Questions to Pr Jérôme Delotte, head of the obstetrics and gynecology center of the University Hospital of Nice.
What is human papillomavirus?
It is a family of viruses which includes around 200 variants. Among them there are harmless forms. Others can cause genital warts (condyloma), benign but very unpleasant lesions.
And some variants, the most resistant (16 and 18, in particular), have significant carcinogenic potential and are the cause of the majority of cancers. For the record, HPV has always existed. It is probably linked to a sexual relationship between a homo sapiens and a Neanderthal. HPV would therefore be a “gift” left by Neanderthal Man.
How is this virus transmitted? It is a sexually transmitted infection (STI), with or without penetration. Simple caresses can be enough to contaminate his partner. This virus is very contagious: it is estimated that 80% of sexually active women and men will be exposed to it during their lifetime.
In 90% of cases, the immune system spontaneously eliminates the virus. For the remaining 10%, the body cannot get rid of it. If it is a so-called oncogenic papillomavirus, the infection can cause precancerous lesions, which can develop into cancer.
Why do some people eliminate it and not others?
It depends on each person’s immunity. People who have immunosuppression (1) (HIV, transplant, etc.) will have more difficulty getting rid of the virus. Smoking can also promote HPV recurrence or its maintenance.
Do HPV-induced cancers also affect men?
Yes, if two-thirds of HPV-induced cancers (cervical, vulva, vagina, etc.) concern women, one-third of them occur in men: cancer of the ENT sphere but also of the anus and penis.
Anti-HPV vaccination is slipping in France… Why?
In France, there has been a real problem of communication around vaccination because this virus has been “sexualized”. People imagine that having HPV means having had sex, or even “risky” behavior.
Let’s be clear: HPV can be transmitted by simple caresses and without penetration. Anal cancer does not mean anal intercourse. This is because HPV can spread to the genitals. Sex toys, under certain conditions, can transmit HPV. This virus is not a marker of sexual practices, but that is how it was apprehended. Also, some parents think that vaccinating their 12-year-old daughter is not necessary since she does not have sex.
But that’s not the point at all. A person will have a very high chance of being exposed to the virus during their lifetime, and they cannot be prevented from having sexual intercourse. The question is: how to prevent her from developing cancer? The answer is simple: we must vaccinate and screen.
According to the Opinion way poll from last April, parents also fear the side effects of the HPV vaccine…
There are no particular complications, except pain in the arm at the injection site, like many vaccines. There is a low percentage of headache, fever and fatigue. Studies have shown that the vaccine is not associated with an increased risk of phlebitis, multiple sclerosis or Guillain-Barré syndrome.
What about self-tests for cervical cancer screening?
Laboratory kits exist and others are still under study and their exact use is to be defined according to the populations. These self-tests, to be done at home, consist of a sample identical to a smear. It is enough to put a small device in the vagina and send the result. They do not require the intervention of a health professional. This device is promising, knowing that 40% of women do not do their screening regularly.
Why can’t we vaccinate against the papillomavirus after the first sexual intercourse?
Because vaccinating before the start of sexual intercourse leads to maximum efficiency. The vaccine helps to prepare the body’s immunity. In the event of contamination, the response is rapid. Prevention is the best defense against HPV.
On the other hand, research is making new discoveries: the vaccine would thus seem to be effective after contamination. Studies have shown that a woman vaccinated post-conization (2) would have a lower recurrence rate.
This is a major discovery!
Yes, but at the moment, the important thing is to protect the whole population. Healing on a case-by-case basis will come later.
1. Reduction or abolition of the immune system’s ability to fight infection and disease.
2. Intervention that consists of surgically removing lesions that can potentially progress to cancer of the cervix.