HPV itself does not affect a woman’s ability to become pregnant, carry and give birth to a healthy child. But in the human body everything is interconnected, and one problem in most cases can lead to a number of others - the “domino principle” works. Therefore, in the case of a diagnosed human papillomavirus, it is recommended to regularly undergo immunological, gynecological and oncological examinations and treatment.
According to statistics, up to 30 percent of Russian women of reproductive age are exposed to the human papillomavirus (HPV). Therefore, it is important for every expectant mother to know how this virus can affect the ability to have children.
Victoria Viktorovna Zaletova, chief physician of the MAMA clinic:
And what danger can neoplasms on the breast pose?
The female body is an amazing biological system, which during pregnancy faces enormous stress and not only successfully overcomes all challenges, but also transforms and transforms, adapting to any needs of the baby. It’s great when the period of bearing a child passes easily, without such unpleasant surprises as papillomas during pregnancy.
But if epidermal tumors do appear, the expectant mother faces an acute question regarding the removal of the growth and its effect on the development of the baby. Indeed, is it possible for pregnant women to remove papillomas and why, while expecting a baby, do warts choose the breasts of the expectant mother?
“How to get pregnant with HPV? Is it possible to get pregnant with HPV?
- many women ask.
We answer:
It is generally accepted that the human papillomavirus does not affect a woman’s reproductive function. By itself, it really does not have any effect on the ability to become pregnant, bear and give birth to a child. But HPV is often the “tip of the iceberg”, under which many immune and gynecological problems are hidden.
The human papillomavirus, like any other virus, negatively affects the immune system. The immunity of an HPV-infected person is constantly in a depressed state, which means that he is more susceptible to infectious diseases, which can lead to a variety of consequences.
If we talk about pregnancy, then this is stress for a woman’s immune system. The embryo combines the cells of the mother (“its own”) and the cells of the father (“foreign”). The main task of the immune system is to fight “foreign” cells. But pregnancy is an exception, the body adapts, the immune system does not work at full strength and accepts the “stranger” for the whole 9 months.
Provided that the immune system is in order. If its functioning is disrupted, spontaneous abortion in the early stages is possible. Moreover, the woman herself may not know about her situation, and her body has already rejected the tiny embryo. In this case, we are talking about immune infertility. An immunologist and a reproductive specialist can help: they will conduct blood tests and recommend treatment that will allow the woman to become a mother.
Human papillomavirus is a risk factor for the development of cancer. Moreover, the female reproductive organs take the hit: the cervix and uterus.
There are about 40 types of HPV that affect the mucous membranes of the genital organs and provoke gynecological diseases of varying severity.
Medical research has shown that HPV can cause benign lesions of the cervix and cervical cancer (some types of HPV).
Studies have also shown that certain types of HPV are detected in cervical intraepithelial neoplasia (CIN) and early stages of dysplasia.
Papillomas in pregnant women: features of formation and localization
Before moving on to the main topic, it is necessary to recall that papillomas are benign neoplasms that are formed as a result of atypical proliferation of epidermal tissue. The cause of such skin defects is the human papillomavirus (HPV), which is present in a latent state in the body of almost all people on the planet. The vital activity of the virus can be activated by factors that weaken the body, such as decreased immunity, fatigue, severe infectious or inflammatory processes, poor nutrition, etc.
Hormonal changes can become an ideal background for the activation of HPV and the formation of papillomas, which is what happens in the body of pregnant women. If we add to all of the above the enormous load on the body of a woman who is in an “interesting situation,” the etiological picture becomes obvious.
Doctors noted that the localization of papillomas during pregnancy changes somewhat. The priority area of damage is the breast of the expectant mother. Moreover, neoplasms can appear on any part of the mammary gland, from the nipple to the internal ducts. This does not mean that the possibility of papillomas appearing on the neck, face, arms and legs during pregnancy is excluded, however, the incidence of such defects is significantly reduced.
There are several types of location of breast tumors:
- Papilloma on the chest - forms on the epidermis of the mammary gland and is a small oval or spherical growth on a narrow base, which has a soft consistency. Such a neoplasm is most often not accompanied by pain, but when wearing tight underwear it can become injured, inflamed and bleed.
- Papillomas under the mammary glands - usually form in the form of multiple small papules, which are located directly under the breast. They are also prone to injury and spread to healthy areas of the skin.
- Papilloma on the nipple - forms in the form of a soft, light structure with a rough surface, and can be localized both directly on the nipple and on its halo (pigmented part of the breast). This type of neoplasm not only makes wearing underwear difficult, but also significantly complicates subsequent breastfeeding.
- Intraductal papilloma of the mammary gland - forms in the internal duct of the breast, which makes it difficult to detect. You can detect such an internal growth yourself by palpating the breast. Often intraductal papilloma is accompanied by specific discharge from the nipple, as well as burning and intense pain. Only a professional mammologist can make a final diagnosis based on ultrasound of the breast.
HPV and pregnancy
The modern world is replete with information about the human papillomavirus. We are terrified of its ability to cause cervical cancer.
And since it causes cervical cancer, what can it do during pregnancy?
You need to know the enemy by sight. There are different types of human papillomavirus, there are more than 200 types. And only some of them are oncogenic, that is, they can cause abnormal changes in the cell, which subsequently lead to cervical cancer. The most oncogenic types are types 16,18,31 and 33.
Question one:
how it is transmitted. This is a delicate question. The main thing is sexual intercourse. Men are more often transient carriers, and women get sick. This is the philosophy of life. There may be another contact route of transmission, barrier contraception itself: a condom, when used correctly, protects against the transmission of HIV infection, hepatitis B, C, and syphilis; but from HPV, alas, not always.
Question two:
How is he treated? If the virus is embedded in a human cell, then it is impossible to cure it. It is possible to improve the state of immunity - all the drugs that a doctor can prescribe are aimed at improving immunity and putting the virus into a dormant state. If there are already virus-associated consequences on the cervix, that is, the cells are in a state of change under the influence of the virus (cancer is still far away, but the first “bells” should be caught right here), then the doctor can quite rightly recommend removing the damaged tissue (preferably the most gentle method, for example laser vaporization). Removal of damaged tissue is both the prevention of cancer complications and the treatment of a source of chronic infection, because, as a rule, under the influence of a virus, opportunistic bacteria are added, which cause chronic inflammation of the cervix: chronic cervicitis, or the doctor may say colpitis. It should be noted that even if the virus is detected, it can go away within two years - be eliminated on its own if a woman monitors her health and treats inflammatory processes in the vagina and cervix in a timely manner. So if you are diagnosed with HPV, then you shouldn’t panic, but you shouldn’t put off visiting the doctor either. The doctor must take control of this situation.
Thus, the presence of HPV is not a contraindication for planning pregnancy, it is not a teratogenic factor for the fetus, and does not cause congenital malformations, Down syndrome or any hereditary diseases. A woman needs to clearly understand that there is no relationship here, and not be afraid for the health of the unborn baby. If a woman is only a carrier of HPV, she does not have atypical cells in the cervix, there is no inflammatory process in the cervix, then treatment is not only not indicated, but there is absolutely no indication for the use of immunomodulatory drugs and the use of destructive methods on the cervix. The cervix is still useful during pregnancy, preferably before its full term (37-40 obstetric weeks). The human microbiome is such that we are inhabited by more than 10 thousand different microorganisms. This includes viruses. There is no sterility here, and there shouldn’t be. There must be harmony in living together and in friendship, good immunity and a positive attitude. So, if a woman planning a pregnancy has HPV, it is necessary to check whether there is inflammation or atypical cells. These studies are carried out by an obstetrician-gynecologist. And if the results are good, then there is a green corridor for planning the birth and there is no need to fear complications during pregnancy.
If, with HPV detected, there are still changes in the cervix, then it is necessary to undergo treatment. We will talk about competent approaches and methods of treating HPV when planning pregnancy and during pregnancy itself in the next part.
Are breast papillomas dangerous during pregnancy?
Regardless of location, papillomas during pregnancy can cause significant discomfort to a woman and cause concern for the health of the child. It should be understood that the papillomavirus cannot influence the development of the baby in any way, however, with a high degree of probability, the child will be a carrier of the viral agent at birth, which will enter the body through the perinatal route of infection. This most often manifests itself in the formation of epidermal neoplasms in childhood.
As for the risks to a woman’s health, there are several potential dangers, the most significant of which can be considered the possibility of malignant transformation of a harmless neoplasm, which leads to an oncological process. This is especially true for intraductal papillomas, which can exist for a long time in a latent, undiagnosed form. In addition, such papillomas after childbirth during the process of active growth can clog the duct, preventing the outflow of breast milk, which can cause stagnation.
There is also a risk of mechanical damage to the tumor when wearing too tight underwear and clothes. This outcome may be accompanied by severe bleeding and infection of the wound, which is unacceptable during pregnancy.
Why get tested for HPV
Cervical cancer is a disease with a proven viral etiology. Its causative agent is the human papillomavirus (HPV), an infection transmitted primarily through sexual contact. However, the more specialists accumulate knowledge about the nature of this disease, the more myths and misconceptions accumulate among the population. Today we’ll try to figure out what to believe and what not – and at the same time answer the most frequently asked questions about HPV.
Human papillomavirus - what is it?
First of all, it's a virus. Like all other viruses, it penetrates the cell, declares itself the local ruler and sets up a factory from the cell to produce its beloved self. These viral copies penetrate neighboring cells and take control of them in the same way.
Researchers have now identified more than 150 different types of HPV. Some of them cause small, harmless papillomas on the skin, and about 40 varieties prefer the tissue of the genital organs.
HPV is a highly contagious virus, easily jumping from person to person during any form of sexual contact, including petting. Due to its high contagiousness, almost every sexually active woman will be diagnosed with HPV at least once in her life.
What will happen to me if I am diagnosed with HPV?
Since HPV prefers to “settle” in the cells of stratified squamous epithelium, which is constantly renewed and exfoliated, in most cases no disease develops.
But if something goes wrong, HPV manages to integrate into the genome of the host cell and says: “I’m in the house.” From this moment on, the immune system ceases to recognize HPV, and the development of the disease begins. Which one depends on the specific type of HPV.
Some viruses are considered low-oncogenic and cause the development of genital warts (anogenital warts) in the genital area. These growths can appear on the skin and mucous membranes of the genital organs in men and women, around the anus, on the rectal mucosa or on the cervix in women. The most common low-oncogenic types are HPV-6 and HPV-11.
Genital warts can look very ugly, sometimes even scary, but they are easy to remove with the help of medications (not on your own! There may be such a chemical burn that it doesn’t seem like much) or surgical methods (cryotreatment, radio waves, laser or electrosurgery).
Highly oncogenic types of HPV (at least 14 different types) slowly but surely “enslave” all layers of the epithelium and penetrate deeper. This process does not manifest any symptoms at all, develops very slowly, but almost inevitably leads to the development of cancer of the cervix, anus and rectum, vagina, penis, mouth and throat. The most dangerous and “evil” types are HPV-16 and HPV-18.
How is HPV infection treated?
Whether you like it or not, attempts to treat HPV infection with all sorts of magical immunotropic drugs, extracts of potatoes, broccoli and some kind of flies are a waste of money.
You can find hundreds of domestic publications and studies telling how amazingly these medicines “work”. The problem is one thing - no one can claim that the virus is defeated by the pill, and not by the body’s own work. In women under 30 years of age, spontaneous clearance of HPV occurs in most cases.
If the virus has entered the integrative phase (into the “house”) and the development of an HPV-associated disease has begun, treatment can only be surgical. If these are genital warts, they must be excised; if this is a precancerous lesion of the cervix (CIN - cervical epithelial neoplasia) - the entire area of the lesion (the doctor sees this place through a colposcope) must be removed.
What can I do to prevent the disease?
The principles of protection are the same as for other infections transmitted primarily through sexual contact. However, even constant and correct use of condoms does not exclude infection (HPV is highly contagious), although it significantly reduces the risk.
The onset of the disease caused by HPV is possible within 8–10 years from the onset of sexual activity, but in order to identify the initial signs of the disease, it is necessary not only to go to the gynecologist, but to undergo cervical screening: a cytological smear from the cervix from the age of 21 (not less than once every 3 years) and analysis for HPV of high carcinogenic risk from the age of 30 (at least every 5 years)1.
Debate has been going on for many years about at what age it is advisable to start HPV testing. In our country, they decided to add an HPV test to cytological screening from the age of 30, and in some countries, including the USA2, from the age of 25. But experts are unanimous on one thing: in young patients, HPV is detected in 90% of cases and leaves the body as quickly and easily as it is colonized. Therefore, there is no need to start testing too early - there will be a lot of unnecessary movements, tears and pointless attempts at treatment.
Does correct diagnosis guarantee protection against cancer?
It is important to understand: screening is good, but not ideal. Of course, the opportunity to catch cervical cancer in its pre-stages is a magical chance given to humanity by Georgios Papanicolaou, but there are many different “buts”.
The analysis must be taken well, transported carefully, colored correctly, viewed correctly - and at each of these stages, errors can, unfortunately, occur. In any case, the task of screening is to “catch” an already started disease at the stage of early, still precancerous, changes in order to cure it as quickly as possible.
But there is a second strategy - vaccine prevention, the task of which is to prevent infection at all. And we’ll talk about the possibilities of preventing HPV-associated diseases through vaccination next time.
Oksana Bogdashevskaya
Photo istockphoto.com
1 Benign and precancerous diseases of the cervix from the perspective of cancer prevention. Clinical recommendations (treatment protocol). Letter from the Ministry of Health of the Russian Federation dated November 2, 2017.
2 Society of Gynecologic Oncology (SGO) and the American Society for Colposcopy and Cervical Pathology (ASCCP): Interim clinical guidance for primary hrHPV testing 2015
Papillomas during pregnancy: treatment
It is advisable to remove any neoplasms located on the skin and mucous membranes before pregnancy. If for any reason this rule was not followed, or primary papillomas appeared during pregnancy, the woman should immediately contact a specialist. Depending on the location of the defect, medical advice and assistance can be provided by a dermatologist, mammologist, gynecologist or oncologist.
It is strictly forbidden to resort to self-medication with the help of pharmaceutical ointments and plasters, folk recipes, as well as mechanical cutting of the body of the wart during pregnancy.
Little dirty tricks, or what papillomas are silent about
The head of the gynecological department of the Nuriev Clinic, Nelly Mikhailovna Samukova, answers the main questions regarding human papillomavirus infection. What kind of virus is HPV?
HPV - human papillomavirus (also known as PVI - human papillomavirus infection and HPV - Human Papillomavirus) is the cause of condylomas and genital warts and a frequent “precursor” of cancer. HPV transmission can occur through intimate intimacy, even without actual sexual intercourse. The virus can also be transmitted through household contact: through contact with contaminated personal hygiene products (through towels, washcloths, a shared bath or toilet). This infection has no specific symptoms. Many people do not even know that they are carriers of the virus until papillomas begin to cause inconvenience.
Do I need to get rid of papillomas?
I recommend that my patients get rid of external manifestations of HPV before a planned pregnancy or in cases where papillomas or condylomas cause physical and psychological discomfort. There are many methods of disposal: surgical destruction, cryodestruction, electrocoagulation, radio wave exposure. However, after the procedure, the person remains a carrier of HPV (only the risk of relapse is reduced).
You need to understand that papillomavirus manifests itself when immunity decreases, and smoking, drinking alcohol, pregnancy and stress are also “accomplices” of HPV. Therefore, we, doctors, strongly recommend that patients who carry HPV take responsibility for their health. And regardless of your length of sexual activity, visit your doctor regularly. Women should be checked by a gynecologist at least once a year!
How to protect yourself from HPV?
The most reliable protection against the virus is timely vaccination. The course consists of 3 injections into the shoulder muscle: the first is done on the day of treatment, the second – 2 months later, the third – 6 months after the first vaccination. Already after the second stage of vaccination, a person develops a fairly stable immunity to HPV. There is no other cure for HPV.
HPV vaccination should be carried out before sexual debut. Optimally – at 9-26 years old. Before vaccination, you need to be tested for HPV carriage. I will add that if HPV types 6, 11, 16 or 18 are detected, vaccination is useless. This is a waste of money, no matter how much you are convinced otherwise!
Is it dangerous to get pregnant if you have HPV?
HPV does not affect the course of pregnancy, but there is a slight risk of transmission of the virus from mother to child as it passes through the birth canal and the development of respiratory papillomatosis or condylomatosis of the larynx and respiratory tract.
There are about 300 types of HPV, and 15 of them can cause changes in cells in the lining of the cervix that can then develop into cancer. Therefore, at the Nuriev Clinic, we especially closely monitor expectant mothers in the “Pregnancy Management Program” if they are already carriers of HPV.
If infection has occurred, then there are 3 options for the development of events: either the virus is eliminated (it goes away without a trace), or it lies dormant, waiting for an opportune moment for relapse (decline of immunity), or it develops rapidly (this is indicated by clinical manifestations such as the growth of papillomas and rapid increase in their number). In the latter case, we have a risk of cancer complications. Therefore, I recommend that all women, regardless of their viral status, regularly undergo a smear test for oncology and undergo colposcopy - an examination of the uterus. The second most common cancer (after breast cancer) in women is cervical cancer. Every day in Russia 17 women die from it.
Is HPV dangerous for men?
HPV does not directly affect male potency. However, in some cases, the consequences of this infection in men can be severe: cancer of the penis, rectum, anal canal and perineum. I recommend that representatives of the stronger sex monitor any deviations from the norm on the skin of the penis, on the scrotum and around the anus. And consult a doctor if any changes are detected on the skin, even if they do not hurt.
Remember: you can become infected not only from a sexual partner, but also in everyday life. Neither a condom, nor the virginity of the partner, nor the presence of a permanent sexual partner, nor abstinence guarantees 100% protection against HPV!
Myths about human papillomavirus (HPV)
The most common myths about human papillomavirus.
Myth 1 The HPV virus is common in African countries where the standard of living is low.
Human papillomavirus does not choose a continent or country.
It can infect any sexually active person in any part of the world. Today it is one of the most common pathogens transmitted through sexual contact or skin and mucous membranes. Even four out of five sexually active people become infected with this virus at least once in their lives. Myth 2 Only women are infected with HPV.
Any sexually active person can be infected with the HPV virus, even if they have only one partner.
Men face the same or higher risk of acquiring HPV and can become carriers and spreaders of the virus. During their lifetime, 4 out of 5 sexually active people will become infected with HPV at some point in their lives. Although the body of most infected people clears the virus on its own, the possibility of reinfection with this or another virus remains for life. If the human body does not remove the virus and it remains in the cells, the risk of developing the cervix, vagina, vulva, anus, penis, mouth, pharynx, larynx, and root of the tongue increases. Long-term low-risk HPV infection causes warts on these organs. Myth 3 Among my friends, I am the only one who has been diagnosed with this virus, so I don't think it is that common.
The vast majority are unaware of the virus.
It is not surprising that they may simply not know about their disease. Research shows that one in four women of reproductive age is infected with HPV, and even four out of five sexually active people will become infected with HPV during their lifetime. This virus can disappear from the body on its own, so a woman is sometimes unaware of a possible HPV infection if she has not been tested at this stage of life, especially since a temporary infection does not cause any symptoms of the disease. Men are generally not tested for HPV infection, although they can carry and spread the virus. Myth 4 HPV is only transmitted through casual sex or multiple sexual encounters.
It is true that the transmission of STIs is higher when there are multiple sexual partners, but the belief that infection only affects those with many casual relationships is inherently false. In fact, HPV also threatens those who are involved with one long-term partner. Even if your sexual partner is your first and only sexual partner, you can still become infected with HPV if he or she had contact with someone infected with HPV in the past and became a carrier. Myth 5
If I was diagnosed with HPV, then my partner was unfaithful to me.
A diagnosis of HPV does not mean your partner is unfaithful.
This myth causes anger, confusion, anxiety and fear. The virus lurks in a latent, asymptomatic state in the patient's body for weeks, months and years. Then they talk about a chronic infection. Obvious symptoms sometimes take time (months, years). If you are confirmed to have the virus with one regular partner, this means that your friend may have had sex with someone who was infected with HPV at some point in their life before you. Myth 6 All types of HPV cause cancer.
Not true.
HPVs are classified into high- and low-risk types (genotypes). Cancer is caused by high-risk HPV genotypes. The International Agency for Research on Cancer has confirmed that papillomavirus type 14 has a high risk of developing cancer. The oncogenicity of other viruses is being studied. The highest oncogenic risk is for types 16 and 18 of HPV. Low levels of HPV, for example 6 and 11, do not cause cancer. Myth 7 Genital warts will immediately become cancer.
Warts localized in the genital area are benign in almost all cases.
There’s a reason why these types of HPV are called “low-risk.” Low-risk HPV types may cause temporary changes in cervical cytology; however, these changes are not cancerous. If you find cytological changes, you should make sure that there are no high-risk human papillomaviruses, which are the biggest factor in the development of cervical cancer. Myth 8 If I get HPV, I will feel some signs of infection.
Most people infected with HPV do not feel any symptoms. A temporary infection is unlikely to cause warts or cancer. In nine out of ten people who are infected, the infection clears up within two years. Although they do not feel any symptoms, they can infect their sexual partners. Myth 9 An "abnormal" cytological change in the cervix is cancer.
Cytological changes in the cervix are caused not only by HPV infections.
These cellular changes can occur due to microdamage, bacterial infection, a low-risk HPV type, or even inadequate tissue collection and evaluation studies. For these reasons, repeating the test several months later will usually not detect cytological changes. The doctor will most likely recommend a colposcopy, take a tissue biopsy, may suggest assessing the type of HPV infection for high risk, and only then will be able to say Are these changes truly precancerous and should they be treated at this time, or can they be observed until they may go away on their own? In all cases, women should take responsibility for their own health and be checked at intervals recommended by health care professionals. Myth 10 If I was diagnosed with HPV, the disease will recur again and again.
In some cases, if the HPV infection persists in the body for a long time and the person's immune system is weak, warts or precancerous genital changes may appear several times during a given period of life.
The good news is that most people do not have an infection after two years. The bad news is that one in five sexually active people can become infected with the same HPV virus every year. The human immune system is weakened by chronic diseases, certain medications, injury, stress, anemia, various infections and other factors. We cannot determine how long the HPV infection will remain in the body. Each individual case is individual. Myth 11 For older women, cytological examination of the cervix is not required.
Cancerous changes take time.
This may take a year, ten years or more. If HPV infection occurs in old age, the virus is released from the body more slowly, and the longer it remains in the human body, the higher the risk of precancerous changes and cancer. At older ages, latent infection may reactivate. The decision not to get tested can be fatal: one in four women diagnosed with cervical cancer are 65 years of age or older. More than 40% of deaths from cervical cancer also occur in women of this age. Myth 12 If I cure my warts, I will no longer pose a threat to my partner.
Removing warts does not mean the HPV infection is completely gone. Visible warts are usually treated with medications or surgically removed.
The risk of wart transmission after HPV treatment is likely to be reduced by destroying the cells in which the virus was found. However, the virus can also remain in surrounding cells that do not show any changes visible to the eye, so transmission of infection is possible. Myth 13 I don't have to worry about HPV because my partner doesn't have genital warts.
The absence of warts on the genitals does not necessarily mean that your partner does not have HPV.
Often the HPV virus is physically invisible, so you cannot tell by sight whether your partner has the infection. Myth 14 If a woman is diagnosed with cervical lesions, her partner should be tested for HPV infection.
It is now generally accepted that if female cervical lesions are detected, there is no need to identify sexual transmission of HPV infection. The partner likely had an HPV infection for some time in his life, although no signs of infection were diagnosed or vice versa. Of course, if a woman is diagnosed with genital warts, her partner is also advised to get tested because most people do not even notice very small warts in their genital areas.
Myth 15 I have no risk of contracting HPV because I use condoms.
When using condoms, the likelihood of contracting HPV is reduced, but using a condom can sometimes only help “get rid of existing HPV infections faster.” Proper and timely use of condoms can prevent diseases that are transmitted through body fluids (gonorrhea, trichomoniasis, etc.), in while human papillomavirus, herpes infection is spread by contact of skin and mucous membranes.
The condom does not cover the entire perineal membrane, so the vulva, anal, perianal areas, base of the penis, and scrotum remain open to contact and transmission of HPV. Myth 16 I don’t have sex, so I can’t get HPV.
HPV viruses can be transmitted during any sexual relationship, as well as through direct contact with skin or mucous membranes.
HPV infection can be transmitted to a newborn from the mother. Myth 17 HPV can be cured.
Cancer caused by warts or precancerous lesions can be cured, but there is no vaccine or drug for all types of the virus. Each body has the ability to destroy this virus on its own.
The spontaneous disappearance of the virus depends on the strength of the body's immune system, the aggressiveness and quantity of the virus. It is also true that a person's immune system can suppress the aggressiveness of the virus so that it does not compromise health until it disappears completely. Myth 18 HPV infection can cause infertility.
HPV infection does not affect women's fertility. If a woman is pregnant and infected with HPV, she may develop warts or precancerous lesions, but regular checkups help ensure timely treatment. However, women can pass HPV infection to their newborns during childbirth.
Rumyantseva, md.
The issue of the connection between HPV vaccination and infertility is discussed quite often. Therefore, I would like to talk a little more about this topic.
Is there any reason to believe that HPV affects fertility?
- HPV reduces sperm motility in men, leading to impaired fertility (male factor infertility).
- Among women who underwent insemination (an assistive technology to help conceive a child), pregnancy occurred 6 times less often among those who were infected with HPV.
- HPV leads to cervical cancer, which can lead to removal of the uterus and the technical inability to bear a child.
In other words, available evidence suggests that HPV negatively affects the fertility of both men and women.
Protection against HPV could counteract some of these problems and improve fertility. But I am quite sure that many of you have heard the opposite point of view: HPV causes infertility! Let me make a reservation right away: until very recently, this thesis was not supported by anything at all.
But recently (in June 2022), a “trump card” appeared in the hands of opponents of vaccination: the article “A lowered probability of pregnancy in females in the USA aged 25–29 who received a human papillomavirus vaccine injection.” 25-29 years old, living in the United States and vaccinated against HPV).
I couldn’t pass by and allow myself to speak on this topic.
So,
1. The article was published in a journal that has nothing to do with obstetrics, gynecology, or pediatrics (Journal of Toxicology and Environmental Health). Question: Why publish such important information in a journal that is not read by obstetricians-gynecologists and pediatricians who vaccinate girls and women? If I made such an important discovery, I would try to convey it to those who are related to vaccination after all.
2. The author of the article (the only one) is Gayle DeLong, place of employment - Department of Economics and Finance, Baruch College/City University of New York, New York, NY, USA (Department of Economics and Finance). I can assume that the author has studied all possible methods of medical statistics (mathematics is clearly close to him), but why not ask at least some physician to read an article related to medicine and become a co-author? Loneliness of a genius? Let's say!
3. In the introduction, the author focuses on the decline in the birth rate in the United States as a whole and on individual publications on the effect of various components of vaccines (not against HPV, but vaccines in general) on “morbidity” (not on fertility), and provides isolated reports on the effect of vaccines on premature ovarian failure (without reference to further investigation of these cases, which did not establish a connection between vaccination and the disease. I think it is worth clarifying that there were only 2 such confirmed cases (ovarian exhaustion after (not to be confused with “due to”) HPV vaccination)). Consciously or not, the author avoids mentioning the largest HPV vaccine studies and their results, as well as mentioning the largest (published in 2022) study on the effects of HPV vaccination on fertility in men and women.
4. Methods: The author used the results of a US database that collects population health information. All results are from a survey. The author was able to use data from 2007 to 2014 (I think it’s worth clarifying that vaccination was introduced in the USA in 2006, not in all states at the same time, and the vaccine is administered mainly before the onset of sexual activity). Why take into account the period of time when many vaccinated girls did not even think about pregnancy?
5. From a statistical point of view, one more clarification: the birth rate in the United States is declining every year. The analysis began with data from 2007, when there were very few vaccinated people (and the birth rate was higher), and ended with data from 2014 (when there were more vaccinated people, and the birth rate was lower). The birth rate is also falling in those countries where HPV vaccination has not been introduced, but with this form of analysis an inevitable bias arises: the longer the time from the start of vaccination, the more vaccinated, and the birth rate is lower, but we have no way to say that these factors are related reasons! In Russia, too, the birth rate is so-so, but the HPV vaccination is also very bad.
6. The results are shown for a single age group: 25-29 years old! Why?? Why not earlier (so that more vaccinated girls were included in the analysis, because they had matured and were technically included in the analyzed group)? Why not later so that all women who want to can realize their childbearing potential (the average age of first birth in the US is 30)? I cannot answer these questions.
7. The analysis included 118 vaccinated and 582 unvaccinated women. More than 100 million doses of HPV vaccines have been administered in the United States. Why is it necessary to narrow the analysis to one age group, and even include only 118 vaccinated people?
8. A bit of poetry: I cannot call myself a phenomenal expert in the field of medical statistics. But, as they say, “there are lies, there are big lies, and then there are statistics.” If I am given a sufficiently large array of data on patients and asked to prove (with statistical certainty) 2 opposing points of view, I am very likely to be able to do this (including and excluding different age groups, certain concomitant diseases, etc.) . Why am I saying this? We must be very careful about data that is obtained not as a result of a targeted study, but by analyzing databases, unless data for other age groups, general data on the database, etc. are provided.
9. I could spend a long time analyzing the publication of a non-doctor in a non-specialized journal on a narrow group of patients if there were no major studies on this subject.
Vaccination safety is closely monitored by the CDC and FDA in the US:
- The Vaccine Adverse Event Reporting System (VAERS)
- The Vaccine Safety Datalink (VSD)
- The Clinical Immunization Safety Assessment (CISA) Network
All cases of side effects, consequences, etc. are entered into these databases. Why the author of the publication under discussion ignored their presence and analyzed the NHANES database, I have no answer.
10. Well, the last thing (it’s the main thing).
— Animal studies have not shown any effect of HPV vaccination on fertility.
— In 2022, the Journal of Pediatrics and Perinatal Medicine published the publication “The Effect of Vaccination Against Human Papillomavirus on Fecundability.” The largest study on the effect of HPV vaccination on fertility. Authors: epidemiologists and obstetricians-gynecologists. Time period 2013 – 2022 The study was prospective: they included couples planning a pregnancy, looked at how many succeeded, and analyzed which of them were vaccinated and which were not. The study included about 3,500 women and 1,000 men. Age group 21-45 years.
There is no connection between HPV vaccination and the ability to conceive a child. Vaccinated women were less likely to have miscarriages and a history of infertility. Women who had an STI but were vaccinated against HPV were more likely to conceive than women who were not vaccinated against HPV.
— In 2022, the study “Quadrivalent HPV Vaccination and the Risk of Adverse Pregnancy Outcomes” was published. The study was conducted in Denmark. It included women who gave birth to a child from 2006 to 2013. The following outcomes were analyzed: stillbirth, miscarriage, preterm birth, malformations, fetal growth restriction, low birth weight. Among 1665 vaccinated women, none of the complications occurred significantly more often than among 6660 unvaccinated women.
The decision is always yours.
I am grateful to the subscriber who sent me a screenshot of the publication, thanks to which I once again started checking and double-checking, sorting it out, reading it, recalculating it, raising the available data, etc. Keeping your finger on the pulse is important. It is right to doubt. Making the right decision in the modern world is not easy. But I believe in the best!
Sources:
- https://www.ncbi.nlm.nih.gov/pubmed/29889622
- https://www.ncbi.nlm.nih.gov/pubmed/28881394
- https://www.ncbi.nlm.nih.gov/pubmed/28355499
