HPV virus

HPV virus, genital warts and cervical cancer What is HPV and what is the origin of genital warts?

Human papilloma virus (HPV) is one of the most common infections of the reproductive system, which is usually transmitted through sexual intercourse and causes a range of cancers and other clinical symptoms in men and women. HPV virus causes cervical cancer, which is the fourth most common cancer among women. This virus has an important role in the occurrence of disease and mortality of women, so it is considered as one of the priorities of public health. HPV is a very common virus that causes skin and mucosa infection and almost all people in the world They are infected with this virus once in their lifetime. There are different types of HPV and most of these viruses do not cause complications and the symptoms go away by themselves, but some HPV viruses are considered dangerous and the symptoms can worsen and eventually lead to cancer. In addition to cervical cancer, HPV can also cause other types of diseases in men and women, including various types of cancer and genital warts. The virus can also spread non-sexually. There are safe and effective vaccines to prevent HPV infection.

How many types of HPV are there?

More than 100 types of HPV have been identified, of which more than 40 types cause genital tract infections. Some of these viruses have been classified as high risk by the “International Agency for Research on Cancer” and are carcinogenic in humans. HPV types 16 and 18 are two types of cancer-causing viruses that are responsible for about 70% of cervical cancer cases. Types 31, 33, 45, 52, and 58 together account for about 15% of cervical cancer cases. HPV type 6 and 11 are low risk and are not carcinogenic and cause genital warts.

How is the HPV virus transmitted?

The HPV virus is one of the most common sexually transmitted infections in the world and is usually spread during sex or skin-to-skin contact. It is difficult to determine who was infected first. Because symptoms may develop several years after having sex with an infected person. HPV can even be transmitted when using a condom. Since this virus is resistant to extreme dryness and disinfection, it can survive on the surface of objects for a long time. Also, this virus can be spread through non-sexual means, but this transmission is not common.

Can a pregnant mother transmit HPV to her child?

Although rare, HPV infection can be transmitted when the baby passes through the mother’s infected duct.

What is the prevalence of HPV?

HPV is a very common infection and it is estimated that 90% of people will be infected with this virus at some point in their life and it exposes them to serious health problems such as cervical cancer in women. In 2017, the World Health Organization (WHO) estimated that the prevalence of HPV in women worldwide was 7.11%. The most common types of HPV are type 16 and 18, and women who are infected with one of these types of viruses can be infected with another type of these viruses at the same time. The prevalence of HPV is also high in men in all regions of the world, so that the peak of infection in men is at a relatively higher age than in women.

What are the symptoms of HPV?

A person with HPV may not show any symptoms, but in general, the most common cause of HPV is warts

How is HPV diagnosed during pregnancy?

HPV diagnosis is usually done when a wart is found by a doctor or during a pap smear test. During a Pap test, your doctor uses a swab to remove a small number of cells from your cervix. They send this sample to a lab and test it for cancer cells. The presence of cancer cells may indicate HPV infection.

What are all the health problems associated with HPV?

In addition to the above, HPV types 16 and 18 are responsible for 85% of head and neck cancers and 87% of anal cancers, which are the second and third cancers associated with HPV infection, respectively. These two types of viruses also cause other cancers, including penile, vaginal and oropharynx cancer. Other health problems of HPV in men and women are mucosal and skin infections. Mucosal HPV infections generally appear as oral lesions and genital warts and can occur in the external genitalia, penis, intestines, and cervix. Many types of HPV can cause genital warts, but 90% of these genital warts are caused by infection with HPV types 6 and 11.

Is there an immune response after infection with HPV?

HPV virus infections are usually asymptomatic and often the infected person is not aware of the infection. Viruses are mostly eliminated by the immune system and do not cause significant health problems. But in some cases, infection with high-risk types of HPV virus can lead to the slow growth of cells until it leads to cancer after a few years. Therefore, the HPV vaccine is an important cancer prevention tool. The immune response created by the vaccine is much stronger than the body’s natural immune response against the virus and provides long-term protection against the virus in the body.

What is the burden of cervical cancer?

Cervical cancer is the fourth most common cancer among women. HPV type 16 and 18 infection is responsible for more than 70% of cervical cancer cases in the world. The World Health Organization has estimated that if necessary measures are not taken in the field of cervical cancer prevention and control, by 2030, about 700,000 new cases will be diagnosed each year. Persistent infection with the high-risk type of HPV virus is strongly associated with the development of cervical cancer. It should be noted that although HPV infection is the cause of more than 99% of cervical cancer cases, it does not mean that every woman who is infected with HPV will get cervical cancer. The percentages vary by region, and women in low-income regions are more exposed to cervical cancer

Will all people infected with HPV get cancer in the future?

Most HPV infections resolve spontaneously within 1 to 2 years, and most cervical lesions do not lead to cancer.

How long does it take to get cancer after being infected with the HPV virus?

Although most people who are infected with HPV do not develop cancer, persistent infection with the high-risk type of this virus can lead to cancer. When a person is infected with HPV, it usually takes 10 to 20 years from the time of contracting the virus to the onset of the disease, but sometimes this time may be less. Immunocompromised people, including people with HPV, are more likely to be infected with this infection, and therefore, the development of cancer occurs faster in these people.

How does HPV infection progress to disease?

Progression of cervical cancer infection starts with the infection of normal epithelial cells with HPV and eventually leads to cervical cancer. Although 70-90% of HPV infections are asymptomatic and most of these infections resolve spontaneously within 1-2 years and most cervical lesions do not lead to cancer. Mild lesions in the cervix are common, especially in women in their 20s and 30s. As mentioned earlier, malignant lesions usually do not lead to cancer unless the person is continuously infected with high-risk HPV virus.

How is HPV infection and cervical premalignancy screened?

HPV Testing Method: This test is the most effective method to detect the risk of cervical cancer. In this test, the DNA or RNA of the virus is checked to identify the presence of the high-risk HPV virus such as HPV-16 and HPV-18. This test is not recommended for women under 30 years of age. As infection with this virus is very common in young women, but usually these viruses resolve by themselves and only a small percentage of persistent infections with this virus turn into cancer. There is an exception for girls and women with HIV because these people are at high risk of cervical cancer.
Cytology: screening based on cytology is the most common screening method. In this method, abnormal epithelial cells are examined. A sample of cervical or vaginal cells is removed by a sampling device. The possible low quality of the results is the problem of this screening method.

How is cervical cancer diagnosed?

Diagnostic and confirmatory tests are used to diagnose cervical cancer because not all women who have a positive screening result actually get this disease. The most common diagnostic methods for cervical cancer are colposcopy, biopsy and endocervical curettage.
Colposcopy: Colposcopies are commonly used to guide biopsies from abnormal areas and are helpful in determining appropriate treatment such as cryotherapy and loop electrical excision (LEEP). Colposcopy uses a colposcope, which is a microscope equipped with an optical system and is used to look into the cervix to observe the cellular pattern and blood vessels around the cervix and vagina.
Biopsy: In this method, a small number of samples of abnormal tissue are taken, and these cells are used to determine the degree of cellular changes in the abnormal area of the cervix using a microscope, and it helps to determine the histology of the lesion, and ultimately, cancer. The cervix is either approved or rejected.
Endocervical curettage (ECC): It is a simple method in which surface cells are gently removed from the endocervical canal area and sent to the laboratory for examination. If the results are suspicious for cancer, ECC may be done to evaluate cells in the cervix that are not visible by colonoscopy

How is HPV infection and cervical premalignancy treated?

There is no specific treatment for the virus itself, but strengthening the immune system can be effective in clearing the virus. But there is treatment for cervical premalignancy, which is very effective in preventing the virus from progressing and turning into cervical cancer. Precancerous lesions can be removed through reduction methods or through tissue surgery. There are three treatment methods for precancerous cervix: 1- Cryotherapy- 2- Loop electrical extraction method (LEEP)
3- Cold Knife Conization (CKC)

How to prevent HPV and cervical cancer?

The World Health Organization (WHO) recommends that all women between the ages of 30 and 49 be screened for cervical cancer. These screening tests identify early premalignant changes in the cervical area, which can then be treated before cervical cancer develops. If the screening result is negative, it is still recommended to repeat the screening every 3-5 years.

When should I get tested for HPV?

According to the guidelines, a pap smear test is recommended every 3 years to women who have sex, from the age of 21. Some women are at a higher risk of HPV infection, and if a woman is infected with HIV or undergoing chemotherapy It should be frequently checked for HPV infection, and HPV molecular testing is recommended as an alternative method every 5 years to women aged 30 to 65 with moderate risk.
If women have factors such as a weakened immune system or a history of premalignant lesions, they should be screened frequently at a younger age.
If a woman is between the ages of 21 and 29 and the Pap test is abnormal, HPV molecular testing is recommended.

What is a pap smear test and how is it?

Pap smear test, which is also called Pap test, is performed in laboratories that have a pathology department. It is a screening method for cervical cancer. This test checks the presence of precancerous or cancerous cells in the cervix. During the test, cells from the cervix are gently removed and checked for abnormal growth. This operation should be done in the office of a gynecologist or midwife. This test may be a little uncomfortable, but it usually does not cause long-term pain.

What is the HPV molecular test?

HPV molecular testing is done by identifying the genetic material of the virus in the genetics laboratory and determines the type of virus.

How is HPV treated during pregnancy?

Currently, there is no cure for HPV, but most women do not need any treatment during pregnancy. There is no medication available to treat the virus itself, treatment focuses on managing symptoms. Also, HPV should not pose a risk to your baby.

All tests related to HPV infection, including taking and examining pap smear samples and HPV molecular examination, are performed in the genetics and pathobiology laboratory.

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