HPV refers to a large family of viruses, some of which infect the genital mucous membranes. Often benign, the infection can however persist and be at the origin of cancers: cervix, penis, anus, ENT sphere. We take stock with Dr. Amélie Ménard, dermato-infectiologist.
HPV is short for Human papillomavirus (HPV) in English. This is a large family of viruses with over 200 viruses identified to date. “They are given numbers to tell them apart. For example, the HPV 1 is the one responsible for palmoplantar warts well known to children“, illustrates Amélie Ménard, infectiologist. It is a virus extremely contagious. “It is estimated that approximately 90% of the population will encounter a papillomavirus in their lifetime. Being in a relationship with an HPV-positive partner multiplies the risk of being contaminated by 6 according to a Canadian study published in May 2021 in the National Library of Medicine“advances Amélie Ménard.
The man and the woman can be contaminated indifferently by intimate contact. Several studies find a higher rate of transmission from women towards men (1.6 times more).
HPV contamination remains asymptomatic in the vast majority of cases but “we know that there is a genetic susceptibility to HPV”, explains the specialist. Also in a certain number of individuals the HPV will infect the cells and be expressed by warts of the skin or mucous membranes and sometimes turn them into cancers. Genital wart, or condyloma, is the most common symptom. “In France, each year, 100,000 people, men and women, are treated for genital warts, sometimes in the anus but also in the oral mucosa.“. In 10% of cases, an infection linked to HPV with a high oncogenic risk (HPV-HR, there are about fifteen known to date) can transform our cells into pre-cancerous cells and then into cancers. In humans, we find cancers of the anus, cancers of the penis and cancers of the ENT sphere. These are becoming more and more frequent. “Today the majority of oropharyngeal cancers are linked to the papillomavirus and not only to alcohol and tobacco as was the case a few years ago“, emphasizes the infectiologist. HPVs with a high oncogenic risk are the HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, HPV 16 being the most common.
It’s a transfer by mucosa-to-mucosal contact. “HPV viruses are not found in secretions but in skin and mucous membrane cells. Also condoms are not an effective protection against this STI, it is important to explain it. A simple caress can be enough to contaminate or be contaminated, with or without penetration“, specifies Amélie Ménard. She adds: “men get infected more than women for several reasons still poorly understood, but in particular because they manufacture fewer antibodies after an infection and their natural protection lasts less. They therefore become more easily re-contaminated, which means that they actively participate in the epidemic.“. Even asymptomatic, an infected individual can infect another individual.
In 10% of infected individuals, HPV will progress to cancer.
If the HPV test – and cervical smear- are well-established tools for organized cervical cancer screening in women, there is no no or few similar tests for humans. “According to the new recommendations of the French Proctology Society 2023, HPV tests can be performed for a certain type of population at high risk of developing HPV 16-related anal cancer. Anoscopy and HPV test can then be made“, explains the specialist. These populations at risk are “lmen over 30 living with HIV who have sex with men, women with a history of precancerous lesions or vulvar cancer, women who have had a solid organ transplant for more than 10 years“, notes the French National Society of Coloproctology (SNFCP) on its website. For the ENT cancers and penile cancerthere are currently no tests available.
The danger of the virus varies by type of HPV contracted. “Thus, the type of HPV depends on the probability that an infection remains inapparent or results in cell abnormalities, whether the infection or disease resolves spontaneously or persists, and whether the infection leads to a high grade lesion, that will regress or persist (cancerous lesion). The HPV virus is as dangerous in men as in women. There exists a genetic, immune predisposition and some risk factors are well known such as tobacco to promote the chronicization of HPV infection. So yes it is dangerous because we do not have the possibility of knowing who the 10% of infected individuals in whom an infection will progress to cancer“, develops the specialist.
To date, we do not haveno antiviral treatment against the papillomavirus. We do not treat a papillomavirus but the symptoms for which it is responsible, including warts, precancerous lesions and cancers. “The burden in man of treatment of pre-cancerous anal lesions or of the penis is very cumbersome“notes Amélie Ménard.
The only effective prevention is vaccine. Recommended at the start among girls since 2007 Then in boys since 2019, HPV vaccination is recommended, reimbursed from the age of 11. By two doses if it is done before the age of 15 and 3 doses if it is done between the ages of 15 and 26. At the end of 2021, according to Public Health France, 37.4% of 16-year-old girls had a full two-dose vaccination schedule. Among boys, 6% had received a dose at age 15. In France, vaccination coverage is among the lowest in Europe. For example in Spain or Portugal they are at 80%, in England at 81% and 60% in Italy…”In many countries, catch-up vaccination is recommended until the age of 45, which is not yet the case in France today. concludes Amélie Ménard. “It could be interesting because having been contaminated once by an HPV 18 for example does not naturally protect against being contaminated later by an HPV 16 for example, which we know is more likely to cause cancer”.
Thanks to Dr. Amélie Ménard, dermato-infectiologist at AP-HM in Marseille and coordinator of the Multidisciplinary Consultation Meeting (RCP-HPV complex) which brings together different medical specialties concerned by cancers induced by papillomaviruses.
Source: Sex- and type-specific genital human papillomavirus transmission rates between heterosexual partners: a Bayesian reanalysis of the HITCH cohort, May 2021, National Library of Medicine.
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