The Link Between HPV Infection and Infertility: Expert Explains

Infection with HPV or the human papilloma virus (Human Papilloma Virus) is one of the most common sexually transmitted infections. Currently, more than 100 strains of this virus are known, and they affect not only women, but also men. HPV infection can be very dangerous because over time it can lead to cervical, oral or other types of cancer. HPV infection also raises problems in relation to fertility. What is the connection between HPV infection and infertility, explains Dr. Ioana Drăgan, specialist in obstetrics and gynecology.

CSID: What is the link between HPV and infertility, especially if left untreated?

Dr. Ioana Dragan: HPV infection is one of the most common sexually transmitted diseases and is estimated to affect more than 90% of the population. Practically all sexually active people will be infected once in their life with at least one of the 50 strains of HPV in the ano-genital sphere. In general, HPV infection is a self-limiting infection, meaning that a healthy, immunocompetent body will be cured of HPV within about 1 year of infection, and this is true for 90-95% of infections. There are currently few studies that support a direct correlation between HPV infection and impaired fertility, but it should be noted that HPV DNA fragments have been identified both in the sperm of infected men and in the endometrium (uterine cavity) and ovaries women with HPV.

There are studies that claim that HPV infection in men causes a decrease in sperm quality (asthenospermia) and an increase in the number of anti-sperm antibodies, which would translate into a global decrease in male fertility; HPV infection is now considered a risk factor for male infertility. Also, in HPV positive couples who resort to assisted human reproduction procedures (intrauterine insemination, IVF, ICSI), the chance of success can be up to 6 times lower. It seems that in these cases there is a higher risk of spontaneous abortion due to the fact that HPV infection contaminates the oocyte at the time of fertilization, which can induce the activation of immune mechanisms, with the rejection of pregnancy implantation.

CSID: How can HPV treatment affect fertility in both women and men?

Dr. Ioana Dragan: HPV screening is recommended as a co-test with Pap smears for all patients, but especially for those who are preparing to become pregnant. Given that a new correlation is emerging between HPV infection and infertility, all couples seeking reproductive health care should undergo HPV genotyping.

HPV treatment mainly has two directions: the first would be that of eradicating the infection by supporting one’s own immunity and the second direction would be that of the integrity of the cervical epithelium (removing abnormal cells, as a result of HPV infection, that could exist at the level cervix). The optimal treatment, suitable for each individual case, can extend for a maximum of 6 months so that, with the removal of the HPV infection, the potential risks of HPV infection and fertility/pregnancy are also eliminated.

CSID: There are many myths about vaccination, and one of them is the myth that the HPV vaccine causes infertility. Let’s clear this up.

Dr. Ioana Dragan: There is NO medical evidence to support the correlation between HPV vaccination and couple infertility. HPV vaccination is the only way, besides total sexual abstinence, to protect against common strains of HPV. We are talking here about vaccination with Gardasil 9, which includes 7 oncogenic strains (that is, High Risk strains – directly involved in the occurrence of cervical cancer) and 2 low-risk strains that are involved in the occurrence of anogenital condylomatosis in both women and men. By vaccinating before the start of sexual life, we reduce the risk of infection by up to 90% in both women and men.

CSID: If a woman becomes pregnant but is diagnosed with HPV, how can this affect the health of the fetus?

Dr. Ioana Dragan: HPV infection in pregnancy was associated with a higher risk of miscarriage than in HPV-naïve women. Also, persistent HPV infection during pregnancy may result in a higher risk of premature rupture of membranes and spontaneous preterm birth. The risk of contaminating the fetus with HPV from the mother is about 40% and, of these, there are significantly more cases of transmission of the virus in women born vaginally than in those born by caesarean section.

Although there is still much controversy about the mode of transmission of the infection to the fetus, it seems that at least three modes are involved: one is the mode of periconceptional transmission, right at the conception of the embryo (given the presence of HPV in sperm and ovaries), the second is the mode of intrauterine transmission during pregnancy (HPV DNA fragments have been identified in the amniotic fluid and in the umbilical cord) and the third transmission route is perinatal, at birth, when the fetus passes through the pelvic-genital tract. The presence of vulvo-vaginal condylomas in the mother during vaginal births increases the risk of respiratory papillomatosis in children.

CSID: Apart from cervical cancer, what other types of cancer can be triggered by the HPV virus?

Dr. Ioana Dragan: HPV with high oncogenic risk has been implicated in the occurrence of cancer of the anorectal mucosa and oropharyngeal mucosa. Unfortunately, for such types of cancer there are no screening programs for early detection and therefore vaccination is the best prevention method for these types of cancer. In addition, in men, high-risk HPV has been associated with penile cancer.

CSID: What are the preventive measures regarding HPV infection, but also the treatment options?

Dr. Ioana Dragan: The best prevention measure is HPV vaccination with Gardasil-9 (which includes the 9 most common strains: 7 High Risk and 2 Low Risk), but it is important to remember that the vaccination must be done before the start of sexual life to have the benefit maximum reduction of the risk of cervical cancer by 97%. Once the organism is no longer naive to HPV, the effectiveness of vaccination decreases but it maintains its importance, because although it no longer confers the same risk reduction as in HPV-naive organisms, there is still a risk reduction compared to the unvaccinated.

Another preventive measure is of course total sexual abstinence. It should be understood that the usual contraceptive measures, and I mean here especially the condom, do not offer protection against HPV infection. Treatment options are focused on boosting immunity, since HPV being a viral infection, i.e. intracellular, does not benefit from specific treatment. Also, lifestyle changes, sports, anti-inflammatory diet, smoking cessation, rest are all adjuncts in the healing process. Depending on the presence or absence of cervical squamous cell lesions, as a result of HPV infection, there are several treatment schemes, but they must be individualized according to the patient’s history.

2023-12-29 09:09:53
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