HPV (Human Papilloma Virus)

General

This group includes more than 150 types of viruses. Of these, over 30 types infect the genital area. Each virus is given a number, which is called the HPV type. Only 80 of them have had their sequences fully studied. HPV contains DNA that colonizes mucosal or cutaneous epithelium and causes hyperproliferation, which leads to the formation of warts at the site of infection. In 80-100% of cervical carcinomas, HPV DNA has been found, especially types 16, 18, and 31. HPV is divided into two groups: - high oncogenic risk and - low oncogenic risk. Some types of HPV can cause warts while others can cause precancerous and cancerous conditions. In women, it can cause cervical, vaginal, and vulvar cancer, in men penile cancer, and in both women and men, it can cause anal, oropharyngeal, genital warts. Over 30 types are transmitted through sexual contact.

Prevalence

The high oncogenic risk group includes 13 types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68. Of these, type 16 and 18 are found in 70% of cervical cancers.

1. Distribution of HPV according to the type of CA
   90% in anal CA, 40% in vulvar CA, 40% in vaginal CA, 12% in oropharyngeal CA, 3% in oral CA.
   The global prevalence of HPV is 12%. It is highest in Sub-Saharan Africa 24%, Eastern Europe 21%, and Latin America 16%.
2. Prevalence by age is:
   14-19 years old is 24.5%, 20-24 years old is 44.8%, 25-29 years old is 27.4%, 30-39 years old is 27.5%, 40-49 years old is 25.2%, 50-59 years old is 19.6%.
3. Prevalence by sex is:
   Women are 22-35%, men 2-35% The female/male ratio is 1.4/1
   The prevalence of warts is 9% in women and 13% in men.
   The black race has a 1.5 times higher prevalence than the white race.

Etiology

HPV is one of the most common STIs.
In the USA, 14 million new cases are diagnosed every year.
Over 80% of people are infected at least once in their life with one of the HPV virus types.

Risk Factors

-Smoking
-HIV or other conditions that lower the body's immunity (pregnancy, folate deficiencies, immunosuppression)
-Multiple sexual partners
-Ultraviolet radiation
-Oral contraceptive use for over 5 years, when their use is stopped, the risk decreases again.

Transmission

Transmission occurs through vaginal, oral, or anal sexual contact with an infected person. You can be infected and not have symptoms. The affected person may start showing symptoms several years later, which makes it difficult to understand when you were infected. In many cases, HPV goes away without causing health problems. When it does not go away, it can cause various problems. The incubation period is unknown, varying from 3 weeks to 8 months.

Clinic

1. Genital warts usually appear as small bumps, alone or in groups in the genital area. They can be small or large in size, flat or raised, or in the form of cauliflower. Diagnosis is made directly by inspection. Rarely, they may cause discomfort, pain, and itching.
2. Ca early appears without symptoms while later it may cause discharges or bleeding from the vagina, post-coital hemorrhage.

Treatment

There is no cure for HPV, but the symptoms it causes are treated. Genital warts often resolve spontaneously without treatment. In other cases, medical treatment is done with:

-Podophyllin, every week for 4-5 weeks and washed off 6 hours after application and contraindicated in pregnancy.
-Imiquimod, applied 3 times a week for up to 16 weeks.
-Trichloroacetic acid, applied every 1-2 weeks until healed.

Surgical treatment. Performed for large lesions.
-Cryotherapy, uses liquid nitrogen which freezes abnormal areas.
-Electrocauterization, burns abnormal areas.
-Laser therapy

Other techniques
-Interferon injections
-Surgical removal

Diagnosis

1. Pap test Assesses changes in cervical cells. Recommended from ages 21-65. The frequency of its performance depends on the result. In women over 65 years old, with previous normal results, when you have removed the cervix, you do not need to perform Pap tests anymore. Not always abnormal results mean that we have cancer, but we should conduct a further careful assessment for a complete diagnosis.
2. HPV test. Detects the HPV virus that causes these cellular changes. Performed over 30 years old and every 5 years. Can be performed alone or accompanied by a Pap test. There is no HPV test performed for men.

What to do when you have the virus

There is no cure for treating HPV. We live a healthy life so that we can help the body to clear the virus and reduce the chance of it turning into cancer and the persistence of the virus. Measures taken are:

-Stop smoking
-Stop using oral contraceptives
-Have a healthy diet (include in the diet vegetables and fruits that have vitamin C)

Can you get pregnant when you have HPV

The presence of the virus does not affect the ability to become pregnant. In some cases, having HPV, you have a higher risk of developing precancerous and cancerous changes in the cervix. This in turn affects fertility and the ability to carry a pregnancy to term.

How long does HPV take to go away

This depends on the body's immunity that fights it or prevents it before it causes cellular changes in the cervix. 70% of new infections disappear within a year and 91% within two years. That means 9 out of 10 cases disappear spontaneously within one to two years. A small part persists and can lead to precancerous and cancerous changes over a long period of time that varies from 10-30 years. Only 1% may persist.

Prevention

1. Protected sexual intercourse (condom), does not protect you 100% because the skin area that comes into contact with the virus can be infected.
2. Tests (Pap test and HPV test). Even women who are vaccinated should have regular Pap tests.
3. Vaccination. Three types of vaccines are known: Cervarix, Gardasil, and Gardasil 9. Done from age 9 to 26. Recommended from ages 11-12 for girls and boys. The vaccine is done with 2 or 3 doses depending on the age.