HUMAN PAPILLOMA VIRUS Diagnosis n t.pptx

Hpv

1. HUMAN PAPILLOMA VIRUS

2. Herpes Papilloma Virus Papillomaviruses are non-enveloped, measure 50-55 nm in size, have icosahedral capsids and contain a circular dsDNA. Most common viral STI Many serotypes are there but HPV 6, 11 cause genital warts or condyloma acuminata and HPV 16 and 18 are concerned with cervical cancer

3. Pathogenesis

4. Clinical Features These warts spread diffusely over the whole of the vulval area. The verrucous growths may appear discrete or coalesce to form large cauliflower-like growths. Affect- labia majora, perineum, perianal region and vagina. Vaginal discharge, OCPs and pregnancy favour their growth The presence of koilocytes const it utes the histological marker for the virus. O ther histological features are perinuclear halo, multi nucleation, organophilic cytoplasm , acanthosis and chronic inflammatory infiltrate. Dysplasia may be seen in warts in elderly women

5. Diagnosis Colposcopic study - acetic acid and 1% toluidine blue . The abnormal vulval skin with the abnormal nuclei retains the blue dye, whereas the normal skin allows the dye to be washed off Described as patches of raised projection of acetowhite epithelium with speckled appearance. Cytology - Koilocytes , with perinuclear halo, multinucleation and orangeophilic cytoplasm Histology - A canthosis , chronic inflammatory infiltration and sometimes dysplasia cells. Viral tests - DNA test, hybridization, PCR staining. CD4 count shows immune functioning.

6. Treatment Flat lesions may be observed for 6 months especially during pregnancy as they often disappear spontaneously Local Application of Podophyllin 25% in alcohol Podophyllin 20% in tincture benzoin for 6 h daily 25% trichloraceticacid + 5% fluorouracil causes sloughing off of small warts in 3–4 days in 70–80% cases. The treatment may need to be repeated weekly as the warts recur at 3–6 weeks interval. C/I First trimester of pregnancy because the drug is absorbed into the circulation and is cytotoxic causing abortion and peripheral neuropathy. Vaginal and cervical lesions because of severe inflammatory reaction provoked at these sites

7. The larger lesions are best removed by diathermy loop or laser ablation. The surgical excision of a localized growth is another alternative I nterferon local ointment or cream or intralesional injection. The cream is applied four to five times daily 1 g each time with total daily dose of 6 g for 8 weeks. Contraindicated in pregnancy as interferon inhibits cellular and viral growth

8. Preventive Measures Vaccines at 0, 1 and 6 months before exposure to sexual activity in adolescent girls and boys are available, though they are expensive. Bivalent vaccine against HPV 16 and 18 is known as Cervarix . Quadrivalent vaccine against HPV 6, 11, 16 and 18 is known as Gardasil or Silgard . The high cost of vaccine precludes the prophylactic use in general population. Cervarix is given at 0, 1 and 6 months. Gardasil is given at 0, 2 and 6 months. Recently, two doses of HPV vaccine given at 0 and 6 months have been found to be effective.

9. Improve body immunity with antioxidants such as vitamin C and folic acid. Avoid smoking. Inosiplex is an immunomodulator which is used as an adjunet to conventional therapy. Orally, it is given 5 mg/kg daily for 12 weeks. About 20% complete response and 40% partial response are reported. Imiquimod cream applied three times a week for 1 months cures 75% of cases of condvlomata accuminata but recurs in 15% of cases. Some develop local erythematous reaction to the cream