention, with the application of which the physician tries to eliminate the chances of cervical cancer, without it still being possible. As for the vaccine, this provides a primary essential protection from this serious disease and should be done regardless of the fact that the woman should continue to have the Pap test, or later the HPV DNA test, so that in combination of primary and secondary prevention the best results are achieved.

MYTH 5: The HPV vaccine is only for little girls.

TRUTH: The HPV vaccine is for all girls from 9 years of age and all women up to 45 years of age. Responsible Health Agencies of the US, Australia, Canada and other countries recommend vaccinating 9-13 year old girls and boys, usually in schools. Both types of vaccine are available in our country. According to the National Vaccination Program vaccination is recommended for girls aged 12-15 but also for girls and women aged 15-26 if they have not been vaccinated at the recommended age. In these groups the costs are covered by the insurance funds. For indications for men up to 26 years of age, these are the prevention of acute warts as well as precancerous and cancerous lesions of the anus. These costs have not yet been covered by the social security funds.

The vaccine protects against the two most dangerous types of virus (types 16 and 18). Because little girls and boys generally do not have sex and therefore have not come into contact with the virus, the protection afforded by the vaccine is the greatest possible, i.e. definitely both of these types. This does not mean that an older woman or man is necessarily infected by both types at the same time. Thus, a woman or man who has sex is either not infected with the virus at all, or infected with other types of virus, or infected with one of the 2 most dangerous types (16 or 18), has a lot to gain from the vaccine. Because the probability of a woman being infected simultaneously with both types is minimal (<1%), no prior screening is required to detect the virus type (s) but may proceed with vaccination immediately.

MYTH 6: The HPV vaccine has serious side effects.

TRUTH: The HPV vaccine has no serious side effects. The only side effects observed and certified as being due to vaccination are mild local side effects, i.e. pain, redness and swelling at the injection site, as well as some mild systemic side effects, such as dizziness and possibly fainting (especially in little girls and boys), mild fever, headache and bad mood for 2-3 days, and rarely an allergic reaction. None of the serious side effects and deaths reported from time to time were causally correlated with HPV vaccination, they were only temporally correlated.

MYTH 7: Any woman who gets the HPV vaccine does not need a Pap test.

TRUTH: Definitely needed! The vaccine protects against the two most dangerous types of the virus, 16 and 18. These two types, however, are responsible for only about 70% of cervical cancers. The remaining ~ 30% is due to other “high risk” types of the virus, e.g. 31, 33, 35, 39, 45, 52, 56, 58, etc., from which the vaccine offers no protection. In practice, of course, it has been found that due to the molecular affinity between these different types, there is also the so-called cross-protection, i.e. vaccine protection and other types of virus, to a lesser extent of course. Thus, the total protection provided by the vaccines in circulation exceeds 70%, although it does not reach 100%. Therefore, the coexistence of the vaccine and the Pap test, or later the HPV test, is necessary and mandatory. When the second generation HPV vaccines are released, protected by more (e.g. 9) types of virus, then in the coming decades the girls vaccinated with them will no longer need further screening, except once or twice during their lifetime with HPV test.

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The Doctor

Dr. Nikolopoulos maintains a private practice in ATHENS, while collaborating exclusively with MITERA’s maternity hospital and the new HYGEIA IVF Athens Assisted Reproduction Unit. At the same time, he is in charge of the Fertility and In Vitro Fertilization clinic at City Hospital, in the city of KALAMATA.

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