In this video we will talk about one of the most devious enemies of women's health, which many women have learned to know and fight to defend themselves from infection and prevent its complications. I'm talking about the human papilloma virus (also called HPV), which during the lesson we will learn more closely together with the consequences of the genital infection for which it is responsible. First of all, it is important to clarify that there is no single type of papilloma virus. HPV is in fact characterized by a wide genetic variability, which is why we know more than 100 serotypes that can infect humans. Some HPV viruses are responsible for benign lesions of the skin and mucous membranes, such as warts, warts or papillomas. Other viral strains, on the other hand, have oncogenic potential, that is, they are able to produce lesions which can develop into a tumor. The papilloma virus, in particular, is the main risk factor for cervical cancer, which is diagnosed every year in about 3,500 Italian women. Fortunately, only a small fraction of women who have come into contact with the papilloma virus will have problems of this type. This is for two reasons. First of all, in most cases (around 70-90%), the HPV infection is eliminated by the immune system without causing damage. Furthermore, secondly, in the rare cases in which the virus survives the immune attack, cervical cancer develops very slowly and is preceded by precancerous changes, called dysplasias. If detected early, thanks to simple tests such as pap smears. and colposcopy, these lesions can be treated effectively, before they evolve into a tumor, by removing only the affected part of the mucosa, thus without compromising the woman's fertility.
It is estimated that over 75% of sexually active women contract a "genital HPV infection in their lifetime, especially at the start of sexual intercourse." However, as we have seen, only in a minority of cases this infection is persistent and can lead to the development of a tumor. Genital papilloma virus infection is transmitted mainly through vaginal, anal and oral sexual intercourse. Among the methods of contagion, manual intimate contacts and the exchange of sex toys contaminated by infected people must also be included. The use of condoms, in this case, it is therefore only partially effective in preventing infection, since contact with the virus can occur between the parts not covered by the condom. In general, the infection can occur especially if there are active viral cells and if they are present lacerations, cuts or abrasions in the skin or mucous membranes. Transmission of the HPV virus can also occur indirectly. Particularly at risk are places that host many people, such as public bathrooms, changing rooms or swimming pools, where contact is possible with surfaces previously used by carriers of the infection. We have therefore seen that in most cases the HPV infection is transient and resolves spontaneously, without leaving any consequences. The body's defenses, in fact, are generally able to react against the virus, eliminating it before it can cause major damage. . When this does not happen, the immune system is unable to eradicate the virus, which in this way, albeit very slowly, is able to gradually cause quite serious problems. In particular, if the infection persists and becomes chronic, after about 5 years, precancerous lesions may arise in the mucous membrane that lines the cervix, also known as the uterine cervix. In turn, with the passage of time (approximately over 7-15 years) these lesions can turn into a tumor. It should be noted, however, that this malignant evolution is observed above all in women infected with HPV strains with a high oncogenic risk. In particular, among the more than 100 known, the most dangerous in this sense are genotypes 16 and 18. Those associated with cutaneous and genital warts, for example, have a very low oncogenic potential.
In addition to cervical cancer, human papilloma viruses can also give rise to other clinical manifestations at the genital level. We have already mentioned, in fact, how some viral strains are involved in the onset of genital warts, also called sharp warts or ridges. of rooster. To be more specific, it is genotypes 6 and 11 that are responsible for 90% of genital warts. We are therefore talking about genotypes other than those that cause tumor lesions. Generally, these viruses reproduce by exploiting the cells of the skin and mucous membranes, promoting an excessive growth, called hyperplasia, which causes the typical and unsightly growths. Genital warts can be located on the external genitals, in the vagina, around the anus and on the perineum. Genital warts are also transmitted through sexual intercourse with an infected partner. They look like small, raised or flat lumps or bumps. sometimes arranged in clusters. In most cases, they do not cause pain, but they can cause discomfort, itching or discomfort. These lesions have very little oncogenic potential. However, they are very infectious, so they must be treated. Remember that warts can still also occur in extra-genital sites, such as in the oral cavity and on hands, feet or face. I also remember how, unlike cervical cancer, genital warts also affect men.
After this necessary digression on acute condylomas, let's go back to talking about the most dangerous strains of HPV, because they are potentially oncogenic. These viruses produce a subtle infection, because unlike warts it does not manifest itself clearly. It is, in fact, characterized by asymptomatic changes affecting the genital mucous membranes, typically of the uterine neck. The absence of symptoms, among other things, favors their spread, since the majority of affected individuals are not aware of the infectious process in progress. However, there are some signs that may suggest a "uterine infection and they can put you on alert. Common symptoms include unusual bleeding, especially after intercourse, and pain in the lower back, when urinating or during sexual intercourse. In the presence of these manifestations, it is advisable to consult your doctor or gynecologist.
During a gynecological examination, the doctor looks for any changes associated with papilloma virus infection. The Pap test assumes particular importance, which we will discuss in more detail in the next video. This examination, in fact, if carried out regularly, allows to exclude the presence of malignant cells, therefore it can identify a “dangerous” genital lesion early, even before it evolves into carcinoma. For this reason, the Pap smear is part of the cervical cancer screening program. If, from the results of the pap test, there are indications of lesions worthy of further study, the gynecologist can check the uterine cervix with a colposcopy. The colposcopic examination allows the enlarged view of the tissues and deepens the analysis of suspicious lesions. During colposcopy, targeted biopsies can be performed, that is, the sampling of a small amount of tissue from the surface of the neck and from the cervical canal of the uterus. These samples will then be subjected to cytological analyzes and tests for the search for viral DNA.
There is currently no cure for HPV infection. However, it is possible to successfully treat pretumor lesions caused by the virus. Remember that HPV lesions often undergo spontaneous regression, so many cases of mild dysplasia are not treated, but are only monitored over time. When necessary, precancerous lesions of the uterine cervix are instead removed with small conservative surgical procedures or by laser therapy. In cases where the tumor has already developed, therapeutic options include partial or total removal of the uterus, chemotherapy and radiotherapy. As for genital warts, an application of chemical solutions or a laser treatment. As we will see in the next video, for some years now, a vaccine has been available that protects the cervix from the most dangerous strains of HPV, especially useful if carried out before the start of sexual life.
