What is HPV Virus: Vaccine Causes Diagnosis Treatment.Human papillomavirus (HPV) infection is the most prevalent s@xually transmitted disease (STD) in the world. Know the health problems that can cause, and the best way to prevent and treat them.
- 1 What is HPV infection?
- 2 Causes and forms of HPV transmission
- 3 HPV in women: associated symptoms and diseases
- 4 HPV in man: associated symptoms and diseases
- 5 Diagnosis of HPV infection
- 6 Treatment of HPV infection
- 7 Prevention of HPV infection: HPV vaccine
- 8 Frequently Asked Questions about HPV Vaccine
- 9 Recommendations of the American Pediatric
- 10 Association for the Application of the HPV
- 11 Vaccine
What is HPV infection?
Infection with human papillomavirus (HPV) is currently the s@xually transmitted disease (STD)more prevalent in the world. This infection is caused by more than 150 types of virus, and its main symptoms are the appearance of warts on the hands, feet, and genitals, where they are also known as condyloma acuminate.
HPV was first described in 1935 by Dr. Francis Peyton Rous, who had demonstrated the existence of a virus with oncogenic (ie, capable of inducing the formation of tumors) that caused cancer in the skin of rabbits, And whose description coincided with the papillomavirus.
HPV and cancer: high and low-risk virus
High or low-risk virus terms are used to classify the various papillomavirus serotypes according to their greater or lesser capacity to cause malignant transformation of the cells they infect, degenerating into a neoplasm or cancer.
The transforming activity of the virus is due to the action of two constitutive proteins called oncoproteins E6 and E7, which interact with a large variety of receptors involved in various biological processes, such as programmed cell death or apoptosis, and the division, proliferation and differentiation Cellular, among others.
Serotypes of high-risk human papillomavirus include 16 and 18, which cause approximately 70% of cervical cancers. Other high-risk viruses are 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73 and 82.
The serotypes considered low risk are papillomaviruses 6 and 11, which cause about 90% of genital warts, which rarely develop into cancer. Genital warts can look like bumps or growths that are sometimes shaped like cauliflower. There may be weeks or months after exposure to an infected s@x partner.
Causes and forms of HPV transmission
The human papillomavirus belongs to a family of viruses called Papillomaviridae, whose only genus in the papillomavirus; These are double-stranded acid (DNA) viruses that preferentially infect skin cells and mucosal epithelial (genitalia, anus, mouth, or respiratory tract).
Of the 100 types of known papillomaviruses, about sixty types produce warts in areas such as the hands or feet and are transmitted person-to-person through direct contact with these lesions. The other types of virus, about forty serotypes, are s@xually transmitted, exhibiting affinity for the mucous membranes of the body, such as the moist layers around the anal and genital areas.
In summary, papillomavirus infection can be transmitted by contact with the skin of infected external genitalia, mucous membranes or body fluids, and through intercourse and oral s@x.
Factors that increase the risk of becoming infected with a s@xually transmitted disease such as papilloma virus include:
- Having multiple s@xual partners.
- Have high social risk for having relationships with promiscuous couples.
- Maintain s@xual contact without protection or without using condoms. However, it is necessary to clarify that the papilloma virus can infect the skin that is not normally covered by the condom, reason why the use of the same does not protect to the hundred percent. In addition, many people are asymptomatic carriers, so the s@xual partner can not realize the risk of spreading the virus.
HPV in women: associated symptoms and diseases
HPV can not manifest symptoms and, in many people, does not cause health problems, but the virus is eliminated by the body’s immune system. However, when HPV infection is not cured and depending on the type of virus involved (as explained in the previous section), it can result from genital warts to serious diseases, like various cancers. The following describes the symptoms and the evolution of these pathologies in both s@xes.
In women, the papillomavirus can cause the appearance of genital warts, which can be of various sizes – flat or elevated – and which the doctor can observe with the naked eye. If no treatment is followed, over time these warts may disappear, remain unchanged, or grow and multiply.
Cancer of the cervix or cervix
The evolution of cervical cancer involves the progressive development of several stages. First the cervical epithelial cells present with certain histological abnormalities known as cervical intraepithelial neoplasia (CIN) or, what is the same, mild dysplasia; Then moderate dysplasia occurs; Third, severe dysplasia or carcinoma occurs in situ and, finally, invasive cancer.
Several epidemiological studies have shown that approximately 85% of severe dysplasias have papillomavirus DNA, and 100% of invasive cervical cancers have the virus.
Phases of Infection
- Latent infection: The papillomavirus is infecting cells or tissues, which are still appear normal and the patient lacks clinical manifestations; Yet the virus is present and can only be detected by molecular biology techniques such as the polymerase chain reaction (PCR).
- Subclinical infection: The papillomavirus has caused small microscopic changes in the epithelial cells of the cervix or cervix; This is known as koilocytotic changes or dysplasia, which can be evidenced in routine cytology or in a biopsy of the affected tissue. At this stage of the infection the presence of the virus can also be detected macroscopically in a routine gynecological examination using a solution with iodine or with acetic acid; If coloration changes are observed, the presence of a premalignant lesion is highly probable.
- Clinical infection: characterized by the presence of malignant tumors; The virus is capable of multiplying rapidly, causing infection of other neighboring tissues.
Cancer of the vulva is a rare entity, which constitutes 4% of gynecological cancer. It is characterized by the formation of tumor cells in the tissues of the vulva, usually in the labia majora. Papillomavirus infection and advanced age increase the risk of this disease.
Signs and symptoms of vulvar cancer include a nodule or ulcer lesion, pruritus or stinging, irritation, bleeding, and hypersensitivity in the vulvar area; Likewise, symptoms that are more characteristic of low urinary tract infections, such as dysuria
The main histological type of cancer of the vagina that is related to the persistent infection by the papilloma virus is squamous cell carcinoma; It has been reported that the virus is responsible for 70% of the cases. This type of cancer is more frequent in Hispanic American women, of the black race, and in people older than 60 years.
At the onset of the disease, the patients are asymptomatic, but as it progresses, there is usually an intermenstrual vaginal bleeding, especially after intercourse. The most frequent symptom of patients with cancer of the vagina is therefore bleeding, which may occur after intercourse, between rules, before puberty, or after menopause. Other symptoms, which are also manifested in other types of pathologies, so they are not so specific, are difficulty or pain to urinate, and pain during intercourse or in the pelvic region.
HPV in man: associated symptoms and diseases
Although most men infected with the papilloma virus show no symptoms, HPV can also cause genital warts in men, as well as in women. Warts can be single or multiple and have various forms: cauliflower, raised or flat, and usually appear around the anus, the penis, the skin covering the testicles (scrotum), the groin region, the glutes, Or on the thighs. The lesions can appear in a time that goes from weeks to months after the s@xual contact with the person infected.
It is important for men to understand how to reduce the risk of infection with this virus, as it may increase the risk of genital cancer, although this is not the most common.
Anal Cancer and Penile Cancer
About thirty serotypes of papillomaviruses associated with anal cancer and penile cancer have been reported in the literature, although they are rare pathologies in immunocompetent men. The American Cancer Society estimates that by 2012 about 1,570 men in the United States will be diagnosed with penile cancer and about 2,250 men could be diagnosed with anal cancer. The risk of anal cancer is approximately 17 times higher in s@xually active homos@xual and bis@xual men than in men who have s@x with only women. Men with human immunodeficiency virus (HIV) infection are also at higher risk of developing this type of cancer.
The other papillomavirus serotypes rarely cause cancer in men, producing only genital warts, whose diagnosis must be made by the specialist (urologist), who must visually check the genital area of the man, and then apply a solution of vinegar or acid Acetic acid to help identify the presence of the virus, but the test is not 100% reliable since sometimes normal skin is erroneously identified as a war.
It is unclear whether men who are infected with papillomaviruses in the penis are more likely to have precancerous or cancerous changes than men who are not infected. This assumption arises from the power of oncogenic transformation of the virus, which induces changes in cells.
Papillomavirus and oropharyngeal cancer
It is estimated that about 7% of adults in the United States have oral papillomavirus infection, the most common serotype being HPV 16, the same type that produces a significant percentage of cervical cancer. Recent studies predict that by 2020 there will be more cases of men with oral cancer in relation to papillomavirus infection than cases of women with cervical cancer.
A few years ago tobacco and alcohol were thought to be the main cause of most cases of oropharyngeal cancer (a type of cancer in the mouth, which mainly affects the base of the tongue and the back of the tongue). Mouth, including the tonsils).
In an effort to better understand the role of papillomavirus oral infection and how it affects the risk of head and neck cancer, US researcher Dr. Gillison and his group analyzed mouthwash samples from a group of people aged Between the ages of 14 and 69 during the period 2009-2010.
Among the main findings were found that 10.1% of men and 3.6% of women had evidence of oral papillomavirus infection; That papillomavirus 16 oral infection was approximately three times more common in men than in women; That oral infection is less common in people without a history of s@xual contact; And that people with the highest number of s@xual partners tended to have the highest risk of oral infection with the virus.
Diagnosis of HPV infection
The diagnosis of HPV infection (human papillomavirus) is performed with the following tests:
- Macroscopic examination: involves direct observation of genital warts; You can use acetic acid, which stains white lesions. Likewise, it is observed by colposcopy of the cervix and vagina, previously stained with iodine or acetic acid.
- Microscopic examination: observation of suspicious cells with koilocytotic changes in cytology of the cervix and vagina in women, using Papanicolaou staining. Suspected lesions biopsies, or even genital warts or genital warts may be taken from both men and women, and samples may be sent to a pathological anatomy section for analysis.
- Direct detection of the genetic material of the virus by techniques of molecular biology, which amplify the DNA of the virus and allow the identification of the different serotypes.
Treatment of HPV infection
The treatment of HPV infection (HPV) may vary depending on several factors, among which is the type of injury (warts, precancerous or cancerous lesions), the anatomic location of the lesions and the number of injuries.
Treatment of warts
The treatment of warts caused by HPV includes:
- Topical application of podophyllin 0.5% directly on the wart, which can be applied by the same patient twice a day for three consecutive days followed by four days of rest, being able to repeat the cycle up to four times.
- Topical application of Imiquimod to 5% (Aldara in cream on mono-dose). This immunomodulatory drug acts by activating the cells of the immune system that attack and destroy the virus. Imiquimod can be applied by the same patient, once a day before bed, three times a week, for a maximum period of 16 weeks. After six to ten hours of action, the medication must be removed from the area with plenty of soap and water. This treatment is contraindicated in pregnancy. It may present slight redness of the area and pruritus, possible indication of the activity of the immune system.
- Application of 80-90% trichloroacetic acid: this substance is a very strong acid that should only be applied topically with an applicator in the area of the lesion by a specialist doctor, repeating the treatment once a week until eliminating the injury.
Other forms of warts removal that should be performed by specialist doctors are liquid nitrogen cryotherapy and surgical removal by electrocoagulation or by the use of lasers.
Treatment of precancerous cervical lesions
If a woman with a papillomavirus pre-cancerous lesion receives the right treatment in time she has a high rate of healing and survival. The therapeutic approach of these lesions consists of:
- Cryotherapy: the tissue is frozen using a metal probe that has been cooled with nitrous oxide or carbon dioxide circulating inside the probe. It has an effectiveness ranging from 85 to 95% and is only used in the case of small lesions of approximately 20 millimeters or less and that does not extend into the canal of the cervix.
- Electro-Surgical Excision by Hand: involves removal of the affected area with a hot handle like the scalpel and requires the use of local anesthesia. It has a 95% effectiveness for the removal of the injury.
- Cold Contraction with Scalpel: involves removing the affected cone-shaped tissue from the cervix using the scalpel. Although it is no longer the treatment of choice for precancerous lesions, it can still be used in cases of injuries that can not be treated otherwise, or when cancer is suspected. It has an effectiveness of 94%, requires the use of anesthesia, and has as main complication the bleeding of the area, as well as the risk of stenosis (narrowing) of the canal of the uterine cervix.
Treatment of papillomavirus cancerous lesions
If a person has been diagnosed with any type of cancer associated with papillomavirus infection, the behavior of the specialists will depend on the location of the lesion and the extent of the neoplasia. Treatment may include surgical procedures, chemotherapy, and radiation therapy, among others.
Micro-immunotherapy to treat HPV
Micro immunotherapy is little known among physicians however it has been applied in the world for about 35 years with good results. It was born in 1967 when Dr. Maurice Jenaer discovered that when Nucleic Acids (DNA and RNA) were administered in highly diluted proportions to cancer patients they were able to stimulate their immune system and the patient improved. Since then, several types of research and studies have made possible the development of a therapeutic system that is used in the effective treatment of any disease, simply cooperating with the immune system.
Dr. Diego Jacques, a physician specializing in gynecology and obstetrics, homeopathic medicine and prenatal medicine, has shown, through research, that the use of very low doses of molecules that are produced by the immune system such as interleukins since 1 To 17, as well as interferon alpha, anti-HLA-DR, and along with other substances like cyclosporin A, fragments RNA and DNA in very diluted doses, contributes to the improvement of the effectiveness of the immune response of the organism to the infection by HPV; To this formula has been called 2L®PAPI
Prevention of HPV infection: HPV vaccine
To prevent HPV (human papillomavirus) infection, in addition to limiting risk factors, such as preventing promiscuity and unprotected s@x, specialists recommend administering the HPV vaccine.
The first vaccine developed and marketed to prevent cervical cancer, precancerous genital lesions and warts due to papillomavirus, has been available since 2006 under the name Gardasil, which consists of an injectable suspension of the purified L1 proteins of four Virus serotypes: 6, 11, 16 and 18.
Gardasil is administered to female patients, aged 9 to 26 years, in three doses, allowing two months to pass between the first and second doses and four months between the second and third doses. The vaccine is given as an intramuscular injection (injection into a muscle), preferably in the arm or thigh.
The second vaccine has been available since 2009 and is called Cervarix. It contains a suspension of the major antigenic protein that comes from the capsid of oncogenic types 16 and 18, this is the L1 protein. Cervarix is a vaccine indicated for the prevention of diseases caused by oncogenic viruses 16 and 18: cervical cancer, cervical intraepithelial neoplasia (NIC) 1 and 2, as well as adenocarcinoma in situ. Its use is approved in women aged 9 to 26 years. Immunization with Cervarix is done by the application of three doses of the vaccine intramuscularly in the deltoid region of the arm at 0, 1, and 6 months.
In 2011, the US vaccine committee and the Atlanta Center for Infectious Diseases (CDC-Atlanta)recommended the use of the Gardasil vaccine against papillomavirus in male patients aged 11 to 21 years old, The 26 years in the case of homos@xuals and men with the depressed immune system.
In December 2014, the World Health Organization (WHO) presented the new version of the guide Comprehensive Control of Cervical Cancer – Essential Practices Guide , which recommends giving girls between the ages of 9 and 13 two doses of the vaccine Compared to the papillomavirus because this vaccination schedule is just as effective as the one of three that was carried out to date and, thus, facilitates the administration of the vaccine and reduces its cost.
Frequently Asked Questions about HPV Vaccine
We answer your questions about the HPV vaccine FAQ:
How does the vaccine work against papillomavirus?
All papillomaviruses have a capsule or “capsid” made up of proteins, among them is the L1 protein. These proteins are produced by biotechnology techniques or recombinant DNA technology, being made by a yeast that has received a gene (DNA) that allows it to synthesize it. Both types of vaccine contain the L1 protein, which has antigenic power, which means that it is capable of inducing a protective immune response against the virus through the production of antibodies. The vaccine also contains an “adjuvant,” an aluminum-containing compound, to better stimulate the immune system response.
How long do HPV vaccines protect?
Scientists are still working to determine how long the protection against papillomavirus remains. Early results suggest that it could be more than four years, but there is insufficient data to state that it could last a lifetime. That is why studies are being carried out to determine if booster doses will be necessary.
Is the vaccine effective in people already infected with papillomaviruses?
Recent studies with Cervarix and Gardasil vaccines in infected women have shown that the vaccine was not effective in treating already established lesions caused by the virus. However, they may obtain a residual immune protection benefit over the other virus serotypes included in the vaccines.
What are the side effects of the HPV vaccine?
In studies, the most common side effects observed in more than one patient in ten have been fewer and reactions in the area where the injection has been given, such as redness, pain, and swelling. Other side effects reported less frequently are the loss of consciousness, dizziness, nausea, and headache.
Vaccines should not be used in people who are hypersensitive or allergic to the active substance or any of the other ingredients. If a patient shows signs of allergy after a dose of the vaccine, he should not receive more doses. Vaccination should also be postponed in people with a high fever.
What studies have been done on vaccines?
The effects of Gardasil and Cervarix were first tested in experimental models before being studied in humans. More than 20,000 women between the ages of 16 and 26 participated in the main studies, compared to placebo (a dummy vaccine that does not induce an immune response). The studies included women who had genital warts, genital lesions, or abnormal cell growth in relation to papillomavirus infection.
Recommendations of the American Pediatric
Association for the Application of the HPV
The following are the recommendations of the American Paediatrics Association regarding the administration of papillomavirus vaccines, updated on March 2012:
- Girls between the ages of 11 and 12 should be immunized routinely with three doses, administered intramuscularly at 0, 1 to 2 months, and 6 months. Vaccines may be given at age 9, at the discretion of the treating physician. In December 2014, the WHO advises that the vaccine is administered in two doses, considering that this pattern is just as effective as the previous one.
- Girls and women between the ages of 13 and 26 who have not been previously immunized or who have not completed the complete vaccination schedule should complete the doses.
- Children between the ages of 11 and 12 should be routinely immunized with three doses of Gardasil administered intramuscularly at 0, 1 to 2, and 6 months. The vaccine can be given at age 9, at the discretion of the treating physician.
- All children and men between the ages of 13 and 21 who have not been previously immunized or who have not completed the complete vaccination schedule should receive the Gardasil vaccine.
- Men between the ages of 22 and 26 who have not been previously immunized or who have not completed the doses may receive the Gardasil vaccine. Cost-benefit models justify stronger recommendations in this age group.
- Special efforts should be made to immunize men who have s@x with men up to the age of 26 who have not been previously immunized or who have not completed the doses.
- Previous s@xual activity is not a contraindication for HPV immunization or to complete the dosing schedule. Patients infected with 1 HPV serotype could still obtain protection benefit against any of the other serotypes present in the vaccine. Tests to identify pre-HPV exposure are not recommended. The vaccine can be given when a woman has an abnormal or misdiagnosed pap smear. There is no known beneficial (as a prophylactic) therapeutic effect of the vaccine application.
- HIV-infected persons of both s@xes, from 9 to 26 years of age, who have not been previously immunized or who have not completed the complete vaccination schedule, should receive or complete their regimens with Gardasil.
- HPV vaccines may be given concomitantly with the other vaccines in the recommended vaccination schedule for each country.
- The HPV vaccine can be given in these special circumstances: a) When a patient is immunocompromised (with low body defenses), either by medication or illness. B) When a patient is breastfeeding.
- The HPV vaccine is not recommended during pregnancy. The doctor should be informed about the possibility of pregnancy in s@xually active women, but a pregnancy test is not required before initiating the immunization schedule. If a patient who initiated the vaccination schedule becomes pregnant, subsequent doses should be postponed until the end of pregnancy. It is recommended that women who become pregnant during the application of the scheme are reported to the records that have been developed to obtain data on the outcome of the vaccination.
- Because the HPV vaccine does not prevent infection of all high-risk serotypes, screening recommendations for cervical cancer (for example the Papanicolaou test) should continue in women who have received the HPV vaccine.
- Administration of the HPV vaccine should not modify current recommendations for the use of barrier methods for the prevention of HPV infection and other s@xually transmitted diseases. Nor should you discuss discussions about healthy decisions about s@xual activity, including condom use and abstinence.
- HPV immunization of children 9 years of age and older should be covered by all public and private health insurance.
Contraindications: The Gardasil vaccine should not be applied to people with a history of immediate hypersensitivity to yeast or to pregnant women.
Precautions: Immunization should be delayed in people with the moderate or acute illness. Because syncope may occur in adolescents after injection and has been reported following HPV vaccination, he or the patient receiving the vaccine should sit or lie down for 15 minutes after dosing.