Human papilloma virus infection

Medicine > Infection

Background knowledge 🧠

Definition

Human papillomavirus (HPV) is a DNA virus from the papillomavirus family.
Infects epithelial cells of the skin and mucous membranes.
Over 200 different types of HPV identified.
Divided into high-risk (oncogenic) and low-risk types.
High-risk types can lead to cancers, low-risk types cause warts.

Epidemiology

HPV is the most common sexually transmitted infection worldwide.
High prevalence among sexually active individuals.
Peak incidence occurs in late teens and early 20s.
HPV-related cancers more common in women (e.g., cervical cancer).
HPV vaccination programs have reduced prevalence of high-risk types.

Aetiology and pathophysiology

HPV is transmitted through skin-to-skin contact, primarily sexual.
Virus infects basal epithelial cells, integrating into host DNA.
E6 and E7 oncoproteins inactivate tumor suppressor genes (p53, Rb).
Persistent infection with high-risk types can lead to cellular dysplasia and cancer.
Low-risk types cause benign lesions like warts.

Types

High-risk types: HPV 16, 18, 31, 33, 45.
High-risk types associated with cervical, anal, oropharyngeal cancers.
Low-risk types: HPV 6, 11.
Low-risk types cause genital warts, respiratory papillomatosis.
Co-infection with multiple types is common.

Clinical Features 🌡️

Symptoms

Often asymptomatic, particularly in early stages.
Genital warts: small, flesh-coloured or grey growths in genital area.
Respiratory papillomatosis: wart-like growths in the respiratory tract.
Symptoms of HPV-related cancers depend on site (e.g., abnormal bleeding in cervical cancer).
Chronic infections may present with precancerous lesions (e.g., cervical intraepithelial neoplasia).

Signs

Visible warts on genital examination.
Papillomatous lesions in the respiratory tract on laryngoscopy.
Colposcopy: aceto-white changes, mosaic pattern, punctation.
Biopsy may show koilocytosis in infected epithelial cells.
Precancerous lesions may present as erythematous or keratotic areas.

Investigations 🧪

Tests

Pap smear: screening for cervical cytological abnormalities.
HPV DNA testing to identify high-risk types.
Colposcopy-directed biopsy for histopathological evaluation.
Visual inspection with acetic acid (VIA) for cervical lesions.
Laryngoscopy for suspected respiratory papillomatosis.
Histopathology to confirm presence of dysplasia or carcinoma.

Management 🥼

Management

Genital warts: topical treatments (imiquimod, podophyllotoxin), cryotherapy, surgical removal.
Precancerous lesions: loop electrosurgical excision procedure (LEEP), cryotherapy, laser therapy.
Cervical cancer: surgery, radiotherapy, chemotherapy depending on stage.
Respiratory papillomatosis: surgical removal, antiviral therapy (cidofovir).
HPV vaccination to prevent infection with high-risk and low-risk types.
Regular follow-up with Pap smears and HPV testing.

Complications

Cervical cancer.
Anal cancer.
Oropharyngeal cancer.
Penile cancer.
Recurrent respiratory papillomatosis.
Emotional and psychological impact.

Prognosis

Depends on type and site of infection.
Genital warts can be recurrent but are not life-threatening.
High-risk HPV infections with dysplasia need careful monitoring.
Early detection and treatment of precancerous lesions improve outcomes.
Prognosis for HPV-related cancers varies by stage at diagnosis.
HPV vaccination significantly improves long-term prognosis.

Key points

HPV is the most common STI and has both high-risk and low-risk types.
Associated with genital warts and several cancers.
Screening, vaccination, and early treatment are essential for management.
HPV vaccination is effective in preventing infection and reducing cancer risk.
Ongoing monitoring and follow-up are critical for those with high-risk infections.
Public health education is key to reducing the spread of HPV.

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