WHAT IS GENITAL WARTS-HPV?
Human papilloma virus (HPV) infection; It is the most common sexually transmitted viral infection in the world, its prevalence in society is 9-13%, and 630 million people in the world are considered to be infected with this virus. It most often manifests itself with genital condylomas (warts) in men and is accused of being the causative agent of many cancers in men and women. There are more than 200 known types of HPV, and 15 of the sexually transmitted HPV types are considered carcinogenic. HPV infection is known to cause cervical cancer, penis, tongue, oro-nasopharynx, larynx and tonsil cancers, and can occur years after the virus is infected. Today's research has shown that carcinogenic types of human papilloma virus (HPV) are responsible for almost all cervical cancers. Conversely, if HPV is prevented or treated with vaccination, the frequency of cervical cancer has been found to decrease significantly. In analyzes and field studies, it has been reported that the probability of sexually active men and women in the world to be infected with HPV throughout their lives is 50%. The patient with genital warts should definitely share this information with his partner and he should also be examined. In order to raise awareness and awareness about HPV and to emphasize that it can be prevented by vaccination, March 4 was declared "World HPV Day" with the participation of the World Papillomavirus Association, the World Cancer Organization (UICC) and many other international associations.
AFFECT
Human Papilloma Virus (HPV) is a DNA virus that causes the formation of Condyloma (wart-papilloma) in humans. The incubation period for HPV infection and wart development after transmission varies between 2 weeks and 8 months, usually between 3 weeks and months for genital warts, and 10 years (10-30 years) for the development of cancer. Approximately 60 cases of infection in humans are required. There are HPV types, and the causative agent of 90% of genital warts is HPV types 6 and 11, and although these are frequently recurring, they are low-risk types in terms of cancer development. These types have also been found to be associated with eye, nose, mouth and tracheal warts. Blood High risk HPV types in terms of ser are 16,18, 31,33,35,45,52,58 and the genital warts caused by these types are not visible to the naked eye, they rarely cause visible genital warts. High-risk HPV types have been determined to play an important role in the development of various cancers, including cervical, vaginal, vulvar, anal, penile and oropharyngeal carcinoma. It is reported that HPV types 16, 18, 31, 33, 45, 52 and 58 are responsible for 90% of this cancer. HPV type 16 has been found to be the most important factor in the etiology of cervical cancer all over the world. This is followed by types 18, 45 and 31. In men, precancerous and precancerous diseases such as squamous cell penile carcinoma, carcinoma in situ, Bowenoid papillosis (pigmented Bowen's disease), erythroplasia of the queyrate (found on the mucosal surface of the glans and foreskin) and Bowen's disease (usually found on keratinized skin). They are associated with neoplastic lesions.
WAY OF TRANSMISSION
There are many risk factors that accelerate the transformation of HPV infection, which is highly contagious, into cancer. The most important of these are polygamy, having the first sexual experience at a young age (before the age of 18) and having more than 3 births, which are seen as risk factors. In addition, the presence of other sexually transmitted diseases (especially chlamydia trichometis and herpes simplex etc.), smoking and tobacco use, conditions in which the immune system is suppressed (such as HIV), malnutrition and poor personal hygiene are among the risk factors. Smokers have a 27% increased risk of developing genital warts compared to non-smokers. Although condoms reduce the risk of transmission, they cannot completely prevent it. HPV transmission can be examined under four headings: sexual contact, perinatal (birth) transmission, transmission from objects and surfaces, and respiratory (droplet) transmission.
1-Transmission by Sexual Contact. : HPV is usually spread during vaginal and anal sexual intercourse, as well as oral intercourse. Transmission can also occur through skin-to-skin contact without sexual intercourse. Genital warts are highly contagious and the risk of HPV transmission to a sexual partner is 64%, and it is known that the rate of transmission from female to male is significantly higher than the rate of transmission from male to female. Also find anal and oral relationships Vaccination rates are very high. It has been found that HPV is the cause of 50-75% of mouth-tongue-throat (oropharyngeal) cancers, including oral sex, head and neck cancers, and is an independent risk factor for this type of cancer.
2- Congenital transmission:
2- Congenital transmission:
strong> HPV can be transmitted from mother to baby during birth and can cause warts in the larynx and eyes in the baby. Transplacental transmission can occur from sperm carrying HPV during fertilization and through the female genital tract.3- Transmission from surfaces and objects: Transmission of HPV from objects is a controversial issue. There are no proven cases reported that HPV is transmitted from surfaces such as toilets and bathrooms. However, it is thought that objects used during the treatment of genital warts may be contaminated with HPV. It is recommended to use separate gloves for manual examination. Vaginal ultrasound probes are thought to be a source and high-level disinfection is recommended.
4) Respiratory transmission: Inhalation/respiratory transmission of HPV is a controversial issue. HPV DNA has been detected in the smoke produced by laser and electrocautery treatment. As a result of these observations, it is recommended to use smoke removal systems, masks, gloves, aprons and glasses during the process. Laser (300nm) is more dangerous than electrocautery (70nm) because HPV DNA is obtained in larger and larger quantities in laser steam than in electrocoagulation steam.
SYMPTOMS AND SYMPTOMS
HPV is a slow-growing virus and its latent period is about 9-12 months. However, contagion is quite high during the period when there are active genital lesions. After the virus is introduced into the body, it is eliminated by the body's immune system at a rate of 70% in the first year and 90% in the second year, depending on the type of virus. Especially in high-risk carcinogenic virus types (types 16 and 18) that integrate into human DNA, it may take longer for the virus to be eliminated from the body. In the remaining 10% of patients, the infection continues and causes genital warts or cancer to develop in various areas in the long term (10-30 years). For this reason, precancerous lesions can be detected early with the pop-smear screening test. It may be possible for them to be caught in extreme conditions. If a condyloma-like lesion occurs, the diagnosis must be confirmed by biopsy and must be typed. Because it is now possible to determine whether the causative agent is the oncogene subtype of HPV.
Genital warts (Condylomas-HPV lesions) in men can generally be located along the entire penis, as well as around the testicle, groin, calf and anus. Although it is rarer, it can sometimes appear in the anus or urinary tract, and can even progress through the urinary tract and reach the bladder. . Many cases have been reported in which the transurethral resection material performed on the bladder was found to be a condyloma-HPV wart as a result of pathology. In women, they are generally located around the anus, vulva, vagina, and cervix. Warts can be single or numerous, in different shapes (flat, flat or cauliflower-shaped, raised from the skin), colors (skin color, pink, red, white or grey), hard or soft consistency and sizes, so that the cauliflower filling area between the anus and the vagina is cauliflower. They can also be seen as giant-looking masses (genital warts). These lesions generally do not cause itching or pain.
The cause/cause of 5% of cancers in the world is HPV. HPV infections are considered a definite risk factor for cancer of the penis, anus, rectum, mouth, nasopharynx and larynx in men. Its role in penile cancer has been scientifically proven. Regarding other urological cancers, although the role of HPV has not yet been proven, HPV infection should be kept in mind in prostate cancer patients and in patients with some types of bladder cancers (squamous bladder cancer, inverted papilloma associated with squamous bladder cancer, chronic urinary tract infection and cases with schistosomiasis). Although there is a relationship between HPV and inverted papilloma, which is a precancerous lesion seen in the bladder, a strong relationship such as HPV-cervical cancer has not been established between HPV-bladder cancer.
It is the most important etiological reason for the development of cervical cancer in women. Studies have shown that almost all cases of cervical cancer are caused by certain types of HPV. Prevention of HPV infections (with vaccination), ted It has been determined that the frequency of cervical cancer decreases by eliminating it or preventing its transmission hygienically. HPV is a DNA virus and infects cervical cells, causing abnormal and uncontrolled cell proliferation, leading to condyloma-wart formation. Over time, these lesions lose control and become cancerous.
Giant Condyloma-Wart (Buschke Loewenstein Tumor): It is a type of HPV wart that grows slowly but can reach giant sizes and has a possibility of becoming cancerous (35-50%). It is generally seen over the age of 50 and is three times more common in men. It is most commonly seen in the penis and although HPV types 6 and 11 are mostly responsible, HPV types 16,18 are also detected in some cases. In cancerous cases, metastasis is generally not observed, but the death rate in 5 years is 20-30%.
A relationship has been found between HPV and male infertility. It has been shown that the presence of HPV affects sperm count, motility and morphology. In addition, it reduces the success of assisted reproductive techniques and increases the possibility of miscarriage in case of pregnancy.
Diagnosis
Physical examination may be sufficient for diagnosis. However, if we are not sure about the diagnosis or if it is resistant to treatment, if the appearance is not typical of warts, if there are hard, bleeding and discharged warts, the diagnosis of warts can be confirmed by taking a biopsy. HPV typing can be done using biopsy or swab material taken from warts. The swab sample can be taken from the glans penis/coronal sulcus, penile shaft, scrotum, perianal area by turning 360° with dacron swabs moistened with saline and passing over all surfaces of the areas. To sample the urinary tract (urethra), the swab is advanced approximately 2 cm into the urethra from the urethral opening and rotated 360° while being removed. Cervical smear screening may be appropriate for women over 30 years of age. In suspicious cases, oral, nasopharyngeal and anal swabs can be taken. HPV is not cultured and there are no reliable serological methods. Since sufficient antibodies are not formed after HPV infection, re-infections with the same HPV types are common
Differential diagnosis: Some skin diseases, precancerous skin lesions and sexually transmitted infections. molluscum contagiosum vi
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