HPV infection is endemic worldwide, and is very common in the population (both female and male): up to 80% of sexually active women come into contact with an HPV virus during their lifetime, with higher prevalence for young women up to 25 years of age. However, the prevalence of the virus is higher in males than in females, and 50% of genital condylomas are in males. In addition, the diagnosis of tumors in males usually occurs at an advanced stage of carcinoma, which is more difficult to treat. In China, for example, cervical cancer caused by HPV is the most common type of cancer in the female genital system. It ranks as the eighth most frequent cancer among women in China and is the second most common cancer in women aged 15-44 years.However, the introduction of the HPV vaccine in many countries has led to major reductions in the rates of specific human papilloma virus infection. Relatively little is known about the natural history of oral HPV infection, but it is likely that subclinical oral HPV infection that persists for decades precedes the development of head and neck cancer caused by HPV. The reported prevalence of oral HPV infection from individual studies is highly variable because it is influenced by sampling technique and study population. Oral infection is rare and differs significantly by sex, with a significantly higher prevalence observed in men. The largest population-based study conducted in the United States (conducted as part of the National Health and Nutrition Examination Survey) reported a prevalence of oral HPV of 6.9 percent, with a significant difference among men. High lifetime sexual partners, cigarette use, and older age increase the acquisition of oral HPV infections. Among healthy individuals, the oral prevalence of HPV16 is low (1.3-1.6 percent) and is consistently lower than what is typically observed in the anogenital region.
Depicted in the map are the age-standardized incidence rates of ano-genital cancer cases (per 100,000) attributable to HPV in 2012, in both sexes.
Represented in the map are the age-standardized incidence rates of head and neck (oropharynx, oral cavity and larynx)(per 100,000) cancer cases attributable to HPV in 2012, in both sexes.
Plantar warts can sometimes be painful. When small thermal vessels thrombize, black dots appear on the wart. Flat warts are more common among children and occur on the face, neck, chest, and flexor surfaces of the forearms and legs.
Ano-genital warts occur on the skin and mucosal surfaces of the external genitalia and perianal areas: they may appear as condylomata acuminata. In men they most often localize on the member, scrotum, and perianal area: lesions often localize to the urethral meatus and may later extend.
In women, warts first appear at the posterior introitus and adjacent part of the labia. They may spread to other parts of the vulva and commonly affect the vagina and cervix. The relief of external lesions suggests the presence of internal lesions, although internal lesions may also be present without external lesions, particularly among women.
For diagnosis, it is essential that women undergo routine periodic examinations through gynecological prevention programs. In fact, through the evaluation of cytologic or histologic changes, obtained by Pap test or other biopsies, the diagnosis of HPV infection can be made.
Among men, the prevalence of HPV is highest at the level of the penis and lowest at the level of the urethra. Among women, the prevalence is highest at the level of the cervix and vagina and lowest at the level of the vulvar epithelium.
Screening is therefore most important for follow-up and diagnostic earliness.
Also, useful investigations for further investigation, such as colposcopy, anoscopy, and laryngoscopy, should not be forgotten for possible cancers that may affect the throat.
The decision for initiating therapy must be made based on the knowledge that currently available treatment modalities are not fully effective.
It should also be kept in mind that many warts disappear spontaneously. The goal of treatment is elimination of the lesions rather than elimination of the virus.
External lesions are removed by cryotherapy, which consists of burning with cold Liquid Nitrogen, laser therapy, diathermocoagulation or hot burning, or by surgical removal.
Local treatment of active substances with immunomodulatory resultant like Epigallocatechin or cytotoxic like Podophylline is also used.
The therapy of condylomas is definitely time-consuming, and even if the lesions are taken away, the virus may remain in the cells and cause new lesions after some time.
Therefore, there is a tendency to supplement local therapy with drugs based on systemic targeted phytotherapy active ingredients such as Ellagic Acid complexes with Acetogenin or pure Graviola extract or dextrorotatory and levogyra methionine with combined zinc.
Prevention is based on preventive vaccination. In Italy, vaccine is available for prevention to HPV strains that generally cause precancerous genital lesions of the cervix, vulva, and vagina and invasive lesions of the anus. As of late 2016, the nonovalent vaccine (Gardasil 9) is the only one available and routine vaccination is recommended at age 11 or 12. This vaccine protects against five other high-risk hpv (hpv 31/33/45/52/58) not covered by previously developed bivalent or quadrivalent vaccines. The vaccine has been shown to be highly immunogenic, with the potential to prevent an additional 18.3-20% of cervical cancers.It should be remembered that vaccination is not a substitute for screening because the papilloma virus vaccine cannot be 100% effective and does not result in protection against every viral type.Instead, secondary prevention is implemented through early detection of carcinoma precursors by Pap smear and HPV-test. It has been shown in women that performing a Pap test every 3-5 years reduces the risk of developing invasive cervical cancer by at least 70%.