What is Human Papillomavirus?
Human Papillomavirus is a small DNA virus of the papovaviridae family. More than 100 types have been detected, approximately 40 in the lower genital tract, being implicated in the appearance of precancerous pathologies and in carcinomas, especially types 16 and 18. Also in pathologies such as condylomatous warts, types 6 and 11.
What are the symptoms?
When warts appear, contagion is evident, but when this is not the case, sometimes the infection is asymptomatic, being discovered in the revisions made to the patient when she goes to the gynecologist’s office. In some cases, the patient may present with small bleeding or intermenstrual spotting (the presence of droplets of blood between menses) and may also present with cohorting or bleeding with sexual intercourse.
What is the link between this type of virus and cervical cancer? What is the incidence rate?
Cervical cancer is a sequel to an unresolved papillomavirus (HPV) infection. The infection is necessary for the appearance of cervical cancer, if there are also adjacent cofactors such as smoking, sexually transmitted diseases, promiscuity, susceptibility or immunosuppression, among others, interact with the virus and initially cause intraepithelial lesions that if they progress would end in cervical cancer (LSIL – HSIL – cervical cancer).
The degree of incidence varies from country to country. In Latin America, Southwest Africa there is a very high rate, followed by Australia, Southeast and Central Asia and the countries of Eastern Europe. In Europe, there is an incidence of 60,000 new cases per year.
How is it diagnosed and what are the risk factors?
For the diagnosis of HPV we have the following tests: cytology, which is used in consultation as a means of screening or escreaning, the HPV-DNA test and colposcopy. For the diagnosis of certainty of the lesion we use the cervical biopsy.
The presence of HPV is necessary for the development of most cervical cancers and their precursor lesions. The HPV types in order of cumulative risk are: 16, 18, 45, 31, 33, 52, 58, 35, 59, 56, 51, 39, 68, 73, 82 and others. Types 18 and 45 have a cumulative risk of 73%, with type 16 being the most aggressive (54.6%).
As for risk factors, we have already mentioned that they act as cofactors in the development of viral persistence. Most HPV infections return spontaneously, but when there are reinfections, sexually transmitted diseases, risky or promiscuous contacts, smoking, immunodeficiency, nutritional deficiencies, etc., all of these can facilitate the progression of the disease.
Nowadays we have an integrated vaccination plan in the vaccination calendar of women for the prevention of the disease.
Cervical cancer in our environment is easily detectable, since in order for it to develop, precursor lesions appear first, so it is possible to monitor it and act in time. That is why the check-ups and screening or prevention programs carried out in gynecology offices are so important.
What does treatment consist of?
As for the treatment of precursor lesions, destructive methods have been used, such as electrocoagulation, thermocoagulation, cryocoagulation and laser vaporization. The excisional treatments currently used because they are also diagnostic are: conization with diathermic loop or laser.
Finally, cervical cancer can only be prevented by diagnosing the precursor lesions, as there is no curative treatment for viruses. Thus, the primary goal is vaccination of all girls at an early age before their first sexual intercourse and screening or prevention programs.