March 07, 2015

Human Papilloma
Virus (HPV)
A Written Report in Virology

Submitted by: Clarizza Rein S. Corpus, BSMT 3-1

Submitted to: Sir Joseph Ancla, RMT

Human Papilloma Virus (HPV)

Human Papilloma Virus or HPV are small, double-stranded DNA viruses that
infect the epithelium. More than 100 HPV types have been identified; they are
differentiated by the genetic sequence of the outer capsid protein L1. HPV is a
common virus that infects the skin and mucous membranes (cervix, anus, mouth
and throat) characterized by an abnormal tissue growth. A member of the family
papillomaviridae, has an icosahedral shape and enveloped virion. The virus size
ranges from 40 to 55 nm. HPV causes plantar warts, genital warts and flat warts.
Some HPVs are associated with cervical cancer.
HPV is classified into two groups namely low-risk HPV and high risk type of
HPV. Low-risk HPV. Low-risk HPV strains, such as HPV 6 and 11, cause about 90% of
genital warts, which rarely develop into cancer. Genital warts can look like bumps or
growths. Sometimes they are shaped like cauliflower. The warts can show up weeks
or months after exposure to an infected sexual partner. High-risk HPV strains
include HPV 16 and 18, which cause about 70% of cervical cancers. Other high-risk
HPV viruses include 31, 35, 39, 45, 51, 52, 58, and a few others.
In one study, the national cancer institute after 3 years, 10 % of women with
HPV type 16 or 18 developed advanced, pre-cancerous cervical disease (cin3). After
10 years: 20 % women with HPV development occurs.
Most HPV infections are asymptomatic and result in no clinical
disease.Clinical manifestations of HPV infection include: anogenital warts, recurrent
respiratory papillomatosis, cervical cancer precursors (cervical intraepithelial
neoplasia) and cancer (cervical, anal, vaginal, vulvar, penile, and some head and
neck cancer).
HPV incubation
The average incubation of HPV is 3 weeks to 1 year. Possibly years before
appearance of warts or cervical abnormalities will develop, some will be transient
and may never be detected

Charactersitics
HPV causes: common warts, plantar warts, genital warts and flat warts and some
HPV is associated with cervical cancer.
Common warts can grow on your hands or fingers. They're small, grainy
bumps that are rough to the touch. They're usually flesh-colored, white, pink or tan.
Plantar warts are caused by the same type of virus that causes warts on your
hands and fingers. But, because of their location, they can be painful.
Flat warts are smaller and smoother than other warts. They generally occur
on the face or legs and are more common in children and teens than in adults.
Genital warts: female genital warts are a common sexually transmitted
infection. They can appear on the genitals, in the pubic area or in the anal canal. In
women, genital warts can also grow inside the vagina. Male genital warts are a

common sexually transmitted infection. They can appear on the genitals, in the
pubic area or in the anal canal.
Most cases of cervical cancer are caused by two specific varieties of genital
HPV. These two HPV strains usually don't cause warts, so women often don't realize
they've been infected. Early stages of cervical cancer typically cause no signs or
symptoms.

Laboratory tests
HPV test is only recommended if your pap test was abnormal, showing
atypical squamous cells of undetermined significance (ascus) and you're age 30 or
older.
Although HPV infections are extremely common in women under 30, they
usually go away on their own before they cause problems. Thus, medical guidelines
do not recommend routine HPV testing in this age group. Cervical cancer is most
common in women who are older than 30, because HPV infections are more likely to
be persistent at this stage. That's why it's now recommended that women age 30
and over get a regular HPV test along with their Pap.
The HPV test is available only to women; no HPV test yet exists to detect the
virus in men. Others suggest the pap (papanicolaou) screen for cell changes in the
anus (precancerous and cancerous changes).
The laboratory test for HPV includes vinegar (acetic acid) solution test,
papanicolaou (pap) test and dna test: digene HPV test.
Vinegar solution test: application of a vinegar solution that turns HPV-infected
genital areas white. This may help in identifying difficult-to-see flat lesions.
Pap test: a sample of cells from cervix or vagina to send for laboratory analysis.
Pap tests can reveal abnormalities that may lead to cancer.
Dna test: digene HPV test: this test can recognize the dna of the high-risk
varieties of HPV that have been linked to genital cancers. The test is conducted on
a sample of cells taken from your cervix. It's recommended for women 30 and older
in addition to the pap test.

Epidemiology
Reservoir is human. Transmission is through direct contact, usually sexual.
There is no temporal pattern and is highly communicable. Although very rare, a
pregnant woman may pass HPV to her baby during vaginal delivery, resulting in

warts in the throat or voice box (laryngeal papillomatosis or recurrent respiratory

papillomatosis, RRP).
HPV Disease Burden in the United States: Anogenital HPV is the most
common sexually transmitted infection in the US estimated 20 million currently
infected and 6.2 million new infections/year, common among adolescents and
young adults. More than 80% of sexually active women will have been infected by
age 50 and infection also common in men
Cervical Cancer Disease Burden in the United States: The American Cancer
Society estimates that in 2008 there are 11,070 new cervical cancer cases and
3,870 cervical cancer deaths. Almost 100% of these cervical cancer cases will be
caused by one of the 40 HPV types that infect the mucosa.
The epidemiology of HPV and cervical cancer: over 99% of cervical cancers
have HPV dna detected within the tumor. 70% of cervical cancer is caused by one of
two types of HPV, 16 or 18

Prevention and control

HPV treatment

Vaginal warts: cryotherapy or tca/bca 80-90%

Urethral meatal warts: cryotherapy or podophyllin 10-25%

Anal warts: cryotherapy or tca/bca 80-90%

Cryotherapy literally, "cold therapy." sometimes referred to as cryosurgery, is

a procedure used to destroy tissue of both benign and malignant lesions by the
freezing and re-thawing process. Liquid nitrogen is the most commonly used
freezing source for cryotherapy. TCA/BCA meaning trichloroacetic acid or
bichloroacetic acid.
HPV in pregnancy has no link with premature labor, miscarriage, or other
complications and there is low rate of transmission to baby that ranges generally
from 0.4 to 1.1 cases/100,000 births. C-section is not recommended in most
instances
Treatment of pregnant women with imiquimod, podophyllin, and podofilox
should not be used, wart removal is suggested. HPV types 6 and 11may respiratory
papillomatosis in infants and children

HPV treatment options: HPV prevention, abstinence, monogamy, condoms,

removal of warts, and vaccine (females aged 9-26).
HPV vaccine

Two HPV vaccines are currently licensed in the United States. Both vaccines
are inactivated subunit vaccines. The antigen for both vaccines is the L1 major
capsid protein of HPV, produced by using recombinant DNA technology. L1 proteins
self-assemble into noninfectious, nononcogenic units called virus-like particles
(VLP).
In June 2006, quadrivalent HPV (HPV4) vaccine, Gardasil which is produced by
merck and co. protects against types 6, 11, 16 and 18 and considered as the first
vaccine to prevent cervical cancer. The use of Gradsil was approved for use in
females aged 9-26, ideally, before becoming sexually active. Women arent
protected if they have already been infected with the HPV type(s) that are covered
by the vaccine prior to vaccination.
In October 2000, bivalent HPV (HPV2) vaccine Cervarix by GlaxoSmithKline
was approved by the FDA containing types 16 and 18 (high risk). The vaccine is
approved for females 10 through 25 years of age. HPV2 is not approved for males.
The L1 antigen is adsorbed onto aluminum (as hydroxide salt).
Still human papilloma virus or HPV is incurable. Warts can and often do recur
after treatment and virus can remain in surrounding tissue after warts have been
destroyed.
Human Papilloma Virus Image

References
HPV/Genital Warts Health Center: http://www.webmd.com/sexual-conditions/hpvgenital-warts/hpv-virus-information-about-human-papillomavirus
HPV test: http://labtestsonline.org/understanding/analytes/hpv/tab/test/
Laboratory tests: http://www.mayoclinic.org/tests-procedures/hpvtest/basics/results/prc-20015066
HPV classification: http://www.thehpvtest.com/about-hpv/high-and-low-risk-hpvtypes/
Center for Disease Control and Prevention: www.cdc.govs/std/hpv
American Social Health Association (ASHA): www.ashatd.org
Other source: http://www.thehpvtest.com/about-the-digene-hpv-test/?
LanguageCheck=1

Http://www.mayoclinic.org/diseases-conditions/HPV-infection/basics/symptoms/con20030343