Hpv Infection Steph
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HPV infection : Treatment & Prevention by Stephanie Chieng Mei Ling
Introduction
HPVhuman papillomavirus Is a virus that infect skin and mucous membranes of humans When someone is infected with HPV, the condition that results will depend a lot on which type of HPV virus is transmitted and the location of transmission. Some diseases that HPV can cause include: - Warts, including common warts (verrucae vulgaris), plantar(foot) warts (verrucae plantaris), and flat warts (verrucae plana) - Genital warts - Cervical cancer - Other precancerous lesions or cancer, including on the penis, anus, vagina, and vulva
Introduction (cont)
- Laryngeal papillomas, which are noncancerous tumors on the larynx (voice box), vocal cords, or the air passages leading from the nose into the lungs (respiratory tract). About 30-40 HPV types are typically transmitted through sexual contact and infect the anogenital region. Some sexually transmitted HPV types may cause genital warts. HPV infection is also the cause of nearly all cases of cervical cancer.
HPV Types and Associated Conditions Disease Plantar warts
HPV types 1, 2, 4
Common warts
1, 2, 4, 26, 27, 29, 41, 57
Flat warts
3, 10, 27, 28, 41, 49
Genital warts
6, 11, 30, 40-45, 51, 54
Cervical cancer
16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58
Precancerous changes
16, 18, 34, 39, 42, 55
Laryngeal papillomas
6, 11, 30
High & low risk types
HPV research scientists have separated HPV types into: "high-risk" types which are more likely to lead to the development of cancer, while "low-risk" viruses rarely develop into cancer. Low-risk HPV types can cause no symptoms or may cause conditions such as genital warts, but do not cause cervical cancer. Warts can form weeks, months, or even years after sexual contact with a person who has genital HPV.
Causes
HPV infection occurs when the virus enters the body through a cut, abrasion or imperceptible tear in the outer layer of the skin. Is transferred primarily by skin-to-skin contact. HPV infections that associated with genital warts and related lesions are contracted through sexual intercourse, anal sex and other skin-to-skin contact in the genital regions. Some HPV infections that result in oral or upper respiratory lesions are contracted through oral sex.
Pictures of Some Warts
Plantar warts Tongue warts filiform wart
common warts flat warts
smaller and smoother than other kinds of warts and tend to grow in large numbers
Tests available
The HPV test on the market is only used as part of cervical cancer screening. Genital warts by visual inspection. Cervical cell changes (early signs of cervical cancer) identified by routine Pap tests (pap smear). The HPV test can identify highrisk HPV types on a woman’s cervix, which can cause cervical cell changes and cancer. In Malaysia, all women who are, or who have been sexually active, between the ages of 20 and 65 years, are recommended to undergo Pap smear testing. If the first two consecutive Pap results are negative, screening every three years is recommended.
Treatments
There is no treatment for the virus itself, as a healthy immune system can usually fight off HPV naturally. There are a numbers of OTC products and home remedies available to remove warts. These treatments appear to reduce the concentration of HPV, but they don't eliminate the virus. OTC treatment for common skin warts are usually based upon the use of products containing salicylic acid.
OTC products
Salicylic acid preparations These are available as drops, gels, pads, and plasters. They are designed for application to all kinds of warts, from tiny ones to great, big lumpy ones. Salicylic acid is a keratolytic medication, which means it dissolves the protein (keratin), which makes up most of both the wart and the thick layer of dead skin that often tops it. Generally, the acid must be placed directly on the wart every day for weeks or months to soften the warts. Duct tape A study in 2002 reported findings that showed that duct tape wiped out more warts than cryotherapy did.
OTC products (cont)
The "duct tape therapy" used in this study included covering warts with duct tape for six days and peel off on 7th day, then soaking the warts in warm water and rubbing them with an emery board or pumice stone. The process was repeated for as long as two months. However, more recent research has not found duct tape to be significantly effective for treating warts. This treatment maybe hard to use, because in order to work, the tape must be left in place all the time and removed only on selected day(s) in the week. Almost always, the tape falls off.
Home Remedies
Banana peel Use fresh banana peel pieces & place the yellow side out each day on the affected areas & covered with bandage for overnight. Change q 12-24hrs. Garlic Crush a glove of garlic and place on area(s) with warts & cover with bandage. Pineapple Apply fresh cut pineapple on warts several times a day will remove warts in 2-3 days. Chalk/ raw potato Rubbing a piece of chalk or raw potato on the area frequently will remove the wart in few weeks.
Other Treatments
If OTC products & home remedies isn’t helping, may seek medical advice. Doctors usually start with the least painful, least destructive methods, especially in young children. Freezing with liquid nitrogen (cryotherapy) Freezing works by causing a blister to form under and around the wart. Then, the dead tissue sloughs off within a week or so. Cantharidin- not available in M’sia Is a substance extracted from the blister beetle. The extract is mixed with other chemicals, painted onto the skin and let it dry. The application is painless, but the resulting skin blister can be uncomfortable. The blister lifts the wart off the skin so the doctor can remove the dead part of the wart.
Medications
Immunotherapy Topical immunotherapy medications that may be prescribed for stubborn warts include squaric acid dibutylester (SADBEnot available here)and topical Imiquimod . Topical imiquimod is marketed for the treatment of genital warts but has also proved effective for treating common warts. Imiquimod 5% cream applied 3x/week. Cream is applied at night and left on the skin for 6-10 hr before washing off. Retinoids Derived from vitamin A, these medications disrupt the wart's skin cell growth. Doctor may rarely prescribe a retinoid cream (0.02% or 0.05%) .
High grade pre-malignant lesions
The high grade pre-malignant lesions will usually require removal of the lesions to prevent development into cancerous tumours. Treatments include surgical removal, or aggressive laser surgery. Since warts are caused by a virus, they may recur following attempts at surgical removal.
Surgery
Minor surgery This involves cutting away the wart tissue or destroying it by using an electric needle in a process called electrodessication and curettage. Local anesthetic will be given before this surgery. Laser surgery Laser surgery can be expensive, and it may leave a scar. It's usually reserved for tough-to-treat warts. Radiation Uses high-powered energy to kill cancer cells. Hysterectomy (major surgery) Involves removal of the cancerous and precancerous areas, the cervix and the uterus.
Cervical Cancer
Cervical cancer is a disease in which malignant (cancer) cells form in the tissues of the cervix. Virtually all cases of cervical cancer are caused by HPV infections. Not all women with HPV infection, however, will develop cervical cancer. Cervical cancer is most treatable when it is diagnosed and treated early. Women who get routine Pap testing and follow up as needed can identify problems before cancer develops. Surgery, radiation and chemotherapy are often needed for this stage.
Radiotherapy (cervical cancer)
The aim of radiotherapy is to deliver a tumouricidal radiation dose with optimal cure rates and minimal complications. External beam radiotherapy (EBRT) Is used to treat the primary tumour and pelvic nodes. Radiotherapy to the pelvis only is recommended for cervical cancer. Brachytherapy (BT) Is an integral part of radiotherapy for carcinoma of the cervix, treating mainly the primary tumour. High doses of radiation can be delivered to the tumour while the surrounding normal tissues (e.g. rectum) are relatively spared.
Gardasil Vaccine
Gardasil vaccine is an inactivated vaccine which protects against 4 major types of HPV. Include 2 types(16,18) that cause about 70% of cervical cancer and 2 types(6,11) that cause about 90% of genital warts. Therefore, can prevent most genital warts & most cases of cervical cancer. Protection from Gardasil is expected last at least 5 yrs. But vaccinated women still need cervical cancer screening because the vaccine does not protect against all HPV types that cause cervical cancer. Is recommended for girls 11-12 years of age because it is important to get the vaccine before 1st sexual contact as they have not exposed to HPV.
Gardasil Vaccine (cont’)
However, if a girl or woman is already infected with a type of HPV, the vaccine will not prevent disease from that type. Is also recommended for girls and women 13-26 years of age who did not receive it before. Gardasil vaccine is given as a 3-dose series: 1st Dose: Now 2nd Dose: 2 months after Dose 1 3rd Dose: 6 months after Dose 1
Cervarix Vaccine
Is a HPV vaccine against 2 types of HPV which is 16 & 18. Both HPV types are the common cause for cervical cancer. It is claimed to provide substantial protection against HPV type 31 and 45 (which can also cause cervical cancer). Is recommended for girls & women of 10-45 years old. The vaccine is also given as a 3-dose series: 1st Dose: Now 2nd Dose: 1 months after Dose 1 3rd Dose: 6 months after Dose 1 GSK recently claimed that Cervarix is effective up to 6.4 yrs.
Avoidance/ Side Effects
Anyone who has ever had a life-threatening allergic reaction to yeast, to any other component of HPV vaccine, or to a previous dose of HPV vaccine should not get the vaccine. Avoid in pregnant women. People who are mildly ill when the shot is scheduled can still get HPV vaccine. People with moderate or severe illnesses should wait until they recover. Mild S/E: pain, ithcing/swelling/redness at injection site, mild fever. These symptoms do not last long and go away on their own.
Prevention
Genital warts & related lesions- reduce risk of developing genital warts and other HPV-related genital lesions by: Being in a mutually monogamous sexual relationship Reducing your number of sex partners Using a latex condom, which may prevent some but not all HPV transmission
Prevention
Common warts Prevent the spread of the infection and formation of new warts by not picking at a wart and not biting the nails Plantar warts Reduce the risk of contracting HPV infections that cause plantar warts by keeping the feet clean and dry, wearing clean socks, and wearing shoes or sandals in public pools and locker rooms
References
Clinical Practice Guidelines- Management of Cancer Cervix www.cdc.gov, Central for Disease Control & Prevention www.mayoclinic.com- Cervical Cancer (Treatments & Drugs) http://www.ncbi.nlm.nih.gov/pubmed/17372095 www.medicinenet.com- Wart (common warts) http://hpv.emedtv.com/hpv/types-of-hpv-p2.html- Types of HPV http://www.medscape.com/infosite/gardasil/article-5 Gardasil & Cervarix official website
Introduction
HPVhuman papillomavirus Is a virus that infect skin and mucous membranes of humans When someone is infected with HPV, the condition that results will depend a lot on which type of HPV virus is transmitted and the location of transmission. Some diseases that HPV can cause include: - Warts, including common warts (verrucae vulgaris), plantar(foot) warts (verrucae plantaris), and flat warts (verrucae plana) - Genital warts - Cervical cancer - Other precancerous lesions or cancer, including on the penis, anus, vagina, and vulva
Introduction (cont)
- Laryngeal papillomas, which are noncancerous tumors on the larynx (voice box), vocal cords, or the air passages leading from the nose into the lungs (respiratory tract). About 30-40 HPV types are typically transmitted through sexual contact and infect the anogenital region. Some sexually transmitted HPV types may cause genital warts. HPV infection is also the cause of nearly all cases of cervical cancer.
HPV Types and Associated Conditions Disease Plantar warts
HPV types 1, 2, 4
Common warts
1, 2, 4, 26, 27, 29, 41, 57
Flat warts
3, 10, 27, 28, 41, 49
Genital warts
6, 11, 30, 40-45, 51, 54
Cervical cancer
16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58
Precancerous changes
16, 18, 34, 39, 42, 55
Laryngeal papillomas
6, 11, 30
High & low risk types
HPV research scientists have separated HPV types into: "high-risk" types which are more likely to lead to the development of cancer, while "low-risk" viruses rarely develop into cancer. Low-risk HPV types can cause no symptoms or may cause conditions such as genital warts, but do not cause cervical cancer. Warts can form weeks, months, or even years after sexual contact with a person who has genital HPV.
Causes
HPV infection occurs when the virus enters the body through a cut, abrasion or imperceptible tear in the outer layer of the skin. Is transferred primarily by skin-to-skin contact. HPV infections that associated with genital warts and related lesions are contracted through sexual intercourse, anal sex and other skin-to-skin contact in the genital regions. Some HPV infections that result in oral or upper respiratory lesions are contracted through oral sex.
Pictures of Some Warts
Plantar warts Tongue warts filiform wart
common warts flat warts
smaller and smoother than other kinds of warts and tend to grow in large numbers
Tests available
The HPV test on the market is only used as part of cervical cancer screening. Genital warts by visual inspection. Cervical cell changes (early signs of cervical cancer) identified by routine Pap tests (pap smear). The HPV test can identify highrisk HPV types on a woman’s cervix, which can cause cervical cell changes and cancer. In Malaysia, all women who are, or who have been sexually active, between the ages of 20 and 65 years, are recommended to undergo Pap smear testing. If the first two consecutive Pap results are negative, screening every three years is recommended.
Treatments
There is no treatment for the virus itself, as a healthy immune system can usually fight off HPV naturally. There are a numbers of OTC products and home remedies available to remove warts. These treatments appear to reduce the concentration of HPV, but they don't eliminate the virus. OTC treatment for common skin warts are usually based upon the use of products containing salicylic acid.
OTC products
Salicylic acid preparations These are available as drops, gels, pads, and plasters. They are designed for application to all kinds of warts, from tiny ones to great, big lumpy ones. Salicylic acid is a keratolytic medication, which means it dissolves the protein (keratin), which makes up most of both the wart and the thick layer of dead skin that often tops it. Generally, the acid must be placed directly on the wart every day for weeks or months to soften the warts. Duct tape A study in 2002 reported findings that showed that duct tape wiped out more warts than cryotherapy did.
OTC products (cont)
The "duct tape therapy" used in this study included covering warts with duct tape for six days and peel off on 7th day, then soaking the warts in warm water and rubbing them with an emery board or pumice stone. The process was repeated for as long as two months. However, more recent research has not found duct tape to be significantly effective for treating warts. This treatment maybe hard to use, because in order to work, the tape must be left in place all the time and removed only on selected day(s) in the week. Almost always, the tape falls off.
Home Remedies
Banana peel Use fresh banana peel pieces & place the yellow side out each day on the affected areas & covered with bandage for overnight. Change q 12-24hrs. Garlic Crush a glove of garlic and place on area(s) with warts & cover with bandage. Pineapple Apply fresh cut pineapple on warts several times a day will remove warts in 2-3 days. Chalk/ raw potato Rubbing a piece of chalk or raw potato on the area frequently will remove the wart in few weeks.
Other Treatments
If OTC products & home remedies isn’t helping, may seek medical advice. Doctors usually start with the least painful, least destructive methods, especially in young children. Freezing with liquid nitrogen (cryotherapy) Freezing works by causing a blister to form under and around the wart. Then, the dead tissue sloughs off within a week or so. Cantharidin- not available in M’sia Is a substance extracted from the blister beetle. The extract is mixed with other chemicals, painted onto the skin and let it dry. The application is painless, but the resulting skin blister can be uncomfortable. The blister lifts the wart off the skin so the doctor can remove the dead part of the wart.
Medications
Immunotherapy Topical immunotherapy medications that may be prescribed for stubborn warts include squaric acid dibutylester (SADBEnot available here)and topical Imiquimod . Topical imiquimod is marketed for the treatment of genital warts but has also proved effective for treating common warts. Imiquimod 5% cream applied 3x/week. Cream is applied at night and left on the skin for 6-10 hr before washing off. Retinoids Derived from vitamin A, these medications disrupt the wart's skin cell growth. Doctor may rarely prescribe a retinoid cream (0.02% or 0.05%) .
High grade pre-malignant lesions
The high grade pre-malignant lesions will usually require removal of the lesions to prevent development into cancerous tumours. Treatments include surgical removal, or aggressive laser surgery. Since warts are caused by a virus, they may recur following attempts at surgical removal.
Surgery
Minor surgery This involves cutting away the wart tissue or destroying it by using an electric needle in a process called electrodessication and curettage. Local anesthetic will be given before this surgery. Laser surgery Laser surgery can be expensive, and it may leave a scar. It's usually reserved for tough-to-treat warts. Radiation Uses high-powered energy to kill cancer cells. Hysterectomy (major surgery) Involves removal of the cancerous and precancerous areas, the cervix and the uterus.
Cervical Cancer
Cervical cancer is a disease in which malignant (cancer) cells form in the tissues of the cervix. Virtually all cases of cervical cancer are caused by HPV infections. Not all women with HPV infection, however, will develop cervical cancer. Cervical cancer is most treatable when it is diagnosed and treated early. Women who get routine Pap testing and follow up as needed can identify problems before cancer develops. Surgery, radiation and chemotherapy are often needed for this stage.
Radiotherapy (cervical cancer)
The aim of radiotherapy is to deliver a tumouricidal radiation dose with optimal cure rates and minimal complications. External beam radiotherapy (EBRT) Is used to treat the primary tumour and pelvic nodes. Radiotherapy to the pelvis only is recommended for cervical cancer. Brachytherapy (BT) Is an integral part of radiotherapy for carcinoma of the cervix, treating mainly the primary tumour. High doses of radiation can be delivered to the tumour while the surrounding normal tissues (e.g. rectum) are relatively spared.
Gardasil Vaccine
Gardasil vaccine is an inactivated vaccine which protects against 4 major types of HPV. Include 2 types(16,18) that cause about 70% of cervical cancer and 2 types(6,11) that cause about 90% of genital warts. Therefore, can prevent most genital warts & most cases of cervical cancer. Protection from Gardasil is expected last at least 5 yrs. But vaccinated women still need cervical cancer screening because the vaccine does not protect against all HPV types that cause cervical cancer. Is recommended for girls 11-12 years of age because it is important to get the vaccine before 1st sexual contact as they have not exposed to HPV.
Gardasil Vaccine (cont’)
However, if a girl or woman is already infected with a type of HPV, the vaccine will not prevent disease from that type. Is also recommended for girls and women 13-26 years of age who did not receive it before. Gardasil vaccine is given as a 3-dose series: 1st Dose: Now 2nd Dose: 2 months after Dose 1 3rd Dose: 6 months after Dose 1
Cervarix Vaccine
Is a HPV vaccine against 2 types of HPV which is 16 & 18. Both HPV types are the common cause for cervical cancer. It is claimed to provide substantial protection against HPV type 31 and 45 (which can also cause cervical cancer). Is recommended for girls & women of 10-45 years old. The vaccine is also given as a 3-dose series: 1st Dose: Now 2nd Dose: 1 months after Dose 1 3rd Dose: 6 months after Dose 1 GSK recently claimed that Cervarix is effective up to 6.4 yrs.
Avoidance/ Side Effects
Anyone who has ever had a life-threatening allergic reaction to yeast, to any other component of HPV vaccine, or to a previous dose of HPV vaccine should not get the vaccine. Avoid in pregnant women. People who are mildly ill when the shot is scheduled can still get HPV vaccine. People with moderate or severe illnesses should wait until they recover. Mild S/E: pain, ithcing/swelling/redness at injection site, mild fever. These symptoms do not last long and go away on their own.
Prevention
Genital warts & related lesions- reduce risk of developing genital warts and other HPV-related genital lesions by: Being in a mutually monogamous sexual relationship Reducing your number of sex partners Using a latex condom, which may prevent some but not all HPV transmission
Prevention
Common warts Prevent the spread of the infection and formation of new warts by not picking at a wart and not biting the nails Plantar warts Reduce the risk of contracting HPV infections that cause plantar warts by keeping the feet clean and dry, wearing clean socks, and wearing shoes or sandals in public pools and locker rooms
References
Clinical Practice Guidelines- Management of Cancer Cervix www.cdc.gov, Central for Disease Control & Prevention www.mayoclinic.com- Cervical Cancer (Treatments & Drugs) http://www.ncbi.nlm.nih.gov/pubmed/17372095 www.medicinenet.com- Wart (common warts) http://hpv.emedtv.com/hpv/types-of-hpv-p2.html- Types of HPV http://www.medscape.com/infosite/gardasil/article-5 Gardasil & Cervarix official website
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