The example of Human Papilloma Viruses

The example of Human Papilloma Viruses (HPV)

HPV infections are easily transferred from partner to partner and are among the most frequent sexually transmitted infections worldwide.

The example of Human Papilloma Viruses (HPV)

HPV infections are easily transferred from partner to partner and are among the most frequent sexually transmitted infections worldwide. A large part of the population is already infected.

International surveys (1) (cf. also Scientific literature) indicate that HP viruses are involved in carcinoma formation (cancer).

Only recently have vaccines become available to protect against a small but common part of the papilloma virus types. However, these substances are sometimes controversial.

HPV infections and cancer

It has been proven that certain HP virus types can pathologically alter the mucous membrane of the cervix. As a result, a precancerous stage often develops from which cervical cancer can develop years later.

Specialist medical examinations and HPV smears often show a cellular change in infected persons in the early stages. Depending on localisation, virus type and assessment, medical measures may be required. They are intended to help prevent serious consequences.

Genital warts (so-called condylomata or condylomas) are caused by certain types of HP virus. They constrain the quality of life, are frequently recurring and are dangerous in different ways.

There are well-founded indications of a risk of cancer from HPV infections for women in the uterus area, in particular the cervix, vulva, uterus and ovaries and in the breast. (2) For cervical cancer, it is known that certain types of HP virus are mainly responsible for the development (e.g. types 16 and 18; but there is also a growing suspicion of its responsible role in the development of cancer in other of the 140 known types).

In case of men there is a risk of cancer in the urogenital area, especially in the testicles and penis as well as in the prostate. (3)

In general, the extended scientific research interest of both sexes now also applies to HPV-induced carcinogenesis in the mouth and throat and other internal organs (esophagus, salivary gland, larynx, breast, lung, kidneys, etc.). (4) According to research literature on the subject (5), 90-93 percent of cases of anal cancer, 12-63 percent of cases of oropharyngeal cancer, 36-46.9 percent of cases of penile cancer, 40-64 percent of cases of vaginal cancer and 40-51 percent of cases of vulvar cancer can potentially be attributed to HPV infections.

The assumption that the virus is not active or does not remain exclusively active at the entry ports of the body has already been confirmed by research

Is cancer prevention possible for HPV infections?

The vaccines that offer protection against a few types of virus have been available for some time now. The side effects of these vaccines have been discussed very debatably between pharmaceutical manufacturers and patients with severe vaccination reactions and consequences. In some countries, however, vaccinations are required by law. However, they currently only offer protection against a few types of virus and only if there is no infection. Therefore this kind of enlightenment and the prevention of the infection are of great importance. Both are often neglected.

If HP viruses were detected during an examination (e.g. of the genital area or the oral cavity), regular monitoring of the effects of infection and the success of treatment should take place, including immunological examinations.

In order to reduce the HPV risk potential, medically recommended periods for monitoring the course of treatment should be strictly adhered to (depending on the type of virus and the condition of the affected tissue).

Enlightenment for responsible partnership

General studies, show that the dangers of HPV infection have so far only insufficiently penetrated the public consciousness. Only precise knowledge of the physiological processes in the body involved in HPV infection enables people to behave responsibly before, during and after coming in touch with a new partner.

A condom offers a certain level of protection after coming in touch with a new partner. However, since human papilloma viruses occur throughout the urogenital area, this protection is not enough.

Prevention through relevant examinations

HPV diagnostic examinations are often cumbersome and complicated. This is partly justified with costs. It would be easy to carry out an HPV examination immediately with the Pap test material, if you wish to do so.

The Pap test or Papanicolaou test allows for a microscopic examination of cells for the early detection of cancer and its pre-stages using a cell smear from the cervix. If Pap tests fluctuate or are elevated, this may indicate precancerous stages.

At the latest when such a test deviates from the norm, it is highly advisable to perform an HPV test (with virus typing). Viruses are the main cause of cell changes that lead to an increase in Pap test values. Unfortunately, in most cases the HPV test is not performed "automatically", but has to be requested from the patient.

In men, similar examinations are unfortunately only carried out within the framework of precautionary measures upon special request. Since prevention is rather unpopular in men anyway, there is also a lack of awareness of a possible infection with HPV that may continue quietly for many years. Prevention takes place almost exclusively as a tactile examination of the prostate and on determining the PSA value. HPV tests are not routine, although men can fall sick from HP viruses just as women can.

A temporal coordination or connection of preventive examinations amongst both sexes (in particular with partnerships) and a related clarification is not a matter of course at present in the medical practice. But it is certain that the transmission by the sexual partner takes place and thus both sexes come into question as carriers and transmitters of the HPV infection.

Pay attention to trigger factors!

In addition to immunological irritation, mixed infections can also cause severe lesions, i.e. injuries to affected mucous membranes. This results in HPV entry ports. Bacteria and fungi in the vaginal secretion, for instance, can lead to chronic wound infections and thus increase the possibility of viruses entering the body. In this respect, the examination and treatment of bacteria and fungi is also part of the prevention of the effects of HPV infections.

In general, the immune system plays an important role in the containment of the consequences of HPV infection (as is the case with other viruses). A weakened spleen and other pathogens in case of mixed infections can additionally support the spread of the viruses.

HPV diagnostics requires careful specimen collection

Against this background, HPV detection should be particularly thorough and systematic.

It is recommended to carry out the material extraction with a suitable technique (e.g. brush application). Such tests are not only available in gynaecological domains but also for men. Men should take the risks of HPV infections seriously and get informed about them.

As part of a check-up, an experienced physician generally also inspects the oral cavity. Leukoplakias (red or white irregular lesions) are searched for therein, which - according to specialist medical assessment - can easily be treated before degeneration.

Please note that a layman cannot give a medically correct interpretation of these lesions. You will need to get checked by a specialist. Only then can a mix-up of a possible HPV infection with other diseases be avoided. Do not transfer and apply images and illustrations to yourself! The evaluation and specimen collection requires a lot of professional experience.

Doctors and dentists have simple tests such as anti-body tests at their disposal that provide information about the risk of developing a carcinoma in the mouth and throat (7). If the test results are positive, the mucous membranes should be observed very carefully. In this context, it can be deceptive to deduce directly from the absence of leukoplakia that there is no papilloma. In this respect, such tests should be included, if a suspicion is obvious - for instance in the event of a present infection of a partner.

Human papillomaviruses can be one of the causes of many ailments

Many HPV infections can initially run "quietly", i.e. inconspicuously. As with other pathogens, infections with the HP virus can remain symptom-free for a long time.

If warts or leukoplakiate or cell changes are detected, medical measures should be taken immediately. Early detection is particularly important here. In case of positive HPV detection, limited treatment methods are available, such as targeted ablation of the tissue regions, if they can be identified.

An HPV examination is part of general prevention, even if no sufficiently plausible explanation is found for one or more of the following symptoms

  • In case of women and men: Warts on the anus and in the rectum, visible and palpable
  • Deposits (so-called leukoplakias) on the mucous membrane of the mouth and throat
  • itching and burning, blood leaking from cracked genital warts
  • In case of women: Warts on genitalia that appear individually or in groups (labia and cervix).
  • In case of men: Warts on the genitals that appear individually or in groups (on the foreskin, penis shaft or urethral orifice).

Thanks to Dr. Jan de Jonge MD for his cooperation

With respect to the presentation of the scientific and clinical topic concerning the consequences of HPV infections on the body, we thank Dr. Jan de Jonge MD, Institute of Pathology and Cytology Schüttorf/Leer, who has given important information, in particular for the examination of the relationship between the HPV genotype and cytological and/or histological findings.

Comments

(1) Cogliano, V. et al., WHO International Agency for Research on Cancer (2005): Carcinogenicity of human papillomaviruses. The Lancet Oncology, Volume 6, Issue 4, Page 204, April 2005.
Find out more literature on HPV and cancer in the bibliography.

(2) Robert Koch Institute (Ed.) und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V. (Society of Epidemiological Cancer Registries in Germany) (Ed.) (2012): Krebs in Deutschland 2007/2008. 8th (Cancer in Germany 2007/2008) Edition, Berlin 2012, see p. 68.
Heng, B. et al. (2008): Human papilloma virus is associated with breast cancer. Br J Cancer. 2009, October 20; 101(8), pp. 1345-1350.

(3) Dillner, J. et al. (1998): Sero-Epidemiologal Association Between Human Papillomavirus Infection And Risk Of Prostate Cancer. Int. J. Cancer 75: 564–567 (1998).
Giuliano, A. R. et al. (2008): Epidemiology of Human Papillomavirus Infection in Men, Cancers other than Cervical and Benign Conditions. Vaccine, Vol. 26, Supp. 10, (August 2008), K 17-28.
Miralles-Guri, C. Bruni et al. (2009): Human papillomavirus prevalence and type distribution in penile carcinoma. Journal of Clinical Pathology, Vol. 62, No. 10, (October 2009), pp. 870-878.
May, M. et al. (2008): The detection of papillomavirus DNA in the prostate. Der Urologe (The urologist), July 2008, Volume 47, Issue 7, pp. 846-852.
Serth, J. et al. (1999): Increased levels of human papillomavirus type 16 DNA in a subset of prostate cancers. Cancer Res 59(4): 823-825 (1999).

(4) Castellsagué, X. et al. (2002): Environmental co-factors in HPV carcinogenesis. Virus Research, Vol. 89, No. 2, (February 2002), p. 191-199.
Chaturvedi, A. K. (2010): Beyond Cervical Cancer: Burden of Other HPV-Related Cancers Among Men and Women. Journal of Adolescent Health, Vol. 46, Supp. 4, (April 2010), pp. 20-26.
Gillison, M. L. (2008): Human Papillomavirus-Related Diseases: Oropharyngeal Cancers and Potential Implications for Adolescent HPV Vaccination. Journal of Adolescent Health, Vol. 43, No. 4, (April 2008), pp. 52-60.
Heng, B. et al. (2008): Human papilloma virus is associated with breast cancer. Br J Cancer. 2009, October 20; 101(8), pp. 1345-1350.
Holzinger, Dana (2012): Viral and cellular factors to identify HPV-associated oropharyngeal carcinomas. Dissertation Heidelberg 2012 Robert Koch Institute (Ed.) und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. (Society of Epidemiological Cancer Registries in Germany) (Ed.) (2012): Krebs in Deutschland 2007/2008. 8th (Cancer in Germany 2007/2008) Edition, Berlin 2012, see p. 24 (Mouth-Throat), p. 28 (Oesophagus), p. 52 (Larynx), p. 56 (Lung).
Salehipoor, M. et al. (2012): Role of viruses in renal cell carcinoma. Saudi J Kidney Dis Transpl. 2012 Jan; 23(1) p. 53-7. Tzamalis, Georgia (2012): The Importance of HPV in Adenoid-Cystic Salivary Gland Cancer. Dissertation Berlin 2012. Research and studies
Van den Broeck, Davy (Ed.) (2013): Human Papillomavirus and Related Diseases From Bench to Bedside. A Diagnostic and Preventive Perspective. InTech Publication 2013.

(5) Cogliano, V. et al., WHO International Agency for Research on Cancer (2005): Carcinogenicity of human papillomaviruses. The Lancet Oncology, Volume 6, Issue 4, Page 204, April 2005.

(6) Klug, S. J. et al. (2008): Knowledge about infection with human papillomavirus: a systematic review. Prev. Med. 46 (2), 2008, S. 87–98.

(7) Kreimer, A. R. et. al. (2013): Evaluation of human papillomavirus antibodies and risk of subsequent head and neck cancer. J Clin Oncol. 2013 Jul 20;31(21):2708-15. doi: 10.1200/JCO.2012.47.2738. Epub 2013 Jun 17.

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