HPV is a very common virus that can affect both males and females.

Papillomavirus infection, which is primarily sexually transmitted, is often asymptomatic, so whoever is affected is not aware of it, greatly increasing the risk of transmission of the virus. HPV infection is common, but in most cases it is completely overcome by the body without health consequences. However, when the virus is not spontaneously eliminated, HPV infection persists in the body, and can cause the development of many pathologies, both benign and malignant, that affect both men and women. Almost 80% of women test positive for HPV infection at least once in their life. Its prevalence increases in sexually active women between the ages of 15 and 24, and then decreases throughout the fertile age, increasing again prior to menopause at around 45-52 years of age. What is the reason for this second peak? The answer is not known for sure. There are two expert hypotheses that garner the most credit. The first is that it may be caused by re-activation of the virus that was originally contracted during the first sexual encounters of adolescence. The second is that it may be caused by a change in sexual habits and/or by the sexual encounters had with new partners at an older age.  

Contagion occurs through sex, although not necessarily following complete sexual intercourse. In some cases, HPV infection can be transmitted from one person to another many years after one partner has contracted it. Therefore, having an infection may not have anything to do with your current partner, and is not a "sign of infidelity."

The HPV infection is quite common and in most cases resolves entirely spontaneously and without any consequences on health. However, when the virus is not eliminated, the HPV infection persists in the body and certain cancers can develop. 5% of all cancers are caused by HPV, totaling over 600,000 new cases per year, worldwide.

In Europe, it is estimated that every year there are about 50,000 new cases of cancer caused by HPV; even though most of these are related to cancer of the cervix. Other cancers constitute almost one-third of all cases of HPV-related cancer, in fact in men there are approximately 15,500 new cases including cancer of the anus, penis, head and neck (oral cavity, oropharynx and tonsils).

In women, all cervical cancers are caused by HPV. Still in Europe, between 267,000 and around 510,000 new cases each year of precancerous lesions of the cervix have been estimated, related to the 9 types of HPV contained in the new vaccine.

The 45 different types of Human Papillomavirus which may be found on our skin and mucous membranes can be divided into low and high risk tumor types.

• Infections caused by low-risk types (e.g. HPV 6 and 11) are usually associated with the development of warts in the genital region.
• Persistent infections, related to HPV types such as α-papillomavirus, are instead associated with high risk types and therefore the risk of developing cervical cancer and other types of HPV-related cancer.
• The types considered high risk are: HPV 16, 18, 35, 39, 45, 51, 31.33, 52, 56, 58, 59, 68, 73 and 82, while 26, 53 and 66 are considered as probably carcinogenic.
• HPV types 16, 18, 31, 33, 35, 45, 52 and 58 are the types most commonly involved in the pathogenesis of cervical cancer and other HPV-related cancers and lesions.

High cancer risk HPV types may be present, even silently, in subjects with benign lesions caused by low-risk strains.

Indeed, the initial Papillomavirus (HPV) research focused on cervical cancer, and therefore on prevention exclusively for women. However, with the development of new studies, in recent years it has been shown that ALL people who come into contact with the virus can be affected by the consequences of HPV infections. Males, therefore, not only have a role in virus transmission, but they themselves may be affected by both cancerous and non-cancerous pathologies.

There are several types of HPV, each identified with a number. Some types, such as HPV 16 and HPV 18, are responsible for most cervical cancers, male and female genital cancers, anal cancers and oral cavity (oropharyngeal) cancers.

Other types of Papillomavirus, especially HPV 6 and HPV 11, are responsible for genital condylomas (also known as "genital warts"), which are very annoying warts that affect men and women equally, often causing symptoms such as burning, pain, and bleeding.

In many cases, the HPV infection in men is asymptomatic and therefore gives no signs of its presence, without manifesting any symptoms, as a "latent" or "sub-clinical" infection. In other cases, there may be skin lesions or mucous membrane lesions , or more complex diseases related to the cancerous genotypes 16 and 18 of the HPV virus. These are cancers of the ano-genital area located at the penis and the anus, genital warts. These genital lesions are not life-threatening but, despite being benign, have a strong impact on the health and quality of life of the person.

It should also be mentioned that in men, HPV types 6 and 11 can cause another rare pathological condition: recurrent respiratory papillomatosis (RRP) which is characterized by the appearance of warts in the respiratory tract, particularly the vocal cords (oropharyngeal tract warts) and larynx (laryngeal papillomas).

Papillomavirus infection is transmitted sexually, between men and women and between partners of the same sex, even in the absence of penetration. In fact, the transmission occurs by skin-skin or skin-mucous membrane contact, which explains the limited effectiveness of a condom in preventing HPV infection. Vaccination is therefore the only method to prevent HPV infection, which, when persistent, plays a decisive role in the development of cervical cancer. Vaccination intervenes before contagion occurs.

Another prevention method, although limited to cervical cancer, is screening (Pap Test or HPV test), which allows for the diagnosis of lesions at the initial stage, before they can become cancerous. For other HPV cancers, including those affecting men (anus, penis, oropharyngeal), no organized screening programs exist, and so they are often diagnosed at an advanced stage and may require mutilating interventions.

Leading a healthy lifestyle from a sexual point of view as well can help you protect yourself. Making your sexual debut too early as well as having multipartner relationships represent risk factors, as does smoking, which lowers immune defenses. Even after getting the vaccine, it is good to use a condom during sexual intercourse because HPV infection increases the risk of other sexually transmitted infections.

That's a very good question because it helps to clarify the differences between the various levels of prevention and early diagnosis and the screening which many people still confuse with primary prevention, often deluding themselves that they can avoid the onset of a dreaded disease, like cancer, through a simple examination.

• Primary prevention seeks to prevent a disease from occurring (i.e. to reduce the incidence) for example by increasing the body's defenses, eliminating the causal factors of the disease, selecting and treating conditions of risk, for example with the use of a vaccination or with advice on how to change your lifestyle.
• Secondary prevention concerns clinically healthy individuals with biological damage in progress and aims to heal the lesion before it can evolve into full-blown disease (this applies to cancer in particular).
• Early diagnosis concerns individuals at the very earliest stage of the disease so as to be able to intervene with appropriate treatment and increase life expectancy/ reduce mortality, despite there being no guarantees of being cured.

In fact, throughout their lives the individuals will have to undergo check-ups aimed at immediately intervening in the case of relapses.

• Secondary prevention and early diagnosis are achieved through adequate screening programs.
• Tertiary prevention lastly concerns the prevention of relapses, with the aim of reintegrating the patient in the family and social context as well as possible.

To be even clearer let's take as an example, the prevention of HPV-related cervical cancer.

**The development of the nonavalent vaccine represents an important advance in the primary prevention of HPV-related disease.

In reality, this is a good age to receive the vaccine since it is most effective when given prior to a person's sexual debut, that is, prior to the first possible contact with the virus. Furthermore, at a young age, the immune system response and therefore the production of protective antibodies is greater than that observed in older people.

The most favorable time for vaccination (immunization in medical terms) is between 9 and 13 years of age, the age during which normal vaccinations are in fact provided. During this period, you can take advantage of the free offer from SSN. Once the vaccine has been given, the antibody coverage lasts for at least 10 years according to the currently available studies. New and updated data is continuously being collected on this subject.

If you decide to vaccinate later, the vaccine offer varies from region to region, up to 26 years of age, with an individual contribution. The data collected so far have shown that the vaccine is effective and safe up to 45 years of age, so it is also possible to vaccinate on a voluntary basis and - in some regions (and European countries) - for free. However, it should be kept in mind that the efficacy of the vaccine decreases as the time that passes since a person's sexual debut increases.

Genital condylomas are caused by some human Papillomaviruses (HPV type 6 and 11) that cause small upraised bumps (genital warts) from the usually indented surface, typically located near the penis or the female genitals, both inside and outside. They both affect both sexes, and are so small that they can go unnoticed. They are transmitted by direct contact during sex or indirect contact with contaminated surfaces, clothing and linens. They can be treated with specific drugs, lasers and other treatments.

The viruses that cause condylomas are from the same family of strains that cause cervical cancer, but are considered to be low risk strains for cancer. The HPV test done during screening only identifies high-risk HPV viruses. The low-risk Papilloma Virus (HPV) types are rarely associated with cancer, but still have a major impact on human health.

They are very contagious. They should not be neglected because with time they grow in number, causing ano-genital lesions that could be the basis of the more serious illnesses.

In more than 90% of people who have had an HPV infection, the virus is spontaneously eliminated by the body within two years, especially in girls before 30 years of age, without any need for treatment.

However, it is not known for sure whether the body completely eliminates the virus or whether it remains latent. In particularly predisposed subjects, some experts believe that "old" HPV infections can "reactivate" (but this does not always happen) after a few years, most likely because of immune system disorders. Additionally, if you have regular sex, there is a risk of contracting a new infection caused by a different HPV strain, especially if you frequently change partners. But don't be afraid. By regularly screening, you can keep the virus at bay, preventing its development right from the start.

Exactly, it depends on age. In Italy today, screening for cervical cancer involves performing a Pap test every 3 years in women aged 25 to 65, in the case of 2 negative tests in a row. The Pap test is not indicated before 25 years of age because Papillomavirus infections in young women typically regress spontaneously. Undergoing an exam would thus be a useless exposure to stress and further examinations without any real preventative necessity. On the other hand, the HPV test before 30 years of age is not considered useful because the probability that it results positive is very high, considering that it is at this age that the initial infection usually occurs. The National Health System has established that by 2018, Italian regions will have to organize screening for cervical cancer using the HPV test in women over 30 years of age, to be repeated every five years. For younger women between 25 and 30, the current Pap test will continue to be used.

HPV infection is asymptomatic, and therefore, its transmission is very widespread. Thus, it is advisable to check for any pre-cancerous lesions through screening (Pap Test or HPV Test) in order to identify these lesions as early as possible, and keep them under control, and, if necessary, treat them before they evolve into a tumor.