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Human Papilloma Virus


OVERVIEW OF Human Papilloma Virus :

HPV is a highly contagious yet curable sexually transmitted disease (STD).Genital herpes is a sexually transmitted disease. This STI causes herpetic sores, which are painful blisters (fluid-filled bumps) that can break open and ooze fluid. But it might also leads to cancer.

Cervical cancer is by far the most common HPV-related disease. Nearly all cases of cervical cancer can be attributable to HPV infection.

The infection with certain HPV types also causes a proportion of  cancers of the anus, vulva, vagina, penis and oropharynx, which are preventable using similar primary prevention strategies as those for cervical cancer.

Non-cancer causing types of HPV (especially types 6 and 11) can cause genital warts and respiratory papillomatosis (a disease in which tumours grow in the air passages leading from the nose and mouth into the lungs). Although these conditions very rarely result in death, they may cause significant occurrence of disease. Genital warts are very common, highly infectious and affect sexual life.


CAUSES :

Unsafe sexual practices

Multiple sexual practices

Sharing common needles

Failure to screen blood before blood transfusion

Transfer of the virus from mother to foetus

Also spreads by break in the skin surface.

Anal intercourse


PATHOPHYSIOLOGY :

Herpes is contracted through direct contact with an active lesion or body fluid of an infected person. Herpes transmission occurs between discordant partners; a person with a history of infection (HUMAN PAPILLOMA VIRUS seropositive) can pass the virus to an HUMAN PAPILLOMA VIRUS seronegative person. Herpes simplex virus 2 is typically contracted through direct skin-to-skin contact with an infected individual, but can also be contracted by exposure to infected saliva, semen, vaginal fluid, or the fluid from herpetic blisters. To infect a new individual, HUMAN PAPILLOMA VIRUS travels through tiny breaks in the skin or mucous membranes in the mouth or genital areas. Even microscopic abrasions on mucous membranes are sufficient to allow viral entry.

HUMAN PAPILLOMA VIRUS aymptomatic shedding occurs at some time in most individuals infected with herpes. It can occur more than a week before or after a symptomatic recurrence in 50% of cases. Virus enters into susceptible cells by entry such as nectin-1, HVEM and 3-O sulfated heparan sulfate. Infected people who show no visible symptoms may still shed and transmit viruses through their skin; asymptomatic shedding may represent the most common form of HUMAN PAPILLOMA VIRUS-2 transmission. Asymptomatic shedding is more frequent within the first 12 months of acquiring HUMAN PAPILLOMA VIRUS. Concurrent infection with HIV increases the frequency and duration of asymptomatic shedding. Some individuals may have much lower patterns of shedding, but evidence supporting this is not fully verified; no significant differences are seen in the frequency of asymptomatic shedding when comparing persons with one to 12 annual recurrences to those with no recurrences.

Antibodies that develop following an initial infection with a type of HUMAN PAPILLOMA VIRUS prevents reinfection with the same virus type—a person with a history of orofacial infection caused by HUMAN PAPILLOMA VIRUS-1 cannot contract herpes whitlow or a genital infection caused by HUMAN PAPILLOMA VIRUS-1. In a monogamous couple, a seronegative female runs a greater than 30% per year risk of contracting an HUMAN PAPILLOMA VIRUS infection from a seropositive male partner. If an oral HUMAN PAPILLOMA VIRUS-1 infection is contracted first, seroconversion will have occurred after 6 weeks to provide protective antibodies against a future genital HUMAN PAPILLOMA VIRUS-1 infection. Herpes simplex is a double stranded DNA virus.


ROUTES OF TRANSMISSION :

infection by the  human papilloma HPV) is the most important risk factor for cervical cancer. HPV is a group of more than 150 related viruses. Some of them cause a type of growth called papilloma which are more commonly known as warts.

  • HPV can infect cells on the surface of the skin, and those lining the genitals, anus, mouth and throat, but not the blood or internal organs such as the heart or lungs.
  • HPV can spread from one person to another during skin-to-skin contact. One way HPV spreads is through sexual activity, including vaginal, anal, and even oral sex.
  • Different types of HPV cause warts on different parts of the body. Some cause common warts on the hands and feet; others tend to cause warts on the lips or tongue.

Certain types of HPV may cause warts on or around the female and male genital organs and in the anal area. These are called low-risk types of HPV because they are seldom linked to cancer.

Other types of HPV are also known as the high risk types because they are strongly linked to cancers, including cancer of the cervix, vulva and penile cancer in men, vagina in women, and cancers of the anus, throat and mouth in both men and women. 

Infection with HPV is common, and in most people the body can clear the infection by itself. Sometimes, however, the infection does not go away and becomes chronic. Chronic infection, especially when it is caused by certain high-risk HPV types, can eventually cause certain cancers, such as cervical cancer.

 

Sexual  Transmission:

About 80% of infections worldwide are transmitted through sexual transmission. The risk of transmission depends on various factors including - sexual partner's viral load, the type of sexual exposure, coinfection with other conditions like HUMAN PAPILLOMA VIRUS and genital inflammation or damage.

  1. Vertical transmission

When the bacteria spreads from mother to child during pregnancy, childbirth or during breast feeding, it is called as vertical transmission. The Risk of transmission can be lowered significantly if infection is treated consistently and bacterial load is maintained below the limit of detection.


COMMON CLINICAL SIGNS AND SYMPTOMS :

Appearance of warts

Inflammation of the urethra- urethritis

Vaginal discharge

Pain

Small tiny blisters

Scabs – the ulcers which forms and heal by itself leaving a scar like tissue

Bleeding in the sore

Dysuria- A condition caused by the urethral discharge

Routes of transmission:

Sexual route

Sometimes by blood products.

Touching or exposure arears of the infected person.

 


DIAGNOSTIC :

Viral culture: This test involves taking a tissue sample or scraping of the sores for examination in the laboratory and investigations are made.

Polymerase chain reaction (PCR) test: PCR is used to copy your DNA from a sample of your blood, tissue from a sore or spinal fluid. The DNA can then be tested to establish the presence of HUMAN PAPILLOMA VIRUS and determine which type of HUMAN PAPILLOMA VIRUS you have.

Blood test: This test analyzes a sample of your blood for the presence of HUMAN PAPILLOMA VIRUS antibodies to detect a past herpes infection

Immunofluoroscent test: It detects the antibody to the viral infection.

Swab test: the health care physician takes swab from vaginal site and then laboratory investigations are made.

Lumbar puncture: It is done if anyone is suggesting for spinal cord or brain infections.

HPV DNA testing

This test determines whether the individual has any of the types of HPV most likely to cause cervical cancer. It involves collecting cells from the cervix for lab testing.

The test can detect high-risk HPV strains in cell DNA before any anomalies become clear in the cervical cells.

If there are signs and symptoms of cervical cancer, or if the Pap test reveals abnormal cells, a doctor may recommend additional tests.

Colposcopy: This is visual examination of the vagina using a speculum and a colposcope, a lighted magnifying instrument.

Examination under anesthesia (EUA): The doctor can examine the vagina and cervix more thoroughly.

Biopsy: The doctor takes a small section of tissue under general anesthesia.

Cone biopsy: The doctor takes a small, cone-shaped section of abnormal tissue from the cervix for examination.

Diathermy:  Diathermy using a wire loop with an electric current helps remove abnormal tissue. The healthcare professional then sends the tissue to the lab for checking.

Blood tests: A blood cell count can help identify liver or kidney problems.

CT scan: A medical professional might use a barium liquid to show up any cellular abnormalities.

MRI: Special types of MRI may be able to identify cervical cancer in its early stages.

Pelvic ultrasound: High-frequency sound waves create an image of the target area on a monitor.

 

 


TREATMENT AND PROGNOSIS :

Medical management:

The antiviral medications provide a better relief to the patients. The medicines used are:

Acyclovir

Valacyclovir

Famcicyclovir

  • Empiric treatment for other viral infection and syphilis is also recommended (as they are more common and coinfections may exist).

Surgical management

  • Incision and drainage of suppurative buboes
  • Needle aspiration can be performed, but patients may need repeat aspirations.
  • Without treatment, fistulous tracts and deep tissue destruction can occur.
      • Trachelectomy:
      • This treatment is indicated for early stage cancer. This treatment involves the removal of cervix alone.
      • Hysterectomy:
      • It is the treatment used to remove the vagina, cervix and uterus.

 

  • Chemotherapy:
  • A chemotherapy is after the sugery or before the surgery to shrink the cancer cells. A chemotherapy is nothing but the delivery of drug intravenously.
  • Drug used:
  • Cisplatin Cisplatin
  • Carboplatin
  • Paclitaxel (Taxol)
  • Topotecan
  • 5 -fluorouracil

 

  • Radiation therapy:
  • It uses powerful x rays or emission of protons to destroy the cells. The radiation therapy also aids  in shrinkage of the cells and also relief the symptoms caused by the cancer.
  • Salicylic acid:

 Over-the-counter treatments that contain salicylic acid work by removing layers of a wart a little at a time. For use on common warts, salicylic acid can cause skin irritation and isn't for use on your face.

  • Imiquimod:

 This prescription cream might enhance your immune system's ability to fight HPV. Common side effects include redness and swelling at the application site.

  • Podofilox;

 Another topical prescription, podofilox works by destroying genital wart tissue. Podofilox may cause burning and itching where it's applied.

  • Trichloroacetic acid:

This chemical treatment burns off warts on the palms, soles and genitals. It might cause local irritation

 

HPV vaccine:

HPV vaccines work best if administered prior to exposure to HPV. Therefore, WHO recommends to vaccinate girls, aged between 9 and 14 years, when most have not started sexual activity. The vaccines cannot treat HPV infection or HPV-associated disease, such as cancer.

 


PROGNOSIS :

Recovery and prognosis of the chancroid purely depends upon the size  and severity of the ulcer sores. Large ulcers from human papilloma virus might take 2-3 weeks to heal fully.

 


PREVENTION :

Prevention:

  • Limiting or reducing the number of sexual partners
  • using protection during sexual contact or intercourse at all times
  • regularly checking the genital region for signs of abnormal bumps, sores, or swollen lymph nodes
  • talking with sexual partners about testing for STIs or their STI status before engaging in sexual contact
  • asking sexual partners about any unusual sores or bumps in their genital region
  • talking with a doctor about unexplained groin pain
  • getting regular STI testing
  • avoiding or limiting alcohol use and avoiding recreational drug use as these may impair judgment in making healthy choices
  • screening of the blood and other products before transfusion