What is HPV
Human papillomavirus (HPV) is a DNA-type virus, of which more than 100 different strains are currently known. Of these, some are related to simple warts, which for example affect the hands, feet or neck and are of little pathological significance. Two other strains are related to genital warts (condylomas) and, although they are very annoying, are usually of little pathological significance. The remaining strains can be classified as low risk or high risk for epithelial cancer.
Special attention should be paid to high-risk strains which, by affecting the skin and mucous membranes, can develop into a type of cancer. They especially affect the cervix, vagina, anus, penis and oropharynx (oral cavity).
It is usually a sexually transmitted virus, and can be analyzed by tests that are already very well proven for their efficacy, such as cytology. If its presence is detected, the strain to which it belongs must be catalogued by in situ hybridization, or better by PCR, since the management is very different if it is a high-risk or low-risk strain.
Symptoms
Symptoms also vary according to the type of strain. Those that produce the so-called common warts, which are usually located on the hands, feet and neck, are shaped like a small cauliflower and usually disappear on their own. They are also not linked to the development of cancer. There are other strains that produce genital, anal and oropharyngeal warts. They also tend to evolve favorably in people without immunological depression, although they sometimes require some type of medical intervention for their elimination, and are not associated with the development of cancer.
In contrast, the other strains, especially the high-risk ones, cause cell involvement and potentially lead to cancer. They produce dysplasia, which evolves in varying degrees of severity over a period of years. The lesions are not clinically detectable and can only be detected by cytological analysis (Pap smear).
Relationships with several sexual partners, early onset of sexual relations, infection by a high-risk virus, persistence of infection over time, immunosuppression and smoking are some of the risk factors for developing cancer.
Existing treatments
Common warts do not usually require treatment, in any case it is sufficient to remove them by topical application of specific creams or liquid nitrogen, or through the electric scalpel. The same can be said of genital warts, and we must be careful in the application of creams due to the delicate areas to be treated.
With regard to the infection of the rest of the strains, the most important thing is prevention. This is achieved by avoiding risky sexual relations, using condoms and recently with the anti-HPV vaccination. At present there are two vaccines on the market, one that protects against infection with virus 6, 11, 16 and 18 (GardasilĂ’) and another that protects against virus 16 and 18 (CervarixĂ’). They are recommended for use by women between 11 and 25 years of age, although the indications are increasingly being extended.
Once the infection has developed, if it persists over time or is caused by a high-risk virus, excision of the affected area (usually surgical slicing) should be indicated, and thanks to this, healing and analysis of the possible extension is achieved by means of anatomopathological investigation of the excised area.