Cervical cancer is caused by sexually acquired infections with certain types of HPV. Two HPV types (16 and 18) cause 70% of cervical cancers and pre-cancerous cervical lesions. There is also evidence linking HPV with cancers of the anus, vulva, vagina, penis, and oropharynx

1. HUMAN PAPILLOMAVIRUS
INFECTION AND CERVICAL
CANCER.
COMR. EZEKWU PRINCE-PRECIOUS K. (MLT, OHS)

2. HUMAN PAPILLOMAVIRUS
WHAT IS HUMAN PAPILLOMAVIRUS
INFECTION?
Human Papilloma virus is usually the cause of human papilloma
infections. Most HPV causes no harm and resolve spontaneously.
It is a DNA virus in which more than 70 types are known, some capable
of causing warts in some regions of the body ranging from mouth, skin,
anus etc.
TYPES OF HPV
DISEASE TYPES
Common warts. 2, 7, 22
Planter warts 1, 2, 4, 63
Flat warts 3,10, 28
Anogenital warts 6,11,42,44,
Anal Dysphagia 6,16,18,31,53,58
Genital Cancer Highest risk;
16,18,31,45
Other high risk;
33,35,39,51,52,58,59
Probably high risk;
26,53,66,68,73,82
Epidermidysphasia
Verrucifforms
More than 15 types.

3. Focal epithelial
hyperplasia
13,32
Mouth papillomas 16
Verrucous cyst 60
Laryngeal
papillomatosis
6,11
WARTS
These are skin infections (also known as cutaneous infection), with HPV usually the
causes due to its wide spread nature.
• Skin infections caused by HPV are leading cause tnon cancerous skin growth
called; Verrucae (warts).
• In cases of warts especially dealing with children, about 80% tends to suffer
from this infection and tends to regress spontaneously.
• 10% of adults also suffers from this infection usually recurring after first
infection.
TYPES OF WARTS
1. COMMON WARTS; Usually affecting the feets, hands, elbows, and knees.
2. PLANTAR WARTS; They usually affect the Soles of feets, they grow inside
usually causing pain while walking.
3. SUBUNGUAL /PERIUNGUAL WARTS ; Under the fingernails, around the
fingernails, or on the cuticle. Usually more difficult to treat than the others.
4. FLAT WARTS; Commonly found on the arm, face, or forehead.
Usually affecting children and teens.
GENITAL WARTS
HPV infections of the skin in the genital area is the most common
sexually transmitted infections worldwide. These warts are the most
easily recognised signs of genital infection.
• Different varieties of HPV types are capable of causing genital warts
with 6 & 11 together accounting for about 90%.
• Other variety or huge variety of HPV can be transmitted through
sexual intercourse but asymptomatic .
• Most of the genital warts are cleared spontaneously by the immune
system in matter of days/months and people may transmit the
infection to others sexually even if they show no visible symptoms.
Most people acquire genital HPV infections at some point in their lives
and about 10% of women are currently infected.

4. RISK FACTORS
NUMBERS OF SEXUAL PARTNERS;
The greater the number of sexual partners, the more likely
you're to contact the virus.
AGE
Common warts occurs most often in children. While plantar
warts may occur in adults. Genital warts occurs most often in
adolescents and young adults.WEAKENED IMMUNE SYSTEM
People who have weakened immune systems are at greater risk
of of HPV infections. HIV/AIDS or immune suppressing drugs
used after transplant are few factors causing weakened immune
system.
DAMAGED SKIN
Broken skin due to puncture or bruises are more prone to HPV
infection. Usually developing common warts.

5. PERSONAL CONTACTS
Touching someone's warts or not wearing protection before contacting surfaces
that have been exposed to HPV.
▶ Public showers or swimming pools may increase the risk of HPV infections.
HPV IN CANCER
Cancer of the oropharynx, larynx, vulva, vagina, cervix, penis, anus can be due to
HPV with the following types called higher risk due to their nature of causing
cancer [16,18,31,45].
Individuals with both HIV and HPV have increased risk of developing cervical or
anal cancer.
▶ In 2008,there were an estimated 529,000 new cases and 274,000 deaths due
to cervical cancer.
▶ More than 85% of cervical cancer deaths are in developing countries, where
it accounts for 13% of all female cancers.
In the United States, about 27,000 cases of
cancer due to HPV occurs each year.
CANCER
AREA
AVERAGE
ANUAL NO.
OF CASES
HPV
ATTRIBUTAB
LE
(ESTIMATED)
HPV 16/18
ATTRIBUTAB
LE.
CERVIX 11,967 11,500 9,100
VULVA 3,136 1,600 1,400
VAGINA 729 500 400
PENIS 1,046 400 300

6. CERVICAL CANCER
Cervical cancer is a cancer that starts in the cervix, narrow
opening into the uterus from the vagina.
▶ The normal “ectocervix” (the portion of the uterus
extending into the vagina) is a healthy pink colour and is
covered with thin flat cells called “squamous cells”.
▶ The endocervix or cervical canal is made up of another kind
of cell called “columnar cells”.
Most cervical cancers (80-99%) are squamous cell cancers.
ADENOCARCINOMA
Adenocarcinoma is the second most type of cervical cancer,
accounting for the remaining 10-20% of cases. Adenocarcinoma
develops from the glands that produces mucus in the endocervix.
While less common than squamous cell carcinoma, the incidence
of adenocarcinoma is on the rise, particularly in younger women.
▶ National cervical cancer coalition (NCCC) a program of the
American sexual Health association ; estimates that more
than 12,000
ANUS (FEMALE) 3,089 2,900 2700
ANUS (MALE) 1,678 1,600 1,500
OROPHARYNX
(FEMALE)
2,370 1,500 1,400
OROPHARYNX
(MEN)
9,356 5,900 5,600
TOTAL MEN 12,080 7,900 7,600
TOTAL WOMEN 21,291 18,000 15,000

7. Women in the United States will be diagnosed with cervical cancer each
year and more than 4,000 will die. Cancer of the cervix tends to occur
during midlife. Half of the women diagnosed with the disease are between
35 and 55 years of age. It rarely affects women less than 20yrs. and
approximately 20% of diagnosis are made in women older than 65yrs. For
this it is important for women to continue cervical screening until age
70yrs.
SYMPTOMS OF CERVICAL CANCER
▶ Abnormal or irregular bleeding [bleeding btwn regular periods, after
sexual intercourse, after menopause.
▶ Pain during sex
▶ Vaginal discharge
▶ Increased urinary frequency
HPV IN PREGNANCY
Even if one is pregnant, one can get HPV. You can get genital warts or
develop abnormal cell changes on the cervix. Most of the frequently test
carried out for pregnant women involves test checking for HPV.
▶ A pregnant woman who has HPV is more likely to develop genital
warts than a woman with HPV who is not pregnant. In rare cases
genital warts may affect both canals. In these cases a cesarean
delivery may be needed to prevent bleeding that could result from
tearing warts during delivery.
TESTS AND DIAGNOSIS
One can diagnose warts by macroscopic examinations of the
lesions.
In the absence of warts, HPV can be diagnosed through any of
the following;
1. VINEGAR (ACETIC ACID) SOLUTION TEST
Applications of vinegar solutions at the site of infection turns
area white. This may be helpful in the identification of difficult -
to-see lesions.
2. PAP TEST
Here sample of cells are collected from the cervix or vagina to
send for laboratory analysis. PAP tests can reveal abnormalities
that may lead to cancer.
3. DNA TEST
This test can recognise the DNA of the higher risk varieties of
HPV that have been linked to genital cancers. The test is
conducted on cells from cervix recommended for women 30yrs.
and older in addition to PAP test.
TREATMENTS AND DRUGS
Warts often go away without treatment. But even if your warts
have disappeared or have been removed, you can still harbour
HPV & may transmit the virus to others.

8. MEDICATIONS
Medications to eliminate warts are typically applied directly to the lesions
and usually take many applications before they're successful.
Examples :
● Salicylic acid (causes skin irritations and doesn't used on the face)
● Imiquimod (this cream enhances your immune system to fight HPV.
Common side effects of Imiquimod includes redness and swelling at
application site.
● Podofilox (condylox); another type of topical prescription, Podofilox
works by destroying genital wart tissues. It may cause pain and itching
where its applied.
● Trichloroacetic acid; This chemicals burns off genital warts and my
cause local irritation.
SURGICAL AND OTHER PROCEDURES
If medication doesn't work, physical procedure may be used to remove warts.
● Freezing with liquid nitrogen (cryotherapy)
● Burning with an electrical current (electrocautery)
● Surgical removal
● Laser surgery.
LIFESTYLE AND HOME REMEDIES
It is difficult to prevent HPV infections that causes
common warts.
● If you have a common wart, you can prevent the
spread by not picking at the warts or biting your
nails.
● PLANTAR WARTS Risk may be reduced by
wearing shoes/sandals in public pools or locker
rooms.
● GENITAL WARTS; Risks can be reduced by;
being in a mutually monogamous sexual
relationship.
● Reducing your number of sex partners.
● Use of latex condoms.
VACCINES
Three HPV vaccines are now being marketed in
various countries throughout the world.
● Bivalent
● Quadrivalent
● Nonavalent vaccines

9. All three are efficacious in preventing infection with virus types 16 & 18 which
are together responsible for 70% of cervical cancer cases globally.
● The quadrivalent vaccine is also highly efficacious in preventing
anogenital warts, a common genital disease which is virtually always
caused by the HPV types 6 & 11.
● Nonavalent provides additional protection against types 31, 33, 45, 52,
and 58.
PRIMARY TARGET GROUP
Young adolescents girls age 9-14yrs. for all three vaccines, the vaccination
schedule depends on the age of the vaccine recipient.
● Females <15yrs at the time of first dose; a 2-dose schedule (o, 6 months)
is recommended.
If the interval between doses is shorter than 5 months, then a third dose should
be given atleast 6 months after the first dose.
● Females> 15yrs at the time of first dose; a 3 dose schedule (0,2,6months)
is recommended.
;/B; A 3dose schedule remains necessary for those known to be
immunocompromised and HIV infected.
● All boys aged 11 or 12yrs should be vaccinated.
● Catch up vaccination are recommended for boys and men through age 21
and for girls through age 26 if they were not vaccinated younger.