8 misconceptions about cervical cancer and papillomaviruses

We are erroneously talking about HPV, of which there are about 200 types, classified according to their pathogenicity (ability to cause disease). Therefore, human papillomaviruses, commonly referred to as HPV, are a family of viruses that can infect the skin and mucous membranes. These viruses are highly contagious and transmitted by skin-to-skin contact, that is, from skin to skin, including during sexual intercourse. There are several types of HPV: those that have a low carcinogenic risk – responsible for the development of genital or plantar warts – and those that have a high carcinogenic risk, the most common and dangerous being HPV-16 and HPV-18 (which can It can cause pre-cancerous lesions and the development of several types of cancer including cervical cancer). There are many misconceptions about HPV and cervical cancer. On the occasion of the 46ᵉ Congress of the French Society of Colposcopy and Pathology of the Cervix-Vaginal (SFCPCV) held in mid-January 2023 in Paris, Science and the future Separate right from wrong.

Myth #1: HPV only affects heterosexual women

forged. All people who have had at least one sexual relationship can become infected with HPV: 80% of sexually active people will experience an HPV infection, half of whom are between the ages of 15 and 24. In most cases, the virus is recognized and eliminated by the immune system. Only 5% to 10% of people will have a persistent infection.

Myth 2: Only men can transmit the virus to women

forged. HPV is a type of sexually transmitted infection (STI). These are highly contagious viruses, and infection can occur through skin-to-skin contact during sex. As a result, all people who carry HPV can transmit the virus to their partner(s) during sexual relations (man-man relationship, woman-woman relationship, man-woman relationship).

Myth 3: Wearing a condom prevents HPV infection

forged. Although considered a sexually transmitted infection (STI), wearing a condom does not completely protect against HPV infection (70% condom effectiveness if used systemically). In fact, human papillomaviruses are viruses that are transmitted through skin contact (neither through blood nor through sexual fluids). This means that contamination can occur even without penetration. However, condoms protect against other STDs (HIV, chlamydia, and herpes) and prevent unplanned pregnancies.

Misconception #4: My screening test says I have HPV, and I will inevitably develop cervical cancer

forged. A positive HPV diagnosis does not mean that a person has precancerous lesions or cancer. This simply means that the virus with a high risk of cancer (HPV-16 or HPV-18) is in our cells and that we can pass it on to our sexual partners. In fact, it takes more than five years for precancerous lesions to develop after infection. For this reason, from the age of 25, it is important to carry out regular monitoring with a smear every three years in order to monitor the development of infection and control it. This also means that having a Pap smear every year is not helpful.

Misconception #5: I will inevitably pass the virus on to my partner if I test positive

True. If you are infected with HPV, transmission of the virus has already occurred in your partner, certainly during the first sexual intercourse. However, a positive examination should not prompt you to change your lifestyle and sexual practices. It is very important to have regular gynecological follow-up and check-up every three years to avoid complications. However, although there are factors that support the development of the virus such as tobacco consumption or immunosuppression (disruption of the immune system through immunosuppressive therapies in order to combat autoimmune diseases or to prevent rejection of transplants), the risk of developing a lesion or cancer in men is very low.

Misconception #6: HPVs are responsible for the majority of cervical cancers

True. Papillomaviruses are responsible for 60% of cervical cancer cases. HPV screening allows for better care, better control and progress monitoring if the test proves positive.

Myth 7: Screening is for young women only

forged. The examination is carried out every three years by means of a “smear”, and the examination is intended for all people with a uterus:

• Women between the ages of 25 and 65 without symptoms and said to be “immunocompetent” (the body’s ability to produce a normal immune response)
• Women who have ever had sex and have had it before
• Postmenopausal pregnant women who have been vaccinated against human papillomavirus
• Transgender men who have not had a hysterectomy (complete removal of the uterus)

Depending on the age of the patient, the HPV screening test will not focus on the same goals:

• Before the age of 25 years, the examination consists of analyzing the presence or absence of cytological abnormalities (abnormal cellular lesions). Not to be confused with the presence or absence of a virus! Indeed, 80% of people between the ages of 18 and 25 have already been infected or are carriers of the virus. At this age, looking at the presence of the virus is not an indication of the presence or absence of significant cell damage. If the test result is negative, this indicates that there is no abnormality in the cells of the cervix. You will have to come back after three years to take a screening test again. If the test is positive, rapid support will be provided by the medical services for additional examinations.
• From the age of 25, a cytological examination looks for the presence of the virus in the cells. The absence of a high-risk cancer virus will result in a negative HPV test result. A positive HPV test detects the presence of a virus with a high carcinogenic risk in the cells but does not detect the presence of precancerous lesions or cancers. It is important to get tested every three years until age 65 to monitor the progression of the infection.

Myth 8: Vaccination is highly recommended for young girls

True, and among young boys too! HPV vaccination is highly recommended for girls and boys ages 11 to 14 on a two-dose schedule. If the vaccination was done before the first sexual intercourse, the effectiveness of the vaccination is close to 100%. There is also a “compensation” preparation for males and females ages 15 to 19 on a three-dose schedule. When vaccinated after the start of sexual life, the protection is lower, because the vaccine does not protect against a previous infection with HPV. Please note that vaccination does not exempt women from regular gynecological follow-up and examination every three years.

Vaccination against HPV is also recommended:

• In immunocompromised people (whose immune system is weak or even inactive) up to the age of 19, and from the age of 9 in children who are candidates for a solid-organ transplant.
• Up to age 26 in men who have had sex with or who have sex with other men.