Human Papillomavirus (HPV), Diagnosis and Treatment
Human Papillomavirus (HPV)
- The sample can be taken with an Endocervical swab.
- Take a biopsy sample from the affected tissue.
Indications for Human Papillomavirus (HPV)
- Isolation of the Human papillomavirus.
Definition of human papillomavirus
- This virus is double-stranded DNA, without an envelope.
- Papova means papillomavirus, polyomavirus, causing perinuclear vacuolization.
- >50 strains of Human papillomavirus are described.
- The most common clinical manifestation is warts (skin), condyloma (in the genital area).
- This double-stranded DNA virus infects the squamous epithelium and gives a spectrum of the diseases of the skin, respiratory system, genital tract from warts to dysplasia to carcinoma.
Pathophysiology of Human Papillomavirus (HPV)
- Human papillomavirus (HPV) belongs to the Papovaviridae family.
- This is also called the wart virus.
- It measures 44 to 55 nm.
- This is a double-stranded DNA virus.
- This is icosahedral, and no envelope.
- This virus can cause the infection of:
- Hands, feet, arms, and forehead.
- In the case of cervical lesions, HPV types 6 and 11 are associated with low-grade malignancy.
- HPV types 31, 33, and 35 are seen in low-grade malignancy.
- HPV types 16 and 18 are found in high-grade malignancy.
- Various types of warts/lesions are:
- Verruca plantaris are caused by HPV-1.
- Verruca Vulgaris is caused by HPV-2.
- Condyloma acuminatum is caused by HPV-6, 11.
- laryngeal papilloma is caused by HPV-6, 11.
- Cervical and laryngeal dysplasia/carcinoma is caused by HPV-16, 18, 31, 33.
- Papillomaviruses are tropical for the epithelial cells of the skin and mucous membranes.
- Viral nucleic acid can be found in basal stem cells.
- This virus causes cervical cancers and squamous cell carcinoma of the head and neck.
- Biological and molecular studies show that the disease progress slowly.
- HPV-16 and 18 are considered to be high-risk viruses for cancers.
- HPV-31 is classified as an intermediate-risk virus.
- HPV-6, 11 are considered low-risk viruses for cancers.
Human papillomavirus and its relation to various diseases:
|Type of papilomavirus||Disease|
|HPV-1, 2||Common warts|
|HPV-3, 7||Butcher wart|
|HPV-6, 11, 30, and a few others||Respiratory system|
|HPV-6, 11, 42, 43, 44||Genital area with low risk|
|HPV-16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68||Genital area with high risk|
|HPV-3, 5, 8, 9, 10, 12, 14, 15, 17, 19, 20, 21, 22, 23, 24, 25||Epidermodysplasia|
- It is 1 to 8 months for warts, once the virus settles in the area.
- Genital warts develop for 1 to 3 months.
- The wart is more common in children and young adults. These are uncommon in older adults.
Structure of the Human papillomavirus:
- Papillomaviruses are non-enveloped viruses without a lipid layer and there is a capsid consisting of protein.
- It contains a large genome of 8 kb. This genome is very complex.
- There is double-stranded DNA in a circular shape.
- The papillomavirus is slightly larger in size measuring roughly 52 to 55 nm.
Mode of spread:
- This spreads :
- In genitalia through sexual contacts (unprotected anal, vaginal, or oral sex).
- Transmission of cutaneous HPV is by direct contact, skin to skin (handshakes or hugs).
- This may spread during pregnancy (mother to baby, labor, and nursing).
- Some people have no symptoms but they can spread the disease through sexual contact.
Signs and symptoms:
- It is dependents on the area involved:
- Warts are tender when these are irritated.
- Warts are seen on hands, feet, arms, forehead, larynx, and genitalia.
- Anal warts cause itching called venereal wart Condylomata.
- Different kinds of warts are:
- Skin wart. Non-plantar warts are usually associated with HPV-2.
- Plantar warts. HPV-1 is associated with warts on the sole of the foot.
- Flat warts.
- Genital condyloma.
- Laryngeal papilloma.
- Palmer warts are sensitive to pressure.
- HPV-associated sexually transmitted genital lesions are becoming more common.
- Cervical cancers in women are common in the world and a major cause of death in developing countries.
- HPV-6 and 11 are associated with cervical low-grade dysplasia (CIN I and II).
- HPV- 16 and 18 are seen in 80% to 95% of the high-grade cervical dysplasia (CIN III), and some cases of carcinoma of the penis.
- HPV-16 is also associated with squamous cell carcinoma in situ of the anogenital area skin (Bowen’s disease) and invasive carcinoma of the anal area.
- The majority of cervical, penile, and valvular cancers carry HPV-DNA.
- These lesions show HPV-16 and HPV-18 and these types are more common.
Classification of the Human papillomavirus and its relation to diseases:
|Type of Human papillomavirus||Clinical presentations||The outcome of the infection|
|HPV-3, 10, 28||
|HPV-12, 17, 20||
|HPV-9, 14, 15, 19-25, 36, 40||
|HPV-16, 18, 31, 33, 35, 39||
|HPV-26, 27, 29||
|HPV- 30, 40||
- This may become chronic and may last many years or lifelong.
- In the USA this disease is very common, roughly 3 million cases are reported.
- Another reference says 80 million cases in the USA according to CDC.
- 14 million people including teenagers will suffer from this infection each year.
Summary of the Human papillomavirus features:
|size of the virus||Average 55 nm|
|Outcome of infection||It forms a benign tumor (Wart)|
|Genome transformed cells||
|Type of papillomavirusus||
|Where it is found||
Diagnosis of Human Papillomavirus (HPV)
- Diagnosis is made with immunohistologic stains or nucleic acid DNA probes on cervical biopsy.
- Cervical biopsy gives more positive results than the cervical scrapings smear.
- It can find the virus in Papanicolaou stain cells of the cervical smear.
- Or can advise liquid-based cytology.
- PCR for detection of the HPV.
- HPV DNA hybridization technology.
Treatment of Human Papillomavirus (HPV)
- Warts need surgical excision.
- Also, can try electro dissection.
- Can use acid.
- It can use freezing with liquid nitrogen.
- Sometime it may disappear without any treatment.
The complication of human papillomavirus:
- The most common complication is cervical cancer in females. It is found in 90% of cases.
- This is also found in the cancers of the vulva, penis, anal canal, and head and neck.
Prevention of Human Papillomavirus (HPV)
- Avoid contact with HPV-positive patients.
- Condoms use can prevent infection.
- The vaccine can be recommended to prevent HPV (for genital warts, and cervical cancers).
- HPV vaccine Cervarix prevents types 16 and 18.
- These types are 70% cause of cervical cancers.
- All boys and girls need to be vaccinated at the age of 11 or 12 years.