The document discusses human papillomavirus (HPV), which can lead to various cancers, particularly cervical cancer, and its transmission through sexual contact. It covers HPV testing, symptoms, prevention methods including vaccination, and the situation of cervical cancer in India, highlighting the need for better vaccination awareness and screening. Vaccination with HPV vaccines can significantly reduce the risk of cervical cancer, yet more efforts are required for widespread awareness and implementation in developing regions.

1. HUMAN PAPILLOMAVIRUS
A. R. DEBORAH
I M. SC. APPLIED MICROBIOLOGY
SACRED HEART COLLEGE (AUTONOMOUS)
TIRUPATTUR, TAMILNADU, INDIA.

2. CONTENT
 Introduction
 Human papillomavirus and warts
 Transmission of HPV
 HPV testing – smear/ pap test
 HPV symptoms
 HPV prevention
 HPV vaccine
 Reduction of cervical cancer in India
 Conclusion
 Reference

3. INTRODUCTION
 Papilloma viruses cause Papillomas or tumour of cutaneous and mucosal epithelia in humans
and animals, they are known as papilloma viruses. Though papilloma viruses are known to be
associated with cervical carcinoma which is mostly common among women with partners. Yet
no direct evidence of cause of cervical carcinoma, penile cancer or benign genital warts by
papilloma viruses is available (Durst et al. 1983).
 It has been found that different papillomaviruses have similar organization of genome. The two
regions i.e. E6 and E2 to E5 of genome in some papilloma viruses have been found to encode
open reading frame and to transform the infected cells, human papillomavirus Type 16 (HPV –
16) and Type 18 (HPV – 18) are the most common in cervical carcinomas. Approximately, 80%
cases harbour one of these viruses (Schwarz, 1985).
 In 1983, Dr. Harald Zur Hausen found HPV – 16 and HPV – 18 in Germany, Europe. The
Human Papillomavirus (HPV) strains 16 and 18 are the two most common cases of genital
cancer. HPV is sexually transmitted disease, resulting in more than fourteen million cases per
year in the United states. HPV leads to high risks of cervical, vaginal, vulvar, anal and penile
cancers.

4. HUMAN PAPILLOMAVIRUS AND WARTS
 Genital warts develop in both men and women as a result of infection by
human papilloma virus. Sometimes they can be passed on to children during
childbirth, through an infected vagina. HPV can also cause warts in other
parts of the body, such as inside the mouth, and the upper respiratory tract.
The latter occurs in a rare condition called recurrent respiratory
papillomatosis. HPV types such as 16, 18, 31, 33 and 35 also cause genital
warts, but the presence of HPV 6 or 11 is usually required.
 Genital warts are flat, fleshy, large or small bumps that grow in or near the
genital areas. Sometimes they appear in a dense cluster, looking like a
cauliflower. They may be located on the vagina, vulva, penis, anus, scrotum,
cervix, urethra and the groins or the uppermost part of the thigh.

5. TRANSMISSION OF HPV
 Human papilloma virus (HPV) is commonly transmitted between humans through their
skin or moist membrane linings such as in the vagina, anus, mouth, or throat.
 A patient with genital warts can also spread the infection to another area on the body. Thus
hand contact or contact with the infected organ may pass the HPV virus on from place to
place, and from person to person. Warts can also develop inside the mouth, but this is not
very common.
 Genital warts do not spread through the use of shared items such as cups, towels, plates.
The presence of the infection requires that the patient adopt safe sexual behavior to avoid
spreading the infection to sexual partners.
 Patients may experience discomfort or itching. The warts may also become inflamed and
bleed. Sometimes warts in the urethra can also alter the flow of urine. The occurrence of
genital warts is not associated with a higher risk of cervical cancer.

6. HUMAN PAPILLOMAVIRUS TESTING
 HPV testing for high-risk infections such as type 16 and 18 in the cervix of women
but there are currently no reliable HPV tests for penile and anal cancers. Also,
there are no specific HPV tests for oral cancers. The disease is often discovered
when it has spread to the lymph nodes which is fairly late. This can affect the
patient’s chances of survival.
 Smear / Pap Tests
In some developed Nations, women undergo screening tests at regular intervals
for cervical cancer. In the smear or pap test, a medical professional will open a female
patient’s vagina with a clinical tool called a speculum. Cells will be removed from the
woman’s cervix to be tested for abnormalities.

7. Cervical dysplasia stages and
cervix cell morphology
Image
(Copyright: 2014 terese winslow
LLC, U.S. Govt).

8.  The performs of procedure may also look for other physical signs of
abnormalities in the genital area of the patient at the same time. The sample of
cells is sent for analysis at a laboratory where it is first examined for evidence of
an HPV infection. If this is positive, the cells are then tested for abnormalities.
 If the cells show abnormalities, the patient will be advised to return for a
colposcopy for further inspection. A colposcope is an instrument which includes
a microscope to allow a medical professional to more easily view the vagina,
cervix, and vulvar of a patient. Once again the speculum is used to hold open the
vagina of the patient and the instrument is used to look for any abnormal lesions.
 If there are signs of abnormalities, the patient is invited to have regular tests to
observe whether the cells disappear over time or whether the lesions continue to
grow. An infection will often improve without the need for further treatment.

9. Colposcopy instrument and
cervical cancer stages
(source:
http://www.medicaltourismiran.com/)

10. HPV SYMPTOMS
In the early stages there are no real signs of the disease. As the disease progresses symptoms appear,
such as:
 Vaginal bleeding at unusual times. This refers to bleeding outside the period of menstruation for women of child-bearing
age, and at any time after women have been through the menopause.
 Pain and discomfort during sex
 Unusual-smelling vaginal discharge
 Constipation
 Fatigue
 Blood in urine
 Incontinence
 Swelling of one leg
 Kidney pains in the side or back
 Weight loss, Bone pain and Loss of appetite

11. HPV PREVENTION
 Most humans are infected by at least one type in their lifetime. However, there are
ways of preventing and reducing HPV infection.
 One way to reduce the infections by the virus completely is by a person abstaining
from all sexual intercourse. This includes oral, anal, and vaginal sex. This works
because the virus is most infectious through sexual organs, the mouth, and throat.
 Condoms can act as a barrier against some sexually transmitted diseases. When it
comes to the transmission of HPV, the condom does not completely eliminate the
risk of contracting the virus as HPV is spread through skin to skin contact. However,
it can reduce the risk. Condoms should never be reused. When a person has a genital
wart, the best way to reduce the risk of spreading HPV is to avoid sexual activity.

12. HPV VACCINE
 HPV vaccines protect against infection with human papillomaviruses (HPV).Three vaccines that
prevent infection with disease-causing HPV have been licensed in the United States: Gardasil,
Gardasil 9, and Cervix. Since 2016, Gardasil 9 is the only vaccine available in the United States.
It prevents infection with the following nine HPV types:
 HPV types 6 and 11, which cause 90% of genital warts.
 HPV types 16 and 18, two high-risk HPVs that cause about 70% of cervical cancers and an even
higher percentage of some of the other HPV-caused cancers (2–4).
 HPV types 31, 33, 45, 52, and 58, high-risk HPVs that account for an additional 10% to 20% of
cervical cancers. Cervix prevents infection with types 16 and 18, and Gardasil prevents infection
with types 6, 11, 16, and 18. Both vaccines are still used in some other countries.
 vaccination can be started at age 9 to 26 years. Some people who are vaccinated may develop side
effects such as headaches, dizziness, stomach pains, diarrhea, soreness, and aching muscles.

13. REDUCTION OF CERVICAL CANCER IN INDIA
 Two types of HPV - type 16 and type 18 are responsible for about 70% of cervical cancer
cases. HPV vaccines are not part of the national immunization program nor is there any
awareness of the vaccine availability. In 2008, India approved two HPV vaccines that have
been available in the private sector.
 Bivalent and quadrivalent HPV vaccines were licensed in the country in 2008, and a
nonvalent vaccine was licensed in 2018. Nonvalent is an immunization used to protect
against diseases/precancerous conditions caused by human papillomavirus (HPV) types 6,
11, 16, 18, 31, 33, 45, 52, and 58. Demonstration projects initiated in Andhra Pradesh and
Gujarat in 2009 introduced HPV vaccination in public health services in India.
 The current estimates indicate approximately 132,000 new cases diagnosed and 74,000
deaths annually in India, accounting to nearly 1/3rd of the global cervical cancer deaths.
Indian women face a 2.5% cumulative lifetime risk and 1.4% cumulative death risk from
cervical cancer.

14. CONCLUSION
 HPV vaccination is for primary prevention (serotype-specific with limited
cross-protection) of carcinoma cervix. A cost-effective second-generation
HPV vaccine is needed for developing countries to address various issues
specific to the region. However, till such time, secondary prevention through
periodic cervical cancer screening should be in place to use the existing
infrastructure and cost-effective screening methods such as Pap smear and
HPV DNA tests. There is no risk of getting an HPV infection from the vaccine
as the vaccine does not contain live virus. HPV vaccination and regular
cervical screening is the most effective way to prevent cervical cancer.

15. REFERENCE
 A textbook of MICROBIOBIOLOGY by Dr. R.C. Dubey and Dr. D. K. Maheshwari (Revised Edition) Pg. No: 757
 Human Papillomavirus – 16 (https://www.iomcworld.org/medical-journals/humanpapillomavirus-40277.html)
 Virology current research – human papillomavirus (https://www.hilarispublisher.com/open-access-journals/human-
papillomaviruses-12494.html)
 News medical life sciences – human papillomavirus (https://www.news-medical.net/condition/Human-Papillomavirus)
 (https://www.news-medical.net/health/HPV-and-Warts.aspx)
 (https://www.news-medical.net/health/HPV-Testing.aspx)
 (https://www.news-medical.net/health/HPV-and-Cervical-Cancer.aspx)
 (https://www.news-medical.net/health/HPV-Prevention.aspx )
 National cancer institute (https://www.cancer.gov/about-cancer/causesprevention/risk/infectious-agents/hpv-vaccine-fact-
sheet)
 Dramatic reduction in cervical cancer in UK following the introduction of HPV vaccination by Dr. Liji Thomas MD
(https://www.newsmedical.net/news/20211107/Dramatic-reduction-in-cervical-cancer-in-the-UKfollowing-the-introduction-
of-HPV-vaccination.aspx)
 Cervical cancer in India and HPV vaccination(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385284/)

16. THANK YOU !!