HPV-Condylomas

| HPV viruses (or HPV in English) respond to the acronym human papillomavirus. It is an infection that affects both men and women. Most HPV infections go unnoticed as they are transient and asymptomatic.

They are a group of more than 100 viruses, and they differ according to the type of surface they affect, some affect the skin and others mucous membranes. Some of them cause the common warts on the hands and feet. These are different from those that produce alterations in the genital area. Among the viruses that affect the genital mucosa, there are those at high risk of being associated with cancer and there are those at low risk. The importance of this virus lies in the fact that it is a necessary infection for cervical cancer to occur.

It is the most common sexually transmitted virus and it is estimated that between 70-80% of sexually active people will be in contact with genital HPV in some period of their life. It is an infection that affects both men and women, and half of the infected people are sexually active adolescents or young people. High-risk viruses can be found associated with invasive cancers of the vulva, or anus. The most common among high-risk are 16 and 18. Low-risk cause benign low-grade lesions or warts, but are rarely associated with cancerous lesions. HPV 6 and 11 are the most frequently associated with genital warts. The virus is contracted by skin-to-skin contact and more easily in penetrative relationships, but this is not necessary for contagion.

Risk factors for women

• Young age
• Multiple sexual partners
• Early first sexual intercourse
• Male partner with multiple sexual partners.

Most HPV infections go unnoticed as they are transient and asymptomatic. 70% of women with HPV infections have negative cultures after one year and 91% after two years of infection. The body's natural immune response is the one that in most cases eliminates the virus by itself, and therefore it will be a transitory contamination that will resolve itself naturally. But in some cases the virus can remain in an undetectable latent state and reactivate years later. For this reason, when the infection is detected, we cannot know when the virus was acquired.

Cervical cancer is not inherited, but requires HPV infection to develop. But only a small percentage of women infected with HPV will end up with cervical cancer. It is a tumor produced from the malignant transformation of the cells of the cervix and is the second most frequent tumor in women aged 15 to 44 years worldwide. The time between HPV infection and the appearance of cancer is long (usually between 10 and 15 years) and in this period it is possible to easily identify premalignant lesions that can be treated. It is very important to understand that the fact that HPV appears in the cytology or in a culture does not imply the appearance of cancer and that in many cases no aggressive treatment should be done up front. There is no treatment for the virus, but in the event of precursor lesions of a malignant lesion, treatment is carried out to anticipate possible cancer.

The main risk factors for developing cervical cancer after HPV infection are:

• Do not perform periodic gynecological check-ups with cytology. It is the most important risk factor for developing invasive cervical cancer.
• Immunosuppression Women who have an immunity disorder, either acquired, by infections such as it, or by medication.
• . smoking has been associated with the persistence of HPV infection and with the risk of developing cancer.

Given this, it is necessary to insist on the performance of periodic cytologies for the detection of precursor lesions and their possible treatment before the spread of the cancer. For the detection of HPV, painless tests are used that obtain cellular material in the same way as cytology is performed. The laboratory is capable of determining the presence of high-risk HPV for developing cancer, but it will not indicate the time of evolution of the infection or the prognosis of the lesions.

It is estimated that 10% of the population will present with condylomas at some point in their life. Condylomata are soft, warty-looking bumps that appear on the. They can occur singly or in clusters and usually occur on the labia, in the vagina, or more rarely on the cervix or perianal area. In men, they are usually in the scrotum and in those who have homosexual relations, they can appear in the perianal area. They can also produce flat tumors on the cervix or genital area.

They can appear weeks or months after infection. They do not usually give more discomfort than the appearance of the injury although sometimes they can be accompanied by itching or pain. The diagnosis of these warts is visual, although in case of doubt a biopsy can be performed. Without treatment, some may disappear on their own, remain stable, or increase in size and quantity. The objective of the treatment is the disappearance of warts for basically cosmetic reasons.

The recommended treatments can be applied by the same patient in the form of creams or the doctor can use cryotherapy, some chemical products or surgical excision with scissors, laser or curettage. The treatment of the lesions eliminates them but does not eliminate the virus, so the reappearance of the lesions is very possible. Neither the presence of condylomas nor their treatment is associated with the development of cervical cancer if there is no concomitant infection with another high-risk HPV.

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