HPV

The most common symptom is the appearance of genital warts (also known as condylomas) in the infected area (genital area, anal area or throat). These warts can be itchy and, although not dangerous to health, they are highly contagious.

In cases where HPV infection has caused precancerous or cancerous lesions, symptoms of these lesions may appear. These symptoms vary according to the type of cancer, and generally appear when the cancer is already at an advanced stage.

The majority of HPV infections are asymptomatic. 

In 90% of cases of HPV infection, the immune system eliminates the virus within one or two years, with no serious health consequences.

However, in certain cases and with certain strains of the virus known as oncogenic, it is possible for cancer to develop:

- Vulvar cancer

- Vaginal cancer

- Mouth and throat cancer

- Anal cancer

- Penile cancer

Human papillomaviruses (HPV) are the leading cause of cervical cancer (more than 90% of cervical cancers are caused by papillomaviruses)*. In Belgium, this cancer is the fourth most common among women* aged 15 to 44**.

Other strains of papillomavirus can cause condylomata. These genital warts are benign, meaning they have no serious health consequences. However, they can be itchy and reappear after several months, despite treatment. The main consequence may be cosmetic discomfort. 

*Cancer Research Foundation, What Is Cervical Cancer?, Online: https://www.fondation-arc.org/cancer/cancer-col-uterus 

**HPV Information Center, Human Papillomavirus and Related Cancers, Fact Sheet 2023, Online: https://hpvcentre.net/statistics/reports/BEL_FS.pdf?t=1725269477253

In Belgium, in the absence of symptoms, screening is offered only to women (or people with a cervix) through two types of screening: 

The first type of screening, called cytology, is covered every 3 years for women aged 25 to 29. The purpose of this screening is to analyze cells from the cervix to determine whether they are healthy or whether some show (pre)cancerous lesions and are therefore at risk of developing into cancer.

The second type is an HPV screening, which is covered every 5 years for women aged 30 through 64, inclusive. The goal of this screening is to directly detect the presence of the virus in the cervix. This screening allows for the treatment of individuals well before the cells can develop into a potential cancer. 

Although these two screening tests are handled differently in terms of laboratory analysis, the examination and the procedures involved are the same: a Pap test.

How it goes: 

Step 1: Make an appointment with your doctor, gynecologist, at your local health center, at a family planning clinic, at a hospital, or at a lab (if you have a prescription).

Step 2: Using a spatula or a small, appropriate brush, the doctor will collect cells from the vaginal lining and the cervix by inserting the instrument into the vagina for a few moments. This exam may be uncomfortable but does not take long. You may experience light bleeding immediately after the test, so it may be helpful to have a panty liner on hand. 

Step 3: The sample will be sent to the lab for analysis. The results are then sent to your doctor. Generally, if the results are negative, you will not be contacted, and you won’t need to do anything else until your next screening (in 3 or 5 years, depending on your age). If an abnormality is detected, your doctor will contact you to discuss next steps (such as undergoing further, more in-depth tests or monitoring the progression of the abnormality, etc.). 

Please note that a positive result on this type of test does not mean that you have a precancerous lesion or cancer. It means that an abnormality in the cells of the cervix or a strain of human papillomavirus has been detected, and that further testing will be required. In this case, it is important to undergo regular follow-up to monitor the condition and to practice safe sex to reduce the risk of transmission.

How much it costs:

In Belgium, a Pap test is recommended and covered by insurance every three years for women (or anyone with a uterus) aged 25 to 29, and every five years for women (or anyone with a uterus) aged 30 to 64, inclusive. Feel free to talk to your doctor or gynecologist to learn more.

Currently, there is no routine screening available for people with penises or for other strains of HPV (which cause cancers of the throat, anus, penis, etc.). If you have symptoms, screening may be offered. See a healthcare professional for more information on this topic.

In 90% of cases of HPV infection, the immune system eliminates the virus within one or two years.

There is no cure for HPV, but it is possible to treat the symptoms and consequences. 

Certain lesions known as low-grade (early-stage and slow-progressing) require medical follow-up to monitor their progression. A cream may also be prescribed to boost the immune system and help clear up genital warts. Other treatments are available, such as cryotherapy, laser therapy, and excision.

If the lesions progress to a more concerning stage (high-grade lesions), more invasive treatments may be recommended to reduce the risk of cancer:

Conization : a surgical procedure that involves removing a portion of the cervix containing abnormal cells.

Laser treatment : a technique that burns affected cells to promote their elimination.

These procedures are generally carried out under local or general anaesthetic, removing affected cells before they become cancerous.

For cancers detected at a more advanced stage, treatment with chemotherapy, radiotherapy or a combination of the two (radiochemotherapy) may be indicated. Other therapies include immunotherapy to boost the immune system.

Papillomaviruses are transmitted by simple contact. This means that contamination can occur even if there is no penetration.

Condoms (internal or external) or latex squares reduce the risk of HPV transmission, but do not provide 100% protection against these viruses, as they do not cover all areas of sexual contact. The internal condom offers better protection against HPV thanks to its external part, which covers more of the outside of the vulva or anus.

Vaccination is the most effective way of protecting against the serious consequences of HPV. The vaccines currently used in Belgium protect against the 9 strains responsible for the majority of HPV-related genital warts and cancers. 

FOR WHOM?

The Superior Health Council recommends widespread vaccination of young people between 9 and 14 years of age, inclusive and catch-up vaccination catch-up vaccination for those aged 15 to 26, inclusive, regardless of gender. Ideally, vaccination should occur before a person becomes sexually active. The vaccine is also recommended for people with compromised immune systems (those who are HIV-positive or have received an organ transplant) and men* who have sex with men* (MSM).

FREE ?

As part of the Wallonia-Brussels Federation's vaccination schedule, the vaccine is free (through the organized school program) for anyone, regardless of gender, aged 13 to 14 years old, in differentiated 11th grade or 10th grade, through the school nurse or at their doctor’s office (via e-vax).

REIMBURSED?

The vaccine is covered by insurance regardless of gender for people ages 12 to 30 inclusive (€12.10 copay per dose) and up to age 45 for individuals classified as “high-risk” (people living with HIV, people who have undergone a stem cell transplant, and people awaiting an organ transplant). 

IN PRACTICE?

“The vaccine can be administered in one or two doses. People with weakened immune systems should receive two or three doses” (WHO, 2024)*. It is administered in the upper arm and is well tolerated (side effects sometimes reported: pain and irritation at the injection site, temporary headaches). 

HPV vaccines, like all other vaccines, offer not only individual protection for those vaccinated, but also collective protection. If a sufficient proportion of the population is vaccinated, the virus types concerned can no longer be transmitted.

To find out more about vaccines and reimbursement, don't hesitate to contact your doctor, nurse, midwife, pharmacist, family planning center, medical center or school health promotion service.

HPV Information Center, Human Papillomavirus and Related Cancers, Fact Sheet 2023, Online: https://hpvcentre.net/statistics/reports/BEL_FS.pdf?t=1725269477253