Human Pappilomavirus

Human papillomavirus DNA typing has demonstrated over 90 genotypes, of which HPV-6, HPV-11, HPV-16 and HPV-18 most commonly infect the genital tract through sexual transmission. It is important to differentiate between the benign genotypes (HPV-6 and 11) that cause anogenital warts, and genotypes such as 16 and 18 that are associated with dysplastic conditions and cancers of the genital tract but are not a cause of benign warts. All genotypes usually result initially in subclinical infection of the genital tract rather than clinically obvious lesions affecting penis, vulva, vagina, cervix, perineum or anus. It can also infect the mouth and throat. Many of them infected with HPV are asymptomatic and do not know that they have it.

HPV

  • Transmission of  HPV 

  • Signs and symptoms of HPV

  • The health effects of HPV

  • Prevention of  HPV transmission

  • Screening measures available for the HPV

  • Prevention of HPV related diseases

  • Treatment for HPV

  • Is HPV vaccine safe ?

 

Video of  Human Pappilomavirus

Transmission of HPV 

         The route of transmission HPV is through sexual contact. It’s mainly transmitted through vaginal and anal sex but sometimes through oral sex also. HPV can be passed on the client with single sex partner as well as the one with multiple sexual partners. A person can develop HPV infection even if years have passed since he / she had sexual contact with an infected person. Most infected persons are not aware that they are infected or they are passing the virus to their sex partner. Sometimes there is also a chance to get more than one type of HPV.

          If the pregnant woman is infected with genital HPV, rarely there is chance of transmitting infection from mother to her baby during the vaginal delivery. In such cases, the baby may develop recurrent respiratory papillomatosis (RRP), a rare condition in which warts grows in the throat. In children, this is known as juvenile-onset recurrent respiratory papillomatosis (JORRP).

Signs and symptoms of HPV

          In most of them the HPV is asymptomatic without causing not even a single symptom or health problems from it. In 90% of cases, the body’s immune system clears HPV within two years. But it is difficult to know which people who get HPV will go on to develop health problems.

          One of the most common manifestations of HPV is genital warts in males and females. Genotype (HPV-6 and 11) is responsible for developing anogenital warts in males and females. Rarely, HPV can also leads to a condition called recurrent respiratory papillomatosis or RRP which is manifested by warts in the throat.

The health effects of HPV

           In most of the individual HPV is silent without causing any symptoms but in some it can cause major health problems. There are about 90 genotype of HPV virus, of which some produces serious health problems. Lower risk HPV infection produces genital wart which is otherwise known as condyloma acuminata. Anogenital warts are the result of HPV-driven hyperplasia and usually develop after an incubation period of between 3 months and 2 years. They may be single or multiple, exophytic, papular or flat. Condylomata are papillary lesions caused by human papilloma virus usually type 6 and type11. These are usually multiple and can be contaminated from other parts of the body. They can be transmitted sexually. They are found in heterosexual men and women. Associated vaginal discharge favours their growth and so does pregnancy. Typically they grown in clusters along a narrow stalk giving it a cauliflower appearance but at times the stalk may be broad and thick. The warts are usually painless and not a serious problem. Usually it is diagnosed by the Health care providers by looking at the genital area during the visit. Women with HPV might have warts on the vagina, vulva, or cervix. In men HPV causes warts on the groin, penis and scrotum. Both the men and women can have genital warts on the anus or thigh.

         Left untreated the condylomata may at times, spread to the vagina or even the cervix. These lesions should be differentiated from syphilitic condylomata or vulval carcinoma. Very rarely, it becomes malignant. Rarely, a giant condyloma (Buschke-Lewenstein tumour) develops with local tissue destruction. Atypical warts should be biopsied. In pregnancy warts may dramatically increase in size and number, making treatment difficult. Rarely, they are large enough to obstruct labour and in this case delivery by CS will be required. Perinatal transmission of HPV rarely leads to anogenital warts, or possibly laryngeal papillomas, in the neonate. Recurrent respiratory papillomatosis ( RRP )causes warts to grow in the throat blocking the airway, causing troubled breathing and hoarseness in the sound . Although rare, RRP can occur among adults and children.

        High-risk HPV infections can sometimes develop into carcinoma of cervix (the opening of the uterus). There may be an association between HPV infection and malignant epithelial transformation of the cervix, vagina and vulva. These infections may also leads to anal cancer. In some cases, high-risk HPV infections can persist and leads to cell changes. If these cell changes are not treated on time, they may lead to cancer over time. It is usually associated with HPV type 16 or 18. HPV plays important role in the development of cervical intra epithelial neoplasia (CIN). Cervical cancer usually does not have symptoms until it is quite advanced, very serious and hard to treat. HPV infected cells are characterised by enlarged cells with perinuclear halos. The nucleus is large, irregular and hyperchromatic. Depending on their oncologenic potential, HPV types are broadly grouped into two.

  1.  High oncogenic risk-type 16,18,31,58.
  2.  Low ongenic risk-types 6,11,42,43.

 

          Over 90 % of patients with CIN and invasive cancer are found to be positive with HPV DNA. So it is important that all high risk women should do regular screening for cervical cancer. Screening test helps to identify the early signs of disease so that the problem can be treated early, before it turns to malignancy.

        Other HPV-related cancers include the cancer of vulva, vagina, penis, anus, and oropharynx (including the base of the tongue and tonsils, cancers of the back of the throat). It may also have no signs or symptoms until they are advanced and hard to treat.

Prevention of HPV transmission

           One of the best ways to prevent HPV is not to have sex with anyone. If you are sexually active, always have safe sex practices like using condoms lowers risk of getting HPV, cervical cancer or genital warts. But it is important to use condoms every time you have sex, from the beginning to the end. This is not a 100 percent reliable method to prevent transmission of HPV, as this virus can also infect the areas that are not covered by condom. Immediately washing the genitals, urinating or douching after sexual intercourse will not prevent the transmission of the any sexually transmitting diseases. Another method to lower the risk of HPV is by maintaining a faithful relationship with one partner, limiting their number of sex partners and being with a partner who has had no or few prior sex partners.

             Vaccination is available to protect the females and males from HPV. These vaccines are given in 3 doses over 6 months. Ideally, the same vaccine product should be used for the entire 3-dose series. The vaccines are most effective when all doses are received before a person has first sexual contact with his / her first partner.

         Two licensed HPV vaccines are bivalent vaccine (Cervarix) containing HPV types 16 and 18 and a quadrivalent vaccine (Gardasil) containing HPV types (6, 11, 16, &18.) These both vaccines offer protection against the HPV types that cause 70% of cervical cancers (i.e., types 16 and 18), and the quadrivalent HPV vaccine also protects against the types that cause 90% of genital warts (i.e., types 6 and 11). Either vaccine can be administered to girls aged 11–12 years or can be administered to those as young as 9 years of age and it can be also given to the women between the age of 13–26 years who have not taken the vaccine before. The quadrivalent (Gardasil) HPV vaccine can also be used in males aged 9–26 years to prevent genital warts (17).

           Women should continue routine cervical cancer screening, even after the vaccination because 30% of cervical cancers are caused by HPV types other than 16 or 18. Vaccination >26 years of age is recommended for the prevention of HPV.

Screening measures available for HPV

  •  Pap Smear test:-This is a test used to detect the cervical cancer. It helps to identify precancer cells which may turn to cervical cancer if not treated properly. All woman should start doing the Pap smear test at the age of 21 years and every three years after that.
  • HPV DNA detection in cervical tissues is a screening procedure as that of pap smear. Polymerase chain reaction or southern blot or hybrid capture technique is also used for HPV DNA detection. HPV testing using hybrid capture method can reliably detect the high risk HPV DNA will ever develop CIN (cervical intra-epithelial neoplasia).This test is recommended for all woman above the age of 30 years.
  • There is no specific test is recommended to identify HPV related health problems like genital wart ,cancer of penis, vulva, anus, vagina and oropharynx.

 

Prevention of HPV-related diseases

  •  Preventing Genital wart:-This is one of the most common problem caused by HPV. Gardasil is the vaccine which protect against most genital warts in men and women.
  • Preventing Cervical Cancer: – Cervical cancer can also prevented by routine cancer screening (Pap test) and follow-up of abnormal results. This helps to identify abnormal cells on the cervix so that the early treatment can be initiated before turning cancerous cell. Success of the treatment depends on the woman’s age, their severity in the progress of the disease, past medical history, and other test results. In some cases along the Pap test HPV DNA test, is also available to detect certain HPV types on a woman’s cervix. Even the vaccinated women should also undergo continuous regular screening because the vaccines do not protect against all cervical cancers.
  •  Preventing Anal and Penile Cancers:Gardasil is the vaccine to protect against most of the anal cancers. Specifically there is no routine screening test for anal or penile cancer. More over there is no data regarding the efficacy of vaccine to prevent cancers of the penis, but most of the HPV related cancers of the penis are prevented by the vaccines.
  • Preventing Cancers of the Oropharynx :- There is no approved test to find early signs of oropharyngeal as well as there is no data on efficacy of the vaccine to prevent cancers of the oropharynx but most HPV-associated cancers of the oropharynx are caused by the HPV types prevented by the vaccines.
  • Preventing (JORRP) Juvenile-Onset Recurrent Respiratory Papillomatosis: Usually the vaginal delivery is not encouraged for the women with genital wart because the baby will get HPV while it passes through the birth canal so she can electively decide for Cesarean.

 

Treatment for the HPV

  •  There is no specific treatment for genital HPV. In 90 % of the individual the body immune system will fight against the virus. The treatment is available for the condition caused by the genital HPV like cervical changes, genital warts, and cervical cancer.
  • Podophyllotoxin, 0.5% solution or 0.15% cream (contraindicated in pregnancy) applied 12-hourly for 3 days, followed by 4 days’ rest, for up to 4 weeks is suitable for home treatment of external warts.
  •  Imiquimod cream (contraindicated in pregnancy) applied 3 times weekly (and washed off after 6-10 hours) for up to 16 weeks is also suitable for home treatment of external warts.
  • Cryotherapy using liquid nitrogen to freeze warty tissue is suitable for external and internal warts but often requires repeated clinic visits.
  • Hyfrecation-electrofulguration that causes superficial charring-is suitable for external and internal warts. Hyfrecation results in smoke plume which contains HPV DNA and the potential to cause respiratory infection in the operator/patient. Masks should be worn during the procedure and adequate extraction of fumes should be provided.
  • Surgical removal- surgical removal is one of the treatment modality.
  •  Cervical cancer can be treatable when it is diagnosed early. Prognosis depends on the severity of illness, age of the woman, past medical history, and other test results. So all the women after the age 20 should undergo routine screening for cervical cancer, for the early identification and treatment cervical cancer. Prevention is always better than treatment. Other HPV-associated cancers are also more treatable when diagnosed and treated early.
  •  Recurrent Respiratory Papillomatosis (RRP) is a condition in which HPV causes warts grow in the throat. It can be treated with surgery or medicines. It can sometimes take many surgeries or treatments over a period of years.
  •  The virus will remains in the body even after the treatment of underlying condition. It means that you may still pass HPV to your sex partners.

 

Is HPV Vaccine Safe?

        All vaccines used in the United States are required to go through years of extensive safety testing before they are licensed by the U.S. Food and Drug Administration (FDA). Once in use, they are continually monitored for their safety and effectiveness.

      Gardasil and Cervarix are two human papillomavirus (HPV) vaccines. These vaccines are mainly to protect females against the two HPV types that cause most cervical cancers. The safety of Gardasil and Cervarix was studied in clinical trial in US before it was licensed. Till now there is no reported case of any adverse effect for this vaccine in the study trail.

Conclusion

           Human pappiloma virus is one of the most common sexually transmitted organisms which can infect large number of people. But it can be prevented by maintaining safe sex practices like using condom, single sex partner and vaccination. This virus is very common and most of them will be salient carrier of it. Most women have not had regular Pap tests before diagnosing cervical cancer. So all women above the age of 20 years should do regular and continuous Pap test to check for any problem to prevent the occurrence of cervical cancer. Be sincere and faithful to your partner, talk openly about sexually transmitting disease and treat immediately to prevent the further progress.

 

We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

 

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The Team Manager Web Diseases

 

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