Dossier: Sexuality

HPV infections often go unnoticed

The human papillomavirus (HPV) is one of the most common sexually transmitted infections and is the biggest risk factor for cervical cancer. However, using condoms and getting vaccinated against the most dangerous varieties of HPV can provide good protection.

Text: Nicole Krättli; photo: iStock

The rather unwieldy name “human papillomavirus (HPV)” covers a whole range of different types of viruses that are usually transmitted through sexual intercourse. In fact, it is estimated that 70 to 80% of sexually active men and women will contract HPV at some point in their lives.

However, two-thirds of infections are asymptomatic, which means that those affected don’t notice that they’ve been infected. However, certain types of HPV, such as types 6 and 11, cause visible or hidden genital warts in both men and women. Other HPV varieties, such as types 16 and 18, can persist in infected cells for months or even years. If an infection with a high-risk type of the virus goes unnoticed, this can cause precancerous lesions and eventually cancer.

Any woman can be affected by cervical cancer

Recently, around 250 new cases of cervical cancer and around 5,000 new cases of precancerous lesions have been diagnosed in Switzerland each year. According to figures published by the Federal Office of Public Health, cervical cancer is the fifth most common type of cancer among women aged between 20 and 49 in Switzerland. 

Any woman can be affected by cervical cancer. However, the biggest risk factor is infection with a high-risk variant of HPV. The risk of developing cervical cancer is increased by smoking, sexual intercourse at a very young age and with frequently changing sexual partners, additional infections of the genital organs through sexually transmitted pathogens, and chronic disorders of the immune system.

Since sexually active women with frequently changing partners are particularly at risk, a certain clustering of the disease can be observed in 20 to 30-year-olds and again in 50-year-olds.

“The pros of the HPV vaccination outweigh the cons”

Consistent use of condoms can significantly reduce the risk of catching HPV and other sexually transmitted diseases. What’s more, young women aged between 11 and 26 can be vaccinated against the most dangerous HPV varieties. “For the best possible protection, young women should ideally get the vaccine before they have sex for the first time,” explains Matti S. Kuronen, a gynaecologist and obstetrician at the Hirslanden hospital in Aarau. 

The Federal Commission for Vaccination recommends the HPV vaccine as a primary vaccination for all girls aged 11 to 14. A second vaccine should be administered between the age of 15 and 19. For young women aged 20 to 26 and for boys and men aged 11 to 26, the Federal Office of Public Health recommends the HPV vaccination as a supplementary vaccination. The protection provided by the vaccination lasts at least ten years. 

One of the main arguments against the vaccination, which Kuronen finds justified, is that it only protects against some of the viruses, so you don’t get 100% protection. “However, I believe that the pros of systematically vaccinating young girls against HPV outweigh the cons,” says Kuronen.  Even women who’ve already had HPV once should get vaccinated, because it boosts the immune system. 

Cervical cancer can be effectively prevented by a simple check-up.

Smear tests can save lives

In contrast to the HPV vaccine, smear tests are not just recommended − they are essential. No other cancer can be so effectively prevented by a simple check-up as cervical cancer. Kuronen explains that, since cytological screening was introduced in the 1960s, the number of new cases in Switzerland has been massively reduced and is currently at one of the lowest levels worldwide. Depending on each patient’s situation, HPV screening can be performed at the same time as the cancer smear test to determine the presence of any viruses.

A cancer smear test is a simple examination in which the doctor takes a sample of superficial cells from the cervix and the outer part of the cervix using a swab. ​ These cells are then examined to determine whether any changes have occurred. If the results of the smear test show that changes have taken place, six-monthly check-ups are recommended to keep an eye on developments.

A colposcopy can be performed to provide a more detailed diagnosis. ​ “If changes are noticed in two or three smear tests, conisation may be recommended,” says Kuronen. This is a procedure in which a piece of abnormal tissue is removed from the cervix. It is used to check for cervical cancer or to treat certain cervical conditions.

The procedure may minimally increase the risk of a premature birth later in life. That’s why it’s important to determine whether the specific diagnosis warrants such an intervention or whether it’s better to hope that the changes will heal themselves.