BY.

Dr.

Benedetta Alberghetti

Gynecologist at the Ovarian Cancer Center

HPV is a very common virus and, in most cases, does not cause problems. Knowing about it, however, is important to make informed choices and protect your own health, that of your partner and any children. In this article you will find answers to frequently asked questions about transmission, screening, and prevention, so you can get clear information and take care of your health with greater awareness.

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What is HPV and how widespread is it?

HPV (Human Papillomavirus) is a very common group of viruses that is transmitted mainly through sexual contact.

What are the different strains and how frequent is the infection?

There are more than 200 types of HPV. Some are low risk and can cause condylomas (such as types 6 and 11); others are high risk (such as types 16 and 18) and can cause cancers, particularly cervical (or cervix) cancer, but also cancers of the anus, penis, vagina, vulva, and oropharynx. It is estimated that about 80 percent of the sexually active population will contract HPV at least once in their lifetime.

How is HPV transmitted?

Transmission can occur with any type of sexual contact, even just skin-to-skin in the genital area. Condoms reduce the risk but do not fully protect because the virus can also be present in uncovered areas (groin, perineum, scrotum, vulva, anal area).

Does HPV give symptoms?

In most cases the infection is asymptomatic, unlike other viral or bacterial infections.

When should I be concerned?

If I test positive for HPV, should I worry right away?

No, you should not be alarmed, but it is important not to underestimate the infection and follow your doctor’s instructions.

Can HPV go away on its own? In how much time?

In 80% of cases, the immune system spontaneously eliminates the virus, usually within 1-2 years. It is important that the immune system is efficient and that factors that can weaken it, such as smoking or the use of immunosuppressant drugs, are reduced.

When can HPV become a serious problem?

It becomes a problem when a high-risk HPV infection persists over time.

What does “precancerous lesion” mean, and how quickly can it develop?

Precancerous lesions are tissue changes caused by the virus and represent a stage prior to cancer. They are distinguished into low-grade dysplasia (LSIL) and high-grade dysplasia (HSIL).
Low-grade forms can regress spontaneously; high-grade forms, however, must be treated. The evolution to cervical cancer is generally slow: it can take about 5-10 years from the diagnosis of cervical dysplasia to the development of carcinoma, in the absence of treatment.

Are there any symptoms that should suggest something more serious?

In the early stages of infection or dysplasia, no symptoms are felt. Symptoms usually appear when the disease is already advanced and may include:

• Watery or foul-smelling discharge;
• bleeding between periods (intermenstrual spotting);
• Bleeding after intercourse (post-coital spotting);
• Menopausal bleeding.

Pap test and HPV test

What is the difference between Pap test and HPV test?

The Pap test checks for precancerous or cancerous changes in the cells of the cervix: it then detects any damage caused by the virus.
The HPV test, on the other hand, directly detects the presence of the high-risk HPV types responsible for cervical cancer: it thus identifies the cause, even before cellular changes appear.

Today, screening relies mainly on the HPV test because it is more sensitive: it detects women at risk early and, if negative, provides longer protection, allowing repeat testing after 5 years.

What does it mean to have positive HPV test but negative Pap test?

It means that the infection is present but has not yet caused cellular changes. This is a frequent situation. In these cases, it is recommended to repeat HPV testing after one year.

What does it mean to have altered Pap test but negative HPV test?

It means that mild changes in cervical cells were observed, but high-risk HPV was not detected.
In most cases this is of little concern: the changes may be due to inflammation, hormonal imbalances, or transient changes. Theabsence of the virus is reassuring because the risk of evolution to major lesions is very low.

How often should these tests be done?

• Pap test: every 3 years
• HPV test: every 5 years

Intervals may be changed if symptoms are present or based on the gynecologist’s assessment.

HPV in men and the couple

Can men also contract HPV?

Yes, HPV is also very common in men and often gives no symptoms because it can regress spontaneously.
It can, however, cause genital warts, generally not dangerous but bothersome, and, more rarely, increase the risk of cancers of the penis, anus, or throat, especially if the infection persists. Even in the absence of symptoms, men can transmit the virus to their partner(s). Vaccination is the most effective form of prevention.

Is there a test to diagnose HPV in men?

In the presence of symptoms, penile, perianal, or pharyngeal samples can be taken for the virus. However, there is no routine screening for the male population.

If one partner has HPV, what should the other partner do? Does it change anything in the life of the couple?

HPV infection does not require separations or termination of long-term relationships. This is a common and manageable situation.
Open communication and correct information help reduce anxiety and overprotective behaviors. Vaccination and adherence to screening programs remain key.

Vaccine and prevention

Is the HPV vaccine safe and effective? What strains does it protect against?

The HPV vaccine is safe and effective: it prevents infection before the virus enters the body and reduces the risk of precancerous lesions and cancers.
The vaccine currently used in Italy protects against 9 strains of HPV. It is most effective when administered before the onset of sexual activity, but can also be useful in young adults.

Who should get the vaccine and at what age?

It is recommended for boys and girls between the ages of 9 and 14, ideally before the onset of sexual activity, when it provides maximum protection.

Can adults vaccinate as well?

Yes, even young adults can get vaccinated. However, efficacy is greater if one has not already come into contact with the strains included in the vaccine.

If I already have HPV, does it make sense to get vaccinated?

Yes, because the vaccine protects against strains not yet contracted. It does not cure an infection that is already present or lesions that have already developed, but it does reduce the future risk of new infections, warts, or tumors.

Regional screening

How does HPV screening work?

Screening is organized according to vaccination status:

• Unvaccinated women: Pap test every 3 years from age 25 years – HPV test every 5 years from age 30 years
• Vaccinated women: HPV testing every 5 years starting at age 30

What happens if the screening test comes back positive?

If the HPV test is positive but the Pap test is negative, the HPV test is repeated after one year.
If both tests are positive, a colposcopy is scheduled, a second-level examination that allows assessment of any lesions of the cervix or vagina using specific reagents and, if necessary, targeted biopsies.