Human papillomavirus

Human papillomavirus (HPV) is a group of more than 200 related viruses, some of which can lead to health complications ranging from genital warts to various cancers, including cervical, anal, and throat cancers. While most HPV infections are harmless and resolve on their own, certain high-risk types can cause serious disease. HPV is primarily spread through sexual contact, but some forms may also be transmitted through skin-to-skin contact.

HPV affects both men and women and is often asymptomatic, making regular screening and preventive measures critical. In recent years, vaccines have significantly reduced the incidence of HPV-related diseases, especially in countries with robust immunisation programmes. However, stigma and lack of awareness continue to be barriers to effective prevention and treatment.

HPV is a viral infection that affects the skin and mucous membranes. It is one of the most prevalent sexually transmitted infections worldwide. The virus enters the body through minor cuts or abrasions and establishes infection in epithelial cells. While most HPV types cause benign skin growths like warts, others are considered high-risk due to their association with cancers of the cervix, anus, penis, vulva, vagina, and oropharynx.

There are over 200 types of HPV, each labelled with a number. Some types only infect the skin, while others infect mucous membranes. The immune system usually clears the virus naturally within two years. However, persistent infection with high-risk HPV types can lead to cellular changes and cancer over time, which is why consistent monitoring is so important.

Globally, around 291 million women are estimated to be carriers of HPV at any given time, with approximately 528,000 new cases of cervical cancer annually attributed to the virus. In addition, more than 80% of sexually active individuals will contract HPV at some point in their lives.

In India, HPV prevalence varies by region, but approximately 6.6% of women have a cervical HPV infection, and the country accounts for nearly one-quarter of the world’s cervical cancer deaths. Despite increased awareness, vaccination and screening coverage remain limited in many parts of India. The lack of regular Pap smear programmes in rural areas, cultural taboos, and misinformation further exacerbate the situation.

HPV is categorised into:

• Low-risk types: Typically cause benign warts (e.g., HPV types 6 and 11).
• High-risk types: Linked with various cancers, especially types 16 and 18, which are responsible for approximately 70% of cervical cancer cases.

Other high-risk types include 31, 33, 45, 52, and 58, which are also associated with various anogenital and oropharyngeal cancers. In contrast, low-risk HPV types usually cause skin lesions or warts and do not lead to cancer.

HPV spreads primarily through:

• Vaginal, anal, or oral sex with an infected person
• Skin-to-skin contact in the genital area
• Transmission during childbirth (rare)

Risk of infection increases with:

• Early sexual activity
• Multiple sexual partners
• Unprotected sex
• Weakened immune system
• History of other STIs
• Smoking, which impairs the body’s ability to clear the virus

HPV is often silent, meaning many people don’t exhibit symptoms. When symptoms do occur, they can include:

• Genital warts: Small growths in the genital area, may be flat, raised, or cauliflower-shaped
• Common warts: Found on hands and fingers
• Plantar warts: On soles of the feet
• Flat warts: Smooth, flat-topped lesions often found on face or legs

For high-risk types:

• Precancerous lesions in the cervix, vagina, vulva, anus, or penis
• Persistent sore throat or hoarseness (possible signs of oropharyngeal cancer)

Some people with HPV may experience itching, discomfort, or bleeding from warts. In others, particularly women, cellular changes in the cervix may go unnoticed until detected during routine screening

Diagnosis of HPV

HPV can be diagnosed using several methods:

• Pap smear: Detects abnormal cervical cells
• HPV DNA test: Identifies high-risk HPV types
• Visual inspection: Used for identifying genital warts
• Colposcopy: For closer examination of abnormal cervical cells
• Biopsy: In suspected cancer cases

Newer screening methods like co-testing (Pap test combined with HPV testing) are proving more effective in early detection. Self-sampling kits are also emerging in some countries to improve screening accessibility
 

There is no cure for HPV itself, but treatments can manage symptoms and related complications:

• Wart removal: Cryotherapy, laser treatment, or topical medications
• Surgical procedures: For high-grade lesions or cancerous changes
• Topical agents: Like imiquimod or podofilox for external warts. (Imiquad Cream)
• Regular monitoring: For women with abnormal Pap results

HPV-related cancers are treated with surgery, chemotherapy, and/or radiotherapy depending on the stage. Treatment plans vary by location, age, immune status, and extent of the disease.

Though not a replacement for conventional treatment, some alternative approaches are explored:

• Green tea extract (sinecatechins): For external warts
• Diet rich in antioxidants: May support immune response
• Herbal supplements: Such as echinacea or AHCC (Active Hexose Correlated Compound) are being studied

Other practices include meditation and yoga to reduce stress, which may support immune function indirectly. However, these methods should never replace evidence-based treatment.

Note: Always consult a qualified healthcare provider before starting any alternative therapy.

Factors that increase the likelihood of contracting or developing complications from HPV include:

• Early age of sexual activity
• Multiple sexual partners
• Smoking
• HIV or other immune-compromising conditions
• Poor genital hygiene
• Long-term use of oral contraceptives
• Infrequent screening for women

HPV can lead to various health complications, particularly if left untreated:

• Cervical cancer
• Anal, penile, vulvar, vaginal, and oropharyngeal cancers
• Genital warts: May cause discomfort or emotional distress
• Respiratory papillomatosis: Rare, can obstruct airways in infants

Complications are often severe in individuals with weakened immune systems, such as those with HIV/AIDS. Persistent infection is a strong predictor of future malignancy.

Living with HPV can be manageable with the right steps:

• Stay informed and monitor your health
• Attend regular medical check-ups and screenings
• Communicate openly with sexual partners
• Practise safe sex
• Adopt a healthy lifestyle to strengthen immunity

Psychological support is crucial, especially for those diagnosed with high-risk HPV types or cancer. Joining a support group or speaking to a counsellor may improve mental well-being.

• Myth: HPV only affects women
  
  
  • Fact: Men can also develop warts and HPV-related cancers
     
• Myth: Only promiscuous people get HPV
  
  
  • Fact: Anyone sexually active can contract HPV
     
• Myth: Condoms offer complete protection
  
  
  • Fact: Condoms reduce risk but don’t eliminate it entirely
     
• Myth: HPV always leads to cancer
  
   

Fact: Most infections are harmless and clear naturally
 

Consult a healthcare provider if you experience:

• Unusual growths or warts
• Irregular vaginal bleeding
• Persistent sore throat or difficulty swallowing
• Pain during intercourse
• Abnormal Pap smear results
• Itching or burning in the genital area

Early detection and treatment can prevent progression to cancer and improve outcomes.

• Should I get the HPV vaccine?
• How often should I get screened for cervical cancer?
• What are my treatment options for HPV-related conditions?
• How do I know if I have high-risk HPV?
• Can I still be intimate with my partner?
• Is my HPV infection likely to go away on its own?
• How can I prevent spreading it to others?

• Offer emotional support without judgement
• Accompany them to medical appointments if needed
• Educate yourself about HPV to provide better assistance
• Respect their privacy and confidentiality
• Encourage healthy lifestyle habits
• Be patient and provide reassurance during treatment

HPV is a widespread and often misunderstood health condition. With early detection, preventive strategies like vaccination, and appropriate treatment, its impact can be significantly reduced. Raising awareness, breaking stigma, and promoting regular screenings are key to curbing the long-term effects of HPV across populations. Public health education and better access to vaccines are crucial in tackling the HPV burden in countries like India.