HPV (human papilloma virus) is a sexually transmitted DNA virus that causes oropharyngeal and genital infection in humans. More than 200 types of HPV have been identified today. Human papillomavirus types are clinically divided into three categories.
These are; in terms of cancer
low risk HPVs (6, 11, 40, 42, 43, 44, 54, 55 and 62)
possible high risk HPVs (26,53 and 66) )
They are grouped as high-risk HPVs (16, 18, 31, 33, 35, 39, 45, 51, 56, 58, 59, 68, 73 and 82)
Human papilloma virus is transmitted in many ways; Direct or indirect transmission occurs from contaminated surfaces, skin lesions and the birth canal.
Studies report the presence of HPV in 75% of sexually active women. In addition, 60-66% of the spouses of individuals with genital HPV infection experience genital HPV lesions after an average of 3 months.
The most important factors in transmission through sexual intercourse are the number of sexual partners and the age at which the infection is acquired. Especially the early age of first sexual intercourse is very important in terms of HPV infection and malignant lesions that will develop later.
Low-risk types cause benign lesions including genital warts and low-grade genital abnormalities. However, they are not found in genital cancers. That's why they are called "low risk". High-risk types cause both low- and high-grade precancerous lesions. However, the types seen in invasive cancers are defined as "high risk".
Most HPV infections are asymptomatic and are detected only when HPV DNA testing is applied. In healthy individuals, more than 75% of the infection becomes evident in the thirtieth month.
Main clinical stages of genital HPV infection; l. Latent, 2nd Subclinical and 3rd Clinical periods. The virus first infects cells in the stratum germinativum close to the basal lamina, which occurs most frequently in the area where microtraumas due to sexual intercourse occur. There are no cytological or morphological findings of the disease in the latent period; HPV DNA can only be demonstrated with ultrasensitive PCR techniques. Cytological-microscopic changes due to HPV in the subclinical period There are lesions that can be seen by applying magnification methods such as eyelids or colposcopy. Cervical intraepithelial neoplasia (CIN) and intraepithelial neoplasias generally occur in this period. The period when visible lesions and symptoms such as genital condyloma or invasive cancer are present is the clinical period.
Methods Used in the Diagnosis of HPV Infection;
1. Non-molecular techniques
Naked eye examination
Colposcopy
Cytology and Histology
2. Molecular techniques
Polymerase Chain Reaction (PCR
Hybrid Capture Test
Determination of HPV mRNA
Treatment for HPV Infection;
When planning treatment for an individual diagnosed with HPV, many factors such as the extent of the lesion, the age of the patient and the desire for children are taken into consideration.
Treatment Methods;
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electrocauterization
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cryotherapy
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laser vaporization or conization
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hot or cold conization
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LEEP
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hysterectomy
Follow-up in HPV infection;
It is known that approximately 90% of people infected with HPV have viral clearance. No specific period can be given for this. However, studies have shown that regression is observed between 4-6 months and 1-2 years.However, 10% of these cases progress to intraepithelial lesions, and 1% of these can turn into invasive cancer. For this reason, the patient must have an annual Pap smear follow-up
Protection and Vaccinations in HPV Infection;
It protects against the future. The goal of this vaccine is to prevent possible infection and reinfection by creating an immune response in the area where the infection occurs.
The quadrivalent vaccine was approved by the American Food and Drug Administration (FDA) in June 2006 for use starting from adolescence. This vaccine was licensed as of April 2007. It has completed its stage and taken its place in our country's pharmaceutical market.
The bivalent vaccine that protects against HPV 16 and 18 is especially aimed at preventing cervical cancer and precursor lesions. The resulting antibody titer can remain at high levels for a long time. The FDA approved the use of this vaccine starting from adolescence in October 2009.
Prophylactic antibody-stimulating vaccines cannot eliminate the existing persistent infection.
In order to prevent cervical cancer, HPV vaccination should be administered before the age of 20. is required.
It is unclear whether vaccination of adults who have been exposed to the virus may be beneficial.
Conclusion ;
HPV is present in the body. It is a virus that hides well from natural immune mechanisms. Therefore, the most important thing is to be protected from the virus by getting vaccinated against it. Vaccination programs are carried out in the world between the ages of 9-26. Cervical cancer is among the preventable cancers, and the most important known prevention method is HPV vaccination programs.
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