Five things to know if you test positive for papillomavirus

You have recently made an appointment with your gynecologist or midwife to carry out a papillomavirus (HPV) smear test, as recommended by the health authorities every 5 years. And a few days later, the result comes: you are positive. In other words, the cells of your cervix harbor one or more so-called “high risk” carcinogenic papillomaviruses. A very worrying announcement at first glance, when we know that these viruses are responsible for almost all cases of cervical cancer (3,159 new women affected in 2023 in France). However, there is no reason to panic. Le Figaro takes stock with Dr Jean-Luc Mergui, gynecological surgeon specializing in the prevention of cervical cancer and papillomavirus infections.

Be careful not to take shortcuts. A positive HPV test just means the presence of a high-risk papillomavirus. “This does not mean that there is a cancerous lesion, but simply that there is perhaps a risk, ultimately, of developing a lesion,” specifies Dr Jean-Luc Mergui. Indeed, the presence of the virus does not automatically lead to cancerous lesions. “Only 7% of HPV-positive patients have lesions on the cervix. And among them, only 10% have high-grade lesions (the beginning of cancer, Editor's note). In other words, only 1% of women infected with a papillomavirus have a precancerous lesion and are at risk of developing cancer subsequently,” reassures the specialist.

Furthermore, it takes at least five years for high-risk HPV to cause mutations in cells. As for cancer, it only appears ten to twenty years after infection with a persistent HPV virus. It is enough to regularly monitor the presence of the virus by smear. If it persists, a colposcopy (examination of the cervix and vagina using a magnifying glass attached to a speculum, editor's note) will make it possible to monitor the development of possible precancerous lesions in order to prevent the appearance of cancer. Detail to know: a negative HPV test does not protect for life. You can get reinfected or reactivate HPV that was silent. Furthermore, “the test may very well be negative even though there is virus, but it is simply not in sufficient quantity to be detected nor to cause a possible lesion,” underlines Dr. Mergui. Hence the interest in doing it again every 5 years.

Papillomavirus infection is extremely widespread and almost inevitable from the moment sexual life begins. “It is estimated that 80% of women are infected with HPV in the first five years of their sexual life,” says Dr. Mergui. Same for men. Another figure: each year, around 17% of the population contracts one or other of these viruses. The good news is that in 9 out of 10 people it is spontaneously eliminated by the immune system within two years, without any health consequences. In the vast majority of cases, HPV therefore causes no symptoms and goes completely unnoticed.

On the other hand, when the immune system fails to destroy the virus, it becomes chronic. This is where problems can possibly start. “It is when the virus persists that lesions can develop. After eleven years, between 20 and 30% of infected women will have a high-grade lesion on the cervix,” indicates Dr Jean-Luc Mergui. A minority of people will never be able to get rid of the virus. “With age, immunity decreases and it happens that the virus manifests itself again, sometimes forty to fifty years after the first contamination,” reports the gynecologist. This is why the HPV screening test is recommended up to age 65.

“At present, there is no known treatment for this infection,” the doctor immediately points out. Surgical treatments, such as conization (removal of part of the cervix), are not indicated in the event of a positive HPV smear. “Conization is only used to remove high-grade lesions, this concerns around 30,000 women each year in France,” indicates Dr Mergui. But this does not necessarily remove the virus. As for the HPV vaccine, it is of no use if the infection has already occurred. It only helps strengthen the immune system in preparation for a first encounter with the virus. This is also why it must be done before the start of sexual life, for both girls and boys. In adults, “the only solution that we can offer is regular monitoring,” notes the doctor.

A positive HPV test does not mean infidelity! Firstly because it does not allow the infection to be dated. The contamination can certainly be recent, but it can also be an old infection, contracted with another partner. It is entirely possible that a papillomavirus infection may not become detectable until several years after infection. It is also possible that it was your current companion himself who transmitted the virus to you. “These viruses are quite contagious, they are transmitted during sexual intercourse, including by digital touching. The condom is therefore not a guarantee of protection,” emphasizes Dr Mergui.

Note that vaccination of young boys immunizes them against future infection by most oncogenic papillomaviruses, which will indirectly protect their future partners. But papillomaviruses are also a matter that directly concerns men, even if they are less severely affected than women. Around 1700 cancers (mouth, throat, anus, penis) occur each year in France in men due to HPV infection.

There is no radical and definitive treatment for HPV infection, but there is one factor that can be controlled: smoking. “By disrupting local immunity and causing the excretion of toxins in the cervical mucus, smoking increases the risk of persistent HPV infection and contributes to the risk of precancerous lesions,” explains Dr Julia Maruani, gynecologist at the University Hospitals of Marseille. “Smoking reduces the chances of eliminating the virus by 50%. We accumulate problems, which will lead to injuries,” she continues. This risk would even be proportional to the duration of smoking and the quantity smoked. “Stopping smoking is a good option for reducing viral load,” emphasizes Dr. Mergui.