Human Papilloma Virus (HPV) Infection and Pre-Malignant Lesions of the Cervix

What is Human Papillomavirus (HPV)?

Human Papillomavirus is a common virus that can affect different parts of your body. There are over 200 known types of HPV, with various levels of severity and symptoms. Around 30 of the over 200 types are known to affect the genitals of both males and females, including the vulva, vagina, cervix, penis and scrotum, as well as the rectum and anus.

Who Is At Risk Of Getting HPV?

HPV is one of the most common Sexually Transmitted Infections globally, anyone who is sexually active is at risk of contracting an HPV infection.

What Are The Symptoms of HPV?

Many types of HPV go unnoticed and cause no symptoms, some of the less-serious strains cause benign warts on the skin of the hands or feet. However there are known types of HPV that are linked to an increased risk of developing premalignant cells in the genitals, specifically HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59. Infections of HPV types 16 and 18  are responsible for most HPV-related cancer cases

How Is HPV Infection Diagnosed?

This test detects the presence of the virus in the blood that causes pre-malignant lesions of the cervix or cervical cancer.

The HPV virus is actually a family of numerous virus sub-types (nearly 200) that fall into two categories:

• Low risk: Two of the most common low-risk HPV subtypes are 6 and 11. These strains cause genital warts but do not cause cervical cancer.

There are two kinds:

1. Warts located on the external genitalia (easily seen): these warts are caused by certain types of HPV, especially types 6 and 11. However, the types 6 and 11 viruses are unlikely to cause cancer. These types are transmitted through sexual contact and infect the genital and anal areas.
2. Warts located on the internal genitalia (less visible): Other types of HPV, especially types 16 and 18, infect the genital area, but do not give rise to visible warts easily. They produce tiny flat warts on the cervix or anus that are only visible with a magnifying instrument called a colposcope. Warts can also appear in the vagina, vulva, and urethra.

• High risk: Two of the most frequent high-risk HPV subtypes are 16 and 18. They can stimulate the uncontrolled growth of cervical cells and cause pre-malignant lesions and, later, cancer.

How is HPV and Cervical Lesions Diagnosed

Abnormal cell growth on the cervix is typically first suspected after a Pap Smear returns an abnormal result. Following an abnormal pap result, the next step is to perform a colposcopy

What Is a Colposcopy?

A colposcopy is a procedure where a special magnifying device called a colposcope is used to assess the surface of the cervix and vagina. The colposcope allows the physician to magnify the surface of the cervix between 6 to 40 times closer than the naked eye, allowing the evaluation of different lesions at the level of the cervix, The procedure of a colposcopy is slightly uncomfortable, but doesn’t cause any harm, with no recovery time necessary.

HPV and Cervical Lesions

Cervical Lesions can be classified with various designations, each with its own level of severity

SIL of BG or low-grade intraepithelial lesion: represents the beginning of precancerous diseases of the cervix

SIL of AG or high-grade intraepithelial lesion: means the evolution of the above and, without proper diagnosis and treatment, could progress to cervical cancer

Atypical Squamous Cells of Unknown Significance (ASCUS)-AGUS: means a cytology result of uncertain significance. This result indicates that additional testing is necessary because the pathologists cannot make a diagnosis based on the remitted tissue sample.

What To Do If The Colposcopy Result Comes Back Positive For Premalignant Cell Growth?

If the colposcopy reveals abnormal lesions in the cervix, a targeted biopsy should be performed. The biopsy consists of taking a small portion of tissue to analyze through a pathological anatomy study and thus define what type of injury that organ presents and guide a possible treatment.

Cervical or vaginal biopsies are mildly painful and are usually performed in the same office. They are performed using special forceps under colposcopic guidance to offer greater precision at the site of the sample.

It is essential to perform them to confirm the diagnosis since the cervical biopsy is more precise. In this way, a suitable treatment plan can be defined for each patient and for each particular injury.

In some cases, a LEEP or Cervical Conization procedure may be recommended to proactively remove any malignant tissue.

How Can HPV Infection be Prevented?

Over the last few decades there have been significant advances in research behind HPV and its impact on genital cancers, and methods of prevention in younger populations.

Proactive Multivalent HPV Vaccinations

In many places around the world, it is now recognized that vaccination against HPV infection are the first line of defence for children and young adults before they become sexually active as HPV is only transmissible through sexual skin-to-skin contact. Multivalent Vaccines like Gardasil9 have been developed to protect against multiple strains of HPV including HPV 16 and HPV 18.

Safe Sex using Barrier Methods and Condoms

Since HPV is transmitted exclusively through sexual skin-to-skin contact, the use of condoms during oral, vaginal, and anal sex is recommended to reduce the risk of HPV transmission.

Avoiding Tobacco Use

Among the many health detriments of tobacco use and smoking, smoking is associated with a higher risk of cervical cancer in women infected with HPV. Avoiding tobacco can help reduce this risk.

Maintaining a Healthy Immune System

A strong immune system can help fight off HPV infections. This includes eating a balanced diet, exercising regularly, getting enough sleep, and managing stress. While it is entirely possible that people in otherwise good health can develop HPV-related disease, a healthy lifestyle can prevent other diseases as well.

Treatment may include surgical procedures as an effective resolution for malignant cervical abnormalities.

Medical information developed by Gynecologist Oncologist Lucas Minig, specialist in Human Papilloma Virus in Valencia, Spain.

Frequently Asked Questions about Human Papillomavirus

Frequently Asked Questions about Human Papillomavirus

HPV epidemiology