Edited by Eugenio Ciuccetti, Obstetrician
Generality
Synthetically defined and known as HPV, the Human Papilloma Virus is the most important causative agent for cervical cancer. That is one of the most common forms of cancer among women worldwide after breast cancer.
HPV virus
It is a small DNA virus, characterized by a particular tropism for the cells of the squamous epithelium, in which it penetrates through micro-abrasions, until it reaches the nucleus. Here it is able to alter the normal cell cycle and cause proliferative processes. Subsequently, the virus is able to transmit and spread to other people through the peeling of the most differentiated and superficial layers of skin and mucous membranes.
Contagion
To learn more: HPV Infections - Contagion, Frequency, Risks
Papillomavirus infection actually begins with sexual contact at the genital level. It should be kept in mind in this regard that the infection can also be transmitted at the level of the penile shaft, groin or perineum. Areas therefore not covered by the condom.
Among the main risk factors for HPV infection we mention the young age, the number of sexual partners, frequent sexual relations, anal sex, promiscuous sexual habits of the partner.
HPV diseases
To learn more: Papilloma virus diseases
All over the world, HPV is primarily responsible for the so-called warts : also known as rooster crests. However, most infections are asymptomatic. A genital HPV infection can even persist throughout life without ever manifesting itself.
HPV and Tumor of the Uterus Neck
A latent infection (contracted years earlier) can be reactivated in the event of the loss of one's immune defenses. However, it should be noted that less than 1% of women with HPV infection actually develop cancer . This highlights the role of other important cofactors such as smoking, the use of oral contraceptives, the presence of other sexually transmitted diseases and even pregnancy.
At the moment, over 100 types of HPV have been identified: more than 90% of genital condylomatous lesions are associated with HPV types 6 and 11. The HPV subtypes characterized by the highest oncogenic risk are 13, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68.
Prevention
Of course, the work of screening and prevention is fundamental, which in this area is based primarily on the so-called Pap test and on Colposcopy. Every woman should have a Pap test once every 3 years from the moment she starts having sex.
The goal is to identify as early as possible any pre-neoplastic lesions at the level of the cervix and take appropriate action accordingly.
The so-called low-grade lesions - such as those from HPV or CIN-1 (mild dysplasia that only affects the basal layer of the epithelium) - often regress spontaneously within two years and rarely lead to cancer. High-grade lesions - such as CIN-2 and CIN-3 (ie, mean and severe dysplasia affecting two layers of epithelium or whole epithelium, respectively) - instead carry a higher risk of developing cancer. This happens when the lesion, or neoplasm, overcomes the basement membrane that separates the epithelium from the surrounding connective tissue and becomes invasive.
Treatment
As mentioned most HPV infections remain asymptomatic and regress spontaneously. Often therefore an attitude of expectation and control is the most indicated.
Only in some cases is a real therapeutic intervention necessary. In the case of precancerous lesions of the epithelium, for example, it can be used for conization or laser therapy while electrocoagulation or cryotherapy are effective for the removal of condylomas.
Vaccination
To learn more: HPV vaccine
Further studies are underway to assess the real efficacy of the treatment on major age groups (especially between 13 and 18 years), therefore on sexually active girls.
The anti-HPV vaccine in fact does not have a therapeutic effect and is indicated exclusively for the prevention of the viral types with which the woman has not yet come into contact.
The introduction of the vaccine therefore should not be mistakenly interpreted as an overcoming of the pap test and of the traditional gynecological controls which every woman should instead undergo regularly.
This must be underlined above all in the face of some alarming recent data, such as those provided by a survey by the Tomorrow Swg research institute for GSK, according to which only 54% of Italian women, aged between 15 and 54, would make gynecological checks periodicals and just 43% would perform the same pap-test on a regular basis.
