The human papillomavirus (HPV) is a pathogen that infects skin and mucosal cells. Currently, more than 100 different types of HPV are known.
Some HPV types cause common skin warts on the feet, hands, or face. Such warts occur in 5 to 20 percent of children and 3 to 5 percent of adults.
About 40 HPV types are sexually transmitted and are grouped as low-risk or high-risk for causing disease.
Low-risk types cause unpleasant but harmless genital warts (condylomas).
High-risk types can cause tissue changes in the:
- Oral and pharyngeal tissue
- Genital tissue.
- Cervix.
- Vagina.
- Penis.
- Anus.
And may lead to malignant tumors. The most common cancer caused by HPV is cervical cancer (cervical carcinoma).
Transmission of HPV occurs through direct contact with infected skin. The virus enters the body via microscopic skin lesions.
Because HPV tolerates drying, indirect transmission via contaminated items (for example, shared intimate towels) is possible.
Transmission from mother to newborn during birth is extremely rare.
Genital HPV types spread mainly through vaginal, anal, or oral sex; exchange of body fluids is not required.
About 70 percent of sexually active people will acquire HPV in their lifetime, with prevalence highest between ages 15 and 24. Frequent partner change increases risk.
HPV can remain dormant for years, so infection often predates diagnosis; if one partner has a genital HPV type, the other is likely exposed as well.
More than 80 percent of infections are asymptomatic and clear spontaneously within two years, as the immune system usually eliminates the virus. Sensitive information only on official channels; do not share sensitive information.
Persistent infection with high-risk HPV types increases the risk of cervical cancer. About 1 to 3 percent of women with long-term infection develop cervical tumors. In 70 percent of cervical cancers, HPV types 16 or 18 are detected.
Additional factors that increase the risk include:
- Weakened immune system.
- Chronic smoking.
- Sexually transmitted infections such as chlamydia.
- Long-term use of oral contraceptives.
- Multiple pregnancies.
Worldwide, about 440,000 women develop cervical cancer each year, mainly in developing countries. In Germany, there are about 5,500 new cases annually, with 1,500 deaths. Among women aged 15–49, cervical cancer is the second most common cancer after breast cancer, accounting for 9 percent of cases.
Cervical cancer develops from precancerous stages called intraepithelial neoplasia, which affect only the epithelial layer of the cervix.
If untreated, abnormal cells invade deeper tissues. Once they reach the blood or lymphatic system, the condition is no longer precancerous but cancerous. On average, it takes 10–15 years from HPV infection to cancer development.
Most cervical cancer and precancer cases show no symptoms. Possible signs include:
- Irregular bleeding.
- Bleeding during intercourse.
- Unusual discharge.
Through screening, the gynecologist can detect precancerous lesions. Early detection can prevent progression to cancer.
Since several years, HPV vaccination has been recommended for girls and young women before sexual activity. It protects against HPV types 16 and 18, providing a highly effective prevention of cervical cancer.
Anal cancer is rare (about 0.7 per 100,000 women and 0.4 per 100,000 men) and is caused by HPV infection in roughly 80 percent of cases.
Risk factors include a weakened immune system and frequent receptive anal intercourse; HIV-positive men who have sex with men and HIV‑positive women who have anal sex are at higher risk and should receive regular clinical surveillance. Annual rectal exams and anal swabs are recommended for these higher‑risk groups.
When precancerous anal lesions are found, local treatment such as imiquimod cream applied three times weekly can stimulate a local immune response, reduce HPV levels, and help prevent progression to cancer.
HPV type 16 is the most common cause of anal cancer; current vaccines, including quadrivalent and 9‑valent formulations, cover this type, so early hpv vaccination offers protection against anal cancer as well as other hpv cancers and genital warts. Although additional research continues, vaccine safety and effectiveness data support vaccination for teens and young adults to provide broad protection against human papillomavirus–related cancers.
The most effective protection against HPV is sexual abstinence; this prevents exposure to the many hpv types and is the strongest protection against hpv. Condoms reduce but do not eliminate risk because infected skin can remain uncovered.
Vaccination (bivalent, quadrivalent, or 9‑valent; commonly given as 2 doses in younger teens) prevents new HPV infections and HPV cancers and genital warts but does not treat existing disease or lesions, and gels, creams, or suppositories do not protect against infection — vaccine safety and effectiveness data support national hpv vaccination programmes for teens and young adults.
Two vaccines are available in Germany: Cervarix® and Gardasil®. Both protect against HPV types 16 and 18.
Gardasil® also protects against types 6 and 11, which cause genital warts.
Since March 2007, the Standing Committee on Vaccination has recommended HPV vaccination for girls aged 12 to 17. This recommendation was reaffirmed in 2009. Health insurance covers the vaccination.
Vaccination requires three doses and should be completed before the onset of sexual activity.
Studies show 99 percent effectiveness in non-infected women. Gardasil® protects for at least 8 years, Cervarix® for at least 5. Effectiveness is much lower in women already infected with HPV.
HPV vaccination effectively prevents the later development of cervical cancer © Sherry Young | AdobeStock
Vaccination is not effective against pre-existing cervical lesions.
Both vaccines are considered well tolerated. Side effects may include local skin reactions, fatigue, or temporary fever.
There is currently no routine public recommendation for HPV vaccination of boys in Germany, although HPV vaccine safety and effectiveness data show clear benefit for males.
Vaccinated boys had significantly fewer cases of:
- Anal cancer.
- Genital warts.
- Precancerous genital and anal lesions.
Quadrivalent and 9‑valent HPV vaccines protect against the relevant HPV types.
Vaccinating boys also reduces transmission to female partners and lowers overall HPV circulation, supporting national HPV vaccination programmes and better vaccine coverage.
The benefit is highest before sexual activity but vaccination may still be considered later after a risk–benefit assessment. Mild side effects (injection‑site pain, mild fever, fatigue) are common; serious adverse events are rare.
HPV vaccines contain non‑infectious virus‑like particles (VLPs) made from the L1 capsid protein; the L1 protein is not carcinogenic.
Two vaccines are licensed in Germany:
Gardasil© protects against HPV types 16 and 18 and additionally against types 6 and 11, which cause genital warts. It prevents:
- High-grade precancerous cervical lesions.
- Cervical cancer.
- Precancerous vulvar lesions.
- Genital warts.
Cervarix© protects against HPV types 16 and 18 and prevents:
- High-grade precancerous cervical lesions.
- Cervical cancer.
- Precancerous vulvar lesions.
Vaccination is given by intramuscular injection. Antibody levels after vaccination are markedly higher than after natural infection.
A three‑dose vaccine series provides reliable protection against HPV 16 and 18 when completed before first sexual intercourse; effectiveness is substantially lower in individuals already infected with the targeted HPV types.
Sexually active women may still gain benefit, for example reduced recurrence of genital warts.
Discuss dose of hpv vaccine and vaccine series timing with your clinician and follow national hpv vaccination recommendations for cancer prevention and cervical cancer screening.
Newer vaccines combine components from several hpv types (for example the 9‑valent hpv vaccine versus earlier bivalent and quadrivalent hpv vaccine formulations) to protect against multiple high‑risk types and low‑risk types that cause genital warts, offering broader protection against human papillomavirus and related cancers.
These vaccines show a favorable vaccine safety and effectiveness profile, are under review by German regulators, and may be incorporated into national human papillomavirus vaccination programmes and vaccine recommendations for the usual age range (including vaccination started in early teens through age 26 years) so eligible individuals should discuss whether to receive the vaccine with their clinician.
HPV vaccination effectively prevents infection with types 16 and 18, the main causes of cervical cancer. It is the best prevention available, but effective only in girls and young women.
However, vaccination rates in Germany remain lower than in some other countries.
A newer HPV vaccine may expand prevention, but no vaccine covers all cancer-causing HPV types. Vaccination does not provide 100% protection, and rare vaccine failures may occur. Regular cancer screenings remain necessary even for vaccinated women.
If vaccination is expanded, boys aged 9–14 may also be covered by insurance. Vaccinating both sexes would further reduce cervical cancer rates and lower incidence of other HPV-related cancers, including penile cancer and laryngeal cancer.
