What is Human Papillomavirus?
Human Papillomavirus infection is a sexually transmitted disease caused by the “Human papillomavirus“– HPV.
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It is believed that 60% of women during the generative age get affected by one or more than a hundred known viruses, while the prevalence in the male population is lower and the very presence of the virus is harder to determine. The prevalence of the HPV virus in the younger age groups (1825 A.D.) is around 60%, and only 46% of these young women will have a pathological Papanicolaou findings, which is considered as a passing nature of the HPV infection, because 70% of these women will eliminate the virus within the next 12 months and, after 24 months, only 9% of the women will still be HPV positive.
How Human Papillomavirus is transmitted?
The virus is spread through a direct contact with the infected skin and mucosa. At the same time, it is not necessary for these to be damaged, even though the damage certainly encourages the infection, because it allows the virus to reach the basal layers of the epithelium more easily.
The genital HPV can infect the mucosa of the upper respiratory system, conjunctiva, but the main reservoir for all viruses are most definitely the mucosa and the genital tract’s skin in both sexes, so HPV is most frequently the consequence of a sexual intercourse with an infected person. HPV has also been discovered in virgins, which proves that the sexual intercourse in the narrow sense is not necessary; being that the virus is also located in the skin of the anogenital region.
The average time from the moment of the exposure to the virus to the appearance of the change is 3 months, but this varies greatly and can last from several weeks to several years, which mostly depends upon the individual immune status.
It is believed that the genital-oral transmission is also possible, being that the low-risk and high-risk types of changes have been discovered in the oral cavity. The transmission from a mother to a child through placenta has not been described. Genital condylomata have been described in children, as well.
Human Papillomavirus Causes?
Today, more than 70 types of the papillomavirus are known. All of them show the affinity towards the skin epithelium and the mucosa tissue by creating the epithelial cancer.
The HPV viruses of the genital and the upper digestive systems are usually divided into the ones with high (16, 18, 25, 56), medium (31, 33, 35, 51, 52, 58), and low (6, 11, 42, 43, 44) risk, in accordance with the histopathological changes they are connected to. The damages of the high-level epithelium, especially the uterine cancer, are connected to the infection of the so-called “high-risk “papillomaviruses, HPV-16 and HPV-18.
Through the molecular methods, the presence of different types of HPV from a high-risk group has been found in 99.7% of the cervical carcinomas, which is why these viruses today are reasonably considered as the primary factors in the appearance of this cancer. Genital warts or condylomata acuminata are caused by HPV types 6, 11,16,18,33, and 35. They are sexually transmitted.
HPV diagnostics
The attestation of the HPV presence includes a clinical (gynecological or urological examination), a cytological or a histological examination, as well as the use of the molecular biology methods. HPV is proven by taking the cervical sample, or by taking the urethra sample when it comes to men. The samples are taken with a small brush or a cotton swab.Colposcopy is a method in which the cervix is observed through a magnifying glass in order to discover any changes.
Genital warts (condylomata acuminata)
Warts are soft, moist, pink or grey polyps that grow gradually and often hang on a stem or are positioned in clutters, much like cauliflower.
In men, they are most frequently found under the foreskin around the corona of the glans or in the uric tube opening. They can also be found on the very body of the penis.
In women, they are found on the vulva, wall of the vagina, cervix, and perineum. In homosexuals, warts are most frequently found in the perineal region and the opening of the large intestines. Their growth is unpredictable, but some states, like pregnancy and immunosuppressive therapy, encourage the condylomata’s growth and multiplication.
Treatment (removal) of the condylomata
None of the so far known types of treatment is satisfactory, because condylomata reappear over and over again.
Condylomata can be removed by electro cauterization (“burning“), laser, cryotherapy, or through surgical excision. The local application of different medicines (antimycotics, caustics, interferon inductors, and the very interferon-alpha) are used in the treatment, but they also require weeks and months of persistence and rarely provide the successful long-term results.
Circumcision (“abscission“) can prevent the appearance of the condylomata in men, if they are located in the foreskin area.
Changes on the cervix
It is estimated that at least 80 – 100% of girls between the ages of 18 and 25 come in contact with this virus through sexual intercourse, while only 30% of them develops the symptoms of an infection.
The majority of women who are HPV positive are not going to get genital warts or cervical dysplasia (CIN); while in other women, the infection is connected to the cervical cancer occurrence. Scientific research shows that chronic stress changes the blood flow to the cervix and influences the excretion of its glands, which points to the organic relationship between stress and the changes in this area of a woman’s body.
The weakening of the immune system due to chronic emotional or other types of stress, bad diet, alcohol drinking and smoking, can also cause the changes in the immune system’s responses, which can encourage the activity of the virus.
Various changes that are histologically graded from mild to severe dysplasia precede the development of the cervical cancer, and they can be easily recognized in Papanicolaou smears. Today, these changes are summed up with an abbreviation CIN (cervical intraepithelial neoplasia), and are classified in 3 grades, according to the severity of the changes. CIN1 represents a mild dysplasia, CIN2 represents the moderate one, and CIN3 represents the severe dysplasia or even an in situ carcinoma.
All of these changes mean that the pathological changes are positioned on the inside of the Squamous epithelium itself and that they do not extend beyond the basal membrane. The accuracy of the cytology in the discovery of these changes is greater if the stadium of the lesion is higher. CIN1, CIN2, and CIN3 do not represent different changes on the cervix, but rather different stages of the same disease, so that, in your Papanicolaou test, you can have the cells that are appropriate for CIN1 and the cells that are appropriate for CIN2.
Treatment of the changes on the cervix
Research shows that as many as 50 – 80% women with mild disorders in their Papanicolaou tests that is accompanied with a positive HPV results, return back to normal without treatment. Sometimes, however, they worsen. For the same reason, with the cervical HPV infection results, the most useful advice is taking regular Papanicolaou tests. The repeated dysplasia results, accompanied with an HPV infection, indicate the need for an expanded Colposcopy with the identification of changes.
If needed, histological diagnostics are performed (taking a tissue piece from the cervix – biopsy), and, depending on the results, the available methods for further treatment are surgical methods of conization (laser, classic conization), through which the unhealthy cervical tissue is removed (in the form of a conus, after which this procedure is named – conization), together with the virus.
In the case of the milder cases of dysplasia, amazing treatment results with low doses of the natural interferon have been recorded, with a therapy success rate of 80% – 100%. The main goal of the local interferon treatment is the prevention of the HPV installation within the genome of the yet uninfected cells that form the mucosa of the vagina and the cervix. Treatment is individual and implemented by the gynecologist’s recommendation