H.P.V

The HPV group comprises a specific group of papilloma viruses that infect humans (Human Papilloma Viruses). Because of their specificity human papilloma viruses do not infect animals and vice versa. This virus has a double stranded DNA that is covered by an icosahedron protein capsid and causes tumors and hyperplasias to the skin and the mucosas.

The virus is considered active when warts are present. When there are no condylomata we consider the virus latent within the cells of the skin and cannot be transmitted. Most of the times our immune system deals with the virus or renders it inactive for long time intervals.

It is very hard to pinpoint the time the virus was transmitted because the warts may appear within a week, some months, and years or even never after coming in contact to a person who is a carrier of the virus.

Any sexually active individual can be infected by the virus. HPV types that cause condylomata are usually transmitted by simple skin to skin contact during the sexual contact with a person who has an active infection. It is sure that the virus is easily transmitted when an active wart exists, but it cannot be excluded that it is transmitted even if no apparent symptoms exist.

Warts are rarely found in the oral cavity and therefore it is believed that transmission of the specific viral type is more difficult by oral sex, but it can be found as well as with other papilloma types.

Until now more than 80 genotypes of HPV have been identified (different types of HPV are distinguished based on the base sequence of their DNA). HPVs cause a multitude of lesions (benign and malignant) on the skin and the musocas of the human body. Condylomata acuminata (i.e. the external condylomata) are usually caused by types 6 and 11, they are types that cause inflammations at the lower genital system of both males and females that are ordinarily benign and are not evolving toward cancer. The commonest oncogenic types of HPV are 16 and 18 that are related to dysplasias and cancer. However there are other types that are more rare.

With the PAP TEST only a suspicion of HPV virus infection can be detected. Then, a colposcopy follows when the mucosa and the skin of the lower genital system are examined under strong light and magnification before and after swabbing them with a buffer of acetic acid. The sub clinical lesions by HPV usually turn white after applying acetic acid and are therefore detected. However, anything turning white is not always an HPV lesion; the diagnosis will always be confirmed by histological testing of the biopsy. Colposcopy is a very important test because it is performed not only to prove whether it is a sub clinical inflammation or not but it is also important to detect precancerous lesions or cancer.

There is a test, PCR for the identification of the virus that detects the DNA of the virus. This examination confirms the diagnosis and the type for HPV that has caused the specific lesion.

Yes, individuals with multiple sexual partners are usually prone to sub clinical infection by multiple types of HPV.

Few patients know the role of HPV of cancer in the ano-genital tract. The diagnosis of warts may cause fear of transmission of the disease or relapse, changes of sexual behavior (e.g. abstinence), depression, low self esteem, disturbance or disruption of relationships. PREVENTION: use of condoms

Papanicolaou test is a way to detect changes in the cells of cervix and uterus. If some lesion is found then it is called dysplasia. There is a chance that dysplasia might lead to cervical cancer. The time of evolution is unknown. It might evolve within some months or even within some years. All women should be submitted to PAP TEST once a year, given that the HPV virus is the main causative factor of cervical cancer pathogenesis.

Yes, there is an anal PAP TEST that is performed with a brush and a fixation buffer and it helps to detect dysplasias of the anus.

If condylomata are left untreated, they could subside by themselves, stay invariable or develop further. At the majority of patients condylomata were cured automatically without treatment.

First of all expensive, it should be emphasized that toxic and scarring treatments should be avoided. The treatments that are followed are the following:
• Anti-viral treatments
• Cryosurgical treatments
• Surgical excision
• Electrocauterisations
• Laser

Infection of the ano-genital epithelium by HPV can result in a series of lesions that are referred as squamous intraepithelial lesions that range from mild dysplasia to acanthocytic cancer. Given time, these lesions can relapse, remain the same or evolve toward infiltrating cancer. The lesions of the cervix and the anus present a greater risk to evolve towards infiltrating cancer.

The risk factors are immune-suppression and smoking that cause the development of most dysplastic lesions.

Common warts are usually found on the hands and are multiple.
Flat warts are ordinarily multiple and are located at the forearms or the arms, the face and around the knees.
Plantar warts are located at the soles of the feet and are usually painful because of the pressure of the body weight on the soles.
Finally, filiform warts are most usually located at the face and the neck.

Their transmission is feasible either by direct contact with the infected person or indirectly by contact to infected objects. Incubation period is hard to be determined. It can range from a week to several months. The activities, athletic included, that expose the skin to direct or indirect contact within individuals and increase the chance of infection. Finally skin warts retract automatically within approximately 2 years.

During liquid phase Pap test fluid from the cervix and uterus is collected with a brush and placed in a collection tube with fixative. Then on a microscopy slide a thin- single layer of cells is swabbed. On this mono layer the cytologist can easily distinguish easier and more precisely the lesion if it exists.
Advantages:
• Retesting without reexamination of the patient
• PCR testing

HPV Vaccine:
-Recombinant non infectious viral particles (shell without DNA)
-Produce higher titers of antibodies than natural infection
-The titers remain high for a longer time
-100% protection for types 16 and 18 (if the woman has not already been infected)
The women that have been vaccinated should continue to have a Pap-test because the vaccine protects only for HPV types 16 and 18 that are responsible for 70% of cases of cervical cancer. The vaccine should be administered to girls before starting their sexual activity (9-14 y.o.), although there is indication of vaccine administration to older women that had not had yet sexual contact, as well as young women up to 26 y.o., regardless if they already had sexual relationships as long as they do not already display neoplasmatic cervical lesions.

Epidemiological studies show that foods with high content of vitamins A,C, E anf folic acid can reduce the risk of developing cervical cancer to women that have been infected by papilloma virus.

Yes, it can be transmitted through the same ways as with heterosexual individuals.

Not 100% because of possible condylomata acuminate existing at the penis base or on the vulva correspondingly

It is usually recommended to women with habits and conditions that increase cancer risk as:
• Smoking
• Infection with an HPV type that causes cancer
• Infection with HIV virus (AIDS virus)
• Infection with Chlamydia
• Bad diet
• Treatment with medication that suppress the immune system or a weak immune system and finally a personal or family history of cervical cancer.