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Human Papilloma Virus(HPV).pptx
The document discusses human papilloma virus (HPV), highlighting its high-risk types, mechanisms of infection, clinical presentation, and oncogenic potential. It emphasizes HPV as a common sexually transmitted infection that can lead to various cancers and details screening and treatment options, including local medications and vaccines. HPV vaccines are effective in preventing cervical dysplasia if administered before sexual activity, with specific recommendations for vaccination age.
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Human Papilloma Virus(HPV).pptx
- 1. Human papilloma virus (HPV) By Dr.Ahmed Mohamed Amin Nasef Assistant lecturer in Obstetrics & Gynecology department Benha University
- 2. HPV Human species specific Papillomaepithelium specific More than 120 types have been identified About 40 HPV types known to infect genital tracts of men and women High risk types (HPV 16 & 18)
- 3. Microbiology dsDNA virus Member ofpapova family This family has the following criteria: Replication & assembly occur in nucleus Virions are released by cell destruction Infection are characterized by oncogenesis or host cell transformation This family is resistant to heat or formalin Symptoms can occur after years of infection
- 4. Transformation • Direct skinto skin contact • Direct sexual intercourse • Sexually active women • Homosexuals • Orogenital sex` • Autoinoculation • Fomites
- 5. Mechanism of oncogenesisby HPV • Viral DNA integrate itself into host cell genome • Expression of E6 & E7 viral genes • Oncoproteins production • Inactivation of p53 & other tumor suppressor genes • Rapid cell proliferation and
- 6. • HPV isthe most common sexually transmitted disease • 80% of women will be infected with HPV at some point in their lifetime • 3% - 5% of women HPV infection persist and develop noninvasive lesion • > 1% develop invasive cancer • HPV also causative agent of other malignancies (cancer oropharynx, anus, penis, vulva & vagina)
- 7. Clinical presentation • Asymptomatic • Genitalwarts (raised, flat, inverted, condyloma acuminate) Most cases resolve on its own • Recurrence is common in (OCPs users, DM, immunosuppression, pregnancy)
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- 9. Lab detection • Smear& stain with H&E the infected cells named Koilocytes and have the following criteria: Nuclear enlargement Irregular nuclear membrane contour Darker than normal nucleus (hyperchromasia) Clear area around the nucleus (perinuclear halo) • direct probe assay methods for detection of DNA virus genotype • NAAT (nucleic acid amplification test) by PCR • HPV mRNA assay There is no culture available Serology for HPV is non sensitive
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- 11. HPV screening forcervical neoplasm • WHO recommends HPV testing as the preferred one in areas where pap test isn’t available • Done every 5 years if combined with pap smear • Done for all females (21-65 years old)
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- 14. Local medications Proteolytic agents •Trichloroacetic acid 70% • It is a skin peel Antimitotic agents • Podophyllin delivered from podophyllotoxin • Not to be used during pregnancy had teratogenic and CNS damage effect • No longer 1st line by CDC
- 15. Local medications Topical immunemodulating agent • Imiquimod • Immune response modifier group of drugs • Work by helping activate immune system • Induce macrophages to secrete several cytokines to stimulate cell mediated immune response against HPV chemotherapeutics • 5-flurouracil • FDA approved • Prevent viral replication
- 16. Precautions before local treatment application Use Vaselinebefore application to protect normal skin around the lesion from irritation Wash medications off in 1 to 4 hours to reduce side effects
- 17. Surgical destruction This includes manymethods as follows: Electrosurgical excision Cryotherapy Laser ablation Intralesional injection of interferon
- 18. There is nosuperiority for one treatment over the others treatment option is selected based on circumstances and patient preferences recurrences are common following treatment
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- 21. HPV vaccine types • Bivalent(cervarix) For types 16 & 18 • Quadrivalent (Gardasil) For types 16, 18, 6, 11 • 9 valent (Gardasil 9) For types 16,18,6,11,31,33,45,52,58
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- 23. HPV vaccine effect It prevents cervical dysplasiawith effectiveness approaches 93 to 98% It doesn’t work on existing infection or preinvasive or invasive disease
- 24. Administration IM in upperarm Given initial dose then after 1 month then after 6 months
- 25. Age of vaccination Most effectiveif given prior to sexual activity start and exposure to HPV so target age is 11 or 12 years old
- 26. Indications Adolescents at age11 or 12 years People who get infected with one or more HPV types can still get protection from other HPV types covered by the vaccine Not given in cases of allergy