HPV Infections PDF 2024-2025

HPV infections Prof. A. Kelati Dermatology Academic year: 2024-2025 www.um6ss.ma  The course plan I-Introduction II- Pathogenesis : Pathogen and Transmission III-Epidemiology IV-Diagnosis : Clinical forms and diffe...

HPV infections Prof. A. Kelati Dermatology Academic year: 2024-2025 www.um6ss.ma  The course plan I-Introduction II- Pathogenesis : Pathogen and Transmission III-Epidemiology IV-Diagnosis : Clinical forms and differential diagnosis Intraepithelial neoplasms Paraclinical V-Treatment and Prophylaxis VI-Conclusion 2 I Learning objectives - 1. Recognize the different clinical lesions of cutaneous warts 2. Recognize the clinical lesions of genital warts 3. Treatment of these lesions according to the the global approach of sexually transmitted diseases FACULTY OF MEDICINE – UM6SS – CASABLANCA 3  I- Introduction: Human papillomavirus (HPV) infections are common mucocutaneous conditions =Proliferative diseases caused by HPV infection of keratinocytes Cutaneous warts or condylomas Cutaneous warts : child and adolescent, no risk of degeneration Condylomas= genital warts: is a sexually transmitted disease caused by the human papillomavirus (HPV). : adults, risk of cervical cancer No specific viral treatment  II-Pathogenesis : Pathogen and transmission Virology: Virion structure: Small circular virus with a capsid Double-Stranded DNA virus No envelope: resistance Particular tissue tropism for the skin and squamous mucosa  More than 200 genotypes being identified HPVs can be grossly divided into high-risk types and low-risk types for their carcinogenic potentials. Genotypes: 1,2,3,4 : cutaneous warts 6,11,42,43,44 : Condylomas acuminata (low oncogenic power) 16 , 18 : condylomas with high oncogenic power: cervical dysplasias, cervical cancer) Transmission: warts : Direct: minimal excoriations Indirect: contaminated objects Self-inoculation: spread of lesions Condylomas : Sexual Vertical: mother to child Self-inoculation: spread of lesions  Microtrauma Penetration of the virus at the level of the basal cells Viral DNA reaches the nucleus Latent state Replication superficial layers The life cycle of HPV is closely associated with the proliferation and differentiation of epithelium.  III- Epidemiology: Viral warts are common with a prevalence rate of 7–12% Cutaneous warts - Children and young adults. - Transmission: microtrauma, swimming pools and fitness clubs - Professions (butchers, veterinarians, fishmongers) are more prone to hand warts: (HPV7). Condylomas : Genital warts Incidence on the rise in all developed countries Sexual transmission: the most common STI Young adults +++ Child: sexual abuse Association between exposure to high-risk human papillomavirus (HPV) and the subsequent development of cervical intraepithelial neoplasia (CIN) and cervical cancer. Cervical cancer screening Increasing both the impact and cost effectiveness of secondary cervical cancer prevention. Special case of immunocompromised patients: More frequent and aggressive HPV infections with risk of degeneration. Organ transplant recipients Infection VIH Other: patients on corticosteroid therapy or immunosuppressants  IV- Clinical diagnosis : Skin lesions Cutaneous warts : Common warts: Cauliflower-like papules with a rough, papillomatous and hyperkeratotic surface ranging in size from 1 mm to 1 cm or more Children and adolescents (10-14 years) dorsal surface of hands and fingers+++, and sometimes: periungual location Spontaneous regression possible Common warts Common flat warts: On the back of the hands and on the limbs small yellow or skin colored papules with smooth or finely nippled surface May regress spontaneously. Filiform wart A filiform wart is a cluster of fine fronds emerging from a narrow pedicle base usually found on the face. Palmo-Plantar warts: two types Myrmecia (HPV1):- Deep (endophytic) wart, painful on pressure - Circumscribed by a thick keratotic rim surrounded by yellow hyperkeratotic callus-like skin showing accentuated skin markings, but with discontinuation of the skin lines through the wart. - Spotted with black dots ( micro-hemorrhages) Mosaic warts (HPV2) : superficial Less frequent. Exophytic non-painful Multiple, grouped in a large keratotic patches wart Callus  Mucosal lesions: Condylomas 1- Anogenital mucosa: 1-1: Condyloma acuminata: 40 strains of HPV known to affect the anogenital area HPV strains 6 and 11 are the most prevalent strains that cause condyloma acuminata Skin-colored, fleshy or gray spots or papules Coalescence: cauliflower-like shape Symtomes: asymptomatic in men women: Itching or discomfort Increased vaginal discharge Bleeding 1-2 : Flat condylomas :++++ Isolated macules, coalescent ou mosaic Pinkish in color, sometimes invisible to the naked eye Best visualized by the application of acetic acid: white color Mucous membranes+++ Biopsy: Condyloma or Intraepithelial Neoplasia Close follow up with a repeat smear or biopsy is essential if flat condyloma is suspected in the cytologic smear! 1-3 : Papular condylomas: Pinkish papules or pigmented, smooth or keratotic, isolated or coalescent Bleach with 5% acetic acid  In women: Possible vaginal and cervical extension (cervical cancer): screening with cervicovaginal smear. In both genders: Anorectal extension (anorectal cancer): proctological examination Early diagnosis by Dermoscopy Intra urethral condyloma Tranformation to squamous cell carcinoma  Diagnosis ❖ Viral warts are generally diagnosed by visual recognition+ dermoscopy ❖ Atypical skin lesions should be evaluated by: Pathological examination and HPV genotype testing For early genital mucosa viral warts, the application of 3–5% acetic acid can help in the detection of subclinical skin lesions trichloroacetic acid 5 % 2- HPV infections of extragenital mucous membranes: Oral mucosa: Papillomas or warts Condylomas acuminata: Infections àrares (oral-genital papillomavirus descontact ) muqueuses  Special clinical forms Giant Buschke-Loewenstein condylomas Giant wart proliferation of the anogenital area Risks: local invasion and malignant transformation into squamous cell carcinoma HPV infections in immunocompromised patients :Organ transplant recipients, patients on immunosuppressants and HIV ++++ Profuse forms Risk of degeneration  V-Treatment and Prophylaxis traitement Goals It is important to know that: There is no specific treatment for HPV infections Goals of treatment : – Disappearance of macroscopically visible lesions. – The patient should be informed about the risk of recurrence (approximately 30%) – After the lesions have been eradicated, the virus persists in the healthy epidermis Local medical treatments: Local destruction Keratolytic acids: Trichloroacetic acid (TCA) Salicylic acid Other medical treatments: Cryotherapy: Liquid nitrogen treatment (physical destruction of lesions) Chemical destruction: Podophyllotoxine, Imiquimod, 5–fluoro-uracil  Local surgical treatments: Electrocoagulation Surgery: not as a first-line treatment Ablative co2 laser: cost problem  VACCINATION: Preventive treatment: Preventive vaccination: preventing infection of a person free of HPV infection GARDASIL R Highly immunogenic with high levels of AB produced Significant effectiveness with a 5-year follow- up In Morocco: The HPV vaccine was integrated into the national vaccination schedule from October 2022 targeting all girls aged 11 years old (11-14)  conclusion Frequent infection Public health problem Easy diagnosis: clinical examination Spontaneous regression is possible Risk of recurrence even after treatment Degeneration ++++: HPV 16 and 18 Need of Screening by cervico-vaginal smear Vaccination ++  References 1: Zhu P, Qi RQ, Yang Y, Huo W, Zhang Y, He L, et al. Clinical guideline for the diagnosis and treatment of cutaneous warts (2022). J Evid Based Med. 2022 Sep;15(3):284-301. doi: 10.1111/jebm.12494. 2-helimo C, Wouldes TA, Cameron LD, Elwood JM. Risk factors for and prevention of human papillomaviruses (HPV), genital warts and cervical cancer. J Infect. 2013 Mar;66(3):207-17. doi: 10.1016/j.jinf.2012.10.024.