The Human Papillomavirus, more commonly known as HPV, is the most widespread sexually transmitted infection in industrialized countries. According to recent estimates, around 80% of sexually active individuals contract the virus at least once in their lives, with the highest prevalence among young adults—both men and women. Widely recognized as the primary cause of cervical cancer, HPV is also linked to other genital cancers as well as head and neck cancers. Transmission mainly occurs through direct contact with mucous membranes or bodily fluids, but it can also happen indirectly via microscopic skin lesions. It is essential to emphasize that contracting HPV does not automatically mean developing lesions or cancer. In most cases (around 70% within one year and 90% within two years), the infection resolves spontaneously thanks to the immune system. However, what makes HPV particularly dangerous is its ability to remain in the body silently. Precancerous lesions may appear even five years after the initial infection, and progression to invasive cancer can take decades. It is precisely during this long latency period that prevention plays a crucial role. To explore the topics of diagnosis, vaccination, and treatment, we spoke with Dr. Cinzia Tomasos, a renowned gynecologist in Naples who has long been committed to raising awareness about sexual and oncological health.
By Roberta Imbimbo
Dr. Tomasos, why is it still so important to talk about HPV today?
Despite medical advances and numerous awareness campaigns, HPV continues to be widely underestimated, especially among young people. In reality, it is an extremely common and insidious sexually transmitted infection that spreads easily and remains entirely asymptomatic in most cases. Symptoms typically appear only in advanced stages of the disease. To date, nearly 200 HPV strains have been identified, but about 20 of them are considered high-risk for cancer. These are capable of penetrating cells and, if they persist in the tissues for long periods—between 7 and 15 years—they can trigger cancerous transformations. However, I want to stress that contracting HPV does not automatically mean becoming ill. In the vast majority of cases—especially in young individuals with healthy immune systems—the body can eliminate the virus spontaneously, often within a few months or years, without causing any clinically relevant effects. The greatest risk arises when the infection—especially from high-risk strains like HPV 16 and 18—becomes chronic in a silent form. In such cases, the virus can gradually alter the DNA of epithelial cells, leading to precancerous lesions (such as CIN—cervical intraepithelial neoplasia), which, if left untreated, may slowly develop into cancer over 10–15 years. That is why early prevention, regular screening, and vaccination are essential tools to detect the infection before it causes harm.
What prevention tools are available today?
We have two key tools: vaccination (which I believe should be mandatory) and screening. The HPV vaccine, which now protects against up to nine viral strains, is safe and effective if administered before exposure to the virus, ideally between the ages of 11 and 14. For girls up to 26 and boys up to 18, the vaccine is entirely free of charge. Screening is mainly based on two tests: the Pap smear and the HPV-DNA test. The Pap test is usually performed every two years, especially for women between 25 and 29, when the likelihood of infection is higher. After age 30, the HPV-DNA test is recommended, as it is more sensitive and can detect the virus directly. However, it’s important to note that no test is foolproof. In rare cases, false negatives may occur, meaning the test fails to detect abnormalities even if an infection or precancerous lesion is present. That’s why it’s essential to follow recommended screening schedules and, most importantly, to see a specialist regularly—even when test results seem normal.
What role do men play in prevention?
A central one. HPV prevention is no longer just a women’s responsibility. Vaccinating boys is essential to reduce transmission and protect both sexes. Additionally, men must be informed about risks and symptoms and seek medical advice if they notice suspicious lesions.
Is the vaccine safe and effective?
Absolutely! I want to highlight how effective the HPV vaccine is—it has been tested for decades and offers protection against nine types of HPV, seven of which are cancer-causing and two responsible for genital warts. The cancer-causing types account for over 90% of cervical cancers, 80% of anal cancers, and about 20% of throat cancers. Vaccination, of course, does not eliminate an existing infection or treat a precancerous lesion, but it is critical in preventing HPV-related cancers—especially if administered before sexual activity begins. For optimal protection, two doses are required six months apart before age 15, and three doses for those over 15, spaced by at least six months.
Let’s talk about treatment: what can someone diagnosed with HPV expect today?
It depends on the type of infection and whether lesions are present. In most cases, the infection clears up on its own. If precancerous lesions (CIN 1, CIN 2, or CIN 3) are detected, they can be treated with minimally invasive outpatient procedures such as LEEP or conization. In cases where cancer is present, appropriate oncology protocols are followed, often in collaboration with radiation therapists and oncologists.
What is still needed to improve prevention?
More information—especially in schools, among parents, and general practitioners. Unfortunately, cultural biases and unfounded fears about the vaccine still exist. We must also emphasize including boys in vaccination programs and promote screening among older age groups. Only in this way can we truly reduce the burden of HPV-related disease. Today, we have all the tools needed to prevent this virus—we just have to use them. Getting vaccinated, staying informed, and undergoing regular check-ups means protecting yourself and others from a silent but avoidable threat.
