Over the last decade, there has been much talk in the media about HPV (Human Papilloma Virus). Furthermore, there is great concern over the consequences of this virus. Is there a good reason for that?
Key-points for HPV:
- Three in four people (at least 75% of men/women) will be infected at some point in their lives with HPV;
- HPV is transmitted not only by intercourse, but also by any kind of “skin-to-skin” contact;
- It does not affect fertility;
- Human infection may be asymptomatic most of the times and is spontaneously treated without any medication after the virus having remained in the cells for a certain time period (average 6 to 12 months and up to 2 years at a rate of 90% of viruses);
- The virus does NOT “live” forever in the cells it affects. The period of stay varies;
- The type of lesion caused by HPV depends on the virus type (low or high-risk) AND the condition of the immune system during the period of virus attack (as it occurs in every infection by any virus or microorganism);
- 190 HPV strains have been recognized;
- 60 strains have been recognized in the human body, about 40 of which (15 of high risk and 25 of low risk) cause almost the total of infections and lesions.
The lesions caused by HPV and treatment may be summarized in three groups:
Ι). Genital warts or papillomas (including plantar warts).
They are visible skin lesions affecting the lips, the anus, the buttocks, the penis and, more rarely, the vocal cords. They do NOT lead to cancer. They look like skin-colored small moles with occasionally a slightly irregular contour (like cauliflower) at about the size of a sesame seed or lentil. Their size may reach many inches, even though this is less common in women who visit their gynecologist regularly or have regular tests. Genital warts are caused by about 25 low-risk HPV strains. Strains 6 and 11 are the most common ones. There are creams or solutions applied locally that “burn” such warts and are considered as a good treatment, ideal for small and few warts. In case of multiple, large warts, cauterization (ablation) is recommended using several techniques (Laser, electrodiathermy, etc, performing the same, comparative results).
II). Cervical dysplasia (or vulvar, anal, etc.).
It is a microscopic precancerous lesion often detected via PAP test (medical term: LGSIL or HGSIL) and is confirmed upon colposcopy and cervical biopsy (medical term: CIN I, CIN II or CIN III corresponding to mild, moderate and severe dysplasia, respectively).
Dysplasia is caused by low-risk or high-risk HPV strains. Low-risk viruses cause mild dysplasia (LGSIL / CIN I), a majority of which withdraw spontaneously without any treatment, only by means of monitoring. On the contrary, high-risk viruses often cause persistent infection; while such an infection onsets as a mild dysplasia, it is more likely to evolve into a moderate or severe dysplasia in a period of about 3-5 years. Severe dysplasia, at a low rate, evolves into cervical cancer (or vulvar, anal, penile etc.).
Fortunately, PAP test is able to detect such dysplasias. Should any dysplasia be found, then the specialist performs a colposcopy to obtain biopsy samples from sites strongly indicating a dysplasia (see Figure 2). Depending on the case, the dysplasia may be monitored for a certain period until remission or the lesion is ablated. LASER cervical conization, electrodiathermy or knife (Cold Knife Cone - CKC) is used in more severe dysplasia cases (see above image, figure 3).
III). Cervical cancer (vulvar, anal, penile and less common oropharyngealand laryngeal cancer).
The cancers above are caused by 18 HPV strains, which are ALWAYS of high-risk. The most common ones are strains 16 and 18. Almost always, cancer affecting the organs above is caused by the evolution of a pre-existing, persistent, long-term, severe dysplasia in the relevant organ, affecting patients who do NOT have an annual PAP test (see above image, figure 1).
INFO: Both cervical dysplasia and early-stage cervical cancer (stage I) are NOT visible to the naked eye. This is why PAP test, colposcopy with biopsy or cervical conization is performed.
Relatively rare types of gynecological malignancies, such as vulva or vaginal cancer.
One in 2 women over the age of 40 will usually develop uterine fibroids.
About one in 70 women will develop ovarian cancer during her lifetime.