Characteristics of HPV

HPV is a DNA virus with a tropism for epithelial cells of the skin and mucous membranes. More than 200 types have been identified, about 40 of which are sexually transmitted.

Low-risk oncogenic types

Cause benign lesions, mainly genital warts:

• HPV 6

• HPV 11

High-risk oncogenic types

Responsible for precancerous lesions and cancers:

• HPV 16, 18 – clinically most significant

• HPV 31, 33, 45, 52, 58 – also important

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Routes of transmission

• sexual contact (vaginal, anal, oral)

• skin-to-skin contact in the genital area

• rarely, perinatal transmission

The virus can be transmitted even when the infected person has no symptoms.

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Natural course of infection

In most cases (about 80–90%), the immune system clears the virus within 1–2 years. Persistent infection with high-risk types is the main factor in cancer development.

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Oncogenic mechanism

Viral proteins E6 and E7 inactivate tumor suppressor proteins p53 and Rb, leading to uncontrolled cell division and genetic instability.

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Clinical manifestations of HPV infection

Benign lesions

• genital warts (condylomata acuminata)

• skin warts

Precancerous lesions

• CIN (cervical intraepithelial neoplasia)

• VIN (vulvar intraepithelial neoplasia)

• AIN (anal intraepithelial neoplasia)

HPV-related cancers

• cervical cancer

• anal cancer

• penile cancer

• oropharyngeal cancer

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HPV and cervical cancer

HPV infection is a necessary factor in the development of cervical cancer. The transformation process usually takes many years, which allows effective secondary prevention through screening.

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Diagnosis of HPV infection

Cytology (Pap smear)
Detects cellular abnormalities before cancer develops.

HPV DNA test
Identifies the presence of high-risk HPV types.

Colposcopy and biopsy
Used when screening results are abnormal.

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Treatment

There is no therapy that eliminates HPV from the body. Treatment focuses on lesions caused by the infection.

• removal of genital warts (cryotherapy, laser, electrocautery, topical treatments)

• treatment of precancerous cervical lesions

• oncologic treatment in cases of cancer

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Cervical Conization – What Does the Procedure Involve?

Conization is a gynecological procedure involving the removal of a cone-shaped fragment of the cervix that includes the transformation zone and the area of precancerous lesions. It is most often performed when high-grade lesions (CIN2, CIN3) or abnormal cytology and colposcopy results are detected.

Goals of the procedure

• removal of precancerous lesions

• prevention of cervical cancer

• obtaining tissue for histopathological examination

Methods of conization

• surgical conization (“cold knife”)

• LEEP/LLETZ – loop electrosurgical excision

• laser conization

Procedure course

Usually performed under local or short intravenous anesthesia. It lasts several to several dozen minutes. The removed tissue is always sent for histopathological analysis.

Post-procedure period

After conization, patients may experience:

• spotting or bleeding for several days

• moderate lower abdominal pain

• vaginal discharge

Avoid sexual intercourse, tampons, and strenuous activity for several weeks.

Possible complications

• bleeding

• infection

• cervical canal stenosis

• slightly increased risk of preterm birth in future pregnancies (rare)

Conization is an effective treatment for precancerous lesions and helps prevent cancer while preserving reproductive organs.

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Prevention

HPV Vaccination – Types of Vaccines and Schedules

Vaccination is the most effective method of preventing HPV-related diseases, including cancers associated with high-risk types and genital warts.

Types of vaccines

Modern HPV vaccines are recombinant and do not contain live virus — they cannot cause infection.

1. Bivalent vaccine
Protects against HPV 16 and 18.

2. Quadrivalent vaccine
Protects against HPV 6, 11, 16, and 18.

3. 9-valent vaccine
Provides the broadest protection: HPV 6, 11, 16, 18, 31, 33, 45, 52, 58.

Who should be vaccinated?

• girls and boys before sexual initiation

• adolescents and young adults

• adults (vaccination still provides benefits after sexual debut)

• people at increased risk, including immunocompromised patients

Vaccination schedules

Ages 9–14:
2 doses (0 and 6–12 months)

Ages ≥15 and immunocompromised persons:
3 doses (0, 2, 6 months)

Vaccine effectiveness

Vaccination significantly reduces the risk of:

• cervical cancer

• precancerous lesions

• genital warts

• other HPV-related cancers

Vaccine safety

Common side effects:

• pain and redness at injection site

• low-grade fever

• temporary fatigue

Serious adverse reactions are very rare.

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Screening

Regular Pap smears and HPV testing significantly reduce mortality from cervical cancer.

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Sexual behavior

Condoms reduce transmission risk but do not eliminate it completely.

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HPV in men

Infection is often asymptomatic. It can lead to genital warts and cancers of the anus, penis, and throat. Men play an important role in virus transmission.

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HPV and pregnancy

Infection usually does not affect pregnancy. Transmission to the newborn is rare.

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Factors increasing risk of persistent infection

• smoking

• weakened immunity (HIV, immunosuppression)

• multiple sexual partners

• early sexual initiation

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Psychological aspect

HPV is extremely common. Infection is not a reason for stigma. Education and regular medical follow-up are essential.

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Patient FAQ

Does the HPV vaccine treat existing infection?
No. The vaccine is preventive and does not eliminate existing infection or treat lesions.

Is vaccination useful after sexual debut?
Yes. Most people have not been exposed to all vaccine-covered types.

Does the vaccine provide lifelong protection?
Evidence shows long-lasting immunity. No booster doses are currently recommended.

Does HPV infection mean a partner was unfaithful?
No. The virus can remain dormant for years.

Does conization cure HPV?
It removes abnormal tissue but does not eliminate the virus.

Can you get pregnant if you have HPV?
Yes. HPV usually does not affect fertility or pregnancy.

Does vaccination replace Pap smears?
No. Screening is still necessary.

 

Is the vaccine safe?
Yes. Serious reactions are extremely rare.

References 

1. Luria, L. Human Papillomavirus. In: StatPearls. National Center for Biotechnology Information (NCBI). 2023.
   – Overview of HPV virology, pathogenesis, and clinical features published in the NCBI Bookshelf.

2. Cheng, L. et al. Human Papillomavirus Vaccines: An Updated Review. PMC (PubMed Central), 2020.
   – Review of current HPV vaccines, efficacy, and impact on HPV-related diseases.

3. Centers for Disease Control and Prevention (CDC). HPV Vaccination Recommendations. CDC official guidelines, 2024.
   – Current recommendations for HPV vaccine dosing and age groups.

4. CDC. HPV Vaccination: For Providers. CDC guidance on clinical use and age-specific vaccination advice.

5. Mayo Clinic. HPV Infection – Diagnosis & Treatment. Mayo Clinic overview, 2025.
   – Practical clinical information on HPV screening and management.

6. World Health Organization (WHO). Programmes and Guidelines on HPV Vaccination. (As summarized in mp.pl article, reflecting WHO policy).

7. Polish Public Health Authorities: Szczepienia.Info / Pacjent.gov.pl.
   – Information on HPV vaccines available in Poland, effectiveness, and safety data.

8. European Commission – Health/EU Public Health. HPV and Vaccination in the EU.
   – Epidemiological data on HPV and vaccination implementation in Europe.

9. ACIP (Advisory Committee on Immunization Practices). Evidence to Recommendations for HPV Vaccination. CDC, GRADE evidence summaries.

10. Bergman, H. et al. Human papillomavirus (HPV) vaccination for the prevention of HPV-related disease. The Cochrane Library review, 2025.
    – Systematic review of HPV vaccine effectiveness.