Test for 14 types of High Risk Papillomas (HPV)

General information:

A test for carrying high-risk papillomas (HR-HPV) is performed by detecting the viral DNA with a highly specific PCR method in cells from the mucous membrane of the cervix.

The test simultaneously genotypes the two main causes of dysplasia and cervical papilloma (HPV-16 and HPV-18) and screens for the presence or absence of any of the remaining 12 high-risk HPV types (16, 18, 31, 33, 35, 39, 45, 51 , 52, 56, 58, 59, 66, 68) without specifying the type of virus.

Genotyped types (16,18) are found in 70% of cervical carcinoma cases.

HPV (Human Papillomavirus) are double-stranded DNA viruses of the family Papillomaviridae, classified by types with numbers according to the order of their discovery. More than 100 types of HPV are known, of which about 40 are associated with infections in the genital area. Genital HPV types are categorized according to their epidemiologic association with cervical cancer into:

• Low-risk viral types – 6, 11, 42, 43, 44. Low-risk viral types are associated with a low risk of progression. Causes are mainly benign or low-grade cervical lesions, genital warts or recurrent respiratory papillomatosis.
• High-risk viral types - 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66. High-risk viral types are associated with an extremely high risk of developing malignancy. They are the causative agents of low-grade, high-grade cervical lesions and invasive carcinoma.

High-risk viral types are associated with the development of cervical cancer - they are found in 99.7%. The discoverer of the link between HPV infection and oncogenesis is the German Prof. Harald Zur Hausen, who in 2008 received the Nobel Prize for his discovery.

What are the risk groups and factors for papilloma infection?

A major risk is thought to be the number of sexual partners, especially in risky sexual behaviour. Early initiation of sexual contact, as well as a weakened immune system, smoking and poor intimate hygiene are also risk factors. It is important to know that almost anyone who has had sexual contact with another person can become infected with HPV. Any sexually active woman – even if she has only been with one partner who has had other partners – is at risk of HPV infection. This also includes women who have had sexual contact with other women.

Since the main cause of dysplasia is high-risk strains of HPV, anyone who has ever had intimate genital contact is potentially at risk for this condition.
In addition, some factors can increase the risk of developing an HPV infection in precancerous lesions (and later in cervical cancer):

• Exposure (in utero) to the drug diethylstilbestrol (DES), which was prescribed to many women to prevent miscarriage between 1938 and 1971.
• Infection with chlamydia or Herpes simplex virus type 2 (two different sexually transmitted infections).
• The presence of first-line female relatives affected by the disease (mother, sister). According to the International Journal of Cancer, in these cases the risk increases threefold.
• Conditions leading to a weakening of the immune system (eg AIDS).
• Smoking, which prevents the body from fighting infections. Smoking has been estimated to double the risk of developing CIN 3 from altered cells.
• Low levels of folic acid (a B vitamin).

What are the symptoms of human papilloma virus (HPV)?

HPV infection is most often transient, asymptomatic and does not cause clinical problems. In 70% of cases, the body copes with HPV within 1 year and in 90% within 2 years by means of a cell-mediated immune response. The average duration of new infections is 8 months. Despite the woman's recovery, the primary infection with HPV was not followed by the development of stable immunity, i.e. the woman is not protected from re-infection with HPV of the same or other types. In about 20% of cases, however, the infection does not resolve spontaneously, but progresses slowly and stepwise from low- and high-grade cervical lesions/dysplasia to cervical cancer. In untreated women, the time between infection and the development of cervical cancer is measured in decades, usually 10-20 years.

When is an HPV DNA test recommended?

The HPV DNA test is recommended for women's annual preventive screening. The test is also indicated in the case of a Pap smear result indicating suspected papilloma virus infection. The test is also done before vaccination of young girls/women in order to establish the patient's health status regarding HPV infection. Vaccines are targeted at HPV-16 and HPV-18 genotypes, therefore the Laborexpress 2000 test is extremely suitable.

Dysplasia is the medical term for the presence of cell changes in the cervix caused by HPV. If the changes are mild and few in number, they usually go away without treatment. In some cases of moderate dysplasia and in most cases of severe dysplasia, however, these lesions do not resolve on their own. At this stage, the cells are considered "recancerous": in other words, if not detected and treated promptly, they can develop into cervical cancer.

After treatment, your doctor may also recommend a follow-up DNA test.

How is the human papillomavirus (HPV) transmitted?

The risk of HPV infection is very high, about 80% of women become infected with HPV during their sexually active lives. The infection is transmitted exclusively sexually, but also through skin-to-skin contact. Using a condom reduces the risk of transmission, but does not eliminate it completely. Men can also become infected and transmit the infection, but their risk of cellular changes is lower. The genital surface in men is not as susceptible, even when HPV has been present for a long period of time. The development of cellular changes depends on whether the virus is cleared or remains present for a longer period of time, as well as on other factors that are not yet fully understood.

There is currently no antiviral treatment, but awareness of such an infection allows for more frequent cervical monitoring while the virus is present. If cellular changes occur, they can be treated to prevent them from becoming cancerous.

How is the material taken for HPV - PCR test?

The sample for the HPV DNA test is taken in the same way as for smear material. The test is a DNA analysis of the sample taken and allows to establish the presence of viral DNA in it. The HPV test is recommended alongside the pap smear, and the two tests are not interchangeable.

The test for high-risk papillomas is not a RAP test. Pap smear, also known as RAP test, is a standard screening procedure in the prevention of cervical cancer. By observation under a microscope, the method detects cells with altered morphology taken from the cervical mucosa. In the prevention of precancerous and cancerous changes of the cervix, there are two screening tests that are carried out - pap smear (RAP test) and HPV test. Precancerous conditions and early stages of the disease usually do not cause pain or other symptoms, so they should be actively sought through regular gynecological examinations and tests.

Remember that by examining yourself in Laborexpress 2000 for high-risk papillomas, you and your doctor know about the problem and can take measures for regular follow-up of your cervix. It is important to take any action your doctor recommends as a result of a positive HPV test. The risk remains highest for women with long-term infection with high-risk HPV who are not aware of it and do not have regular pap smears and HPV tests.

Conditions for taking material, preparation and manipulation:

Women - Collection of cervical secretion using a brush/tampon

• Mucous discharge is removed from the cervical canal and ectocervical area with a separate swab or cotton, which is discarded.
• The brush is inserted 1 to 1.5 cm into the cervical canal so that its longest bristles touch the ectocervix.
• Turn 3 full turns clockwise. The brush is removed from the cervical canal, being careful not to touch the vaginal surface.
• The tampon should ONLY be used for HPV testing! Tampons with transport medium-gel are not accepted!
• If the patient wants a bacteriological culture or examination for sex packages, another swab should be provided.

Men - Collection of urethral secretion using a dry swab

• The patient should be instructed not to urinate for at least 1 - 3 hours before the manipulation.
• The tampon is inserted into the urethra to a depth of 2 to 4 cm and rotated at least 2 full revolutions in 3-5 seconds.
• Materials ejaculate, urine are not suitable for this test!

Key words:

human papilloma virus, HPV