HPV screening and typing

HPV is one of the most widespread sexually transmitted viruses, with 80% of the world’s population (4 out of 5 people) being infected with some form of the virus at least once in their lifetime. Once infected, in the vast majority of cases the body’s immune system gets rid of the virus without any other intervention, so they are temporary carriers. Many people never even know they have been infected, but they can still infect their sexual partners. Human papillomavirus (HPV or Human Papillomavirus) is a group of DNA viruses that cause lesions on the skin and mucous membranes. More than 150 different types of human papillomavirus have been identified. HPV viruses are divided into two broad groups, the low-risk group, which cause benign warts that need to be removed, and the high-risk group, which can lead to the development of tumours. HPV typing is necessary to know whether a patient has been infected with a virus in the high-risk group (high or low), as treatment and follow-up of the disease will vary accordingly.It is also important to know whether the infected patient is a low or high risk patient (high risk patient: HIV infected, immunocompromised, immunosuppressive therapy: people with autoimmune disease, promiscuous, homosexual)

This virus is made of DNA, the same hereditary material that regulates the function of plant, animal and human cells.
Viruses, including the DNA viruses that cause tumours, cannot replicate on their own.
This always requires the involvement of a higher living cell.
Once inside the body, viruses become incorporated into healthy cells, including those that replace the tissues’ own senescent cells.
The normal functioning of the cells is ‘re-coded’ so that they no longer just maintain the integrity of the surrounding tissues, but also multiply the viruses within them.
The recoding has repercussions on the host cell’s own vital function, because, for example, the human papillomavirus switches off the defence mechanisms in the cell that are responsible for the integrity of its own genetic material (its DNA).
The infected cell is then no longer able to fend off further DNA-damaging effects from the virus inside it or from carcinogens introduced from the environment.
This can trigger a chain reaction whereby the cell gradually loses its ability to communicate with surrounding cells, divides more frequently and uncontrollably, and eventually transforms into a cancer cell.

Cervical cancer is the second most common malignant tumour affecting women worldwide.
It is responsible for 550,000 cases of cervical and other cancers worldwide.
HPV infection causes 6.1% of all cancers.
Epidemiological studies have shown that more than 90% of cervical cancers and other genital carcinomas (rectal squamous cell carcinoma, vaginal squamous cell carcinoma, vulvar squamous cell carcinoma) are linked to human papillomavirus (HPV).
The 60 strains of HPV are found in the genital area, genital tract, cervix, oral cavity, pharynx, larynx, oesophagus, region around the anus or on the epithelium of the penis.
HPV is the most common sexually transmitted agent known today.
Infection of the oral mucosa most commonly occurs through oral sex, but it can also spread from the infected mother to the oral mucosa of the newborn baby during childbirth.

• high risk: 16, 18, 31, 33, 35, 39, 45, 52, 53, 56, 58, 59, 66, 67, 68, 70
• at temporary risk: 40, 42, 43, 51, 54, 61, 62, 69, 71, 72, 73, 77, 82, 83, 84, 86, 87
• low risk: 6, 11, 44, 55, 74

Some rare HPV variants that are scattered around the world have been found in South American Indians living in isolated communities for at least 12 000 years.
This observation supports the hypothesis that the papillomavirus appeared before the human race evolved and ethnic groups separated.

Fortunately, one group of HPV strains only causes benign skin lesions that are easily removed.
(warts on the palms of the hands, soles of the feet, warts around the rectum, rectum, vagina, vagina)
The other group of papillomaviruses induce a “pre-cancerous” condition and malignant tumours, often after a latency period of up to decades, because, as indicated, other external factors are necessary for the development of the tumour.
Unfortunately, in the case of HPV infection, the time of infection cannot be identified.

In recent years, screening has changed a lot and allows the detection of early cancer or pre-cancerous conditions with the introduction of mRNA-based testing HOLOGIC APTIMA HR-HPV ASSAY COMPARABLE TO DNA-BASED PCR As the mRNA-based HPV test detects only infected cells, it is much more specific than the DNA-based HPV test we used to use.
In the majority of cases, HPV infection is transient, asymptomatic and resolves spontaneously.
These infections are detected by the DNA test and may result in an unnecessary series of tests.
However, the DNA-based test can also give a false negative result, the viral DNA is already integrated into the host DNA, so the viral DNA copy number is reduced, but at the same time the viral RNA level is increased, which is detected by the RNA-based test.
This RNA-based testing is made possible by the Hologic Aptima HR-HPV assay,

1. the RNA-based Hologic Aptima assay gives results from samples with fewer cells
2. Aptima has significantly better specificity than DNA-based tests, especially in severe cases

When testing by age group, as HPV infection is most common in young people, but in the majority of cases the infection is transient and heals spontaneously.
The Aptima HR-HPV assay also significantly outperforms DNA-based PCR tests in terms of specificity and prediction, which significantly reduces the cost of HPV screening and care. The following three types of screening tests can be carried out:

1. Aptima HR-HPV Assay, which detects the presence of high-risk HPV and the extent of cellular entry by the presence of m RNA Group detection: 16,18,31,33,35, 39, 45, 51, 52, 56, 58, 59, 66, 68

2. Aptima HPV HR detects the 3 HPV types that most commonly cause tumours (94% of tumours) by detecting mRNA, i.e. whether it has already been incorporated into the host cell.
   Mapping test for Aptima HR-HPV assay 16, 18/45

3. DNA Technology HPV Assay for the quantification of 21 genotypes LR HPV: 6,11,44 HR HPV:16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 73, 82 Also suitable for therapy monitoring.

If it is a low-risk viral infection for cancer and there are no visible mucosal lesions, regular cytology is sufficient.
If the gynaecological examination reveals an abnormal lesion, and in particular if there is a high-risk HPV 16, 18, 45 infection, but no malignancy has yet developed, the abnormal area can be removed by simple surgery (conisation).
Surgery can be performed even if a more serious precancerous condition already exists.
It does not affect the ability to conceive later.
After surgery, it is often no longer possible to detect HPV infection, but sometimes hidden viruses may still remain.
For this reason, and because of the risk of re-infection, it is still worth getting regular screening.
More recently, a promising anti-HPV drug is being prepared for clinical introduction, which may also make this simple surgery unnecessary or help in prevention.
Once cervical cancer has developed, the uterus must be removed.
The type of surgery and the follow-up after surgery will depend on the early or advanced stage of the tumour.
The most advanced cervical cancers are treated with radiation or drugs.

HPV also infects the genitals of some men, but it usually causes no visible symptoms and does not develop into a disease.
This is because in women the virus penetrates into the lowest layer of cells in the epithelium lining the surface of the cervix, which is necessary for the virus to survive and reproduce over the long term.
For men, there is a risk of re-infection, i.e. a man carrying the virus can re-infect his cured partner – either through vaginal or oral sex.
It is therefore recommended that a man whose partner has been treated for cervical cancer or a cancer-preventing condition should have a test to determine whether he himself is infected with the HPV virus.

Outside the anus and inside the anus (infection occurs mainly during anal intercourse).
The growths can be removed inside and outside in one sitting.
HPV infection is tested for other sexually transmitted infections at the same time.
Source for parts of this text: wikipedia.