What Diseases Are Linked to HPV Virus?
Human papillomavirus (HPV) infection in the last few decades has gained the attention of physicians, dental surgeons, and researchers as it is an endemic affecting public health due to its potential linkage to cause cancers. HPV infection has been recognized as a standard and frequent sexually transmitted disease affecting the genitals and oropharyngeal cavity. The increased incidence of HPV-linked squamous cell carcinoma (SCC) in the head and neck region is also attributed to this viral infection.
Epidemiologic data suggest that HPV infections are responsible for making an individual 14-fold more prone to oropharyngeal cancers, cancers of the tonsils, or affecting the base of the tongue more frequently. According to traditional research, the spread of genital and oral HPV infections has been linked to an increased number of partners or high-risk sexual behavior in the younger population. It is prevalent among adults between 20 to 60 years of age.
HPV infections can be mainly distinguished in their ability to be of a high-risk oncogenic type that can predispose the individual to the developmental of malignant lesions, anogenital cancers, and oral squamous cell carcinomas, and the second type of HPV infections has the potential to cause benign papillomas, warts, and hyperplasia in the same regions.
As per research for cervical HPV infections, the virus first penetrates the cutaneous layers of the hands and feet, consequently the mucosal surface of the upper aerodigestive tract and then the anogenital regions and the urethra. This may explain why people with persistent HPV infections may be predisposed to develop cervical or anogenital cancers.
How Common Is HPV?
One of the most common infections transmitted in the United States is HPV, with estimates suggesting there may be as many as 6.2 million new cases each year. Most people will contract some form of HPV during the first few years of their sexual lives. Because it is so commonplace, there is no need to feel ashamed about a diagnosis. You should have an open discussion with your healthcare provider for proper counseling. All forms of HPV have been classified into nine high-risk types and more than 150 others, of which most cause harmless warts or are unknown to produce any effect on health.
How Is Oral HPV Classified?
The lesions in the oral mucosa may range from the flat, papular, or plaque-like structure that may be grayish, white, or reddish. Clinically, they may be asymptomatic or associated with trouble chewing or swallowing. The oral HPV infections can be grouped as follows:
-
Benign Lesions.
-
Focal epithelial hyperplasia.
-
Squamous cell papilloma.
-
Verruca vulgaris, etc.
-
Potentially Malignant Lesions.
-
Oral erythroplakia.
-
Proliferative verrucous leukoplakia, etc.
-
Malignant Lesions.
-
Oral squamous cell carcinoma.
-
Verrucous carcinomas.
What Is the Structure and Pathogenesis of HPV?
The HPV proteins are double-stranded DNA viruses surrounded by a material of icosahedral capsid. These capsid proteins are mainly composed of primary (L1) and minor (L2) capris proteins along with capsomeres. The viral replication by this cell machinery is a highly regulated process for the infection of the host cell by producing mature virion particles. Soon after the HPV cells infect the host cell body, the dynamic changes in the leukocytes right from the basal to the superficial layer in the orogenital regions cause a suitable microenvironment for this viral cell replication.
Specific HPV cell receptors (like alpha six integrin, heparan sulfate proteoglycans, and extracellular laminin 5) act to enter the viral pathogen into the host cells through micro-wounds of the epithelium. As the viral genome remains active, the infection spreads up the layers of the basal, parabasal, and then the higher layers of the epithelium with the formation of complete virions. The viral cells then finally undergo desquamation after being expelled from the epithelial layers and then transmitted by direct contact (as in the case of genital warts) or in the form of indirect contact as well.
What Is the Route of Spread?
Though the genital route of HPV infection spread remains sexual, that is due to sexual contact with an infected partner, cases of vertical transmission extending to virgins, infants, and children are also reported and possible. This vertical nonsexual transmission might be feasible as the virus gets inoculated and spreads through three main routes, namely:
-
Periconceptual route - HPV transmission around the time of fertilization.
-
Prenatal route - HPV transmission during pregnancy.
-
Perinatal route - HPV transmission around the time after the birthing process.
How Are Oral HPV Lesions Treated?
HPV lesions genitally are treated by the gynecologist or the general physician suggest the following:
-
Local or systemic administration of cytotoxic and immunomodulatory drugs for treating the infection (for example, Podophyllin, Podophyllotoxin, Cidofovir drug therapies, immunomodulatory drugs like Imiquimod, and targeted molecular therapies).
-
For the elimination of genital lesions, surgical and ablative therapy with electrocautery, cold knife, or laser under local anesthesia may be performed.
-
For lesions like anogenital warts and condylomas, cryosurgery, electrocautery, cryotherapy with liquid nitrogen, or lasers are used.
-
The management of oral HPV infections is usually based upon the complete elimination of the virus by follow-up of the HPV DNA test in the patient after eight to 12 months following antiviral therapy.
-
Tested antiviral drugs like Acyclovir and Ribavirin are proved to effectively reduce the viral load, as suggested by the physician.
What Are the Risk Factors of HVP?
Number of Sexual Partners: Genital HPV is also more likely among those who have had more sexual partners, and similarly, while oral sex is practiced, the likelihood of infection through the oral route increases. The risk of this infection is increased with sexual intercourse with a partner who has had multiple sex partners. Reduction of such risk is further possible with proper safe sex measures, for instance, condoms and fewer sex partners. More importantly, clear communication with sexual partners about their sexually related medical history helps in prevention.
Impaired Immunity: Those with impaired immunity have the highest probability of getting an HPV infection. This can be caused by something like HIV/AIDS or patients taking immunosuppressive drugs, such as recipients of organ transplants. If the immune system has been impaired, it becomes more difficult for the body to clear the virus, which increases the risk of persistent infection. Patients with impaired immunity should receive regular check-ups and monitoring.
Conclusion:
To conclude, HPV lesions need the earliest possible diagnosis and drug-based or surgical intervention by the oral surgeon and the gynecologist or physician to establish a long-term prognosis for these individuals and prevent these lesions from potentially developing into fatal cancers. In addition, the dental or maxillofacial surgeon can diagnose the HPV infection by oral sampling, which involves biopsy or cytology procedures to prevent and estimate the risk of oral cancers.
