Different forms of human papilloma virus

  1. Introduction

In general, papillomaviruses are non-enveloped and small viruses (usually 55 nanometers in diameter) that have double-stranded DNA genomes. They occur widely throughout the animal kingdom, and usually infect the squamous epithelium, leading to the generation of warts. One of the first instances of wart transmission in human beings happened accidentally, as reported in 1845. This happened when a Chandler injured his assistant right under his thumbnail as he was removing a seemingly large acicular condyloma with a special instrument (Munger et al., 2004).

There are approximately 200 different forms of human papilloma virus that have been discovered and characterized, and new ones are constantly added to this list. These viruses are classified under two groups, known as cutaneous and mucosal HPVs. The individual viruses within either group are labeled low risk or high risk based on the tendency of malignant development of the lesions caused. A higher percentage of HPVs are low risk and cause localized benign warts that do not turn into malignant ones even when left untreated. Examples of these are HPV-6 and HPV-11, which belong to the mucosal group. Some of the HPVs considered as high risk include HPV-5 and HPV-8 (Munger et al., 2004).

The purpose of this research paper is to shed light on the deeper subject of the human papilloma virus. It involves an in-depth discussion of the disease process, which reflects on how the normal human structure and function works, how the disease works, and things that change within human bodies when they are infected by the virus. The second point of discussion is the clinical manifestations of the virus, which is inclusive of all the signs and symptoms of the disease. The third point is the diagnosis of the human papilloma virus. This includes treatment options as well as the availability of various complementary and alternative medicine options. The fourth point is the public health implication and disease burden. Under this subtopic, we will review how the disease is becoming a burden in various demographics. The last point is prevention and control. This research paper aims at discussing the human papilloma virus at length.

  1. Disease Process

A healthy human being without HPV usually has a smooth skin without blemishes or bumps or swellings. They also happen to have a healthy appearance of the lining of their inner body parts, such as their inside of their mouths, lips, tongue, gums, and palate. These areas are also not painful or have any discomfort. The HPV enters a person’s body through a cut tear or abrasion on their skin. HPV is, therefore, transmitted through skin-to-skin contact.

  1. Clinical manifestations

The most common and characteristic clinical manifestation of HPV infection is warts. These are described as virus-induced tumors that appear on different parts of the body, specifically the skin of mucosa, extremities, oral and laryngeal mucosas, and genital skin. There are different types of warts. One of them is known as common warts. These are papules or nodules that appear individually on the surface of the skin and make it appear rough. A lesion may either appear singularly or in groups, and they all have different sizes. Lesions can also merge into larger masses. Common warts usually appear on any part of the integument, although they commonly form at the back of fingers and hands. Warts that form individually may remain in their same state for months or years. In some cases, several new lesions may form quickly over a short period.

Plantar warts are warts that appear on the plantar region. In such instances, they may adopt a presentation form known as Myrmecia, which means that they have formed deeper into the skin. Patients with plantar warts always suffer from a lot of pain and are usually caused by HPV type 1. When these warts develop closer to the surface in the form of hyperkeratotic plaques, they are considered as mosaic warts and are considered to be less painful. It is usually caused by HPV 2.

Flat warts come in a slightly raised appearance and may either take on the color of the skin or may be pigmented. They are usually rounded but sometimes have a polygonal shape with a diameter of between one to five millimeters. They mostly appear on the back of the hands or on the face. They mostly appear numerously and may have a linear distribution.

Filiform warts usually grow perpendicularly in reference to the surface of the skin. They may either appear as single lesions or may be in multiples. The most common places of occurrence are the face and the neck. Filiform warts are a morphological variation of the first type of wart discussed, the common wart.

Pigmented warts usually appear in colored form, which ranges from gray to black-brown. They present certain uniform cytoplasmic inclusion bodies. There are three types of the virus that lead to pigmented warts. These are HPV 4, 60, and 65.

Focal epithelial hyperplasia (FEH), also known as Heck’s disease occurs rarely and is formed on the oral mucosa. It is characterized by many small papules and is pinkish in color. They appear mostly on the inner part of the lower lip and are sometimes on the tongue.

The other type is the malignant mucosal lesions, such as Bowen’s disease of the genitalia, commonly called BD of the genitalia. It is mostly caused by high-risk HPVs. It is clinically manifested in the form of a plaque, which is mostly in singular appearance. It, however, does not tend to show spontaneous regression and has the potential to progress to SCC.

Vulvar cancer usually occurs following vulvar intraepithelial neoplasia (VIN), also known as cervical carcinoma, that manifests itself as long-course genital warts. The chances of detecting HPV in vulvar SCC lesions usually ranges from thirty to seventy percent. In the case of men, HPV may be expressed in the genital area as penile cancer. From a clinical point of view, the lesions harden and take a nodular appearance. There is a forty to seventy percent chance of detecting HPV in the lesions (Porro & Tomimori, 2011).

  1. Diagnosis

Unlike other diseases, it is not possible to diagnose HPV infections by using blood or swab test. Additionally, having a constant sexual health check at the doctor’s office is also not a way to detect viruses of the skin such as HPV. It is only possible to diagnose HPV if someone has visible warts either on their genital skin or other skin. Head and neck squamous cell carcinoma (HNSCC) is conclusive of malignancies that occur in five common locations, such as the oral cavity, nasopharynx, oropharynx, larynx, and hypopharynx. HNSCC ranks sixth among the most common malignancies. There is currently no unanimity on an ideal way to detect HPV-positive HNSCC. Some of the methods involve the detection of p16 protein expression by using immunohistochemistry (IHC). The other option is detecting HPV-related material through a polymerase chain reaction (PCR).

Polymerase chain reaction (PCR) is an extremely sensitive method and is also a cost-effective method for detecting an HPV infection. This is a method most commonly used in the HPV DNA detection procedure. Another method involves testing tumor samples called ISH. The ISH method has an advantage over PCR due to its high specificity that results from the reliable discovery and identification of HPV. In the case of women, diagnosis of an HPV infection starts with a Pap test, otherwise known as a Pap smear. Doctors are usually looking for any abnormal results that result from these tests. It involves the taking of cell samples from the woman’s cervix, after which it is sent to the lab to be inspected under a microscope (Chai, Lambie, Verma, & Punyadeera, 2015).

Generally, most HPV infections often clear spontaneously, and this makes it difficult or impossible to determine whether the immune systems of the infected individuals have completely eradicated the virus from the body. It is also difficult to know whether the virus, which may sometimes remain in undetectable levels, is capable of reappearing in the event that the immune system weakens (Chai, Lambie, Verma, & Punyadeera, 2015).

  1. Public Health implication and disease burden

Many people around the world have come to the realization that high-risk papilloma viruses play a crucial role in cervical cancer around the world. This has contributed to the development of vaccines. Countries that lack cervical screening programs or vaccination strategies are most likely to have to endure the burden of the malignant nature of HPV. They are unable to provide consistent funding for vaccination programs. The beneficiaries are usually developed nations such as the UK, the US, Canada, and Scandinavia are able to afford cervical screening programs (Adams, Jasani, & Fiander, 2007).

  1. Prevention and Control

The most common preventative method used against HPV infections is through vaccines. Bivalent and quadrivalent vaccines have been found to be safe, and they last long enough to protect individuals against infection. Programs aimed at childhood vaccination are almost universal, but there are very few strategies in place for vaccinating children before their adolescent years. The vaccines mentioned above have antigens that offer protection against health conditions that result from HPV 16 and 18. They are also capable of preventing over ninety percent of infections associated with these two viruses. The third vaccine is known as the nine-valent vaccine, which usually prevents over 90% of lesions caused by HPV 31, 33, 45, 52, and 58.

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