Human Papillomavirus (HPV)

HPV or human papillomavirus is a virus that affects exclusively the skin and mucous membranes, causing the appearance of warts. Warts can be found on all body parts. There are over 100 types of HPV . Each of these virus types has a predilection for a specific body part: face, hands, feet, genitals. HPV infections can be: 1. Clinical, with a visible clinical picture, 2. Subclinical, visible only after performing acetic solution test, 3. Latent (reactivated when the immunity drops). This could explain the persistent recurrence of warts after their removal. According to some studies by the age of 16 every fourth person comes in contact with HPV. In the sexually active population, this percentage rises to 50% or every 11th person. The reason for such great infectivity lies in the fact that HPV for the most part bypasses the immune response when it comes into contact with the skin. It affects the superficial layer of skin where the immune response is weak, and as fibers penetrate deeper, a stronger local immunity is triggered. HPV types 1, 2, 4, 27, 57, 63 are the most common causative agents of hand and foot lesions. In order for the virus to penetrate the skin, it is necessary that a minor damage to the skin exists. Some professions like butchers or fishermen have a bigger predisposition to develop warts on their hands, with as much as 50% of infections among employees in these professional areas. It is possible that the virus spontaneously resolves in children. After 2 years, it can spontaneously resolve in about 80% of cases. During this period, it is possible for the virus to spread from an existing wart. HPV types 3, 10, 28 and 41 most often cause plane warts. They are often appear in young people, on photo-exposed parts of the body.

HPV and condyloma

Condyloma is the most common sexually transmitted disease. More than 30 HPV types are related to genital warts. They are divided into 12 types that cause benign genital warts and at least 15 types associated with the development of cancer. The most common benign types of HPV virus causing genital warts are HPV 6 and HPV 11, but HPV 16 and HPV 18 are the most common causes of carcinoma. Genital warts are transmitted by direct contact, but this contact does not have to imply penetration. It is possible that a person infects oneself just by touching genital warts. For that reason, they can occur in people whose hymen is intact, even in 1% of those surveyed. The carrier does not need to know that they are infected with HPV, since it is asymptomatic in some people. Warts can also appear 5 years after the initial infection, so sometimes it’s hard to determine how we got the virus. In as much as 95% of cervical cancers, Human papillomavirus was found. A PAPA test that women are advised to do once a year is a sufficient prevention to detect the beginning of cancer development. Cancers caused by HPV can be found on the uterus, vulva, penis, anal region, tonsils, the base of the tongue. The duration of genital HPV infection is crucial in cancer development. A period longer than 3 years significantly increases the possibility of complications. There is no unique cure for Human papillomavirus. Persistent mechanical removal or removal by boosting the immune response is the only way to fight the Human papillomavirus. Mechanical removal consists of the use of ectrofulguration with radiofrequency, CO2 laser, liquid nitrogen, various acids or surgery. Activation of the immune response is achieved by imiquimod cream, podophyllotoxin, green tea extract, 5 5-fluorouracil, Bleomycin. It is known that the persistence of a viral infection is affected by the genotype of the virus as well as genetic predisposition, but it is not known why some people are prone to persistent infections. References: – IARC Monographs on the Evaluation of Carcinogenic Risks to Human. International Agency for Research on Cancer; Lyon, France: 2012. v. 100B. – Incidence and duration of cervical human papillomavirus 6, 11, 16, and 18 infections in young women: an evaluation from multiple analytic perspectives.Insinga RP, Dasbach EJ, Elbasha EH, Liaw KL, Barr E Cancer Epidemiol Biomarkers Prev. 2007 Apr; 16(4):709-15.Global burden of cancers attributable to infections in 2012: a synthetic analysis. Plummer M, de Martel C, Vignat J, Ferlay J, Bray F, Franceschi S Lancet Glob Health. 2016 Sep; 4(9):e609-16.
Svetlana Đurišić specijalista dermatovenerologije

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