HPV Infection:
Human Papilloma Viruses (HPV) are very common and highly contagious unencased DNA viruses. According to World Health Organization (WHO) data, approximately 1 in every 10 people has HPV. A woman's risk of contracting HPV infection by the age of 50 is at least 80%.
High-risk HPV types are cervical cancer, vulva, vagina, anus cancers and related precancerous lesions in women; It is also associated with anus and penis cancers in men. HPV types that have a low risk of causing cancer can cause genital warts and precancerous lesions. HPV is responsible for approximately 100% of Cervical Cancers, 83%-95% of anal cancers, 60%-65% of vaginal cancers and 30%-42% of penile cancer cases.
HPV types 16 and 18 are responsible for approximately 70% of cervical cancers (84% in the USA and EU). Cervical Cancer is the second most common type of cancer in women aged 15-44 in Europe. Although breast cancer ranks first, when considered in terms of years of life lost, cervical cancer also surpasses breast cancer.
90% of HPV types 6 and 11 genital warts, CIN1s ( Stage 1 precancerous lesion) and 100% of RRP (Recurrent Respiratory Papillomatosis) cases. Genital warts often lead to depression, sexual dysfunction, and deterioration in social relationships because treatment methods eliminate only 70% of cases and recurrence is common.
According to WHO, approximately 493,000 cases of cervical cancer occur worldwide each year. and approximately 274,000 of these result in death. More than 80% of these deaths occur in developing countries due to the lack of adequate screening programs. Again, according to WHO data, 10 million HSIL (advanced stage precancerous lesion) cases, 30 million LSIL (early stage precancerous lesion) cases and 30 million new genital wart cases are seen every year. Considering these data, it becomes clear that HPV is a comprehensive public health problem that is not limited to genital cancers.
Status of HPV in Turkey
In our country, the number of comprehensive studies on this subject is very limited, and they do not indicate a healthy incidence of HPV in Turkey. It is not enough for us to predict it properly.
In a study covering 8 provinces in Turkey (Ankara, Antalya, Edirne, Erzurum, Eskişehir, İzmir, Samsun, Trabzon), the incidence of cervical cancer was found to be 4.76/100,000.
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In a study conducted on 1800 women in 2008, the presence of genital warts was observed in 10.7% of the participants. There is currently no widespread cervical cancer screening program in our country.
Recommendations for HPV Infection:
General Recommendations:
Routine vaccination against HPV is recommended for girls aged 9-13 years. Ideally, for maximum benefit, the vaccine should be administered before possible exposure to HPV.
It is recommended that adolescent girls and women over the age of 13 who have not been vaccinated before be vaccinated.
Cervical cancer screening tests (pap test) should be performed even if vaccination is performed. It should continue to be administered.
Special Situations:
HPV vaccination is recommended for women whose Pap test result is indeterminate (ASCUS) or contains abnormalities, who have a positive HPV DNA test or It can be used to vaccinate women with condylomas. As a matter of fact, the possibility of women being infected with all HPV types included in the vaccines is minimal.
There is no need for HPV DNA determination and serological HPV tests before vaccination.
There is no need for any specific medical examination (e.g., HPV vaccine) before administering the HPV vaccine. Pap test, colposcopy, HPV DNA molecular determination) does not need to be performed.
Vaccinated persons should be explained that clinical trial data do not show any therapeutic effect of the vaccine on abnormalities in Pap test results, HPV infections, or condylomas.
There is not enough data regarding the effectiveness and safety of vaccinating HIV-positive patients and people with impaired immune response.
Pregnancy:
Vaccination of pregnant women with the HPV vaccine is not recommended. However, there is no need to take a pregnancy test before vaccination.
If a patient becomes pregnant during the vaccination period, the remaining dose(s) of the vaccine should be postponed until after birth.
HPV vaccine can be administered to breastfeeding women.
HPV Vaccines:
HPV vaccines are produced from the major protein of the viral sheath or capsid of HPV and consist of many subunits. These are the vaccines that are formed. VBPs (virus-like particles) are similar to the structure of the natural virus but do not contain viral DNA. Since they do not contain living organisms, VBPs do not cause the diseases they prevent.
Although there is at least 5-year data on the duration of protection effectiveness, long-term follow-up studies are ongoing. Based on the observations in these studies and new data, the duration of protection is expected to be further extended.
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