Gynecology Clinic Archiepiskopou str. 22 & Skouladon str. HERAKLION, Crete
2810 343376 - 6945 268822
IRENE ORFANOUDAKI MD, PhD
Obstetrician & Gynecologist Surgeon
Dr. Orfanoudaki Irene MD PhD - HPV, Prevention, Treatment, Pregnancy
HPV (Human papilloma virus, Virus of human papillomas) is a group of DNA viruses, which can cause a number of lesions, both benign and malignant, on the skin and mucous membranes of the human body.
Today, 200 different types of human papillomavirus have been identified, of which approximately 40 have been linked to the genital system.
HPV infection is the most common sexually transmitted disease in women and men.
How HPV is transmitted.
HPV can be transmitted through sexual contact because it is found in saliva, semen and genital secretions.
HPV can be spread through sexual intercourse or oral sex.
The condom does not protect against infection because does not completely cover the areas of skin affected by the virus.
However, other alternative routes of transmission of the virus are being scientifically tested, such as by hand or by cloth, which so far cannot be ruled out with certainty.
Almost 80% of the population will come in contact with the virus at some point in their lives.
Those who come in contact with the virus will not necessarily develop the disease.
The majority of women who become infected will not show any lesions.
In 75% of cases , the HPV infection can go away on its own over a period of 8-18 months.
However, HPV causes genital warts, cancer of the cervix, cancer of the vulva, vagina, penis, anus, and is also responsible for certain cancers of the mouth, mouth, and larynx.
The HPV subtypes.
A group of about 40 subtypes of HPV are sexually transmitted and infect the genital area.
Some forms of HPV and more specifically types 6,11,40,41,42,43,44,55,61,70,72,81,83,84,89 cause benign lesions called acute warts and are soft, fleshy skin-colored growths most commonly found on the external genitalia, anus, perineum, vagina, and cervix.
Types 6 and 11 in particular are the most common of the benign types and are blamed for about 90% of genital warts.
Types 16,18,31,33,35,39,45,51,52,53,55,56,67,58,59 & 68 are of high oncogenicity and are found in cervical cancers (in a percentage> 95% ) , the vagina, the vulva and the perineum.
In particular, types 16 and 18 are the most common and are responsible for about 75% of all cervical cancers and about 55% of high-grade precancerous lesions (grade 3) at the same site.
In more detail:
HPV 16 and HPV 18 are estimated to be responsible for:
about 70% of cervical cancers,
for 75-80% of anal cancers,
for 80% of in situ adenocarcinoma (AIS),
for 70% of intraepithelial neoplasms of the vulva and vagina.
Symptoms.
HPV is asymptomatic and is not perceived by the patient except in the case of the development of genital (acute) warts on the external genitalia.
The absence of acute warts in the vulva and the presence of asymptomatic HPV infection in the cervix is the most common scenario.
As mentioned above, some forms of HPV can cause warts, while some other forms can cause
pre-cancerous malformations.
When the infection progresses then the acute warts develop on the external genitalia, perineum and anus.
They are visible to the naked eye and with self-examination and can be perceived by palpating the area.
They can cause itching, burning, pain and even bleeding in the area.
HPV lesions associated with cervical cancer are asymptomatic and do not usually appear to the naked eye and require tests such as Papanicolaou test and the colposcopy .
Chronic determination of the disease.
There is no exact timeline for the development of an HPV infection.
According to some proposed models, the average time between the first contact with the virus and the onset of cancer ranges from 9 to 15 years.
However, low-grade precancerous lesions (1st may occur at much shorter time limits, even months after the first infection.
Therapeutic approach.
THE treatment of HPV infection It is very important, both for the person who suffers and for not transmitting it to other people.
For HPV skin warts, they are treated with Cryotherapy, Diathermy, Surgical removal and invasive Laser CO2.
In the event that HPV virus has caused in and out proctogenital area Cellular changes suspected of cancer, invasive HPV treatment is required by the Gynecologist.
Surgical treatment aims to remove or destroy the damage caused by HPV so that it does not develop into cancer.
Removal can be done by various methods (scalpel, diathermy, laser).
The choice of method depends on each case.
Especially for the cervix, the treatment is done with Cryotherapy, with Conoid resection and with excision with diathermy.
The part of the cervix that will be damaged or removed is regenerated by 90% within the next 6 months and there will be no deficit in the cervix that will be operated on.
Prevention.
Cervical cancer is the second most common gynecological cancer in the world up to the age of 45.
But it can now not only be diagnosed in time but prevented and significantly reduced, almost eliminated .
Every woman should have a Pap test every year.
The Pap test is the first and even the best screening test against cancer.
The Pap test is used to detect cellular abnormalities and the presence of HPV.
If the test shows suspicious cells then he should proceed to the examination called colposcopy and depending on the gynecologist's judgment and to identify the subtypes of HPV by PCR.
Also another valuable diagnostic method is the specialized HPV DNA test which is another tool for diagnosing cervical cancer.
The HPV DNA test is a sensitive and non-invasive method for determining the presence of an active cervical infection by HPV oncogenes.
With this method we can first stage to detect the virus and also to classify it into two categories:
high oncogenic risk (those associated with cancer) and
low-risk (those not related to cancer but with warts or other mild pre-cancerous changes.
Vaccination.
There is currently a vaccine that protects against nine types of HPV that cause most forms of cervical cancer.
(Gardasil now contains 9 strains and has been approved for boys as well.)
Clinical studies of HPV vaccines have shown that their effectiveness is close to 100% in preventing the development of precancerous lesions and cervical cancer.
Clinical studies of the Gardasil vaccine also show a very high effectiveness in the prevention of precancerous lesions of the vulva and vagina as well as genital warts.
HPV vaccination should be a routine for all girls aged 12-15.
At this age, the administration of all mandatory vaccinations of the basic pediatric vaccination is completed.
The HPV vaccine has no serious side effects.
The only side effects that have been observed and identified as being due to vaccination are mild local side effects, ie pain, redness and swelling at the injection site in the arm, as well as some mild systemic side effects, such as dizziness and possibly fainting little girls and boys), mild fever, headache and malaise for 2-3 days, and rarely any allergic reaction.
HPV and pregnancy.
HPV can coexist during pregnancy and requires great care , as during childbirth the virus can be transmitted from mother to baby and it can cause warts or laryngeal papillae.
In some women, HPV malformations can worsen during pregnancy, mainly due to severe hormonal changes.
Generally the HPV treatment It is advisable to perform it before pregnancy , as if there are active warts during childbirth, a caesarean section is recommended.
Recent data link HPV infection, and in particular high-risk subtypes (16, 18), to an increased incidence of complications such as preterm birth , premature rupture of membranes, intrauterine fetal growth retardation, and the development of preeclampsia.
Also the presence of HPV in sperm seems to be associated with increased rates of infertility and miscarriage.
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