2023-07-23 22:05:25
Accumulation of papillomaviruses which have multiplied in an infected epithelial cell; visualization by electron microscopy. (Iconography: Sylviane Coumes-Marquet).
“All sexually active people are concerned”
Located in Besançon, the National Reference Center (CNR) for human papillomaviruses, directed by Professor Jean-Luc Prétet, has several key missions in the fight once morest the disease. The CNR carries out missions of expertise, advice and epidemiological surveillance. Accelerated consultation with Quentin Lepiller, doctor-virologist at the University Hospital of Besançon.
Quentin Lepiller, doctor-virologist at the Besançon University Hospital. © Jack Varlet – Minjoz Hospital.
Doctor Lepiller, might you explain to us what a papillomavirus is?
“It is a very small virus, around 55 nanometers. There are over 400 different ones. We call it 400 types or 400 genotypes. And we give them each time a number; we will talk regarding HPV1, HPV6, HPV11, etc.
And among these more than 400 viruses, there is a small subgroup of only 12 to 13 viruses that will be of particular interest to us because they are at risk of causing cancer. Anogenital cancers (cervix, anus, etc.) or cancers of the oropharynx (just behind the oral cavity).
GOOD. And are all people affected? Men like women?
For these high-risk papillomaviruses that will be sexually transmitted, all sexually active people are concerned.
It is truly the number one sexually transmitted infection in order of frequency. It most often goes unnoticed, because most of these infections are eliminated spontaneously by the immune system, but it is indeed very widespread. Everyone is at risk, whether men or women.
“It’s really the most common sexually transmitted infection. », DOCTOR Quentin Lepiller.
Let’s talk a bit regarding proportions. You argue that it is “the first sexually transmitted infection in order of frequency”, but it is not the first in terms of mortality. The risk of getting cancer is low, isn’t it?
So, compared to the number of people infected, the risk, indeed, is relatively low. Fortunately ! In order to have cancer, the virus must persist or it must not be eliminated by the immune system.
Typically, we will have the peak of detection of this virus in the cervix around the age of 20 in women, so shortly following the start of sexual activity. We will have precancerous lesions 10 years later in some of these women. And then, in 10 to 40% of cases, you can have cancer around the age of 50. Overall, we will treat from the stage of precancerous lesions precisely to avoid this risk of cancer.
If you want an order of magnitude of all of these HPV-related cancers. In France, it’s just over 7,000 cases of cancer per year (all inclusive). One-third for boys and two-thirds for women.
This number of cases would be much higher if we did not have the screening devices that we currently have. When you go to certain southern countries, and in particular to certain countries in sub-Saharan Africa, there are many more cancers of the cervix. In some cases, it really is the number one cause of cancer death in women.
And then, is vaccination the solution to avoid these health problems?
The idea is to go vaccinate before the first contact with the papillomavirus, so before the start of sexual activity. This is why we are going to vaccinate preteens, even teenagers, because once the virus is persistent in the mucous membrane, vaccination is no longer of much use. It can be used to protect once morest a new infection which would arrive a little later, but if we want to cover this epidemic peak which is around the age of 20, we must vaccinate before the first contact with the virus.
So, in certain populations, in particular male homosexual populations, it is possible to vaccinate up to the age of 26 as a booster. For the moment, there is no such recommendation in the other populations. It might still have an interest in protecting once morest new papillomavirus reinfections.
There are also benign pathologies, and especially genital warts, so these famous genital warts. In France, it is around 100,000 cases per year, 50,000 in men and 50,000 in women.
Genital warts are very contagious, it can require treatments that are long, sometimes painful, with frequent recurrences. The vaccine protects once morest these genital warts.
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