1. What is Papilloma Virus?
  2. Therapeutic strategies and vaccination
  3. Virus contagion
  4. Symptoms and diagnosis

What is Papilloma Virus?

Papilloma virus (Human Papilloma Virus – HPV) is the viral agent of one of the most common sexually transmitted infections around the world. There are about 120 HPV virus genotypes with a different genetic set, one third of which is associated to pathologies of the anogenital tract. Genotypes 16 and 18 are the principal ones responsible for uterine cervix cancer, while genotypes 6 and 11 are responsible of 90% of genital warts. For the healthy carriers, which have contracted the pathology but do not have the symptoms even though they can transmit it, which is very frequent, the use of safe and effective contraception like the condom is crucial to prevent contagion. Warts are mainly genital lesions; in women they affect the vulva, vagina, anus, and cervix while in men they affect the penis, scrotum, anus and urethra. They appear as small red excrescences or smooth dark cauliflower shaped ones; they can be isolated or grouped, and usually do not cause pain and only occasionally can be accompanied by itching, inflammation and bleeding. It is very important to recognize them promptly through self-inspection and self-exam. In men, harmless warts, caused by low carcinogenic risk genotypes, are more frequent.

Therapeutic strategies and vaccination

Some of the therapeutic strategies are cryotherapy, laser and diathermy. Vaccines are also available nowadays. These contain particles with external conformation similar to that of the virus that do not have any capacity of reproducing themselves or infecting the human body. These stimulate the immune system to produce those antibodies that block the virus before this can even penetrate the mucosa’s cells. The vaccines available on the market are two:

  • Tetravalent vaccine that protects against genotypes 16, 18, 6 and 11
  • Bivalent vaccine that protects against genotypes 16 and 18

Vaccination is demonstrated to be more effective when it is done before the start of sexual activity, thus before a potential contagion. For this reason these vaccines are performed by the Italian local sanitary companies (ASLs) for free to all girls aged 11 to 16.

Virus contagion

HPV is a DNA virus that includes over 100 identified subtypes and over 30 types that infect the genital tract, infecting the mucosa’s membranes and the epithelial tissues. Its diffusion in fact comes from skin contact and primarily through sexual contact. High-risk types, including genotype 16 and 18, can bring to cervical cancer while low risk ones, 6 and 11, are related to genital warts also known as condyloma acuminatum. Several studies have shown that high-risk infections are very common in adolescents even though the majority of infections are spontaneously solved in 24 months.

Symptoms and diagnosis

HPV is usually not accompanied by any particular symptom but when it does cause some symptoms these include:

  • Genital warts: raised lesions that do not cause pain and that are usually in humid areas of the body, the majority of which are spontaneously solved through the immune system that eliminates the infection
  • Cervical neoplasms: very rare in young women but can appear on the routine cervical cytology starting from 21 years of age with abnormal vaginal bleeding.

In terms of diagnosis, healthy young women should undergo periodical screenings either with cervical cytology (Papanicolaou smears or PapTest) or with HPV Tests that highlight the presence of viral strains through the identification of viral Dna. In addition, a preliminary diagnosis can also be obtained through auto inspection or auto palpation.

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