What is HPV?
Human papilloma virus, or HPV for short, is a non-enveloped DNA virus. More than 200 types have been described. Approximately 40 of these types cause infection in the anogenital system. As a result of this infection, they can lead to benign (genital warts-condylomas) or malignant (cervical cancer, anus cancer). Especially HPV DNA types 16 and 18 are responsible for 70% of cervical cancers. Types 6 and 11 are responsible for 90% of genital warts.
How is HPV transmitted?
It is the most common sexually transmitted disease, and approximately 6 million people are infected with HPV annually in the United States. HPV can be transmitted in many ways. The types that cause the warts we see on the skin can be transmitted through contaminated surfaces or objects. If a mother infected with HPV gives birth, the baby may become infected. However, more than 99% of the types that cause cervical lesions or cervical cancer are sexually transmitted. Lesions appear within an average of 3 months after contact with HPV. However, since the incubation period varies between 3 weeks and 2 years, it may occur or recur at any time within 2 years. The most common age is around 25 years of age. The lifetime rate of an adult woman being infected with HPV is around 80%.
Who should have the HPV screening test?
It should be applied to all women over the age of 30 or women with a defect in their smear test. If the HPV test is negative; The probability of developing cervical cancer in the following five years is very low.
What are the methods of protection against HPV?
Prevention methods for this disease is limited. Monogamy may reduce the risk. The risk increases as the number of partners increases. Barrier contraception methods such as condoms do not provide absolute protection because they do not completely cover the genital area, but they reduce the risk of infection by 60%. The use of spermicidal gel may reduce the risk. HPV vaccines reduce the risk of transmitting the virus by nearly 100%.
Can HPV infection be treated?
There is currently no drug to treat the HPV virus. Having a strong immune system is important in eliminating this virus. Smoking is an important risk factor for the persistence of the virus. Therefore, it is necessary to stop smoking. 70% of HPV infections are completely cleared within the first year, and 90% within 2 years. In the remaining 10%, the disease continues. Patients in this group are at risk for cancer development.
What should patients with HPV detection do?
Patients should first stay calm and know that this definitely does not mean cancer. If the detected HPV type is high risk, it is necessary to examine the cervix with a microscope with a camera system, which we call colposcopy. If the lesion we see in the cervix is high-grade, a biopsy is taken and pathological examination is performed.
What are abnormal smear results and how are they treated?
ASC- US, LSIL, ASC-H, HSIL and AGC are abnormal smear results and require further investigation. The cervix is examined with a microscope with a camera system, which we call colposcopy. A biopsy is taken from the lesions we see in the cervix and pathological examination is performed.
To what extent is the relationship between HPV virus and cervical lesions?
ASC -High-risk HPV was detected in approximately 50% of US smear abnormalities, approximately 85% of LGSIL, and 90% of HGSIL. HPV DNA is responsible for 99.9% of uterine cancers.
How are lesions on the cervix or external genitalia treated?
If the lesions occurring in the cervix are low grade (CIN 1), they do not require treatment. However, if it is high grade (CIN 2-3), it can be treated by LEEP or conization (partial removal of the cervix), cryotherapy (freezing), burning with laser or cautery. Since high-grade lesions have a risk of recurrence in the future, close follow-up is required. Condylomas (warts) on the vulva (external female genital organ) can be treated by cauterization or with some creams.
What is the effectiveness of the HPV vaccine and to whom is it recommended?
HPV DNA vaccines are Quadrivalent (quadruple vaccine: 6, 11, 16 and 18 types) and It is available in two types: bivalent (binary vaccine: 16 and 18). The ideal vaccination age for these two vaccines is 11-12 years for girls and boys, if possible before sexual intercourse. For people who are not vaccinated at the age of 11-12, "catch-up" vaccination can be done until the age of 26. Additionally, it has been shown to have the same effect when administered to women up to the age of 45. In our country, both vaccines have approval from the Ministry of Health. The protection of these vaccines against precancerous lesions due to HPV 16 and 18 was found to be 97-100%, and the effectiveness against warts was found to be 99%. For both vaccines to be effective, they must be administered intramuscularly (in the arm or hip) in three doses. The quadruple vaccine should be repeated in the 2nd and 6th months after the first dose of the vaccine. Double vaccination should be repeated in the 1st and 6th months after the first dose. The vaccination program should not be started in pregnant women. If pregnancy occurs after the first dose, you should start from scratch after pregnancy. If pregnancy occurs after two doses, the third dose can be safely administered during breastfeeding, starting from the 6th week after birth. If the vaccine was administered without knowing that she was pregnant, there is no need to terminate the pregnancy; No increase in congenital defects has been demonstrated. It can be done during breastfeeding.
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