Anatomy-Lexicon

What is the HP virus?

definition

The human papilloma virus - HPV for short - is a pathogen about 50 nanometers in size, of which there are well over a hundred different types that cause different clinical pictures. For example, HPV can cause skin warts, but it can also be a predisposing factor for cervical cancer or laryngeal cancer.

Papillomavirus

The papillomaviruses belong to the DNA-carrying viruses and are 45 to 55 nanometers in size. The subspecies of the human papillomavirus - HPV for short - is mainly relevant for humans. Papillomaviruses cause the disease to progress slowly and are therefore not acutely life-threatening in the event of an infection, like other pathogens.

They ensure the development of tissue overgrowth. These can be either benign, such as a skin or genital wart, or malignant, such as in cervical cancer. In addition, papillomaviruses are very environmentally resistant, which allows them to survive for several weeks without a host.

How can you diagnose an infection with the HP virus?

The test to assess whether an infection with HPV has occurred consists of a tissue sample from a potentially suspicious skin growth. This tissue sample is broken down into its individual components with the help of enzymes and breakdown procedures, and these are then examined for the presence of HPV DNA. If this can be found, it is considered evidence of the presence of an infection. Conversely, the absence of HPV DNA cannot rule out an infection with one hundred percent certainty.

In addition, it is advisable to examine whether the viral DNA has already been integrated into the genome of the body's own cells or is still loosely in the cells. From a statistical point of view, integration is associated with a significantly higher risk of degeneration of the skin growth. So-called tumor suppressor genes are destroyed by the integration of the viral DNA, so that cellular control mechanisms are eliminated and the tendency towards degeneration increases.

What diseases does an HP virus cause?

Roughly speaking, a distinction can be made between benign and malignant diseases caused by HPV. Which disease is caused can be identified by the type of HPV that is causing the disease. A distinction is made here between many so-called low-risk types and a few so-called high-risk types.

The low-risk types cause benign skin growths. These include, for example:

Flat skin warts
Deeper plantar warts
Wet warts
Warts in the anogenital area

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Another disease is the recurrent respiratory papillomatosis. These are recurring warts that form on patients' vocal folds. Primarily they cause hoarseness, in the worst case they can cause partial closure of the airways. Nevertheless, these "vocal cord warts" are still counted among the benign diseases.

Tumorous changes can be summarized under the malignant diseases. Prominent examples here are cervical cancer or a variant of skin cancer, the so-called epidermodysplasia verruciformis. The viruses nestle in the cells at the appropriate locations and block the cell-internal control mechanisms that are normally intended to prevent tumor development.

What symptoms can suggest an HP virus?

A clear distinction between symptoms and a complete clinical picture cannot really be made in the case of an infection with human papillomaviruses. In the case of benign HPV viruses, the development of warts is both a symptom and ultimately the complete clinical picture. Since warts in humans are only caused by human papillomaviruses, further research into the cause is not necessary. Only the determination of the HPV type could be important in order to weigh up the risk of developing a tumor.

Symptoms for the presence of a manifest tumor, on the other hand, are the triad of the so-called "B symptoms", consisting of:

fever
Night sweats
Unintended weight loss

This triad is a key symptom of tumor diseases in the later stages. These tumor diseases, however, are not a manifestation of a recent infection with human papillomaviruses, but only appear decades later, so that any "B symptoms" only serve as an indirect indication of the presence of an HPV infection, since the tumor disease is also a completely different one May have origin.

Warts

Warts are benign skin tumors per se, in other words, to put it simply: superficial increases in tissue caused by a viral infection. Different types of warts can be distinguished according to their location and severity:

Flat skin warts: They are usually found on the face or hands and show only a small bump. They mainly affect children.
Common warts: This type is mainly found on the hands of those affected and shows a small bump with a rough surface.
Plantar warts: are found on the soles of the feet and, compared to the other types of warts, grow deeper into the subcutaneous fatty tissue.
Genital warts / anogenital warts: are found on the mucous membranes of the external genital organs such as the vagina, penis, but also the anus.
Larynx warts: These warts are located on the vocal cords in the larynx and must be surgically removed

You might also be interested in: Are genital warts contagious?

Treatment / therapy

Treatment of the infection with human papillomaviruses depends primarily on the type of HPV and thus also on the symptoms the virus causes. If the "benign HP virus" causes warts to develop, therapy is not absolutely necessary - the exception here is larynx warts, which could otherwise block the windpipe.

Usually the local infection site that later forms the wart heals by itself after two years at the latest and the wart disappears. However, since warts are often found unsightly and bothersome, there are ways to treat them; they can either be surgically excised, frozen, or treated with caustic over a long period of time to gradually remove the wart. Unfortunately, all routes are associated with frequent recurrence of the warts.

Read more on the topic: Medicines for warts

In the case of tumorous, ie "malignant" skin changes, the same procedures as for other tumors are to be used. The spectrum of treatment can range from surgical removal to radiation or chemotherapy. This is determined by a dermatologist or oncologist, depending on the type of tumor.

For cervical cancer, vaccination is available to prevent a potential HPV infection that could lead to cancer developing. Tumors of the throat and pharynx, similar to skin tumors, depending on their type, are removed by the facilities available to oncology.

Read more on the topic: Vaccination against cervical cancer

HPV vaccination

Vaccination against HP viruses is officially recommended by the Robert Koch Institute for both boys and girls. The vaccination costs for girls between the ages of 9 and 14 are usually covered by the health insurance companies. If in doubt, you should contact the health insurance company directly and inquire there.

The vaccination is a triple dose of an active ingredient that is said to be effective against nine different types of HPV. The main reason for vaccination is the protection against the development of cervical cancer due to an HPV infection. Since HP viruses are usually colonized with the onset of sexual activity, the vaccination should be given before the first sexual intercourse, if possible.

If this activity has not yet been achieved by the age of 14, a later vaccination is recommended. Health insurance companies then take over these vaccinations in individual cases. For a more detailed list of the assumption of costs as well as possible side effects, etc., please refer to the website of the Robert Koch Institute.

How is the transmission route?

The transmission mostly originates from an HPV-infected person. This can either transmit the virus directly to another person or release the virus into the environment, where it survives for some time until it comes into contact with the next person.

The viruses look for a way "through" the skin, since they strive to lodge in the bottom layer of the skin and allow them to multiply there. The virus achieves this either by penetrating small wounds in the skin, where the top layer of skin, which serves as a protective barrier, is missing, or by contacting the mucous membrane, which also does not have this typical top layer of skin. The mouth or genital area are typical places where mucous membranes can be found.

Once the viruses have lodged in the cells of the bottom layer of the skin, they induce them to divide more strongly. New cells that are also colonized with viruses now emanate from each infected skin cell. As the skin cells divide more often than normal due to the virus, small tissue overgrowths, so-called warts, develop. Over the course of weeks, the virus-containing cells of the lowest skin layer reach the surface, as the skin is constantly renewing itself from below.

If these virus-containing cells, which are now superficially located, are injured or destroyed, viruses are released, which are then either transmitted directly to a person or are released into the environment.

So bleeding warts are highly contagious and can cause new warts in the places where the blood gets.

Can the HP Virus be transmitted through oral sex?

Transmission through oral sex is possible without any problems, as the human papillomavirus needs a "leaky" area of skin in order to penetrate there. Since it is a mucous membrane in the mouth, it does not have a protective horny layer, which allows the viruses to penetrate unhindered. However, transmission in the opposite direction is also possible. There are also mucous membranes on the penis and vagina through which the viruses can penetrate the body.

In both cases, however, a prerequisite is an area of skin contaminated with HPV or something similar that transports the virus to the mucous membranes.

How long is the incubation period?

The incubation period of the human papillomavirus is usually between four weeks and eight months. It depends on the immune situation of the infected person and on the viral load during transmission. The greater the viral load, i.e. the more viruses that are transmitted, the shorter the incubation period as a rule.

Cervical cancer from HPV

To put your mind at ease, it should be said that not every infection with human papillomaviruses per se leads to the development of cervical cancer. Among the well over a hundred different HPV types, types 16, 18, 31 and 45 are particularly associated with an increased risk. The so-called cervical cancer vaccinations are designed against precisely these subspecies in order to minimize infection and thus the risk of cancer development.

If the viruses succeed in infecting the uterus during sexual intercourse, the viruses nestle in the cells of the cervix and slowly begin to disable the cell's own "control mechanisms", so that over the course of 10 to 15 years the disease begins to degenerate Cervical cells.

Throat cancer due to HPV

There is currently no clear evidence for the connection between HPV infections and larynx cancer, as the exact mechanism is still unclear. However, studies have shown that a significant number of people with throat cancer also have HPV infection. Usually it is HPV type 16 or 18, which is known to cause cancer in a certain type of cell that is also found in the larynx.

In this context, however, there is reason for hope that the treatment of larynx cancer caused by human papillomaviruses works relatively well. Far better than the cancer of the throat caused by smoking or alcohol.

Prognosis - Can HPV Infection Be Cured?

The warts resulting from an HPV infection are quite treatable. They can be removed either by etching or by "freezing". If none of this is successful, the warts can ultimately be surgically cut out. However, these treatments are usually associated with a relatively high rate of recurrence. This means that a wart will develop again after all.

In normal cases, the warts also disappear on their own after about two years without any further action, since the body has formed enough antibodies during this time to fight the viruses and get rid of these unaesthetic skin growths.

Regarding the tumorous changes caused by HPV, the stage at which the tumor is discovered plays a decisive factor in the prognosis of the disease. The earlier the tumor, such as cervical cancer or carcinoma of the mouth and throat, is discovered, the better the chances of recovery. Another decisive factor is the type of therapy used and whether the tumor has already been able to infect adjacent lymph nodes or even to metastasize.

With the help of a comprehensive operation and a subsequent combination treatment of chemotherapy and radiation, the prognosis for the healing of the tumor does not look bad.