Among the most rapid growing and fastest killers of women today is the Humanpapilloma virus, commonly referred to as HPV. It is second among women worldwide next to breast cancer (7). This disease, which comes from condylomata acuminatum, is also the cause of various kinds of warts including the genital wart. HPV is strands of DNA enveloped together that resemble a round ball with rough edges when seen under the microscope. Like other warts, they can not be cured but they can be treated. Papilloma viruses are transmitted by close contact and infect the certain areas of the skin or mucous membranes. In related studies, these warts can also cause cervical cancer in women if untreated (1) and 85% of cervical carcinomas contain integrated HPV DNA. The most common types of HPV that cause cancer are HPV-6 and HPV-11. Although these are considered low risk, they do not cause warts, but can lead to the growth of abnormal cancerous cells. These viruses cause raised lesions wherease the high risk cancer causing viruses cause flat lesions(8). Depending on the virus type, site of infection and disease progression varies.Those types causing tumors that can inhibit the tumor suppressor proteins are p53 and p105 retinoblastoma gene product (RB). Virus replication is dependent on the stage of epithelial cell differentiation (2).
Virulence factors for HPV include E6 protein, E7 protein and inhibitors of tumor suppressor genes. Diagnostic factors are clinical findings, DNA probes, hyperkeratosis, koilocytotic cells and PAP smears (2). However, in recent finding, up to 40% of cancer cases are misdiagnosed, leaving the patient with an impression that their exam did not show any cancerous cells or malignancies(4). Researchers have also found that white people have a higher rate of HPV than do others. People who smoke put themselves at higher risks as well (1).
Signs and symptoms of HPV cervical cancer are abnormal pap smears, tumors, pain, vaginal bleeding, weight loss and obvious epithelial cervical carcinoma (2). These symptoms are without the presence of genital warts. Obvious signs of genital HPV are the warts that are flat and smooth in nature or bumps that may take on a cauliflower-like appearance. They may have slight pain or itching to them, but generally does not cause discomfort (5). Women generally remain asymptomatic and the lesions can form within the vaginal canal, but more frequently appear as lesions on the outside of the vaginal entry, the vulva. HPV only produces visible warts in around 30% of cases, leaving 70% of people with HPV who have an invisible infection.
It is estimated that for every 1 million women infected, 10% will develop precancerous changes in their cervical tissue (dsyplasia). Of these, about 8% will develop early cancer limited to the outer layers of the cervical cells. Usually, women in their 20's or 30's are more likely to be diagnosed with the genital wart, women in their mid 30's and older are generally, if showing signs and symptoms of cancer, are diagnosed. For younger women, progression to cervical cancer generally takes place over a period of 10 to 20 years. Unfortunately, some early lesions can become cancerous over a shorter time and as little as a year or two (6).
HPV genital warts are a sexually transmitted disease that is spread through various forms of sexual contact such as vaginal, oral or anal. In newborn infants, it can be passed to them during childbirth if the mother has an outbreak and in some extreme cases, cause blindness for the infant. The most common risk factors for this disease, either warts or cancer, are frequent sexual activity with multiple partners (larger statistics for persons under 20 years), mother or sister with cervical cancer (or family history), smoking, immunosuppression and chronic corticosteroid. In the past 3 years, studies have shown that the increased risk for women has risen dramat! ically because of the increased number of women smoking at an early age and other social factors that suppress the immune system such as drugs and alcohol (6).
Treatment options for genital warts are slim. 30-40% of warts will go away on their own without treatment. Should a person seek medical attention, there are other forms of treatment that are readily available such as cryosurgery (freezing of the wart), surgical excision and a colposcopy. In the case of an abnormal Pap, report recommendations may be to repeat the Pap at more frequent intervals, colposcopy and biopsies. Getting regular Pap smears is the best way to monitor for HPV cancer cells. Condoms, abstinence and less sexual activity and clean hygiene can cut down the outbreak of genital warts. More recent available treatments include prescription drugs, electrocautery (warts are destroyed with an electrical current), laser vaporization and interferon therapy (1). In a recent article published by Merck, they wrote about a vaccine that they had developed that helped reduce the incidence of HPV, but not cure or prevent it. Women who were not vaccinated had 3.8 chance of developing the disease each year. Subjects were to be followed a total of 4 years and at this writing, they were only into the second year. Most patients tolerated the shot with little side effects such as headache and site pain. The shot is in a series of three and is still new to the research field(7).
Although both of these diseases can be fatal and hard to manage, they can be caught early enough to be dissolved. If they go untreated for long periods of time, then pain management is one of the most popular controlled measures.
REFERENCES
1. Http://www.healthsquare.com/fgwh/wh1ch11p3.htm. Human Papilloma Virus (HPV). Accessed February 28, 2003, article written 1997.
2. Http://www.medinfo.ufl.edu/year2/mmid/bms5300/bugs/hpv.html. Accessed March 1, 2003. Updated May 11, 1999.
3. Http://3.uokhsc.edu/benbrooklab/cervix.html CERVIX CANCER . Accessed February 27, 2003.
4. Http://www.webmd.com.WebMD - New Test for Cervical Cancer Allows Women to Gather Tissue Samples Themselves http://my.webmd.com/content/article/20/1728_53941.htm?lastselectedguid=%7b5FE84E90-BC77-4056-A91C-9531713CA348%7d , article written 2000. Accessed February 25, 2003.
5. Http://www.cancerbacup.org.uk/info/hpv.htm. HumanPapilloma Virus and Cervical Changes. December 2001. Accessed February February 28, 2003.
6. Cervical Cancer: Human Papilloma Virus and Cervical Cancer http://www.reproline.jhu.edu/english/3cc/3refman/cxca_hpv1.htm , By Noel McIntosh, MD, ScD. Article dated 2000. Accessed February 27, 2003.
7. http://newscenter.cancer.gov/BenchMarks/archives/2002_04/related_article.html. Accessed March 4, 2003. Article published 2002.
8. Http://www.merck.com/newsroom/press_releases/112002.html. Merck Newsroom. West Point, Pennsylvania, Nov. 20, 2002. Accessed February 28, 2003.