Genital Warts
Immunology of Human Warts
What is Immune Evasion?
HPV infect humans through a mechanism called "immune evasion"
A way of pathogenic microbes and tumors to evade host immune response in order to increase their probability of being transmitted to another. (cells become undetectable for a long time)
Why is it important?
To overcome innate and adaptive immune response
To exploit host immune system
How Immune Evasion works?
Immune Evasion)
Effective treatment depends on the location/position of the warts
Some harmful HPV cannot cause visible warts but can lead to cervical cancer and are undetectable for a very long time
It is possible to have HPV infection without genital warts
Cervical cancer
Non-melanoma skin cancers
Skin and mucous infection
Vulvar cancer (Infection at the outer vaginal surface)
What is genital warts?
A most common types of sexually transmitted infection
Contagious
Cause fleshy growths in the genital or anal area
Caused by human papillomavirus (HPV)
HPV can change the structure of infected cells and can lead to further complications
Genital warts are soft growths that appear on the genitals. They're a sexually transmitted infection (STI) caused by certain strains of the human papillomavirus (HPV).
It is also highly transmittable through skin-to-skin contact.
Refer here
HPV can be spread through oral, vaginal, or anal sex.
How HPV enter our body
Can cause servical cancer, or at least dysplasia (precancerous changes to the cells of the cervix)
How HPV cause warts
Human Papillomavirus (HPV)
Most common STI and different from HIV & HSV. HPV have many types and some of them causes genital warts and cancers
Can be overcome by vaccines ; Three vaccines -- Cervarix, Gardasil, and Gardasil-9
All boys and girls ages 11 or 12 years should get vaccinated
Catch-up vaccines are recommended for boys and men through age 21 and for girls and women through age 26, if they did not get vaccinated when they were younger.
Gay and bisexual men (or any man who has sex with a man) through age 26
Men and women with compromised immune systems (including those living with HIV/AIDS) through age 26, if they did not get fully vaccinated when they were younger.
Infects genital area, vulva, vagina, cervix, rectum, anus, penis, and scrotum, as well as mouth and throat.
Also by skin to skin contact
Small double-stranded DNA viruses that infect the cutaneous and mucosal epithelium.
Treatment
Creams, gels, and ointments
Cryotherapy with liquid nitrogen
Surgery
Trichloroacetic solutions
Prevention
HPV vaccine
abstinence from sexual contact
increase usage of condom or dental dam
Get a PAP test-regular check-up
HPV risks in men can be reduced if they are circumcised.(prevents transmission)
Loop Electrosurgical Excision Procedure(LEEP)
prevents cervical cancer by removing abnormal cells
Vaccines- cervarix will prevent HPV infection from strains 16&18.
Applied in vaginal and anal lesions
Infections
Reported Cases
October 2013, Italy. A 45 years old woman diagnosed with a GGW. review here
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Based on a systematic review, global incidence of AGWs ranged from 160 to 289 cases per 100 000 person-years. review here
HPV types 6 and 11 are estimated to cause ∼90% of genital warts
Symptoms and Pathogenicity
may not start to develop warts for several weeks or months after infection
not always visible to the human eye
very small and resemble the color of the skin or slightly darker
top of the growths may resemble a cauliflower and may feel smooth or slightly bumpy to the touch
may occur as a cluster of warts, or just one wart
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also appear on the lips, mouth, tongue, or throat of a person who has had oral sexual contact with an infected person
non visible warts can cause vaginal discharge, itching, burning, bleeding
Diagnosis
health and sexual history
symptoms experienced and any times engaged in unprotected sex, including oral sex.
a physical examination of any areas where suspected warts may be occurring
For women only- warts can occur deep inside a woman’s body
pelvic examination by applying a mild acidic solution, which helps to make the warts more visible
Pap smear
Certain types of HPV may cause abnormal results on a Pap smear, which may indicate precancerous changes
Genital warts are a complication of HPV infection that’s common and treatable. They can disappear over time, but treatment is essential in preventing their return and possible complications.
DNA sequence differences
potential to cause cancer
diagnosis of oncogenic types and non-oncogenic types
inactivate the p53 and pRb tumor suppressors