Human Papillomaviruses

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Human Papillomaviruses

• Prof. Dr Asem Shehabi
• Faculty of Medicine, University of Jordan

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General Introduction

• Human Papillomaviruses (HPVs).. Small ds DNA..
  Capsid,72 Capsomers with 2 surface major Proteins
  (L1,L2)..Responsible for invasion, widely
  distributed in nature.. Infect Human, Animals,
  Birds.
• Infect basal layers of squamous /columnar
  epithelium ..Viral DNA multiply in nucleus of
  cells.. cause no cell lyses. infectious virus
  DNA found in upper cell layers of epithelium
  (keratinocytes) ..causes Hyperkeratosis in horny
  layer.. Viral DNA can integrate in host
  chromosome.
• Viral infection establish in epidermis mucous
  membranes.. Mostly benign Skin Warts.. Few virus
  types progress to malignant lesions..less than
  0,01.
• HPVs 200 types classified according homology of
  their genomes.. Types are categorized as low,
  intermediate high risk according to their
  Oncogenic potential.

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• About 15 most common HPVs cause skin infections
  .. Viruses found in dead living epidermis
  cells.. Transmitted from one infected person to
  another through direct skin contact, swimming
  floors, showers/ baths ..less clothes, dust
  particles.
• Cutaneous warts Common types HPVs (1-8,10) grow
  in keratinized epithelium.. Face, hands,
  feet..other body parts.
• -Common skin /oral wart (Verruca vulgaris)..
  Types 2,4,7
• -Deep Plantar warts (Verruca Plantaris).. Types
  1,4.. Hard grainy growths appear on soles the
  feet .
• -Flat Warts.. Types 3,10.. Smooth colored face,
  legs fingers ..persist short / long time.
• Children are more susceptible to HPVs than
  adults.
• Skin HPV types are different from those that
  cause
• malignant growths in the throat or genital
  area.

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Warts on Skin-Toe/ Hyperkeratosis
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Genital HPV-1

• Both humoral cell-mediated immune responses
  develop.. Following skin infection.. Persistent
  recurrent warts increased with cell mediated
  immunodeficiency.
• Genital HPV infections are very common and mostly
  associated with sexual contact sexually
  transmitted diseases.
• Anogenital warts/ Condylom acuminatum affect any
  part of the sexual organs.. Penis, Vulva, Vagina,
  Cervix.. Perianal skin , common in sexually
  active adults.
• Types 6,11 cause 90 of benign anogenital
  infections.. mostly Cervical warts (Flat
  Condyloma/ squamous intraepithelial
  neoplasia)..may affect oral cavity

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Genital HPV-2

•  Genital warts often occur in clusters and can be
  very tiny lesion or spread into large masses in
  the extra- genital or rectal area.. Rarely in
  anal colon
• HPV types 1618 are associated with high risk of
  malignancy..mostly found inside vagina cervix.
  
• Most HPV genital infections occur without any
  symptoms and may disappear without any treatment
  over few years. Genital HPV infection sometimes
  persists for many years, without causing cell
  abnormalities.. This mimic its present infection
  increase a womans risk of developing cervical
  cancer.. Each year nearly 1 million women
  worldwide.. killing 250000 lives.

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Genital HPV-3

• Increase risk factors of cervical cancer in women
  with HPV infection include young age, smoking,
  use immune suppressed drugs, oral contraceptive
  drugs, sexually transmitted diseases.
• Precancerous HPV lesions in cervix can progress
  to invasive cervical cancer.. usually takes 1520
  years
• Persistent HPV genital infections ( types 16,18)
  cause 70 of cervical cancer/endocervical
  Adenocarcinoma in Western countries.. Still less
  incidence in Jordan most Arab countries..
  Screening should be done for every woman using
  Colposcopy Pap-smear

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H PV-4

• Respiratory Papilloma .. mostly benign lesions on
  mucosa respiratory tract.. Larynx ( Laryngeal
  Papilloma).. Children and adults .. May cause
  obstruction if not removed early as possible
  ..Caused mostly by HPV types 6 11.. Less types
  16 18.. It is unknown if immunological
  conditions contribute for infection.. Common
  among middle age (30-50) years.
• Squamous oral papillomas Oral Hyperplasia ..
  (Types 6,11) are considered benign growths of the
  surface epithelium ..The lesions found on oral
  mucosa, lips, tongue base..small large..may
  spread to soft palate, throat, tonsils.. Past
  HPVs exposure is increasing the risk of oral
  lesions.. old age, Common in association tobacco
  and alcohol use.

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Lab Diagnosis Treatment

• A Pap smear test is used to detect abnormal cells
  in cervix .. Atypical squamous glandular
  epithelial cells .. A Pap test is recommended at
  least once every 2-3 years.
• Detection of HPV DNA from suspected lesions by
  PCR is more accurate and detect early infection.
• There is currently no antiviral drugs against
  Papillomavirus infection.. the lesions should be
  removed.
• Treatment Cryotherapy/ Cryosurgery.. Removing
  the lesions does not necessary eradicate the
  virus completely.. reoccurrence of warts is
  common.
• New Vaccine is available against HPV types
  16,18.. Effective up 90 and safe.

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Detection and typing of common
human papillomaviruses among Jordanian
patients. S.bdour, L. AkKash, A.Agt ShehabiJ
Medical Virology, 2013, 85158-63

• The epidemiology of human papillomaviruses (HPVs)
  genotype distribution of cutaneous warts in
  Jordanian patients were studied.
• A total of 200 samples were collected using skin
  swabs from patients with warts attending the
  dermatology clinic at the J U Hospital (2010
  -2010). Another 100 control samples were taken
  from healthy Jordanian with no current or
  previous history of warts

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Methods Wart samples
collected using..DNA extraction and sequencing
was carried out using PCR with the specific
primer pair to detect HPV DNA, followed by
multiple-type-specific (Multiplex) PCR combined
with DNA sequencing.

• Results The prevalence of HPV among Jordanian
  patients tested with warts diagnosed clinically
  was 82 .
• Conclusion Alpha HPV types (2, 27, 57).. are
  mostly detected in Cutaneous warts of Jordanian
  patients with skin warts..These types rarely
  associated with malignancy.