Worldwide, androgenic infection by the human papillomavirus (HPV) is the most common sexually transmitted infection, with an estimated 80% of sexually active people exposed to the virus at some point in their lives. According to the Pan American Health Organization (PAHO), practically all cases of cervical cancer (99%) are related to genital HPV infection. “The maximum prevalence of infection occurs in the first decade after the start of sexual intercourse,” explains OneLife Center gynecologist and obstetrician, Dr. Tamara Sánchez Miguel, in an interview for Oxalude.
But HPV doesn’t only cause cancer in women: 99% of carcinomas of the anus are positive for HPV and it affects men and women equally. In recent years, the relationship between HPV and anal cancer has been given increasing importance, particularly among the homosexual population, with particular interest if HIV infection is added. «HIV patients are 2 to 6 times more likely to be infected with HPV than the general population, regardless of their sexual behavior; And the infection is 7 times more likely to persist. The relative risk of developing anal carcinoma is 37 times greater among men who have sex with HIV+ men, compared with the general population, general and digestive tract surgeons specializing in proctologic surgery said in the statement to OKSALUD. Minimally invasive and robotic, from Dr. Mauricio García Alonso Medical-Surgical Center for Digestive Diseases (CMED).
In addition, Dr. Garcia emphasized that the study of HPV-related pathology at the rectal level has increased in the last decade and efforts are being made to carry out follow-up plans similar to follow-up plans for breast cancer. Applies to the prevention or early detection of malignant or premalignant lesions at the cervical, anal level and indicates the procedures that should be followed in the context of prevention and screening of anal cancer caused by HPV:
- Required annually in HIV+ and MSM patients (men who have sex with men).
- Every 2-3 years: HIV+ women, HIV men regardless of sexual history, non-HIV MSM, HIV- women with cervical or vulvar cancer, and immunocompromised patients due to causes other than HIV.
For patients with anal cancer caused by HPV, in many cases the premalignant or malignant lesions are asymptomatic or present with mild symptoms such as itching or slight bleeding in the anus. “The diagnosis is established by careful exploration of the entire perianal and genital area, an anoscopy/rectoscopy in consultation to avoid the involvement of the anal/rectal canal and in selected cases a colonoscopy is essential,” says the expert.
Sánchez Miguel details, “Most infections are asymptomatic and resolve spontaneously within a year, although some oncogenic HPV serotypes (such as 16 and 18, among others) can persist for longer periods of time, leading to The likelihood of producing malignant lesions and cancer increases.”
These lesions are also usually asymptomatic, and in this case are discovered with established screening protocols for cervical cancer (cytology and/or cervical sampling to detect HPV). Tamara Sanchez explains that benign HPV serotypes (HPV 6 and 11 most commonly) can manifest as condyloma acuminata, better known as genital warts, which do not have malignant potential. It can also cause other benign diseases such as recurrent respiratory papillomatosis in newborns and children at birth. In immunocompromised patients, not vaccinated for HPV, smokers and older people, the likelihood of premalignant lesions increases.
Although the most prevalent and well-known cancer that it produces is cancer of the cervix or cervix, it is also associated with premalignant lesions and cancers in other locations:
- Oropharyngeal region.
The most serious consequence of HPV is the development of cancer in the cervix, vagina, vulva, penis, anus or oropharyngeal area. It is the only virus-induced cancer for which we have a safe and effective vaccine. In addition, with some vaccines, we get protection against genital warts (those that cover more serotypes of the virus, such as quadrivalent or 9-valent vaccines).
diagnosis and treatment
The only currently validated screening in Spain is for cervical infections and lesions, with general population screening occurring between 25–65 years of age. In other places the search is made only exceptionally.
When genital warts are diagnosed, it is not necessary to verify the existence of HPV through any test, nor should additional studies be performed on the couple, as they are produced by benign serotypes that do not induce cancer. Huh.
«According to current protocols, the tendency is to search for HPV infection and, if it is positive, to perform screening cytology on the cervix, although in many communities cytology is used as a first step for screening lesions. produced by virus”, explains the gynecologist. If a premalignant lesion is detected in cytology (LSIL, HSIL or CIN among other terminologies), colposcopy to confirm and classify the lesion for its management and possible The study should continue with a biopsy.
Currently, there is no cure for asymptomatic infection by the virus and established surveillance protocols are followed. “Some lesions with a low probability of developing into cancer only require follow-up, because most of the time they disappear on their own due to the immune system, like any viral infection,” says Tamara Sanchez. In more advanced premalignant lesions, a wide excision of the cervical lesion is usually required, which is called a cervical conization. In the event that cervical cancer has already occurred, protocol treatment is followed based on the staging of the cancer.
As measures that may help resolve the infection, it would be to quit tobacco and promote vaccination in non-vaccinated people, although the vaccine does not directly eliminate the current infection in the patient (but it may prevent future Prevents further damage and re-infestation).
Vaccination and Prevention
For both Dr. Mauricio Garcia Alonso and Dr. Tamara Sanchez, vaccination is essential to prevent HPV and therefore possible rectal cancer related to the virus. In adolescents, it is important to vaccinate, if possible, before the start of sexual relations (before possible contact with the virus), in both sexes and regardless of the type of sexual relationship (homosexual, heterosexual, bisexual, etc.). Important in the future prevention of HPV-associated diseases in both sexes. A decrease in the incidence of HPV infection and virus-associated diseases has been observed after the introduction of vaccination, despite poor population coverage of the vaccine (55% of the female population vaccinated). The decline in HPV infection occurs in both vaccinated and non-vaccinated people. A direct correlation of vaccination with a decrease in the number of cases of cervical cancer in unvaccinated populations has already been studied.
Using a condom does not completely protect against HPV infection, as the virus can be in areas of the skin that are not protected by it. However, it does prevent the spread of other sexually transmitted infections, which are sometimes spread at the same time.