Medicine for Africa - Medical Information Service

UMAN   APILLOMA   IRUS

Definition:
  
Human Papilloma Virus, HPV, belongs to the family of sexually transmitted diseases and is, in fact, one of the most common sexually transmitted diseases. The virus can be transmitted during sexual contact between two people; whereas 'sexual contact' does not only imply sexual intercourse, it includes any close bodily contact – that is oral as well as anal contact and intercourse.

To-date, more than 100 subtypes of HPV have already been identified – some of which are benign, i.e. they may only cause warts or small benign polyps, some are considered low-risk types, which may help in preparing the cells and tissue for the invasion of high-risk HPV types which can ultimately cause cancer.  The development of HPV related tissue changes has best been proven in the gynecological and genital area where low-risk types of HPV are known to cause genital warts and high-risk types can develop into malignant cancers of the cervix and even the uterus (womb). They can also be causative of papillomatous and skin cancers in the peri-genital and peri-anal area.

HPV has also been identified in several benign and malignant tumors of other organs.  Thus, HPV has been associated with the development of small cauliflower-like polyps within the urethra, and even within the urinary bladder.  HPV polyps can also occur within the esophagus, where, if present in large numbers, they can interfere with swallowing food.

Malignant tumors that have been associated with one or more subtypes of HPV (other than gynecological cancers) include cancer of the esophagus, skin cancers, verrucous carcinomas, and cancer of the breast.
The association of low-risk and high-risk HPV subtypes in various types of breast cancer has recently been reported by an increasing number of scientific researchers from all over the world.  The DNA of high-risk HPV types had been identified as early as 1992 by the author of this article, and reported in 1993 at the biennial congress of the International Association of Breast Cancer Research.  Recent technological advances in identifying viral DNA in tissue samples and human secretions now support these early findings by other researchers.

The progress of cell changes that is due to HPV, from early dysplastic changes to severe dysplasia and finally invasive cancer of the cervix usually takes many years. However, research has shown that in HIV positive patients and in (untreated) AIDS patients, this progression can take as little as six months.

Although there is no clearly proven connection that non-gynecological HPV-caused cancers are the result of sexually transmitted HPV, there is a strong possibility of a correlation, shown by the fact that HPV has also been diagnosed in metastatic cancer lesions and lymph nodes of primary cancers. A few studies have also identified the same subtypes of HPV occurring in cervical cancer and cancer of the breast of the same patient.

 
Symptoms:

HPV classically causes genital warts on the vulva, in the vagina as well as on the cervix, the tip and shaft of the penis and in the anal area.

 However, symptoms are often not obvious or take a long time to appear as a wart (condyloma acuminatum) or to develop into atypical (dysplastic) cells, which then may have the potential to further develop into cervical cancer. Nevertheless, the viral infection is present and the person is capable of transmitting the virus to his/her partner. The warts can be small, single or multiple in clusters, they can be slightly raised or have a cauliflower-like appearance of small to large dimensions. All of them contain the virus and are highly contagious. They usually develop within about two to three months after infection, their growth rate can be slow or fast and, even if untreated, some disappear after a while. However, whether the wart will disappear or grow is impossible to predict, therefore, anybody who discovers newly developed genital warts should consult a physician and be treated for them.

 
Diagnosis:

The typical cauliflower-like warts caused by HPV can be identified by the physician during a routine physical examination, and are highly suggestive of the diagnosis. The characteristic cell changes caused by the presence of HPV can be seen on a Pap smear, prepared from a cervical cell swab. A biopsy of large lesions or the completely removed wart can further be diagnosed by a pathologist according to characteristic cell changes. However, all these diagnostic tests cannot distinguish between benign, low-risk or high-risk subtypes of HPV.

In order to classify the specific subtype of the HPV, highly sensitive and specific tests will have to be performed, such as HPV-specific serum antibodies, DNA in-situ hybridization, fluorescent in-situ hybridization, or polymerase chain reaction (PCR).  These tests have in common that they need to be performed by specially trained laboratory personnel, require expensive laboratory equipment and highly sterile test conditions, are expensive, and take some time. None of these tests can be performed in a basic or rural healthcare facility or a physician’s office.

 
Therapy:
 
There is no effective medical treatment for the virus.

Cancerous lesions or overt cancer of the cervix can only be ‘treated’ by radical surgery, removing the entire organ that is affected, as well as surrounding tissue and lymph nodes in various amounts, chemotherapy and/or radiation treatment.  However, since the virus can travel via the blood stream, it may already have settled elsewhere and grow again in other organs as so-called metastatic cancers.

Recently developed and (in the USA) marketed vaccines to 'prevent' an infection show some effect (see below). However, there is no treatment for an already infected person at this point in time.

 
Prevention:
 
After many years of research, there are, at long last, two vaccines available - one is called Gardasil® and has been available since June 2006. This vaccine claims to protect against four types of HPV which account for 90% of HPV-caused genital warts and about 70% of HPV-caused cervical cancer. The other, more recently available vaccine is called Cervarix®, which is marketed as providing up to 100% protection for up to four years, especially to women ages 25 to 55.
 
Gardasil® is ideally given in three doses to young girls prior to their first sexual contacts. Cervarix®, also given in three doses, can be given at an older age, but requires booster shots after about four to five years.  Both vaccines have shown good results in protecting against some of the typical high-risk HPV subtypes that can cause cervical cancer. While these vaccines provide a badly needed preventive option for women of all ages, one has to be aware of the fact that no vaccine can really provide 100% protection to 100% of all vaccinated women. Also, vaccines are only effective for a certain period of time and need to be repeated regularly. Furthermore, men can also carry the virus, even without showing any obvious symptoms or the typical papilloma warts, yet they can transmit the virus to their next sex partner.

Thus, the ultimate prevention of HPV is once again the same as for all sexually transmitted diseases - based primarily on avoiding and eliminating sexual contact with an infected person. Since one cannot always be assured of the sexual hygiene of a partner, prevention is best achieved, with a relatively high degree of success, by using a latex condom. Non-latex condoms are not as certain to prevent contact with the infected person's organisms, since some organisms and viruses can penetrate non-latex materials and infect the partner. In addition to the condoms used by men, there are now also condoms for women who can take the initiative if the man does not. A condom should never be used more than once, because contamination with, or leaking of semen occurs frequently upon repeated usage of any kind of condom.

If a person knows that he/she is infected with HPV or with one other sexually transmitted disease (STD), he/she should take responsibility and abstain from sexual contacts with anybody during the period of potential contagion.

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DISCLAIMER: The above article is only intended to provide general information regarding this topic. It is not intended and does NOT replace the need to consult a medical or other professional person, if you have or believe to have this disease/disorder. While the article was researched, written and reviewed by medical professionals, and Medicine for Africa, its staff and publisher made every effort to assure accuracy and correctness, it does not claim to be complete, correct or to reflect the very latest stand of medical/scientific knowledge in the disease’s/syndrome’s pathology, diagnostic and/or therapeutic development. Medicine for Africa, its founder, management, staff, writers, reviewers or publishers may NOT be made responsible or legally bound to any information provided above, and cannot be held liable to any conclusions or decisions the reader may draw after reading this article. The reader is explicitly advised to consult a licensed physician and to present his/her specific situation before making any health related decisions.