HPV infection, according to dermatologist Elisa Pinto

We are dealing with a DNA virus that has a special epidermotropism, which leads to its contamination of the skin and mucous membranes. There are more than 100 sequenced varieties of papillomaviruses., although their number is likely to be more than 150 and they are species specific. Just as some genotypes are responsible for skin lesions (known as warts or papillomas) that typically affect the tissues of the hands and feet, other genotypes are responsible for genital lesions and are considered a sexually transmitted disease (if it can only be transmitted sexually or vertically from mother to child during childbirth).

Towards HPV infections which cause lesions of the genitals and to which we are going to give special attention in these directions, their importance increases due to two factors:

• Its huge prevalence (high percentage of infected population, reaching 100% of the sexually active population).

• the ability of some varieties to cause cancer in various organsThus, it is responsible not only for all cervical cancers, but also for anal squamous cell carcinoma, most vaginal and vulvar cancers, more than half of penile cancers, and about a third of oropharyngeal cancers.

The most important thing is that The entire sexually active population can be considered to have been exposed to the virus at some point. Due to the mode of infection (skin-to-skin), using barrier methods for preventing other STDs (condoms) is not very effective in preventing the spread of HPV and barely reduces the risk by 50%.

Once infected, a high percentage of people are thought to respond immunologically, with resolution of the infection over a period of 6 to 24 months, showing positive serologies for the virus and no local detection. The truth is complete resolution of infection increases to 70% in six months and to 90% of the infected population in two years.

In a population in which the infection persists without immunological response or resolution, only a small percentage will develop symptoms (in the form of condylomas or warts at the sites of exposure) and, to an even smaller extent, cancer. The risk of these clinical manifestations increases progressively over time.

It is believed that The risk of infection and clinical manifestations, especially cervical cancer, increases in cases of early sexual intercourse., a large number of sexual partners, situations of immunosuppression, smoking (doubles the incidence), the presence of other STDs such as chlamydia or herpes simplex, which act as an inflammatory cofactor and interfere with tissue regeneration. In contrast, factors such as circumcision appear to reduce the risk of clinical symptoms in men or persistent infection.

Vaccines have now been developed, and the one that includes 9 genotypes has the greatest coverage. (6, 11, 16, 18, 31, 33, 45, 52 and 58). In this case, the vaccine targets those varieties most likely to develop carcinoma, and its administration is recommended for both girls and boys before any sexual activity (including them in the Spanish vaccination schedule at age 12). In unvaccinated adults, it is estimated current use of the vaccine, especially in patients at higher risk, either due to a weaker immune system or higher frequency of sexual intercourse.

vaccine however does not prevent possible infection and development of other genotypes responsible for skin or genital warts. Consequently, these lesions may appear in vaccinated patients and be transmitted.

Although the risk of developing cancer in infected patients with active infection is low, given the prevalence of the infection, it represents a mortality rate that ranges for cervical cancer from 7 to 90 per 100,000 inhabitants (in developed countries) or underdeveloped countries. ). This diversity in mortality clearly indicates the need to use two vectors that differentiate healthcare in these countries:

• Vaccination of children.

• Annual screening with cytological examination of the cervix.

If the risk of contracting the virus cannot be reduced due to the above, it is necessary to ensure an immune response against carcinogenic variants and early detection of tumors.

It is important to clarify that HPV has no cure for any of its genotypes. It is common for the patient to resolve the infection themselves. In clinical cases, due to persistence, chemical or physical methods of destruction (freezing or laser cauterization) are used. This fact is of particular importance because in infected patients, those with active infection and mucosal lesions, and even those with carcinomas (or dysplastic lesions before the development of carcinoma), treatment of any of these clinical manifestations may resolve but not cure the disease. presence of HPV, so testing and screening mechanisms must be particularly frequent and accurate.

Dr. Elisa Pinto

Head of the Dermatological Hospital Ruber Juan Bravo 39, Madrid