Introduction
As thoroughly analyzed in the introductory article, the Papilloma Virus is the protagonist of negligible skin sores, such as warts, and, at the same time, is involved in the manifestation of terrible tumor lesions, such as those on the cervix. In this discussion, the focus will be on the mode of infection, the consequences and possible medical treatment aimed at removing the Papilloma virus.
Papilloma virus infection
To generate infection, the human papilloma virus must enter an epithelial stem cell, located on the basement membrane; probably, the entry of the Papilloma virus into the cell is favored by the bond with a surface receptor which, however, has not yet been identified with certainty.
While on the one hand the Papilloma Virus has a high affinity for epithelial cells in differentiation of skin and mucous membranes, on the other hand, HPV has a restricted tropism for the cells that form the multilayered squamous epithelium. Once inside the cell nucleus, the Papilloma virus is able to alter the normal cell cycle of the infected cell; it is observed that in most cases the Papilloma Virus preferentially proliferates inside the granular layer of the skin.
Through the desquamation of the differentiated and superficial layers of the skin and mucous membranes, the virus can be transmitted to other subjects.
Papilloma virus is normally transmitted by sexual contact; however, it is important to emphasize that the virus also proliferates at the level of the shaft of the penis, the perineum and the groin: for this reason, often the condom is not sufficient to protect the (healthy) partner from the infection, after a relationship with an infected or carrier.
Recall that in healthy women, having an efficient immune system, HPV infection is often blocked in the bud: the body's defense system, in fact, prevents the virus from creating damage. In some patients, however, the virus remains silent for many years and under favorable conditions can induce the conversion of "normal" cells (especially the superficial ones of the cervix) into mad and cancerous cells.
HPV and cervical cancer
The reasons why some women develop cancer following exposure to the Papilloma Virus are not yet so obvious and immediate: clearly, the efficiency of the immune system is a fundamental element to minimize the risk of malignant degeneration. However, some risk factors have been identified that seem to increase the likelihood of a progression of superficial Papilloma Virus lesions, to the point of developing cancer (cervical intraepithelial neoplasia): from an American study, we can see that women who smoke are twice as likely compared to those who do not smoke to develop cervical cancer. However, it is conceivable that some HPV strains are more aggressive than others, so they can easily induce the tumor.
It seems that even the prolonged administration of contraceptive pills, the co-presence of other venereal diseases and pregnancy can, in some way, expose the woman to a greater risk of malignant evolution of the lesion.
Papilloma virus (HPV) infections
X Problems with video playback? Reload from YouTube Go to Video Page Go to Wellness Destination Watch the video on youtubeHPV and benign lesions
Warts are the most frequent, fortunately benign, skin lesions caused by the Papilloma virus: they are warty growths that preferentially infect the hands, feet and genitals, following contact with another person's wart. Showers, humid and crowded environments, as well as high temperatures and humidity are elements that favor the replication and propagation of the Papilloma virus.
Warts caused by the Papilloma virus are classified into:
- Condylomata acuminata: expression of a genital HPV infection transmitted by sexual means. In the male, the condylomas manifest themselves, preferentially at the level of the glans, urethral meatus, frenulum, penile shaft and balano-preputial sulcus; in women, however, the areas most involved are the vulva, the cervix and the vagina. Most often the warts are asymptomatic, although some variants generate burning, itching and local irritation.
- Common warts: the skin lesions triggered by the Papilloma virus generally have an irregular shape and run asymptomatic often (but not always).
- Plantar warts: typical of the sole of the foot, these warty lesions caused by the HPV virus are easily transmitted in swimming pools and gyms.
- Flat warts: raised warty lesions: the Papilloma virus, infecting hands, feet, face and legs can cause these skin damages, which tend to fade in a short time.
Diagnosis
The diagnostic approach to monitor and control HPV infection, as well as the lesions caused by it, is essentially based on clinical investigation, Pap test, colposcopy and molecular examination (HPV-DNA).
The observation of the lesion from an experienced eye is essential to trace a diagnosis, albeit approximate, of the infection: for female genital warty lesions, a gynecological examination is essential, whose diagnosis will be confirmed, possibly, by a colposcopic examination, indispensable for obtaining an enlarged and more precise view of the cervix.
In case of doubtful or uncertain diagnosis, it is recommended to proceed with a specific biopsy.
Molecular testing, also known as the HPV-DNA test, determines the presence or absence of the viral genome, even before cervical cells develop tumor anomalies.
Finally, but certainly not least, the PAP test, by now common practice in the majority of gynecological check-ups: it is a cytological examination that allows to identify the alterations of the cells of the uterine section by taking a sample of endocervical cells through a swab .
For sexually active women, it is recommended to undergo a PAP test starting at age 25, every three years, for monitoring and early detection of precancerous damage.
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X Watch the video on youtubeTherapy
Treatment for HPV infections depends on the type of Papilloma Virus involved in the injury; for example, when HPV infects the skin and promotes the growth of warts on the hands and feet, drug therapy may not even be necessary: in fact, warty sores tend to regress by themselves. However, sometimes particularly resistant and long-lasting warts can be treated with cryotherapy, laser therapy and electrocoagulation. Even the direct application of drugs such as retinoids, antivirals, immunomodulators and salicylic acid can accelerate healing time.
The same is true for the treatment of condylomata acuminata: pharmacological and medical treatment (such as surgery, laser therapy, etc.) may not even be necessary, especially in the case of asymptomatic lesions of small size. As for the most dangerous Papilloma virus infections, implicated in the appearance of uterine cancer, therapy is more problematic: radiotherapy and chemotherapy, possibly associated, promote the death of malignant cells; surgery is recommended for women with early-stage cervical cancer. For further information: read the article on the treatment of cervical cancer.
Prevention of HPV infections
The vaccine prophylaxis constitutes a shield from HPV infections: the quadrivalent vaccine exerts a good protection against the genotypes involved in the vast majority of benign warty sores, such as genital warts (HPV 6 and HPV 11), and cervical neoplastic lesions (HPV 16 and HPV 18). In some regions of Italy, the anti-papilloma virus vaccine is distributed free to girls under the age of 12; the best known vaccines are cervarix (which offers protection only from HPV 16 and 18), gardasil, gardasil-9 and silgard. The vaccine should be administered in three divided doses and injected intramuscularly; the second dose should be taken two months after the first, and the third after 4 months from the second.
In addition to vaccine prophylaxis, it is possible to undergo post-infection vaccination: after an alleged exposure to the virus, the woman can request the vaccine, a drug useful for treating the disease when the pathogen has already penetrated the body.
Even after vaccination, it is recommended - in particular for women - to continue the regular routine checks: in fact, the vaccine does NOT protect against ALL types of Papilloma Virus.
