Human papillomaviruses (HPV – or HPV for its acronym in English) are transmitted mainly sexually and are very common throughout the world. It is estimated that there are approximately 660 million people infected with any of its variants globally. Among the more than 200 types of HPV that exist, some of them cause certain types of cancer, such as cervical cancer, the fourth most common cause of cancer in women. However, it is a disease that can be prevented and also cured, if it is detected early and treated properly.
It is estimated that more than 80% de Sexually active people will acquire at least one type of HPV at some point in their life since it is a virus that is easily transmitted through skin-to-skin contact or during sexual intercourse. Although 90% of infections clear up on their own in about two years, HPV 16 and 18 variants are responsible for 70% of cervical cancers.
Most of the time, HPV infection has no obvious symptoms and the immune system is responsible for spontaneously clearing the virus. Some low-risk HPVs can cause warts on the genitals or anal region, which are bumps or bumps of various sizes and in severe cases can be shaped like “cauliflower”. Warts can be treated, although they can reappear if the person’s immune system has not fully cleared the virus. However, high-risk variants do not usually generate symptoms in the early stages of infection, which is where the importance of a timely diagnosis lies.
Currently, there are two types of tests to detect HPV: the Pap test (commonly called PAP) and the Human Papilloma Virus molecular assay.
The Pap smear is an examination of the cells of the cervix under microscopy by a trained cytologist. This test can detect changes in the cells of the cervix before cancer develops. It is recommended that all trans women and men undergo PAP annually, as it has a sensitivity of 55% for the detection of precancerous lesions and cancer. If the result is negative, it means that no lesions were detected on the cervix. If the PAP result is abnormal or with alterations, it means that there is some type of lesion that needs to be evaluated and if confirmed, start treatment. The PAP is performed free of charge in health centers and hospitals throughout the country.
For its part, the molecular assay for HPV is a test that detects the presence of HPV DNA. There are different technologies to perform the detection, but all detect the presence of high-risk viruses and some even identify what type / s are present in the sample, a process known as virus genotyping.
Specimen collection is performed identically to the Pap test, but is analyzed with a molecular biology instrument in the clinical testing laboratory. Molecular assays have a sensitivity of more than 90% for the detection of high-risk HPV, so it is not necessary to repeat the test annually in case of a negative result, but it can be repeated after 3 or 5 years depending on the clinical criteria of the gynecologist or medical institution in charge.
“The papanicolaou does not diagnose HPV but the lesions that it produces, it is a very good test with 70 years old. However, in countries like the United States, they have been supplanted by molecular tests of VPH for the prevention of cervical cancer. Molecular tests are clinically more useful since they allow risk stratification, that is, to diagnose with certainty if the person suffers from the subtypes 16 or 18, responsible variants in Argentina of the 70% of the cervical cancers”Explained the doctor. Silvio Tatti (MN 54387), president of the Argentine Society for the study of the human papillomavirus SAEVPH.
Prevention is a key factor. The correct use of latex condoms greatly reduces infection, although it does not completely eliminate the possibility of contracting or spreading HPV. In the case of being allergic to latex, you can use polyurethane condoms.
Vaccines can protect against several types of the virus and provide the most protection when given before exposure to the virus. This means that they are best applied before people become sexually active. That is why in our country the vaccine is applied free of charge and compulsory at age 11, forming part of the national immunization plan.
Regarding treatment, although the infection depends on the elimination by the immune system, in the case of warts there are medications and other therapeutic alternatives such as cryosurgery, electrofulguration or surgically removing them. In the case of precancerous lesions, they should be evaluated by a specialist and treated according to their extent.
Cervical cancer is a preventable disease. It can also be cured, if caught early and treated properly. Despite this, it is the fourth most common cancer among women worldwide. That is why the World Health Organization (WHO) launched the Global Strategy to Accelerate the Elimination of Cervical Cancer, based on three fundamental pillars: vaccination, detection and treatment. Successful application of all three could lead to a reduction of more than 40% in new cases of the disease and prevent 5 million deaths related to it by 2050.
Achieving the following targets by 2030 will put all countries on the path to elimination:
· 90% of girls fully vaccinated before their 15th birthday with the human papillomavirus vaccine.
· 70% of women examined before the age of 35 and again before the age of 45 by means of a high precision test (molecular test).
· 90% of women diagnosed with cervical cancer receive treatment (90% of women with precancerous lesions and 90% of women with invasive cancer).
“Cervical cancer is preventable and preventable. If we join forces in all sectors related to health, we will avoid the 2,500 deaths and 5,000 cases that occur annually in Argentina ”, concludes Dr. Tatti.